Prioritizing critical success factors for reverse logistics implementation using fuzzy-TOPSIS methodology

NASA Astrophysics Data System (ADS)

Agrawal, Saurabh; Singh, Rajesh K.; Murtaza, Qasim

2016-03-01

Electronics industry is one of the fastest growing industries in the world. In India also, there are high turnovers and growing demand of electronics product especially after post liberalization in early nineties. These products generate e-waste which has become big environmental issue. Industries can handle these e-waste and product returns efficiently by developing reverse logistics (RL) system. A thorough study of critical success factors (CSFs) and their ordered implementation is essential for successful RL implementation. The aim of the study is to review the CSFs, and to prioritize them for RL implementation in Indian electronics industry. Twelve CSFs were identified through literature review, and discussion with the experts from the Indian electronics industry. Fuzzy-Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) approach is proposed for prioritizing these CSFs. Perusal of literature indicates that fuzzy-TOPSIS has not been applied earlier for prioritization of CSFs in Indian electronics industry. Five Indian electronics companies were selected for evaluation of this methodology. Results indicate that most of the identified factors are crucial for the RL implementation. Top management awareness, resource management, economic factors, and contracts terms and conditions are top four prioritized factor, and process capabilities and skilled workers is the least prioritized factor. The findings will be useful for successful RL implementation in Indian electronics industry.

E-Nursing: electronic nursing resources on your desktop.

PubMed

Kendall, Sandra; Massaralla, Susan; Hynes-Gay, Patricia; Vincent, Leslie

2003-01-01

E-Nursing represents an innovative approach to nursing education that has the potential to support professional practice throughout the institution. This paper details the benefits, design and promotion of an electronic nursing resource collection. How to divide responsibility, cost and expertise in such a project is also discussed. Preliminary usage statistics validate E-Nursing as a point-of-care education tool for nurses at Mount Sinai Hospital. A planned approach to implementation has been an effective means of introducing E-Nursing in an institution that previously relied on traditional hard-copy resources housed in the hospital's library.

Implementation of electronic medical records requires more than new software: Lessons on integrating and managing health technologies from Mbarara, Uganda.

PubMed

Madore, Amy; Rosenberg, Julie; Muyindike, Winnie R; Bangsberg, David R; Bwana, Mwebesa B; Martin, Jeffrey N; Kanyesigye, Michael; Weintraub, Rebecca

2015-12-01

Implementation lessons: • Technology alone does not necessarily lead to improvement in health service delivery, in contrast to the common assumption that advanced technology goes hand in hand with progress. • Implementation of electronic medical record (EMR) systems is a complex, resource-intensive process that, in addition to software, hardware, and human resource investments, requires careful planning, change management skills, adaptability, and continuous engagement of stakeholders. • Research requirements and goals must be balanced with service delivery needs when determining how much information is essential to collect and who should be interfacing with the EMR system. • EMR systems require ongoing monitoring and regular updates to ensure they are responsive to evolving clinical use cases and research questions. • High-quality data and analyses are essential for EMRs to deliver value to providers, researchers, and patients. Copyright © 2015 Elsevier Inc. All rights reserved.

Success criteria for electronic medical record implementations in low-resource settings: a systematic review.

PubMed

Fritz, Fleur; Tilahun, Binyam; Dugas, Martin

2015-03-01

Electronic medical record (EMR) systems have the potential of supporting clinical work by providing the right information at the right time to the right people and thus make efficient use of resources. This is especially important in low-resource settings where reliable data are also needed to support public health and local supporting organizations. In this systematic literature review, our objectives are to identify and collect literature about success criteria of EMR implementations in low-resource settings and to summarize them into recommendations. Our search strategy relied on PubMed queries and manual bibliography reviews. Studies were included if EMR implementations in low-resource settings were described. The extracted success criteria and measurements were summarized into 7 categories: ethical, financial, functionality, organizational, political, technical, and training. We collected 381 success criteria with 229 measurements from 47 articles out of 223 articles. Most papers were evaluations or lessons learned from African countries, published from 1999 to 2013. Almost half of the EMR systems served a specific disease area like human immunodeficiency virus (HIV). The majority of criteria that were reported dealt with the functionality, followed by organizational issues, and technical infrastructures. Sufficient training and skilled personnel were mentioned in roughly 10%. Political, ethical, and financial considerations did not play a predominant role. More evaluations based on reliable frameworks are needed. Highly reliable data handling methods, human resources and effective project management, as well as technical architecture and infrastructure are all key factors for successful EMR implementation. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Developing knowledge resources to support precision medicine: principles from the Clinical Pharmacogenetics Implementation Consortium (CPIC).

PubMed

Hoffman, James M; Dunnenberger, Henry M; Kevin Hicks, J; Caudle, Kelly E; Whirl Carrillo, Michelle; Freimuth, Robert R; Williams, Marc S; Klein, Teri E; Peterson, Josh F

2016-07-01

To move beyond a select few genes/drugs, the successful adoption of pharmacogenomics into routine clinical care requires a curated and machine-readable database of pharmacogenomic knowledge suitable for use in an electronic health record (EHR) with clinical decision support (CDS). Recognizing that EHR vendors do not yet provide a standard set of CDS functions for pharmacogenetics, the Clinical Pharmacogenetics Implementation Consortium (CPIC) Informatics Working Group is developing and systematically incorporating a set of EHR-agnostic implementation resources into all CPIC guidelines. These resources illustrate how to integrate pharmacogenomic test results in clinical information systems with CDS to facilitate the use of patient genomic data at the point of care. Based on our collective experience creating existing CPIC resources and implementing pharmacogenomics at our practice sites, we outline principles to define the key features of future knowledge bases and discuss the importance of these knowledge resources for pharmacogenomics and ultimately precision medicine. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Electronic Neural Networks

NASA Technical Reports Server (NTRS)

Thakoor, Anil

1990-01-01

Viewgraphs on electronic neural networks for space station are presented. Topics covered include: electronic neural networks; electronic implementations; VLSI/thin film hybrid hardware for neurocomputing; computations with analog parallel processing; features of neuroprocessors; applications of neuroprocessors; neural network hardware for terrain trafficability determination; a dedicated processor for path planning; neural network system interface; neural network for robotic control; error backpropagation algorithm for learning; resource allocation matrix; global optimization neuroprocessor; and electrically programmable read only thin-film synaptic array.

Eavesdropping on Electronic Guidebooks: Observing Learning Resources in Shared Listening Environments.

ERIC Educational Resources Information Center

Woodruff, Allison; Aoki, Paul M.; Grinter, Rebecca E.; Hurst, Amy; Szymanski, Margaret H.; Thornton, James D.

This paper describes an electronic guidebook, "Sotto Voce," that enables visitors to share audio information by eavesdropping on each others guidebook activity. The first section discusses the design and implementation of the guidebook device, key aspects of its user interface, the design goals for the audio environment, the eavesdropping…

Performance evaluation of heart sound cancellation in FPGA hardware implementation for electronic stethoscope.

PubMed

Chao, Chun-Tang; Maneetien, Nopadon; Wang, Chi-Jo; Chiou, Juing-Shian

2014-01-01

This paper presents the design and evaluation of the hardware circuit for electronic stethoscopes with heart sound cancellation capabilities using field programmable gate arrays (FPGAs). The adaptive line enhancer (ALE) was adopted as the filtering methodology to reduce heart sound attributes from the breath sounds obtained via the electronic stethoscope pickup. FPGAs were utilized to implement the ALE functions in hardware to achieve near real-time breath sound processing. We believe that such an implementation is unprecedented and crucial toward a truly useful, standalone medical device in outpatient clinic settings. The implementation evaluation with one Altera cyclone II-EP2C70F89 shows that the proposed ALE used 45% resources of the chip. Experiments with the proposed prototype were made using DE2-70 emulation board with recorded body signals obtained from online medical archives. Clear suppressions were observed in our experiments from both the frequency domain and time domain perspectives.

The use of a fully integrated electronic medical record to minimize cumulative lifetime radiation exposure from CT scanning to detect urinary tract calculi.

PubMed

Kohler, Steven W; Chen, Richard; Kagan, Alex; Helvey, Dustin W; Buccigrossi, David

2013-06-01

In order to determine the effects of implementation of an electronic medical record on rates of repeat computed tomography (CT) scanning in the emergency department (ED) setting, we analyzed the utilization of CT of the kidneys, ureters, and bladder (CT KUB) for the detection of urinary tract calculi for periods before and after the implementation of a hospital-wide electronic medical record system. Rates of repeat CT scanning within a 6-month period of previous scan were determined pre- and post-implementation and compared. Prior to implementation, there was a 6-month repeat rate of 6.2 % compared with the post-implementation period, which was associated with a 6-month repeat rate of 4.1 %. Statistical analysis using a two-sample, one-tailed t test for difference of means was associated with a p value of 0.00007. This indicates that the implementation of the electronic medical record system was associated with a 34 % decrease in 6-month repeat CT KUB scans. We conclude that the use of an electronic medical record can be associated with a decrease in utilization of unnecessary repeat CT imaging, leading to decreased cumulative lifetime risk for cancer in these patients and more efficient utilization of ED and radiologic resources.

Essential Skills and Knowledge for Troubleshooting E-Resources Access Issues in a Web-Scale Discovery Environment

ERIC Educational Resources Information Center

Carter, Sunshine; Traill, Stacie

2017-01-01

Electronic resource access troubleshooting is familiar work in most libraries. The added complexity introduced when a library implements a web-scale discovery service, however, creates a strong need for well-organized, rigorous training to enable troubleshooting staff to provide the best service possible. This article outlines strategies, tools,…

An Empirical Study of Logistics Organization, Electronic Linkage, and Performance

DTIC Science & Technology

1993-01-01

utilization of transportation resources, and improved quality management. Researchers have proposed an information technology (IT) implementation model for...management, more efficient utilization of transportation resources, and improved quality management. Researchers have proposed an information...coordination of (1) facility structure, (2) forecasting and order management, (3) transportation , (4) inventory, and (5) warehousing and packaging. The

What Do You Recommend? Implementation and Analyses of Collaborative Information Filtering of Web Resources for Education.

ERIC Educational Resources Information Center

Recker, Mimi M.; Walker, Andrew; Lawless, Kimberly

2003-01-01

Examines results from one pilot study and two empirical studies of a collaborative filtering system applied in higher education settings. Explains the use of collaborative filtering in electronic commerce and suggests it can be adapted to education to help find useful Web resources and to bring people together with similar interests and beliefs.…

Practical Considerations for Implementing Genomic Information Resources

PubMed Central

Overby, Casey L.; Connolly, John; Chute, Christopher G.; Denny, Joshua C.; Freimuth, Robert R.; Hartzler, Andrea L.; Holm, Ingrid A.; Manzi, Shannon; Pathak, Jyotishman; Peissig, Peggy L.; Smith, Maureen; Williams, Marc S.; Shirts, Brian H.; Stoffel, Elena M.; Tarczy-Hornoch, Peter; Vitek, Carolyn R. Rohrer; Wolf, Wendy A.; Starren, Justin

2016-01-01

Summary Objectives To understand opinions and perceptions on the state of information resources specifically targeted to genomics, and approaches to delivery in clinical practice. Methods We conducted a survey of genomic content use and its clinical delivery from representatives across eight institutions in the electronic Medical Records and Genomics (eMERGE) network and two institutions in the Clinical Sequencing Exploratory Research (CSER) consortium in 2014. Results Eleven responses representing distinct projects across ten sites showed heterogeneity in how content is being delivered, with provider-facing content primarily delivered via the electronic health record (EHR) (n=10), and paper/pamphlets as the leading mode for patient-facing content (n=9). There was general agreement (91%) that new content is needed for patients and providers specific to genomics, and that while aspects of this content could be shared across institutions there remain site-specific needs (73% in agreement). Conclusion This work identifies a need for the improved access to and expansion of information resources to support genomic medicine, and opportunities for content developers and EHR vendors to partner with institutions to develop needed resources, and streamline their use – such as a central content site in multiple modalities while implementing approaches to allow for site-specific customization. PMID:27652374

Real-Time Digital Signal Processing Based on FPGAs for Electronic Skin Implementation †

PubMed Central

Ibrahim, Ali; Gastaldo, Paolo; Chible, Hussein; Valle, Maurizio

2017-01-01

Enabling touch-sensing capability would help appliances understand interaction behaviors with their surroundings. Many recent studies are focusing on the development of electronic skin because of its necessity in various application domains, namely autonomous artificial intelligence (e.g., robots), biomedical instrumentation, and replacement prosthetic devices. An essential task of the electronic skin system is to locally process the tactile data and send structured information either to mimic human skin or to respond to the application demands. The electronic skin must be fabricated together with an embedded electronic system which has the role of acquiring the tactile data, processing, and extracting structured information. On the other hand, processing tactile data requires efficient methods to extract meaningful information from raw sensor data. Machine learning represents an effective method for data analysis in many domains: it has recently demonstrated its effectiveness in processing tactile sensor data. In this framework, this paper presents the implementation of digital signal processing based on FPGAs for tactile data processing. It provides the implementation of a tensorial kernel function for a machine learning approach. Implementation results are assessed by highlighting the FPGA resource utilization and power consumption. Results demonstrate the feasibility of the proposed implementation when real-time classification of input touch modalities are targeted. PMID:28287448

Real-Time Digital Signal Processing Based on FPGAs for Electronic Skin Implementation.

PubMed

Ibrahim, Ali; Gastaldo, Paolo; Chible, Hussein; Valle, Maurizio

2017-03-10

Enabling touch-sensing capability would help appliances understand interaction behaviors with their surroundings. Many recent studies are focusing on the development of electronic skin because of its necessity in various application domains, namely autonomous artificial intelligence (e.g., robots), biomedical instrumentation, and replacement prosthetic devices. An essential task of the electronic skin system is to locally process the tactile data and send structured information either to mimic human skin or to respond to the application demands. The electronic skin must be fabricated together with an embedded electronic system which has the role of acquiring the tactile data, processing, and extracting structured information. On the other hand, processing tactile data requires efficient methods to extract meaningful information from raw sensor data. Machine learning represents an effective method for data analysis in many domains: it has recently demonstrated its effectiveness in processing tactile sensor data. In this framework, this paper presents the implementation of digital signal processing based on FPGAs for tactile data processing. It provides the implementation of a tensorial kernel function for a machine learning approach. Implementation results are assessed by highlighting the FPGA resource utilization and power consumption. Results demonstrate the feasibility of the proposed implementation when real-time classification of input touch modalities are targeted.

Let Me Show You How It’s Done! Desktop Sharing for Distance Learning from the D. Samuel Gottesman Library

PubMed Central

Glassman, Nancy R.; Habousha, Racheline G.; Minuti, Aurelia; Schwartz, Rachel; Sorensen, Karen

2009-01-01

Due to the proliferation of electronic resources, fewer users visit the library. Traditional classroom instruction and in-person consultations are no longer sufficient in assisting library users. Librarians are constantly seeking new ways to interact with patrons and facilitate efficient use of electronic resources. This article describes the development, implementation, and evaluation of a project in which desktop-sharing software was used to reach out to users at remote locations. Various ways of using this tool are described, and challenges and implications for future expansion are discussed. PMID:20183031

Performance Evaluation of Heart Sound Cancellation in FPGA Hardware Implementation for Electronic Stethoscope

PubMed Central

Chao, Chun-Tang

2014-01-01

This paper presents the design and evaluation of the hardware circuit for electronic stethoscopes with heart sound cancellation capabilities using field programmable gate arrays (FPGAs). The adaptive line enhancer (ALE) was adopted as the filtering methodology to reduce heart sound attributes from the breath sounds obtained via the electronic stethoscope pickup. FPGAs were utilized to implement the ALE functions in hardware to achieve near real-time breath sound processing. We believe that such an implementation is unprecedented and crucial toward a truly useful, standalone medical device in outpatient clinic settings. The implementation evaluation with one Altera cyclone II–EP2C70F89 shows that the proposed ALE used 45% resources of the chip. Experiments with the proposed prototype were made using DE2-70 emulation board with recorded body signals obtained from online medical archives. Clear suppressions were observed in our experiments from both the frequency domain and time domain perspectives. PMID:24790573

Paediatric electronic infusion calculator: An intervention to eliminate infusion errors in paediatric critical care.

PubMed

Venkataraman, Aishwarya; Siu, Emily; Sadasivam, Kalaimaran

2016-11-01

Medication errors, including infusion prescription errors are a major public health concern, especially in paediatric patients. There is some evidence that electronic or web-based calculators could minimise these errors. To evaluate the impact of an electronic infusion calculator on the frequency of infusion errors in the Paediatric Critical Care Unit of The Royal London Hospital, London, United Kingdom. We devised an electronic infusion calculator that calculates the appropriate concentration, rate and dose for the selected medication based on the recorded weight and age of the child and then prints into a valid prescription chart. Electronic infusion calculator was implemented from April 2015 in Paediatric Critical Care Unit. A prospective study, five months before and five months after implementation of electronic infusion calculator, was conducted. Data on the following variables were collected onto a proforma: medication dose, infusion rate, volume, concentration, diluent, legibility, and missing or incorrect patient details. A total of 132 handwritten prescriptions were reviewed prior to electronic infusion calculator implementation and 119 electronic infusion calculator prescriptions were reviewed after electronic infusion calculator implementation. Handwritten prescriptions had higher error rate (32.6%) as compared to electronic infusion calculator prescriptions (<1%) with a p  < 0.001. Electronic infusion calculator prescriptions had no errors on dose, volume and rate calculation as compared to handwritten prescriptions, hence warranting very few pharmacy interventions. Use of electronic infusion calculator for infusion prescription significantly reduced the total number of infusion prescribing errors in Paediatric Critical Care Unit and has enabled more efficient use of medical and pharmacy time resources.

Progress and challenges: implementation and use of health information technology among critical-access hospitals.

PubMed

Gabriel, Meghan Hufstader; Jones, Emily B; Samy, Leila; King, Jennifer

2014-07-01

Despite major national investments to support the adoption of health information technology (IT), concerns persist that barriers are inhibiting that adoption and the use of advanced health IT capabilities in rural areas in particular. Using a survey of Medicare-certified critical-access hospitals, we examined electronic health record (EHR) adoption, key EHR functionalities, telehealth, and teleradiology, as well as challenges to EHR adoption. In 2013, 89 percent of critical-access hospitals had implemented a full or partial EHR. Adoption of key EHR capabilities varied. Critical-access hospitals that had certain types of technical assistance and resources available to support health IT were more likely to have adopted health IT capabilities and less likely to report significant challenges to EHR implementation and use, compared to other hospitals in the survey. It is important to ensure that the necessary resources and support are available to critical-access hospitals, especially those that operate independently, to assist them in adopting health IT and becoming able to electronically link to the broader health care system. Project HOPE—The People-to-People Health Foundation, Inc.

Dialectical Behavior Therapy Training and Desired Resources for Implementation: Results From a National Program Evaluation in the Veterans Health Administration.

PubMed

Landes, Sara J; Matthieu, Monica M; Smith, Brandy N; Trent, Lindsay R; Rodriguez, Allison L; Kemp, Janet; Thompson, Caitlin

2016-08-01

Little is known about nonresearch training experiences of providers who implement evidence-based psychotherapies for suicidal behaviors among veterans. This national program evaluation identified the history of training, training needs, and desired resources of clinicians who work with at-risk veterans in a national health care system. This sequential mixed methods national program evaluation used a post-only survey design to obtain needs assessment data from clinical sites (N = 59) within Veterans Health Administration (VHA) facilities that implemented dialectical behavior therapy (DBT). Data were also collected on resources preferred to support ongoing use of DBT. While only 33% of clinical sites within VHA facilities reported that staff attended a formal DBT intensive training workshop, nearly 97% of participating sites reported having staff who completed self-study using DBT manuals. Mobile apps for therapists and clients and templates for documentation in the electronic health records to support measurement-based care were desired clinical resources. Results indicate that less-intensive training models can aid staff in implementing DBT in real-world health care settings. While more training is requested, a number of VHA facilities have successfully implemented DBT into the continuum of care for veterans at risk for suicide. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Ethics of Implementing Electronic Health Records in Developing Countries: Points to Consider

PubMed Central

Were, Martin C.; Meslin, Eric M.

2011-01-01

Electronic Health Record systems (EHRs) are increasingly being used in many developing countries, several of which have moved beyond isolated pilot projects to active large-scale implementation as part of their national health strategies. Despite growing enthusiasm for adopting EHRs in resource poor settings, almost no attention has been paid to the ethical issues that might arise. In this article we argue that these ethical issues should be addressed now if EHRs are to be appropriately implemented in these settings. We take a systematic approach guided by a widely accepted ethical framework currently in use for developing countries to first describe the ethical issues, and then propose a set of ‘Points to Consider’ to guide further thinking and decision-making. PMID:22195214

Electronic Health Record Implementation: A SWOT Analysis.

PubMed

Shahmoradi, Leila; Darrudi, Alireza; Arji, Goli; Farzaneh Nejad, Ahmadreza

2017-10-01

Electronic Health Record (EHR) is one of the most important achievements of information technology in healthcare domain, and if deployed effectively, it can yield predominant results. The aim of this study was a SWOT (strengths, weaknesses, opportunities, and threats) analysis in electronic health record implementation. This is a descriptive, analytical study conducted with the participation of a 90-member work force from Hospitals affiliated to Tehran University of Medical Sciences (TUMS). The data were collected by using a self-structured questionnaire and analyzed by SPSS software. Based on the results, the highest priority in strength analysis was related to timely and quick access to information. However, lack of hardware and infrastructures was the most important weakness. Having the potential to share information between different sectors and access to a variety of health statistics was the significant opportunity of EHR. Finally, the most substantial threats were the lack of strategic planning in the field of electronic health records together with physicians' and other clinical staff's resistance in the use of electronic health records. To facilitate successful adoption of electronic health record, some organizational, technical and resource elements contribute; moreover, the consideration of these factors is essential for HER implementation.

User Perceptions of the Implementation of an Electronic Medication Management System in a Paediatric Setting.

PubMed

Hardie, Rae-Anne; Baysari, Melissa T; Lake, Rebecca; Richardson, Lauren; McCullagh, Cheryl; Westbrook, Johanna I

2017-01-01

The roll-out of a hospital-wide electronic medication management system (eMMS) is a challenging task, requiring planning, coordination, communication and change management. This research aimed to explore the views of doctors and nurses about the strategy used to implement an eMM system in a paediatric hospital. Semi-structured interviews were performed during the first week of the implementation on each ward, and were then followed up three and six weeks post implementation. In total, 90 users (60 nurses and 30 doctors) were asked about their impressions of the implementation, as well as their perceptions of training and IT support. Qualitative thematic analysis was performed by three researchers. Most users perceived the implementation of the eMM to be positive overall. Although perceptions of the implementation process remained largely consistent across the six weeks, users identified several areas where improvements were needed, especially early in implementation, including resources, planning, roll-out strategy and training. These findings are useful for future implementations of eMM systems in paediatric hospitals.

Electronic neural network for dynamic resource allocation

NASA Technical Reports Server (NTRS)

Thakoor, A. P.; Eberhardt, S. P.; Daud, T.

1991-01-01

A VLSI implementable neural network architecture for dynamic assignment is presented. The resource allocation problems involve assigning members of one set (e.g. resources) to those of another (e.g. consumers) such that the global 'cost' of the associations is minimized. The network consists of a matrix of sigmoidal processing elements (neurons), where the rows of the matrix represent resources and columns represent consumers. Unlike previous neural implementations, however, association costs are applied directly to the neurons, reducing connectivity of the network to VLSI-compatible 0 (number of neurons). Each row (and column) has an additional neuron associated with it to independently oversee activations of all the neurons in each row (and each column), providing a programmable 'k-winner-take-all' function. This function simultaneously enforces blocking (excitatory/inhibitory) constraints during convergence to control the number of active elements in each row and column within desired boundary conditions. Simulations show that the network, when implemented in fully parallel VLSI hardware, offers optimal (or near-optimal) solutions within only a fraction of a millisecond, for problems up to 128 resources and 128 consumers, orders of magnitude faster than conventional computing or heuristic search methods.

A New Approach to Geoengineering: Manna From Heaven

NASA Astrophysics Data System (ADS)

Ellery, Alex

2015-04-01

Geo-engineering, although controversial, has become an emerging factor in coping with climate change. Although most are terrestrial-based technologies, I focus on a space-based approach implemented through a solar shield system. I present several new elements that essentially render the high-cost criticism moot. Of special relevance are two seemingly unrelated technologies - the Resource Prospector Mission (RPM) to the Moon in 2018 that shall implement a technology demonstration of simple material resource extraction from lunar regolith, and the emergence of multi-material 3D printing technology that promises unprecedented robotic manufacturing capabilities. My research group has begun theoretical and experimentation work in developing the concept of a 3D printed electric motor system from lunar-type resources. The electric motor underlies every universal mechanical machine. Together with 3D printed electronics, I submit that this would enable self-replicating machines to be realised. A detailed exposition on how this may be achieved will be outlined. Such self-replicating machines could construct the spacecraft required to implement a solar shield and solar power satellites in large numbers from lunar resources with the same underlying technologies at extremely low cost.

A system dynamics evaluation model: implementation of health information exchange for public health reporting

PubMed Central

Merrill, Jacqueline A; Deegan, Michael; Wilson, Rosalind V; Kaushal, Rainu; Fredericks, Kimberly

2013-01-01

Objective To evaluate the complex dynamics involved in implementing electronic health information exchange (HIE) for public health reporting at a state health department, and to identify policy implications to inform similar implementations. Materials and methods Qualitative data were collected over 8 months from seven experts at New York State Department of Health who implemented web services and protocols for querying, receipt, and validation of electronic data supplied by regional health information organizations. Extensive project documentation was also collected. During group meetings experts described the implementation process and created reference modes and causal diagrams that the evaluation team used to build a preliminary model. System dynamics modeling techniques were applied iteratively to build causal loop diagrams representing the implementation. The diagrams were validated iteratively by individual experts followed by group review online, and through confirmatory review of documents and artifacts. Results Three casual loop diagrams captured well-recognized system dynamics: Sliding Goals, Project Rework, and Maturity of Resources. The findings were associated with specific policies that address funding, leadership, ensuring expertise, planning for rework, communication, and timeline management. Discussion This evaluation illustrates the value of a qualitative approach to system dynamics modeling. As a tool for strategic thinking on complicated and intense processes, qualitative models can be produced with fewer resources than a full simulation, yet still provide insights that are timely and relevant. Conclusions System dynamics techniques clarified endogenous and exogenous factors at play in a highly complex technology implementation, which may inform other states engaged in implementing HIE supported by federal Health Information Technology for Economic and Clinical Health (HITECH) legislation. PMID:23292910

A system dynamics evaluation model: implementation of health information exchange for public health reporting.

PubMed

Merrill, Jacqueline A; Deegan, Michael; Wilson, Rosalind V; Kaushal, Rainu; Fredericks, Kimberly

2013-06-01

To evaluate the complex dynamics involved in implementing electronic health information exchange (HIE) for public health reporting at a state health department, and to identify policy implications to inform similar implementations. Qualitative data were collected over 8 months from seven experts at New York State Department of Health who implemented web services and protocols for querying, receipt, and validation of electronic data supplied by regional health information organizations. Extensive project documentation was also collected. During group meetings experts described the implementation process and created reference modes and causal diagrams that the evaluation team used to build a preliminary model. System dynamics modeling techniques were applied iteratively to build causal loop diagrams representing the implementation. The diagrams were validated iteratively by individual experts followed by group review online, and through confirmatory review of documents and artifacts. Three casual loop diagrams captured well-recognized system dynamics: Sliding Goals, Project Rework, and Maturity of Resources. The findings were associated with specific policies that address funding, leadership, ensuring expertise, planning for rework, communication, and timeline management. This evaluation illustrates the value of a qualitative approach to system dynamics modeling. As a tool for strategic thinking on complicated and intense processes, qualitative models can be produced with fewer resources than a full simulation, yet still provide insights that are timely and relevant. System dynamics techniques clarified endogenous and exogenous factors at play in a highly complex technology implementation, which may inform other states engaged in implementing HIE supported by federal Health Information Technology for Economic and Clinical Health (HITECH) legislation.

Intranet and village community: optimization of public service based on electronic government at the local level

NASA Astrophysics Data System (ADS)

Pradana, G. W.; Fanida, E. H.; Niswah, F.

2018-01-01

The demand for good governance is directed towards the realization of efficiency, effectiveness, and clean government. The move is demonstrated through national and regional levels to develop and implement electronic government concepts. Through the development of electronic government is done structuring management systems and work processes in the government environment by optimizing the utilization of information technology. One of the real forms of electronic government (e-Gov) implementation at the local level is the Intranet Sub-District program in Sukodono Sub-District, Sidoarjo. Intranet Sub-District is an innovation whose purpose is to realize the availability of information on the utilization of management, distribution, and storage of official scripts, and also the optimal delivery of information and communication in the implementation of guidance and supervision of local administration. The type of this paper is descriptive with a qualitative approach and focus on the implementation of the Intranet District Program in Sukodono District, Sidoarjo. The findings of the study are the limited number of human resources who have mastered ICT, the uneven network, the adequacy of institutional needs and the existence of budget support from the authorized institution and the information system has not accommodated all the service needs.

Metadata: Standards for Retrieving WWW Documents (and Other Digitized and Non-Digitized Resources)

NASA Astrophysics Data System (ADS)

Rusch-Feja, Diann

The use of metadata for indexing digitized and non-digitized resources for resource discovery in a networked environment is being increasingly implemented all over the world. Greater precision is achieved using metadata than relying on universal search engines and furthermore, meta-data can be used as filtering mechanisms for search results. An overview of various metadata sets is given, followed by a more focussed presentation of Dublin Core Metadata including examples of sub-elements and qualifiers. Especially the use of the Dublin Core Relation element provides connections between the metadata of various related electronic resources, as well as the metadata for physical, non-digitized resources. This facilitates more comprehensive search results without losing precision and brings together different genres of information which would otherwise be only searchable in separate databases. Furthermore, the advantages of Dublin Core Metadata in comparison with library cataloging and the use of universal search engines are discussed briefly, followed by a listing of types of implementation of Dublin Core Metadata.

Resource conservation approached with an appropriate collection and upgrade-remanufacturing for used electronic products.

PubMed

Zlamparet, Gabriel I; Tan, Quanyin; Stevels, A B; Li, Jinhui

2018-03-01

This comparative research represents an example for a better conservation of resources by reducing the amount of waste (kg) and providing it more value under the umbrella of remanufacturing. The three discussed cases will expose three issues already addressed separately in the literature. The generation of waste electrical and electronic equipment (WEEE) interacts with the environmental depletion. In this article, we gave the examples of addressed issues under the concept of remanufacturing. Online collection opportunity eliminating classical collection, a business to business (B2B) implementation for remanufactured servers and medical devices. The material reuse (recycling), component sustainability, reuse (part harvesting), product reuse (after repair/remanufacturing) indicates the recovery potential using remanufacturing tool for a better conservation of resources adding more value to the products. Our findings can provide an overview of new system organization for the general collection, market potential and the technological advantages using remanufacturing instead of recycling of WEEE or used electrical and electronic equipment. Copyright © 2017. Published by Elsevier Ltd.

Refocussing our attention on 'need' in the application of telehealth.

PubMed

Scott, Richard E; Affleck-Hall, Louise C; Mars, Maurice

2014-01-01

Given that e-health (including telehealth) is an opportunity cost (i.e., redirecting already scarce healthcare resources away from more traditional healthcare delivery needs), performing needs assessment ensures that investment of resources in e-health is appropriate. Yet the current literature shows research is on clever, narrow, or 'one disease' telehealth applications (e.g., telediabetes; telesurgery), or creation of electronic records (e.g., EHR's; EMRs; HIS's) and accumulation of 'big data' (e.g. biosurveillance). Given the reality of comorbidity, the complexity of telesurgery, and the lack of successful country-wide EHR implementations, are we using our investments in e-health wisely? The requirement for needs assessment to guide selection and implementation of evidence-based and needs-based e-health solutions is seldom adhered to. We must refocus our efforts on more pragmatic needs. Where might insight to evidence-based health needs come from? Using South Africa as an example, this paper highlights several readily available resources, and how they may guide future telehealth implementations in South Africa and elsewhere.

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.

Systematic review of electronic surveillance of infectious diseases with emphasis on antimicrobial resistance surveillance in resource-limited settings.

PubMed

Rattanaumpawan, Pinyo; Boonyasiri, Adhiratha; Vong, Sirenda; Thamlikitkul, Visanu

2018-02-01

Electronic surveillance of infectious diseases involves rapidly collecting, collating, and analyzing vast amounts of data from interrelated multiple databases. Although many developed countries have invested in electronic surveillance for infectious diseases, the system still presents a challenge for resource-limited health care settings. We conducted a systematic review by performing a comprehensive literature search on MEDLINE (January 2000-December 2015) to identify studies relevant to electronic surveillance of infectious diseases. Study characteristics and results were extracted and systematically reviewed by 3 infectious disease physicians. A total of 110 studies were included. Most surveillance systems were developed and implemented in high-income countries; less than one-quarter were conducted in low-or middle-income countries. Information technologies can be used to facilitate the process of obtaining laboratory, clinical, and pharmacologic data for the surveillance of infectious diseases, including antimicrobial resistance (AMR) infections. These novel systems require greater resources; however, we found that using electronic surveillance systems could result in shorter times to detect targeted infectious diseases and improvement of data collection. This study highlights a lack of resources in areas where an effective, rapid surveillance system is most needed. The availability of information technology for the electronic surveillance of infectious diseases, including AMR infections, will facilitate the prevention and containment of such emerging infectious diseases. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Mind the Gap. A systematic review to identify usability and safety challenges and practices during electronic health record implementation.

PubMed

Ratwani, Raj; Fairbanks, Terry; Savage, Erica; Adams, Katie; Wittie, Michael; Boone, Edna; Hayden, Andrew; Barnes, Janey; Hettinger, Zach; Gettinger, Andrew

2016-11-16

Decisions made during electronic health record (EHR) implementations profoundly affect usability and safety. This study aims to identify gaps between the current literature and key stakeholders' perceptions of usability and safety practices and the challenges encountered during the implementation of EHRs. Two approaches were used: a literature review and interviews with key stakeholders. We performed a systematic review of the literature to identify usability and safety challenges and best practices during implementation. A total of 55 articles were reviewed through searches of PubMed, Web of Science and Scopus. We used a qualitative approach to identify key stakeholders' perceptions; semi-structured interviews were conducted with a diverse set of health IT stakeholders to understand their current practices and challenges related to usability during implementation. We used a grounded theory approach: data were coded, sorted, and emerging themes were identified. Conclusions from both sources of data were compared to identify areas of misalignment. We identified six emerging themes from the literature and stakeholder interviews: cost and resources, risk assessment, governance and consensus building, customization, clinical workflow and usability testing, and training. Across these themes, there were misalignments between the literature and stakeholder perspectives, indicating major gaps. Major gaps identified from each of six emerging themes are discussed as critical areas for future research, opportunities for new stakeholder initiatives, and opportunities to better disseminate resources to improve the implementation of EHRs. Our analysis identified practices and challenges across six different emerging themes, illustrated important gaps, and results suggest critical areas for future research and dissemination to improve EHR implementation.

Performance Support Case Studies from IBM.

ERIC Educational Resources Information Center

Duke-Moran, Celia; Swope, Ginger; Morariu, Janis; deKam, Peter

1999-01-01

Presents two case studies that show how IBM addressed performance support solutions and electronic learning. The first developed a performance support and expert coaching solution; the second applied performance support to reducing implementation time and total cost of ownership of enterprise resource planning systems. (Author/LRW)

Implementation and Student Assessment of Intranet-Based Learning Resources.

ERIC Educational Resources Information Center

Sosabowski, Michael H.; Herson, Katie; Lloyd, Andrew W.

1998-01-01

The University of Brighton (England) pharmacy and biomedical sciences school developed an institutional intranet providing course information, Internet links, lecture notes, links to computer-assisted instructional packages, and worksheets. Electronic monitoring of usage and subsequent questionnaire-based evaluation showed the intranet to be a…

Building a School District's Wide Area Network.

ERIC Educational Resources Information Center

Mastel, Vern L.

1996-01-01

Describes the development of a wide area network (WAN) in the Bismarck Public School District (North Dakota). Topics include design goals, network infrastructure, implementing library access, sharing resources across platforms, electronic mail, dial-in access, Internet access, adhering to software licenses, shareware and freeware, and monitoring…

[Using information resources management to set up the area of health information: a case analysis].

PubMed

dos Santos, Alaneir de Fatima; Ferreira, Janete Maria; Queiroz, Neuslene Rivers; Magalhães Júnior, Helvécio Miranda

2011-06-01

To report the experience of the City Department of Health in Belo Horizonte (SMSA/BH), state of Minas Gerais, Brazil, with the use of information resources management (IRM) to develop a health information system. In this case study we reviewed documents describing initiatives in the area of information, the mechanisms used to enable these initiatives, and the results achieved with a management system focused on the implementation of an electronic medical records system in the period from 2003 to 2008. This process is described and analyzed from the perspective of IRM. The system contributed to a change in the health care model, resulting from the electronic integration of 103 basic health units, 9 specialized units, and 503 family health teams, with emphasis on information that was relevant for the family health program. The following IRM components were effectively implemented as part of the electronic system: creation of a single locus for the areas of information technology and information, potential leveraging of information technology, and establishment of a strategic forum for information-related decision-making. One limitation refers to the use of strategic information for long-term decision-making.

An introduction to web scale discovery systems.

PubMed

Hoy, Matthew B

2012-01-01

This article explores the basic principles of web-scale discovery systems and how they are being implemented in libraries. "Web scale discovery" refers to a class of products that index a vast number of resources in a wide variety formats and allow users to search for content in the physical collection, print and electronic journal collections, and other resources from a single search box. Search results are displayed in a manner similar to Internet searches, in a relevance ranked list with links to online content. The advantages and disadvantages of these systems are discussed, and a list of popular discovery products is provided. A list of library websites with discovery systems currently implemented is also provided.

Best practices in nursing homes. Clinical supervision, management, and human resource practices.

PubMed

Dellefield, Mary Ellen

2008-07-01

Human resource practices including supervision and management are associated with organizational performance. Evidence supportive of such an association in nursing homes is found in the results of numerous research studies conducted during the past 17 years. In this article, best practices related to this topic have been culled from descriptive, explanatory, and intervention studies in a range of interdisciplinary research journals published between 1990 and 2007. Identified best practices include implementation of training programs on supervision and management for licensed nurses, certified nursing assistant job enrichment programs, implementation of consistent nursing assignments, and the use of electronic documentation. Organizational barriers and facilitators of these best practices are described. Copyright 2009, SLACK Incorporated.

Disassembly factories for electrical and electronic products to recover resources in product and material cycles.

PubMed

Basdere, Bahadir; Seliger, Guenther

2003-12-01

Cycle economy as a paradigm for industry in the 21st century depends on the economical and ecological treatment of limited resources. The objective is to achieve more use with fewer resources to increase the use-productivity of these resources. The European Union, aware of the adverse environmental impacts associated with electrical and electronic consumer goods in particular, has passed legislation regulating their appropriate end-of-life treatment. Adaptation processes, including essential disassembly and re-assembly operations, contribute significantly toward the economical fulfillment of these new legal requirements. Typically, the disassembly of used products is characterized by a high rate of manual operations, wide variety of product types, and unknown product properties. To cope with such demands, life cycle units or product accompanying information systems, are being developed and used for acquiring data about a specific product throughout its life cycle to aid in determining the level of product deterioration. Modular disassembly processes and tools have been developed and realized to enable the handling of multiple productvariants. They are being implemented in prototypical hybrid disassembly systemsfor large- and small-size electrical and electronic consumer goods.

Using the diffusion of innovations theory to assess socio-technical factors in planning the implementation of an electronic health record alert across multiple primary care clinics.

PubMed

Lin, Ching-Pin; Guirguis-Blake, Janelle; Keppel, Gina A; Dobie, Sharon; Osborn, Justin; Cole, Allison M; Baldwin, Laura-Mae

2016-04-15

Adverse drug events (ADEs) are a leading cause of death in the United States. Patients with stage 3 and 4 chronic kidney disease (CKD) are at particular risk because many medications are cleared by the kidneys. Alerts in the electronic health record (EHR) about drug appropriateness and dosing at the time of prescription have been shown to reduce ADEs for patients with stage 3 and 4 CKD in inpatient settings, but more research is needed about the implementation and effectiveness of such alerts in outpatient settings.  To explore factors that might inform the implementation of an electronic drug-disease alert for patients with CKD in primary care clinics, using Rogers' diffusion of innovations theory as an analytic framework. Interviews were conducted with key informants in four diverse clinics using various EHR systems. Interviews were audio recorded and transcribed. results Although all clinics had a current method for calculating glomerular filtration rate (GFR), clinics were heterogeneous with regard to current electronic decision support practices, quality improvement resources, and organizational culture and structure. Understanding variation in organizational culture and infrastructure across primary care clinics is important in planning implementation of an intervention to reduce ADEs among patients with CKD.

Integrating Computing Resources: A Shared Distributed Architecture for Academics and Administrators.

ERIC Educational Resources Information Center

Beltrametti, Monica; English, Will

1994-01-01

Development and implementation of a shared distributed computing architecture at the University of Alberta (Canada) are described. Aspects discussed include design of the architecture, users' views of the electronic environment, technical and managerial challenges, and the campuswide human infrastructures needed to manage such an integrated…

Hospital staff views of prescribing and discharge communication before and after electronic prescribing system implementation.

PubMed

Mills, Pamela Ruth; Weidmann, Anita Elaine; Stewart, Derek

2017-12-01

Background Electronic prescribing system implementation is recommended to improve patient safety and general practitioner's discharge information communication. There is a paucity of information about hospital staff perspectives before and after system implementation. Objective To explore hospital staff views regarding prescribing and discharge communication systems before and after hospital electronic prescribing and medicines administration (HEPMA) system implementation. Setting A 560 bed United Kingdom district general hospital. Methods Semi-structured face-to-face qualitative interviews with a purposive sample of hospital staff involved in the prescribing and discharge communication process. Interviews transcribed verbatim and coded using the Framework Approach. Behavioural aspects mapped to Theoretical Domains Framework (TDF) to highlight associated behavioural change determinants. Main outcome measure Staff perceptions before and after implementation. Results Nineteen hospital staff (consultant doctors, junior doctors, pharmacists and advanced nurse practitioners) participated before and after implementation. Pre-implementation main themes were inpatient chart and discharge letter design and discharge communication process with issues of illegible and inaccurate information. Improved safety was anticipated after implementation. Post-implementation themes were improved inpatient chart clarity and discharge letter quality. TDF domains relevant to staff behavioural determinants preimplementation were knowledge (task or environment); skills (competence); social/professional roles and identity; beliefs about capabilities; environmental context and resources (including incidents). An additional two were relevant post-implementation: social influences and behavioural regulation (including self-monitoring). Participants described challenges and patient safety concerns pre-implementation which were mostly resolved post-implementation. Conclusion HEPMA implementation produced perceptions of patient safety improvement. TDF use enabled behaviour change analysis due to implementation, for example, staff adoption of behaviours to ensure general practitioners receive good quality discharge information.

Implementing OpenMRS for patient monitoring in an HIV/AIDS care and treatment program in rural Mozambique.

PubMed

Manders, Eric-Jan; José, Eurico; Solis, Manuel; Burlison, Janeen; Nhampossa, José Leopoldo; Moon, Troy

2010-01-01

We have adopted the Open Medical Record System (OpenMRS) framework to implement an electronic patient monitoring system for an HIV care and treatment program in Mozambique. The program provides technical assistance to the Ministry of Health supporting the scale up of integrated HIV care and support services in health facilities in rural resource limited settings. The implementation is in use for adult and pediatric programs, with ongoing roll-out to cover all supported sites. We describe early experiences in adapting the system to the program needs, addressing infrastructure challenges, creating a regional support team, training data entry staff, migrating a legacy database, deployment, and current use. We find that OpenMRS offers excellent prospects for in-country development of health information systems, even in severely resource limited settings. However, it also requires considerable organizational infrastructure investment and technical capacity building to ensure continued local support.

Supporting research sites in resource-limited settings: challenges in implementing information technology infrastructure.

PubMed

Whalen, Christopher J; Donnell, Deborah; Tartakovsky, Michael

2014-01-01

As information and communication technology infrastructure becomes more reliable, new methods of electronic data capture, data marts/data warehouses, and mobile computing provide platforms for rapid coordination of international research projects and multisite studies. However, despite the increasing availability of Internet connectivity and communication systems in remote regions of the world, there are still significant obstacles. Sites with poor infrastructure face serious challenges participating in modern clinical and basic research, particularly that relying on electronic data capture and Internet communication technologies. This report discusses our experiences in supporting research in resource-limited settings. We describe examples of the practical and ethical/regulatory challenges raised by the use of these newer technologies for data collection in multisite clinical studies.

Electronic labelling in recycling of manufactured articles.

PubMed

Olejnik, Lech; Krammer, Alfred

2002-12-01

The concept of a recycling system aiming at the recovery of resources from manufactured articles is proposed. The system integrates electronic labels for product identification and internet for global data exchange. A prototype for the recycling of electric motors has been developed, which implements a condition-based recycling decision system to automatically select the environmentally and economically appropriate recycling strategy, thereby opening a potential market for second-hand motors and creating a profitable recycling process itself. The project has been designed to evaluate the feasibility of electronic identification applied on a large number of motors and to validate the system in real field conditions.

Refining, revising, augmenting, compiling and developing computer assisted instruction K-12 aerospace materials for implementation in NASA spacelink electronic information system

NASA Technical Reports Server (NTRS)

Blake, Jean A.

1988-01-01

The NASA Spacelink is an electronic information service operated by the Marshall Space Flight Center. The Spacelink contains extensive NASA news and educational resources that can be accessed by a computer and modem. Updates and information are provided on: current NASA news; aeronautics; space exploration: before the Shuttle; space exploration: the Shuttle and beyond; NASA installations; NASA educational services; materials for classroom use; and space program spinoffs.

Implementation of an electronic fingerprint-linked data collection system: a feasibility and acceptability study among Zambian female sex workers.

PubMed

Wall, Kristin M; Kilembe, William; Inambao, Mubiana; Chen, Yi No; Mchoongo, Mwaka; Kimaru, Linda; Hammond, Yuna Tiffany; Sharkey, Tyronza; Malama, Kalonde; Fulton, T Roice; Tran, Alex; Halumamba, Hanzunga; Anderson, Sarah; Kishore, Nishant; Sarwar, Shawn; Finnegan, Trisha; Mark, David; Allen, Susan A

2015-06-27

Patient identification within and between health services is an operational challenge in many resource-limited settings. When following HIV risk groups for service provision and in the context of vaccine trials, patient misidentification can harm patient care and bias trial outcomes. Electronic fingerprinting has been proposed to identify patients over time and link patient data between health services. The objective of this study was to determine 1) the feasibility of implementing an electronic-fingerprint linked data capture system in Zambia and 2) the acceptability of this system among a key HIV risk group: female sex workers (FSWs). Working with Biometrac, a US-based company providing biometric-linked healthcare platforms, an electronic fingerprint-linked data capture system was developed for use by field recruiters among Zambian FSWs. We evaluated the technical feasibility of the system for use in the field in Zambia and conducted a pilot study to determine the acceptability of the system, as well as barriers to uptake, among FSWs. We found that implementation of an electronic fingerprint-linked patient tracking and data collection system was feasible in this relatively resource-limited setting (false fingerprint matching rate of 1/1000 and false rejection rate of <1/10,000) and was acceptable among FSWs in a clinic setting (2% refusals). However, our data indicate that less than half of FSWs are comfortable providing an electronic fingerprint when recruited while they are working. The most common reasons cited for not providing a fingerprint (lack of privacy/confidentiality issues while at work, typically at bars or lodges) could be addressed by recruiting women during less busy hours, in their own homes, in the presence of "Queen Mothers" (FSW organizers), or in the presence of a FSW that has already been fingerprinted. Our findings have major implications for key population research and improved health services provision. However, more work needs to be done to increase the acceptability of the electronic fingerprint-linked data capture system during field recruitment. This study indicated several potential avenues that will be explored to increase acceptability.

Computers and Mental Health Care Delivery. A Resource Guide to Federal Information.

ERIC Educational Resources Information Center

Levy, Louise

Prepared for the mental health professional or administrator who is involved in the planning, developing, or implementation of an automated information system in a mental health environment, this guide is limited to the electronic processing and storage of information for management and clinical functions. Management application areas include…

Redesigning Our Role While Redesigning Our Libraries

ERIC Educational Resources Information Center

Bradburn, Frances Bryant

2013-01-01

This article describes a process one librarian discovered and implemented as she observed the changing role of the librarian and the library. Frustration was growing due to the gradual erosion of school libraries as they struggled to remain, with electronic books, video streaming, and databases supplanting many of the physical resources in the…

Authentication of Radio Frequency Identification Devices Using Electronic Characteristics

ERIC Educational Resources Information Center

Chinnappa Gounder Periaswamy, Senthilkumar

2010-01-01

Radio frequency identification (RFID) tags are low-cost devices that are used to uniquely identify the objects to which they are attached. Due to the low cost and size that is driving the technology, a tag has limited computational capabilities and resources. This limitation makes the implementation of conventional security protocols to prevent…

Music Teacher Perceptions of a Model of Technology Training and Support in Virginia

ERIC Educational Resources Information Center

Welch, Lee Arthur

2013-01-01

A plethora of technology resources currently exists for the music classroom of the twenty-first century, including digital audio and video, music software, electronic instruments, Web 2.0 tools and more. Research shows a strong need for professional development for teachers to properly implement and integrate instructional technology resources…

"Talkin' about a revolution": How electronic health records can facilitate the scale-up of HIV care and treatment and catalyze primary care in resource-constrained settings.

PubMed

Braitstein, Paula; Einterz, Robert M; Sidle, John E; Kimaiyo, Sylvester; Tierney, William

2009-11-01

Health care for patients with HIV infection in developing countries has increased substantially in response to major international funding. Scaling up treatment programs requires timely data on the type, quantity, and quality of care being provided. Increasingly, such programs are turning to electronic health records (EHRs) to provide these data. We describe how a medical school in the United States and another in Kenya collaborated to develop and implement an EHR in a large HIV/AIDS care program in western Kenya. These data were used to manage patients, providers, and the program itself as it grew to encompass 18 sites serving more than 90,000 patients. Lessons learned have been applicable beyond HIV/AIDS to include primary care, chronic disease management, and community-based health screening and disease prevention programs. EHRs will be key to providing the highest possible quality of care for the funds developing countries can commit to health care. Public, private, and academic partnerships can facilitate the development and implementation of EHRs in resource-constrained settings.

Dissemination of Evidence-Based Practice to Directors of Nursing by an Outreach Campaign in Taiwan.

PubMed

Weng, Yi-Hao; Chen, Chiehfeng; Chen, Kee-Hsin; Kuo, Ken N; Yang, Chun-Yuh; Chiu, Ya-Wen

2016-04-01

Directors of nursing (DONs) have an important influence in the dissemination of evidence-based practice (EBP) in hospital settings. The current study examined how the knowledge, skills, and behaviors of DONs changed when EBP was implemented during a 5-year, nationwide promotional campaign providing EBP-related information resources and promotional activities in regional hospitals in Taiwan. Cross-sectional questionnaire surveys for a nationwide representative sample of DONs were conducted in 2007, 2009, and 2011 to examine views related to EBP, including changes in beliefs, attitudes, knowledge, skills, behaviors, and barriers. This study enrolled 267 DONs in 2007, 257 in 2009, and 287 in 2011. During the study period, DONs' EBP knowledge and skills increased, but their beliefs and attitudes did not significantly change. Furthermore, the use of Internet-based resources, including web portals, electronic textbooks, electronic journals, and evidence-based online databases, increased. Most barriers significantly declined after the intervention. DONs' knowledge, skills, and behaviors regarding EBP increased after the multifaceted intervention. The data suggest this outreach program is useful in disseminating EBP implementation to DONs. Copyright 2016, SLACK Incorporated.

Impact of e-alert for detection of acute kidney injury on processes of care and outcomes: protocol for a systematic review and meta-analysis.

PubMed

Lachance, Philippe; Villeneuve, Pierre-Marc; Wilson, Francis P; Selby, Nicholas M; Featherstone, Robin; Rewa, Oleksa; Bagshaw, Sean M

2016-05-05

Acute kidney injury (AKI) is a common complication in hospitalised patients. It imposes significant risk for major morbidity and mortality. Moreover, patients suffering an episode of AKI consume considerable health resources. Recently, a number of studies have evaluated the implementation of automated electronic alerts (e-alerts) configured from electronic medical records (EMR) and clinical information systems (CIS) to warn healthcare providers of early or impending AKI in hospitalised patients. The impact of e-alerts on care processes, patient outcomes and health resource use, however, remains uncertain. We will perform a systematic review to describe and appraise e-alerts for AKI, and evaluate their impact on processes of care, clinical outcomes and health services use. In consultation with a research librarian, a search strategy will be developed and electronic databases (ie, MEDLINE, EMBASE, CINAHL, Cochrane Library and Inspec via Engineering Village) searched. Selected grey literature sources will also be searched. Search themes will focus on e-alerts and AKI. Citation screening, selection, quality assessment and data abstraction will be performed in duplicate. The primary analysis will be narrative; however, where feasible, pooled analysis will be performed. Each e-alert will be described according to trigger, type of alert, target recipient and degree of intrusiveness. Pooled effect estimates will be described, where applicable. Our systematic review will synthesise the literature on the value of e-alerts to detect AKI, and their impact on processes, patient-centred outcomes and resource use, and also identify key knowledge gaps and barriers to implementation. This is a fundamental step in a broader research programme aimed to understand the ideal structure of e-alerts, target population and methods for implementation, to derive benefit. Research ethics approval is not required for this review. CRD42016033033. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The Journal of Earth System Science Education: Peer Review for Digital Earth and Digital Library Content

NASA Astrophysics Data System (ADS)

Johnson, D.; Ruzek, M.; Weatherley, J.

2001-05-01

The Journal of Earth System Science Education is a new interdisciplinary electronic journal aiming to foster the study of the Earth as a system and promote the development and exchange of interdisciplinary learning resources for formal and informal education. JESSE will serve educators and students by publishing and providing ready electronic access to Earth system and global change science learning resources for the classroom and will provide authors and creators with professional recognition through publication in a peer reviewed journal. JESSE resources foster a world perspective by emphasizing interdisciplinary studies and bridging disciplines in the context of the Earth system. The Journal will publish a wide ranging variety of electronic content, with minimal constraints on format, targeting undergraduate educators and students as the principal readership, expanding to a middle and high school audience as the journal matures. JESSE aims for rapid review and turn-around of resources to be published, with a goal of 12 weeks from submission to publication for resources requiring few changes. Initial publication will be on a quarterly basis until a flow of resource submissions is established to warrant continuous electronic publication. JESSE employs an open peer review process in which authors and reviewers discuss directly the acceptability of a resource for publication using a software tool called the Digital Document Discourse Environment. Reviewer comments and attribution will be available with the resource upon acceptance for publication. JESSE will also implement a moderated peer commentary capability where readers can comment on the use of a resource or make suggestions. In the development phase, JESSE will also conduct a parallel anonymous review of content to validate and ensure credibility of the open review approach. Copyright of materials submitted remains with the author, granting JESSE the non-exclusive right to maintain a copy of the resource published on the JESSE web server, ensuring long term access to the resource as reviewed. JESSE is collaborating with the Digital Library for Earth System Education (DLESE) as a federated partner. Initial release is planned for Summer, 2001.

Sustaining "meaningful use" of health information technology in low-resource practices.

PubMed

Green, Lee A; Potworowski, Georges; Day, Anya; May-Gentile, Rachelle; Vibbert, Danielle; Maki, Bruce; Kiesel, Leslie

2015-01-01

The implementation of electronic health records (EHRs) has been extensively studied, but their maintenance once implemented has not. The Regional Extension Center (REC) program provides implementation assistance to priority practices-those with limited financial, technical, and organizational resources-but the assistance is time limited. Our objective was to identify potential barriers to maintenance of meaningful use of EHRs in priority primary care practices using a qualitative observational study for federally qualified health centers (FQHCs) and priority practices in Michigan. We conducted cognitive task analysis (CTA) interviews and direct observations of health information technology implementation in FQHCs. In addition, we conducted semistructured interviews with implementation specialists serving priority practices to detect emergent themes relevant to maintenance. Maintaining EHR technology will require ongoing expert technical support indefinitely beyond implementation to address upgrades and security needs. Maintaining meaningful use for quality improvement will require ongoing support for leadership and change management. Priority practices not associated with larger systems lack access to the necessary technical expertise, financial resources, and leverage with vendors to continue alone. Rural priority practices are particularly challenged, because expertise is often not available locally. Priority practices, especially in rural areas, are at high risk for falling on the wrong side of a "digital divide" as payers and regulators enact increasing expectations for EHR use and information management. For those without affiliation to maintain the necessary expert staff, ongoing support will be needed for those practices to remain viable. © 2015 Annals of Family Medicine, Inc.

Health information technology and dynamic capabilities.

PubMed

Leung, Ricky C

2012-01-01

Health information technology (HIT) purports to increase quality and efficiency in health care organizations. However, health care organizations are situated in constantly changing environments. They need dynamic capabilities to implement HIT effectively. This article builds on the dynamic capabilities perspective and generates propositions about implementing HIT in dynamic environments. Specifically, I identify the (1) the necessary resources and capabilities for organizations to implement HIT; (2) the organizational capabilities and benefits that can be enhanced by HIT; and (3) the similarities and differences between three distinct forms of HIT. I synthesized the literature on dynamic capabilities and HIT to identify dynamic capabilities that are associated with (1) electronic medical records, (2) telemedicine, and (3) social media. In addition, I discuss the benefits of these HITs for improving the dynamic capabilities of health care organizations. PROPOSITIONS/FINDINGS: This article generates three sets of propositions that can be tested empirically. First, I am concerned with how organizational size and human resources affect successful implementation of HIT. In addition, I argue that three technology-specific factors--hospital type, medical specialty, and socially desirable technical features--may affect the implementation of HIT. To cope with constantly changing environmental pressures, health administrators need to deploy, modify, and/or acquire organizational resources skillfully. Practitioners need to identify dynamic capabilities to support specific forms of HIT and understand how HIT enables health care organizations in turn. The concept of evolutionary fitness in the dynamic capabilities perspective may be developed to measure HIT implementation.

Designing for scale: optimising the health information system architecture for mobile maternal health messaging in South Africa (MomConnect)

PubMed Central

Seebregts, Christopher; Dane, Pierre; Parsons, Annie Neo; Fogwill, Thomas; Rogers, Debbie; Bekker, Marcha; Shaw, Vincent; Barron, Peter

2018-01-01

MomConnect is a national initiative coordinated by the South African National Department of Health that sends text-based mobile phone messages free of charge to pregnant women who voluntarily register at any public healthcare facility in South Africa. We describe the system design and architecture of the MomConnect technical platform, planned as a nationally scalable and extensible initiative. It uses a health information exchange that can connect any standards-compliant electronic front-end application to any standards-compliant electronic back-end database. The implementation of the MomConnect technical platform, in turn, is a national reference application for electronic interoperability in line with the South African National Health Normative Standards Framework. The use of open content and messaging standards enables the architecture to include any application adhering to the selected standards. Its national implementation at scale demonstrates both the use of this technology and a key objective of global health information systems, which is to achieve implementation scale. The system’s limited clinical information, initially, allowed the architecture to focus on the base standards and profiles for interoperability in a resource-constrained environment with limited connectivity and infrastructural capacity. Maintenance of the system requires mobilisation of national resources. Future work aims to use the standard interfaces to include data from additional applications as well as to extend and interface the framework with other public health information systems in South Africa. The development of this platform has also shown the benefits of interoperability at both an organisational and technical level in South Africa. PMID:29713506

Designing for scale: optimising the health information system architecture for mobile maternal health messaging in South Africa (MomConnect).

PubMed

Seebregts, Christopher; Dane, Pierre; Parsons, Annie Neo; Fogwill, Thomas; Rogers, Debbie; Bekker, Marcha; Shaw, Vincent; Barron, Peter

2018-01-01

MomConnect is a national initiative coordinated by the South African National Department of Health that sends text-based mobile phone messages free of charge to pregnant women who voluntarily register at any public healthcare facility in South Africa. We describe the system design and architecture of the MomConnect technical platform, planned as a nationally scalable and extensible initiative. It uses a health information exchange that can connect any standards-compliant electronic front-end application to any standards-compliant electronic back-end database. The implementation of the MomConnect technical platform, in turn, is a national reference application for electronic interoperability in line with the South African National Health Normative Standards Framework. The use of open content and messaging standards enables the architecture to include any application adhering to the selected standards. Its national implementation at scale demonstrates both the use of this technology and a key objective of global health information systems, which is to achieve implementation scale. The system's limited clinical information, initially, allowed the architecture to focus on the base standards and profiles for interoperability in a resource-constrained environment with limited connectivity and infrastructural capacity. Maintenance of the system requires mobilisation of national resources. Future work aims to use the standard interfaces to include data from additional applications as well as to extend and interface the framework with other public health information systems in South Africa. The development of this platform has also shown the benefits of interoperability at both an organisational and technical level in South Africa.

A web-based laboratory information system to improve quality of care of tuberculosis patients in Peru: functional requirements, implementation and usage statistics.

PubMed

Blaya, Joaquin A; Shin, Sonya S; Yagui, Martin J A; Yale, Gloria; Suarez, Carmen Z; Asencios, Luis L; Cegielski, J Peter; Fraser, Hamish S F

2007-10-28

Multi-drug resistant tuberculosis patients in resource-poor settings experience large delays in starting appropriate treatment and may not be monitored appropriately due to an overburdened laboratory system, delays in communication of results, and missing or error-prone laboratory data. The objective of this paper is to describe an electronic laboratory information system implemented to alleviate these problems and its expanding use by the Peruvian public sector, as well as examine the broader issues of implementing such systems in resource-poor settings. A web-based laboratory information system "e-Chasqui" has been designed and implemented in Peru to improve the timeliness and quality of laboratory data. It was deployed in the national TB laboratory, two regional laboratories and twelve pilot health centres. Using needs assessment and workflow analysis tools, e-Chasqui was designed to provide for improved patient care, increased quality control, and more efficient laboratory monitoring and reporting. Since its full implementation in March 2006, 29,944 smear microscopy, 31,797 culture and 7,675 drug susceptibility test results have been entered. Over 99% of these results have been viewed online by the health centres. High user satisfaction and heavy use have led to the expansion of e-Chasqui to additional institutions. In total, e-Chasqui will serve a network of institutions providing medical care for over 3.1 million people. The cost to maintain this system is approximately US$0.53 per sample or 1% of the National Peruvian TB program's 2006 budget. Electronic laboratory information systems have a large potential to improve patient care and public health monitoring in resource-poor settings. Some of the challenges faced in these settings, such as lack of trained personnel, limited transportation, and large coverage areas, are obstacles that a well-designed system can overcome. e-Chasqui has the potential to provide a national TB laboratory network in Peru. Furthermore, the core functionality of e-Chasqui as been implemented in the open source medical record system OpenMRS http://www.openmrs.org for other countries to use.

A web-based laboratory information system to improve quality of care of tuberculosis patients in Peru: functional requirements, implementation and usage statistics

PubMed Central

Blaya, Joaquin A; Shin, Sonya S; Yagui, Martin JA; Yale, Gloria; Suarez, Carmen Z; Asencios, Luis L; Cegielski, J Peter; Fraser, Hamish SF

2007-01-01

Background Multi-drug resistant tuberculosis patients in resource-poor settings experience large delays in starting appropriate treatment and may not be monitored appropriately due to an overburdened laboratory system, delays in communication of results, and missing or error-prone laboratory data. The objective of this paper is to describe an electronic laboratory information system implemented to alleviate these problems and its expanding use by the Peruvian public sector, as well as examine the broader issues of implementing such systems in resource-poor settings. Methods A web-based laboratory information system "e-Chasqui" has been designed and implemented in Peru to improve the timeliness and quality of laboratory data. It was deployed in the national TB laboratory, two regional laboratories and twelve pilot health centres. Using needs assessment and workflow analysis tools, e-Chasqui was designed to provide for improved patient care, increased quality control, and more efficient laboratory monitoring and reporting. Results Since its full implementation in March 2006, 29,944 smear microscopy, 31,797 culture and 7,675 drug susceptibility test results have been entered. Over 99% of these results have been viewed online by the health centres. High user satisfaction and heavy use have led to the expansion of e-Chasqui to additional institutions. In total, e-Chasqui will serve a network of institutions providing medical care for over 3.1 million people. The cost to maintain this system is approximately US$0.53 per sample or 1% of the National Peruvian TB program's 2006 budget. Conclusion Electronic laboratory information systems have a large potential to improve patient care and public health monitoring in resource-poor settings. Some of the challenges faced in these settings, such as lack of trained personnel, limited transportation, and large coverage areas, are obstacles that a well-designed system can overcome. e-Chasqui has the potential to provide a national TB laboratory network in Peru. Furthermore, the core functionality of e-Chasqui as been implemented in the open source medical record system OpenMRS for other countries to use. PMID:17963522

Delivering Electronic Resources with Web OPACs and Other Web-based Tools: Needs of Reference Librarians.

ERIC Educational Resources Information Center

Bordeianu, Sever; Carter, Christina E.; Dennis, Nancy K.

2000-01-01

Describes Web-based online public access catalogs (Web OPACs) and other Web-based tools as gateway methods for providing access to library collections. Addresses solutions for overcoming barriers to information, such as through the implementation of proxy servers and other authentication tools for remote users. (Contains 18 references.)…

77 FR 11741 - Approval and Promulgation of Air Quality Implementation Plans; Ohio; New Source Review Rules...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-28

... electronic copy of each of these documents will be available on the World Wide Web. Following publication, a... stay. SUMMARY: EPA is providing notice that it has responded to a petition for reconsideration and a... a petition dated April 26, 2010, for reconsideration from the Natural Resources Defense Council...

Marketing and Promotion of Library Services

NASA Astrophysics Data System (ADS)

Nicholas, Julie

As librarians we should be actively marketing and promoting our library services. This paper aims to demystify marketing for librarians. Practical solutions are provided on how to implement a marketing strategy, with particular emphasis on the value of using electronic information resources. It also shows the link between promoting library services and raising the profile of the library.

Technological trends in health care: electronic health record.

PubMed

Abraham, Sam

2010-01-01

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

The transforming effect of handheld computers on nursing practice.

PubMed

Thompson, Brent W

2005-01-01

Handheld computers have the power to transform nursing care. The roots of this power are the shift to decentralization of communication, electronic health records, and nurses' greater need for information at the point of care. This article discusses the effects of handheld resources, calculators, databases, electronic health records, and communication devices on nursing practice. The US government has articulated the necessity of implementing the use of handheld computers in healthcare. Nurse administrators need to encourage and promote the diffusion of this technology, which can reduce costs and improve care.

CDISC SHARE, a Global, Cloud-based Resource of Machine-Readable CDISC Standards for Clinical and Translational Research

PubMed Central

Hume, Samuel; Chow, Anthony; Evans, Julie; Malfait, Frederik; Chason, Julie; Wold, J. Darcy; Kubick, Wayne; Becnel, Lauren B.

2018-01-01

The Clinical Data Interchange Standards Consortium (CDISC) is a global non-profit standards development organization that creates consensus-based standards for clinical and translational research. Several of these standards are now required by regulators for electronic submissions of regulated clinical trials’ data and by government funding agencies. These standards are free and open, available for download on the CDISC Website as PDFs. While these documents are human readable, they are not amenable to ready use by electronic systems. CDISC launched the CDISC Shared Health And Research Electronic library (SHARE) to provide the standards metadata in machine-readable formats to facilitate the automated management and implementation of the standards. This paper describes how CDISC SHARE’S standards can facilitate collecting, aggregating and analyzing standardized data from early design to end analysis; and its role as a central resource providing information systems with metadata that drives process automation including study setup and data pipelining. PMID:29888049

Understanding and valuing the broader health system benefits of Uganda's national Human Resources for Health Information System investment.

PubMed

Driessen, Julia; Settle, Dykki; Potenziani, David; Tulenko, Kate; Kabocho, Twaha; Wadembere, Ismail

2015-08-31

To address the need for timely and comprehensive human resources for health (HRH) information, governments and organizations have been actively investing in electronic health information interventions, including in low-resource settings. The economics of human resources information systems (HRISs) in low-resource settings are not well understood, however, and warrant investigation and validation. This case study describes Uganda's Human Resources for Health Information System (HRHIS), implemented with support from the US Agency for International Development, and documents perceptions of its impact on the health labour market against the backdrop of the costs of implementation. Through interviews with end users and implementers in six different settings, we document pre-implementation data challenges and consider how the HRHIS has been perceived to affect human resources decision-making and the healthcare employment environment. This multisite case study documented a range of perceived benefits of Uganda's HRHIS through interviews with end users that sought to capture the baseline (or pre-implementation) state of affairs, the perceived impact of the HRHIS and the monetary value associated with each benefit. In general, the system appears to be strengthening both demand for health workers (through improved awareness of staffing patterns) and supply (by improving licensing, recruitment and competency of the health workforce). This heightened ability to identify high-value employees makes the health sector more competitive for high-quality workers, and this elevation of the health workforce also has broader implications for health system performance and population health. Overall, it is clear that HRHIS end users in Uganda perceived the system to have significantly improved day-to-day operations as well as longer term institutional mandates. A more efficient and responsive approach to HRH allows the health sector to recruit the best candidates, train employees in needed skills and deploy trained personnel to facilities where there is real demand. This cascade of benefits can extend the impact and rewards of working in the health sector, which elevates the health system as a whole.

Drug information resources used by nurse practitioners and collaborating physicians at the point of care in Nova Scotia, Canada: a survey and review of the literature

PubMed Central

Murphy, Andrea L; Fleming, Mark; Martin-Misener, Ruth; Sketris, Ingrid S; MacCara, Mary; Gass, David

2006-01-01

Background Keeping current with drug therapy information is challenging for health care practitioners. Technologies are often implemented to facilitate access to current and credible drug information sources. In the Canadian province of Nova Scotia, legislation was passed in 2002 to allow nurse practitioners (NPs) to practice collaboratively with physician partners. The purpose of this study was to determine the current utilization patterns of information technologies by these groups of practitioners. Methods Nurse practitioners and their collaborating physician partners in Nova Scotia were sent a survey in February 2005 to determine the frequency of use, usefulness, accessibility, credibility, and current/timeliness of personal digital assistant (PDA), computer, and print drug information resources. Two surveys were developed (one for PDA users and one for computer users) and revised based on a literature search, stakeholder consultation, and pilot-testing results. A second distribution to nonresponders occurred two weeks following the first. Data were entered and analysed with SPSS. Results Twenty-seven (14 NPs and 13 physicians) of 36 (75%) recipients responded. 22% (6) returned personal digital assistant (PDA) surveys. Respondents reported print, health professionals, and online/electronic resources as the most to least preferred means to access drug information, respectively. 37% and 35% of respondents reported using "both print and electronic but print more than electronic" and "print only", respectively, to search monograph-related drug information queries whereas 4% reported using "PDA only". Analysis of respondent ratings for all resources in the categories print, health professionals and other, and online/electronic resources, indicated that the Compendium of Pharmaceuticals and Specialties and pharmacists ranked highly for frequency of use, usefulness, accessibility, credibility, and current/timeliness by both groups of practitioners. Respondents' preferences and resource ratings were consistent with self-reported methods for conducting drug information queries. Few differences existed between NP and physician rankings of resources. Conclusion The use of computers and PDAs remains limited, which is also consistent with preferred and frequent use of print resources. Education for these practitioners regarding available electronic drug information resources may facilitate future computer and PDA use. Further research is needed to determine methods to increase computer and PDA use and whether these technologies affect prescribing and patient outcomes. PMID:16822323

Top ten challenges when interfacing a laboratory information system to an electronic health record: Experience at a large academic medical center.

PubMed

Petrides, Athena K; Tanasijevic, Milenko J; Goonan, Ellen M; Landman, Adam B; Kantartjis, Michalis; Bates, David W; Melanson, Stacy E F

2017-10-01

Recent U.S. government regulations incentivize implementation of an electronic health record (EHR) with computerized order entry and structured results display. Many institutions have also chosen to interface their EHR to their laboratory information system (LIS). Reported long-term benefits include increased efficiency and improved quality and safety. In order to successfully implement an interfaced EHR-LIS, institutions must plan years in advance and anticipate the impact of an integrated system. It can be challenging to fully understand the technical, workflow and resource aspects and adequately prepare for a potentially protracted system implementation and the subsequent stabilization. We describe the top ten challenges that we encountered in our clinical laboratories following the implementation of an interfaced EHR-LIS and offer suggestions on how to overcome these challenges. This study was performed at a 777-bed, tertiary care center which recently implemented an interfaced EHR-LIS. Challenges were recorded during EHR-LIS implementation and stabilization and the authors describe the top ten. Our top ten challenges were selection and harmonization of test codes, detailed training for providers on test ordering, communication with EHR provider champions during the build process, fluid orders and collections, supporting specialized workflows, sufficient reports and metrics, increased volume of inpatient venipunctures, adequate resources during stabilization, unanticipated changes to laboratory workflow and ordering specimens for anatomic pathology. A few suggestions to overcome these challenges include regular meetings with clinical champions, advanced considerations of reports and metrics that will be needed, adequate training of laboratory staff on new workflows in the EHR and defining all tests including anatomic pathology in the LIS. EHR-LIS implementations have many challenges requiring institutions to adapt and develop new infrastructures. This article should be helpful to other institutions facing or undergoing a similar endeavor. Copyright © 2017 Elsevier B.V. All rights reserved.

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.

Implementation of a World Wide Web server for the oil and gas industry

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

Blaylock, R.E.; Martin, F.D.; Emery, R.

1995-12-31

The Gas and Oil Technology Exchange and Communication Highway, (GO-TECH), provides an electronic information system for the petroleum community for the purpose of exchanging ideas, data, and technology. The personal computer-based system fosters communication and discussion by linking oil and gas producers with resource centers, government agencies, consulting firms, service companies, national laboratories, academic research groups, and universities throughout the world. The oil and gas producers are provided access to the GO-TECH World Wide Web home page via modem links, as well as Internet. The future GO-TECH applications will include the establishment of{open_quote}Virtual corporations {close_quotes} consisting of consortiums of smallmore » companies, consultants, and service companies linked by electronic information systems. These virtual corporations will have the resources and expertise previously found only in major corporations.« less

Implementation of a World Wide Web server for the oil and gas industry

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

Blaylock, R.E.; Martin, F.D.; Emery, R.

1996-10-01

The Gas and Oil Technology Exchange and Communication Highway (GO-TECH) provides an electronic information system for the petroleum community for exchanging ideas, data, and technology. The PC-based system fosters communication and discussion by linking the oil and gas producers with resource centers, government agencies, consulting firms, service companies, national laboratories, academic research groups, and universities throughout the world. The oil and gas producers can access the GO-TECH World Wide Web (WWW) home page through modem links, as well as through the Internet. Future GO-TECH applications will include the establishment of virtual corporations consisting of consortia of small companies, consultants, andmore » service companies linked by electronic information systems. These virtual corporations will have the resources and expertise previously found only in major corporations.« less

Integrating Genomic Resources with Electronic Health Records using the HL7 Infobutton Standard

PubMed Central

Overby, Casey Lynnette; Del Fiol, Guilherme; Rubinstein, Wendy S.; Maglott, Donna R.; Nelson, Tristan H.; Milosavljevic, Aleksandar; Martin, Christa L.; Goehringer, Scott R.; Freimuth, Robert R.; Williams, Marc S.

2016-01-01

Summary Background The Clinical Genome Resource (ClinGen) Electronic Health Record (EHR) Workgroup aims to integrate ClinGen resources with EHRs. A promising option to enable this integration is through the Health Level Seven (HL7) Infobutton Standard. EHR systems that are certified according to the US Meaningful Use program provide HL7-compliant infobutton capabilities, which can be leveraged to support clinical decision-making in genomics. Objectives To integrate genomic knowledge resources using the HL7 infobutton standard. Two tactics to achieve this objective were: (1) creating an HL7-compliant search interface for ClinGen, and (2) proposing guidance for genomic resources on achieving HL7 Infobutton standard accessibility and compliance. Methods We built a search interface utilizing OpenInfobutton, an open source reference implementation of the HL7 Infobutton standard. ClinGen resources were assessed for readiness towards HL7 compliance. Finally, based upon our experiences we provide recommendations for publishers seeking to achieve HL7 compliance. Results Eight genomic resources and two sub-resources were integrated with the ClinGen search engine via OpenInfobutton and the HL7 infobutton standard. Resources we assessed have varying levels of readiness towards HL7-compliance. Furthermore, we found that adoption of standard terminologies used by EHR systems is the main gap to achieve compliance. Conclusion Genomic resources can be integrated with EHR systems via the HL7 Infobutton standard using OpenInfobutton. Full compliance of genomic resources with the Infobutton standard would further enhance interoperability with EHR systems. PMID:27579472

GPAW - massively parallel electronic structure calculations with Python-based software.

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

Enkovaara, J.; Romero, N.; Shende, S.

2011-01-01

Electronic structure calculations are a widely used tool in materials science and large consumer of supercomputing resources. Traditionally, the software packages for these kind of simulations have been implemented in compiled languages, where Fortran in its different versions has been the most popular choice. While dynamic, interpreted languages, such as Python, can increase the effciency of programmer, they cannot compete directly with the raw performance of compiled languages. However, by using an interpreted language together with a compiled language, it is possible to have most of the productivity enhancing features together with a good numerical performance. We have used thismore » approach in implementing an electronic structure simulation software GPAW using the combination of Python and C programming languages. While the chosen approach works well in standard workstations and Unix environments, massively parallel supercomputing systems can present some challenges in porting, debugging and profiling the software. In this paper we describe some details of the implementation and discuss the advantages and challenges of the combined Python/C approach. We show that despite the challenges it is possible to obtain good numerical performance and good parallel scalability with Python based software.« less

Design and implementation of an affordable, public sector electronic medical record in rural Nepal.

PubMed

Raut, Anant; Yarbrough, Chase; Singh, Vivek; Gauchan, Bikash; Citrin, David; Verma, Varun; Hawley, Jessica; Schwarz, Dan; Harsha Bangura, Alex; Shrestha, Biplav; Schwarz, Ryan; Adhikari, Mukesh; Maru, Duncan

2017-06-23

Globally, electronic medical records are central to the infrastructure of modern healthcare systems. Yet the vast majority of electronic medical records have been designed for resource-rich environments and are not feasible in settings of poverty. Here we describe the design and implementation of an electronic medical record at a public sector district hospital in rural Nepal, and its subsequent expansion to an additional public sector facility.DevelopmentThe electronic medical record was designed to solve for the following elements of public sector healthcare delivery: 1) integration of the systems across inpatient, surgical, outpatient, emergency, laboratory, radiology, and pharmacy sites of care; 2) effective data extraction for impact evaluation and government regulation; 3) optimization for longitudinal care provision and patient tracking; and 4) effectiveness for quality improvement initiatives. For these purposes, we adapted Bahmni, a product built with open-source components for patient tracking, clinical protocols, pharmacy, laboratory, imaging, financial management, and supply logistics. In close partnership with government officials, we deployed the system in February of 2015, added on additional functionality, and iteratively improved the system over the following year. This experience enabled us then to deploy the system at an additional district-level hospital in a different part of the country in under four weeks. We discuss the implementation challenges and the strategies we pursued to build an electronic medical record for the public sector in rural Nepal.DiscussionOver the course of 18 months, we were able to develop, deploy and iterate upon the electronic medical record, and then deploy the refined product at an additional facility within only four weeks. Our experience suggests the feasibility of an integrated electronic medical record for public sector care delivery even in settings of rural poverty.

Design and implementation of an affordable, public sector electronic medical record in rural Nepal

PubMed Central

Raut, Anant; Yarbrough, Chase; Singh, Vivek; Gauchan, Bikash; Citrin, David; Verma, Varun; Hawley, Jessica; Schwarz, Dan; Harsha, Alex; Shrestha, Biplav; Schwarz, Ryan; Adhikari, Mukesh; Maru, Duncan

2018-01-01

Introduction Globally, electronic medical records are central to the infrastructure of modern healthcare systems. Yet the vast majority of electronic medical records have been designed for resource-rich environments and are not feasible in settings of poverty. Here we describe the design and implementation of an electronic medical record at a public sector district hospital in rural Nepal, and its subsequent expansion to an additional public sector facility. Development The electronic medical record was designed to solve for the following elements of public sector healthcare delivery: 1) integration of the systems across inpatient, surgical, outpatient, emergency, laboratory, radiology, and pharmacy sites of care; 2) effective data extraction for impact evaluation and government regulation; 3) optimization for longitudinal care provision and patient tracking; and 4) effectiveness for quality improvement initiatives. Application For these purposes, we adapted Bahmni, a product built with open-source components for patient tracking, clinical protocols, pharmacy, laboratory, imaging, financial management, and supply logistics. In close partnership with government officials, we deployed the system in February of 2015, added on additional functionality, and iteratively improved the system over the following year. This experience enabled us then to deploy the system at an additional district-level hospital in a different part of the country in under four weeks. We discuss the implementation challenges and the strategies we pursued to build an electronic medical record for the public sector in rural Nepal. Discussion Over the course of 18 months, we were able to develop, deploy and iterate upon the electronic medical record, and then deploy the refined product at an additional facility within only four weeks. Our experience suggests the feasibility of an integrated electronic medical record for public sector care delivery even in settings of rural poverty. PMID:28749321

Consultant's Playbook: A Survey of Pharmacy Consultant Experiences Among Hospitals In the University HealthSystem Consortium.

PubMed

Hicks, Dave; McCarthy, Bryan; Fanikos, John; Emamifar, Amir; Nedved, Andrea; Thompson, Bruce; Bender, Fred; McMahon, Patrick

2013-10-01

Our team surveyed a group of pharmacy directors to learn about their experiences with pharmacy consultants so that the directors might be able to use their consulting resources in a more effective manner. In May 2012, the University HealthSystem Consortium (UHC) Pharmacy Council Financial Performance Committee developed an electronic survey that collectively measured the characteristics, goals, and methodology of historical pharmacy consultant engagements and level of satisfaction. After e-mailing the initial electronic survey, we conducted follow-up telephone interviews with respondents from July through November 2012. These interviews were designed to include questions about expected outcomes, recommendations for evaluation processes, timelines for implementing the recommendations, consultants' expenses, and insights gained. A total of 23 pharmacy directors responded to the initial electronic survey; their organizations had engaged at least one consultant within the previous 5 years. Data were collected for 28 consultant engagements. Subsequent telephone interviews were conducted with 20 of the 23 pharmacy directors (87%) who completed the initial electronic survey, accounting for 25 of the 28 consultant engagements (89%). Cost reduction along with revenue enhancement was most often the focus of these engagements. These engagements were also mainly within the scope of an organization-wide effort initiated by the executive board or executive team. Consultant experiences varied greatly in terms of (1) the degree to which assistance was provided to the organization, (2) benchmarking methodologies and resources, and (3) timelines for implementing the consultants' recommendations. In general, most respondents rated their consultant experience as positive and were able to provide "pearls of wisdom" or lessons learned.

Evaluation of an Android-based mHealth system for population surveillance in developing countries

PubMed Central

Mbugua, Samuel; Amadi, David; Chepnǵeno, Viola; Saleem, Jason J; Anokwa, Yaw; Hartung, Carl; Borriello, Gaetano; Mamlin, Burke W; Ndege, Samson K; Were, Martin C

2012-01-01

Objective In parts of the developing world traditionally modeled healthcare systems do not adequately meet the needs of the populace. This can be due to imbalances in both supply and demand—there may be a lack of sufficient healthcare and the population most at need may be unable or unwilling to take advantage of it. Home-based care has emerged as a possible mechanism to bring healthcare to the populace in a cost-effective, useful manner. This study describes the development, implementation, and evaluation of a mobile device-based system to support such services. Materials and Methods Mobile phones were utilized and a structured survey was implemented to be administered by community health workers using Open Data Kit. This system was used to support screening efforts for a population of two million persons in western Kenya. Results Users of the system felt it was easy to use and facilitated their work. The system was also more cost effective than pen and paper alternatives. Discussion This implementation is one of the largest applications of a system utilizing handheld devices for performing clinical care during home visits in a resource-constrained environment. Because the data were immediately available electronically, initial reports could be performed and important trends in data could thus be detected. This allowed adjustments to the programme to be made sooner than might have otherwise been possible. Conclusion A viable, cost-effective solution at scale has been developed and implemented for collecting electronic data during household visits in a resource-constrained setting. PMID:22366295

Electronic curriculum implementation at North American dental schools.

PubMed

Hendricson, William D; Panagakos, Fotinos; Eisenberg, Elise; McDonald, James; Guest, Gary; Jones, Pamela; Johnson, Lynn; Cintron, Laura

2004-10-01

Electronic curriculum, or E-curriculum, refers to computer-based learning including educational materials available on CD or DVD, online courses, electronic mechanisms to search the literature, email, and various applications of instructional technology including providing laptops to students, multimedia projection systems, and Internet-compatible classrooms. In spite of enthusiasm about the potential for E-curriculum to enhance dental education, there is minimal guidance in the literature to assist schools with implementation. The study objectives were: 1) identify U.S. and Canadian dental schools that have initiated mandatory laptop programs and assess cost, faculty development issues, extent of curricular use, problems, and qualitative perceptions; 2) determine the extent to which twenty-two other E-curriculum resources were available and used at North American dental schools; and 3) identify factors that influenced E-curriculum implementation. A twenty-six item questionnaire, known as the Electronic Curriculum Implementation Survey (ECIS), was mailed to all sixty-six North American dental schools (ten Canadian and fifty-six U.S. schools) during 2002-03 with a response rate of 100 percent. Twenty-five of the twenty-six ECIS questions employed a menu-driven, forced choice format, but respondents could provide amplifying comments. Fifty-three questionnaires were completed by associate deans for academic affairs, three by deans, and ten by instructional technology (IT) managers, IT committee chairs, or directors of dental informatics departments. The survey found that E-curriculum implementation among North American dental schools is following the classic innovation pattern in which a few early adopting institutions proceed rapidly while the majority of potential adopters make modifications slowly. Fourteen U.S. dental schools have established mandatory laptop programs for students. Ten of these laptop programs were created in the past two years; respondents reported numerous growing pains but were generally pleased with their progress. Other E-curriculum capabilities were incorporated into courses more frequently at laptop schools than the fifty-two non-laptop schools including websites, online course evaluations, and instructor use of email to communicate with students. Few dental schools use online courses, and at most schools, few faculty have received training in online instructional techniques. Virtually all North American dental schools have provided substantial instructional technology resources to their faculty, but use of twenty-two components and capabilities of E-curriculum was limited, especially at schools without laptop programs. Various faculty-related issues were reported as implementation barriers including lack of time, skill, and incentive to develop educational software. We conclude that many North American dental schools, especially those with laptop programs, are functioning at the "learn by doing" phase of initial implementation in a four-stage innovation adoption model. E-curriculum planners should pay close attention to implementation problems that occur at this stage where many innovation efforts break down.

A detailed description of the implementation of inpatient insulin orders with a commercial electronic health record system.

PubMed

Neinstein, Aaron; MacMaster, Heidemarie Windham; Sullivan, Mary M; Rushakoff, Robert

2014-07-01

In the setting of Meaningful Use laws and professional society guidelines, hospitals are rapidly implementing electronic glycemic management order sets. There are a number of best practices established in the literature for glycemic management protocols and programs. We believe that this is the first published account of the detailed steps to be taken to design, implement, and optimize glycemic management protocols in a commercial computerized provider order entry (CPOE) system. Prior to CPOE implementation, our hospital already had a mature glycemic management program. To transition to CPOE, we underwent the following 4 steps: (1) preparation and requirements gathering, (2) design and build, (3) implementation and dissemination, and (4) optimization. These steps required more than 2 years of coordinated work between physicians, nurses, pharmacists, and programmers. With the move to CPOE, our complex glycemic management order sets were successfully implemented without any significant interruptions in care. With feedback from users, we have continued to refine the order sets, and this remains an ongoing process. Successful implementation of glycemic management protocols in CPOE is dependent on broad stakeholder input and buy-in. When using a commercial CPOE system, there may be limitations of the system, necessitating workarounds. There should be an upfront plan to apply resources for continuous process improvement and optimization after implementation. © 2014 Diabetes Technology Society.

The use of quality benchmarking in assessing web resources for the dermatology virtual branch library of the National electronic Library for Health (NeLH).

PubMed

Kamel Boulos, M N; Roudsari, A V; Gordon, C; Muir Gray, J A

2001-01-01

In 1998, the U.K. National Health Service Information for Health Strategy proposed the implementation of a National electronic Library for Health to provide clinicians, healthcare managers and planners, patients and the public with easy, round the clock access to high quality, up-to-date electronic information on health and healthcare. The Virtual Branch Libraries are among the most important components of the National electronic Library for Health. They aim at creating online knowledge based communities, each concerned with some specific clinical and other health-related topics. This study is about the envisaged Dermatology Virtual Branch Libraries of the National electronic Library for Health. It aims at selecting suitable dermatology Web resources for inclusion in the forthcoming Virtual Branch Libraries after establishing preliminary quality benchmarking rules for this task. Psoriasis, being a common dermatological condition, has been chosen as a starting point. Because quality is a principal concern of the National electronic Library for Health, the study includes a review of the major quality benchmarking systems available today for assessing health-related Web sites. The methodology of developing a quality benchmarking system has been also reviewed. Aided by metasearch Web tools, candidate resources were hand-selected in light of the reviewed benchmarking systems and specific criteria set by the authors. Over 90 professional and patient-oriented Web resources on psoriasis and dermatology in general are suggested for inclusion in the forthcoming Dermatology Virtual Branch Libraries. The idea of an all-in knowledge-hallmarking instrument for the National electronic Library for Health is also proposed based on the reviewed quality benchmarking systems. Skilled, methodical, organized human reviewing, selection and filtering based on well-defined quality appraisal criteria seems likely to be the key ingredient in the envisaged National electronic Library for Health service. Furthermore, by promoting the application of agreed quality guidelines and codes of ethics by all health information providers and not just within the National electronic Library for Health, the overall quality of the Web will improve with time and the Web will ultimately become a reliable and integral part of the care space.

Development and implementation of an electronic library tour for the NASA Langley Technical Library. M.S. Thesis, North Carolina Univ., Jul. 1994

NASA Technical Reports Server (NTRS)

Rinker, Nancy A.

1994-01-01

The role of librarians today is drastically influenced by the changing nature of information and library services. The museum-like libraries of yesterday are a thing of the past: today's libraries are bustling with life, activity, and the sounds of new technologies. Libraries are replacing their paper card catalogs with state-of-the-art online systems, which provide faster and more comprehensive search capabilities. Even the resources themselves are changing. New formats for information, such as CD-ROM's, are becoming popular for all types of publications, from bibliographic tools to encyclopedias to electronic journals, even replacing print materials completely in some cases. Today it is almost impossible to walk into a library and find the information you need without coming into contact with at least one computer system. Librarians are not only struggling to keep up with the technological advancements of the day, but they are becoming information intermediaries: they must teach library users how to use all of the new systems and electronic resources. Not surprisingly, bibliographic instruction itself has taken on a new look and feel in these electronically advanced libraries. Many libraries are experimenting with the development of expert systems and other computer aided instruction interfaces for teaching patrons how to use the library and its resources. One popular type of interface in library instruction programs is hypertext, which utilizes 'stacks' or linked pages of information. Hypertext stacks can incorporate color graphics along with text to provide a more interesting interface and entice users into trying out the system. Another advantage of hypertext is that it is generally easy to use, even for those unfamiliar with computers. As such, it lends itself well to application in libraries, which often serve a broad range of clientele. This paper will discuss the design, development, and implementation of a hypertext library tour in a special library setting. The library featured in the electronic library tour is the National Aeronautics and Space Administration's Technical Library at Langley Research Center in Hampton, Virginia.

Computerized provider order entry in the clinical laboratory

PubMed Central

Baron, Jason M.; Dighe, Anand S.

2011-01-01

Clinicians have traditionally ordered laboratory tests using paper-based orders and requisitions. However, paper orders are becoming increasingly incompatible with the complexities, challenges, and resource constraints of our modern healthcare systems and are being replaced by electronic order entry systems. Electronic systems that allow direct provider input of diagnostic testing or medication orders into a computer system are known as Computerized Provider Order Entry (CPOE) systems. Adoption of laboratory CPOE systems may offer institutions many benefits, including reduced test turnaround time, improved test utilization, and better adherence to practice guidelines. In this review, we outline the functionality of various CPOE implementations, review the reported benefits, and discuss strategies for using CPOE to improve the test ordering process. Further, we discuss barriers to the implementation of CPOE systems that have prevented their more widespread adoption. PMID:21886891

Ergonomics in the electronic library.

PubMed Central

Thibodeau, P L; Melamut, S J

1995-01-01

New technologies are changing the face of information services and how those services are delivered. Libraries spend a great deal of time planning the hardware and software implementations of electronic information services, but the human factors are often overlooked. Computers and electronic tools have changed the nature of many librarians' daily work, creating new problems, including stress, fatigue, and cumulative trauma disorders. Ergonomic issues need to be considered when designing or redesigning facilities for electronic resources and services. Libraries can prevent some of the common problems that appear in the digital workplace by paying attention to basic ergonomic issues when designing workstations and work areas. Proper monitor placement, lighting, workstation setup, and seating prevent many of the common occupational problems associated with computers. Staff training will further reduce the likelihood of ergonomic problems in the electronic workplace. PMID:7581189

Understanding Intention to Use Electronic Information Resources: A Theoretical Extension of the Technology Acceptance Model (TAM)

PubMed Central

Tao, Donghua

2008-01-01

This study extended the Technology Acceptance Model (TAM) by examining the roles of two aspects of e-resource characteristics, namely, information quality and system quality, in predicting public health students’ intention to use e-resources for completing research paper assignments. Both focus groups and a questionnaire were used to collect data. Descriptive analysis, data screening, and Structural Equation Modeling (SEM) techniques were used for data analysis. The study found that perceived usefulness played a major role in determining students’ intention to use e-resources. Perceived usefulness and perceived ease of use fully mediated the impact that information quality and system quality had on behavior intention. The research model enriches the existing technology acceptance literature by extending TAM. Representing two aspects of e-resource characteristics provides greater explanatory information for diagnosing problems of system design, development, and implementation. PMID:18999300

Understanding intention to use electronic information resources: A theoretical extension of the technology acceptance model (TAM).

PubMed

Tao, Donghua

2008-11-06

This study extended the Technology Acceptance Model (TAM) by examining the roles of two aspects of e-resource characteristics, namely, information quality and system quality, in predicting public health students' intention to use e-resources for completing research paper assignments. Both focus groups and a questionnaire were used to collect data. Descriptive analysis, data screening, and Structural Equation Modeling (SEM) techniques were used for data analysis. The study found that perceived usefulness played a major role in determining students' intention to use e-resources. Perceived usefulness and perceived ease of use fully mediated the impact that information quality and system quality had on behavior intention. The research model enriches the existing technology acceptance literature by extending TAM. Representing two aspects of e-resource characteristics provides greater explanatory information for diagnosing problems of system design, development, and implementation.

A Fast Healthcare Interoperability Resources (FHIR) layer implemented over i2b2.

PubMed

Boussadi, Abdelali; Zapletal, Eric

2017-08-14

Standards and technical specifications have been developed to define how the information contained in Electronic Health Records (EHRs) should be structured, semantically described, and communicated. Current trends rely on differentiating the representation of data instances from the definition of clinical information models. The dual model approach, which combines a reference model (RM) and a clinical information model (CIM), sets in practice this software design pattern. The most recent initiative, proposed by HL7, is called Fast Health Interoperability Resources (FHIR). The aim of our study was to investigate the feasibility of applying the FHIR standard to modeling and exposing EHR data of the Georges Pompidou European Hospital (HEGP) integrating biology and the bedside (i2b2) clinical data warehouse (CDW). We implemented a FHIR server over i2b2 to expose EHR data in relation with five FHIR resources: DiagnosisReport, MedicationOrder, Patient, Encounter, and Medication. The architecture of the server combines a Data Access Object design pattern and FHIR resource providers, implemented using the Java HAPI FHIR API. Two types of queries were tested: query type #1 requests the server to display DiagnosticReport resources, for which the diagnosis code is equal to a given ICD-10 code. A total of 80 DiagnosticReport resources, corresponding to 36 patients, were displayed. Query type #2, requests the server to display MedicationOrder, for which the FHIR Medication identification code is equal to a given code expressed in a French coding system. A total of 503 MedicationOrder resources, corresponding to 290 patients, were displayed. Results were validated by manually comparing the results of each request to the results displayed by an ad-hoc SQL query. We showed the feasibility of implementing a Java layer over the i2b2 database model to expose data of the CDW as a set of FHIR resources. An important part of this work was the structural and semantic mapping between the i2b2 model and the FHIR RM. To accomplish this, developers must manually browse the specifications of the FHIR standard. Our source code is freely available and can be adapted for use in other i2b2 sites.

Safe and successful implementation of CPOE for chemotherapy at a children's cancer center.

PubMed

Hoffman, James M; Baker, Donald K; Howard, Scott C; Laver, Joseph H; Shenep, Jerry L

2011-02-01

Computerized prescriber order entry (CPOE) for medications has been implemented in only approximately 1 in 6 United States hospitals, with CPOE for chemotherapy lagging behind that for nonchemotherapy medications. The high risks associated with chemotherapy combined with other aspects of cancer care present unique challenges for the safe and appropriate use of CPOE. This article describes the process for safe and successful implementation of CPOE for chemotherapy at a children's cancer center. A core principle throughout the development and implementation of this system was that it must be as safe (and eventually safer) as existing paper systems and processes. The history of requiring standardized, regimen-specific, preprinted paper order forms served as the foundation for safe implementation of CPOE for chemotherapy. Extensive use of electronic order sets with advanced functionality; formal process redesign and system analysis; automated clinical decision support; and a phased implementation approach were essential strategies for safe implementation of CPOE. With careful planning and adequate resources, CPOE for chemotherapy can be safely implemented.

Developing a point-of-care electronic medical record system for TB/HIV co-infected patients: experiences from Lighthouse Trust, Lilongwe, Malawi.

PubMed

Tweya, Hannock; Feldacker, Caryl; Gadabu, Oliver Jintha; Ng'ambi, Wingston; Mumba, Soyapi L; Phiri, Dave; Kamvazina, Luke; Mwakilama, Shawo; Kanyerere, Henry; Keiser, Olivia; Mwafilaso, Johnbosco; Kamba, Chancy; Egger, Matthias; Jahn, Andreas; Simwaka, Bertha; Phiri, Sam

2016-03-05

Implementation of user-friendly, real-time, electronic medical records for patient management may lead to improved adherence to clinical guidelines and improved quality of patient care. We detail the systematic, iterative process that implementation partners, Lighthouse clinic and Baobab Health Trust, employed to develop and implement a point-of-care electronic medical records system in an integrated, public clinic in Malawi that serves HIV-infected and tuberculosis (TB) patients. Baobab Health Trust, the system developers, conducted a series of technical and clinical meetings with Lighthouse and Ministry of Health to determine specifications. Multiple pre-testing sessions assessed patient flow, question clarity, information sequencing, and verified compliance to national guidelines. Final components of the TB/HIV electronic medical records system include: patient demographics; anthropometric measurements; laboratory samples and results; HIV testing; WHO clinical staging; TB diagnosis; family planning; clinical review; and drug dispensing. Our experience suggests that an electronic medical records system can improve patient management, enhance integration of TB/HIV services, and improve provider decision-making. However, despite sufficient funding and motivation, several challenges delayed system launch including: expansion of system components to include of HIV testing and counseling services; changes in the national antiretroviral treatment guidelines that required system revision; and low confidence to use the system among new healthcare workers. To ensure a more robust and agile system that met all stakeholder and user needs, our electronic medical records launch was delayed more than a year. Open communication with stakeholders, careful consideration of ongoing provider input, and a well-functioning, backup, paper-based TB registry helped ensure successful implementation and sustainability of the system. Additional, on-site, technical support provided reassurance and swift problem-solving during the extended launch period. Even when system users are closely involved in the design and development of an electronic medical record system, it is critical to allow sufficient time for software development, solicitation of detailed feedback from both users and stakeholders, and iterative system revisions to successfully transition from paper to point-of-care electronic medical records. For those in low-resource settings, electronic medical records for integrated care is a possible and positive innovation.

Predictors of Success for Electronic Health Record Implementation in Small Physician Practices

PubMed Central

Ancker, J.S.; Singh, M.P.; Thomas, R.; Edwards, A.; Snyder, A.; Kashyap, A.; Kaushal, R.

2013-01-01

Background The federal government is promoting adoption of electronic health records (EHRs) through financial incentives for EHR use and implementation support provided by regional extension centers. Small practices have been slow to adopt EHRs. Objectives Our objective was to measure time to EHR implementation and identify factors associated with successful implementation in small practices receiving financial incentives and implementation support. This study is unique in exploiting quantitative implementation time data collected prospectively as part of routine project management. Methods This mixed-methods study includes interviews of key informants and a cohort study of 544 practices that had worked with the Primary Care Information Project (PCIP), a publicly funded organization that since 2007 has subsidized EHRs and provided implementation support similar to that supplied by the new regional extension centers. Data from a project management database were used for a cohort study to assess time to implementation and predictors of implementation success. Results Four hundred and thirty practices (79%) implemented EHRs within the analysis period, with a median project time of 24.7 weeks (95% CI: 23.3 – 26.4). Factors associated with implementation success were: fewer providers, practice sites, and patients; fewer Medicaid and uninsured patients; having previous experience with scheduling software; enrolling in 2010 rather than earlier; and selecting an integrated EHR plus practice management product rather than two products. Interviews identified positive attitude toward EHRs, resources, and centralized leadership as additional practice-level predictors of success. Conclusions A local initiative similar to current federal programs successfully implemented EHRs in primary care practices by offsetting software costs and providing implementation assistance. Nevertheless, implementation success was affected by practice size and other characteristics, suggesting that the federal programs can reduce barriers to EHR implementation but may not eliminate them. PMID:23650484

Optimization of infobutton design and Implementation: A systematic review.

PubMed

Teixeira, Miguel; Cook, David A; Heale, Bret S E; Del Fiol, Guilherme

2017-10-01

Infobuttons are clinical decision tools embedded in the electronic health record that attempt to link clinical data with context sensitive knowledge resources. We systematically reviewed technical approaches that contribute to improved infobutton design, implementation and functionality. We searched databases including MEDLINE, EMBASE, and the Cochrane Library database from inception to March 1, 2016 for studies describing the use of infobuttons. We selected full review comparative studies, usability studies, and qualitative studies examining infobutton design and implementation. We abstracted usability measures such as user satisfaction, impact, and efficiency, as well as prediction accuracy of infobutton content retrieval algorithms and infobutton adoption/interoperability. We found 82 original research studies on infobuttons. Twelve studies met criteria for detailed abstraction. These studies investigated infobutton interoperability (1 study); tools to help tailor infobutton functionality (1 study); interventions to improve user experience (7 studies); and interventions to improve content retrieval by improving prediction of relevant knowledge resources and information needs (3 studies). In-depth interviews with implementers showed the Health Level Seven (HL7) Infobutton standard to be simple and easy to implement. A usability study demonstrated the feasibility of a tool to help medical librarians tailor infobutton functionality. User experience studies showed that access to resources with which users are familiar increased user satisfaction ratings; and that links to specific subsections of drug monographs increased information seeking efficiency. However, none of the user experience improvements led to increased usage uptake. Recommender systems based on machine learning algorithms outperformed hand-crafted rules in the prediction of relevant resources and clinicians' information needs in a laboratory setting, but no studies were found using these techniques in clinical settings. Improved content indexing in one study led to improved content retrieval across three health care organizations. Best practice technical approaches to ensure optimal infobutton functionality, design and implementation remain understudied. The HL7 Infobutton standard has supported wide adoption of infobutton functionality among clinical information systems and knowledge resources. Limited evidence supports infobutton enhancements such as links to specific subtopics, configuration of optimal resources for specific tasks and users, and improved indexing and content coverage. Further research is needed to investigate user experience improvements to increase infobutton use and effectiveness. Copyright © 2017 Elsevier Inc. All rights reserved.

Free and Innovative Teaching Resources for STEM Educators

NASA Astrophysics Data System (ADS)

Weber, W. J.; McWhirter, J.; Dirks, D.

2014-12-01

The Unidata Program Center has implemented a teaching resource facility that allows educators to create, access, and share collections of resource material related to atmospheric, oceanic, and other earth system phenomena. While the facility can manage almost any type of electronic resource, it is designed with scientific data and products, teaching tools such as lesson plans and guided exercises, and tools for displaying data in mind. In addition to being very easy for educators and students to access, the facility makes it simple for other educators and scientists to contribute content related to their own areas of expertise to the collection. This allows existing teaching resources to grow in depth and breadth over time, enhancing their relevance and providing insights from multiple disciplines. Based on the open-source RAMADDA content/data management framework, the teaching resource facility provides a variety of built-in services to analyze and display data, as well as support for Unidata's rich 3D client, the Interactive Data Viewer (IDV).

The characterization and application of a low resource FPGA-based time to digital converter

NASA Astrophysics Data System (ADS)

Balla, Alessandro; Mario Beretta, Matteo; Ciambrone, Paolo; Gatta, Maurizio; Gonnella, Francesco; Iafolla, Lorenzo; Mascolo, Matteo; Messi, Roberto; Moricciani, Dario; Riondino, Domenico

2014-03-01

Time to Digital Converters (TDCs) are very common devices in particles physics experiments. A lot of "off-the-shelf" TDCs can be employed but the necessity of a custom DAta acQuisition (DAQ) system makes the TDCs implemented on the Field-Programmable Gate Arrays (FPGAs) desirable. Most of the architectures developed so far are based on the tapped delay lines with precision down to 10 ps, obtained with high FPGA resources usage and non-linearity issues to be managed. Often such precision is not necessary; in this case TDC architectures with low resources occupancy are preferable allowing the implementation of data processing systems and of other utilities on the same device. In order to reconstruct γγ physics events tagged with High Energy Tagger (HET) in the KLOE-2 (K LOng Experiment 2), we need to measure the Time Of Flight (TOF) of the electrons and positrons from the KLOE-2 Interaction Point (IP) to our tagging stations (11 m apart). The required resolution must be better than the bunch spacing (2.7 ns). We have developed and implemented on a Xilinx Virtex-5 FPGA a 32 channel TDC with a precision of 255 ps and low non-linearity effects along with an embedded data acquisition system and the interface to the online FARM of KLOE-2. The TDC is based on a low resources occupancy technique: the 4×Oversampling technique which, in this work, is pushed to its best resolution and its performances were exhaustively measured.

Primary Care Physicians' Experience with Electronic Medical Records: Barriers to Implementation in a Fee-for-Service Environment

PubMed Central

Ludwick, D. A.; Doucette, John

2009-01-01

Our aging population has exacerbated strong and divergent trends between health human resource supply and demand. One way to mitigate future inequities is through the adoption of health information technology (HIT). Our previous research showed a number of risks and mitigating factors which affected HIT implementation success. We confirmed these findings through semistructured interviews with nine Alberta clinics. Sociotechnical factors significantly affected physicians' implementation success. Physicians reported that the time constraints limited their willingness to investigate, procure, and implement an EMR. The combination of antiquated exam room design, complex HIT user interfaces, insufficient physician computer skills, and the urgency in patient encounters precipitated by a fee-for-service remuneration model and long waitlists compromised the quantity, if not the quality, of the information exchange. Alternative remuneration and access to services plans might be considered to drive prudent behavior during physician office system implementation. PMID:19081787

Expansion of electronic health record-based screening, prevention, and management of diabetes in New York City.

PubMed

Albu, Jeanine; Sohler, Nancy; Matti-Orozco, Brenda; Sill, Jordan; Baxter, Daniel; Burke, Gary; Young, Edwin

2013-01-01

To address the increasing burden of diabetes in New York City, we designed 2 electronic health records (EHRs)-facilitated diabetes management systems to be implemented in 6 primary care practices on the West Side of Manhattan, a standard system and an enhanced system. The standard system includes screening for diabetes. The enhanced system includes screening and ensures close patient follow-up; it applies principles of the chronic care model, including community-clinic linkages, to the management of patients newly diagnosed with diabetes and prediabetes through screening. We will stagger implementation of the enhanced system across the 6 clinics allowing comparison, through a quasi-experimental design (pre-post difference with a control group), of patients treated in the enhanced system with similar patients treated in the standard system. The findings could inform health system practices at multiple levels and influence the integration of community resources into routine diabetes care.

Continuous wave superconducting radio frequency electron linac for nuclear physics research

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

Reece, Charles E.

CEBAF, the Continuous Electron Beam Accelerator Facility, has been actively serving the nuclear physics research community as a unique forefront international resource since 1995. This cw electron linear accelerator (linac) at the U.S. Department of Energy’s Thomas Jefferson National Accelerator Facility (Jefferson Lab) has continued to evolve as a precision tool for discerning the structure and dynamics within nuclei. Superconducting rf (SRF) technology has been the essential foundation for CEBAF, first as a 4 GeV machine, then 6 GeV, and currently capable of 12 GeV. Lastly, we review the development, implementation, and performance of SRF systems for CEBAF from itsmore » early beginnings to the commissioning of the 12 GeV era.« less

Continuous wave superconducting radio frequency electron linac for nuclear physics research

DOE PAGES

Reece, Charles E.

2016-12-28

CEBAF, the Continuous Electron Beam Accelerator Facility, has been actively serving the nuclear physics research community as a unique forefront international resource since 1995. This cw electron linear accelerator (linac) at the U.S. Department of Energy’s Thomas Jefferson National Accelerator Facility (Jefferson Lab) has continued to evolve as a precision tool for discerning the structure and dynamics within nuclei. Superconducting rf (SRF) technology has been the essential foundation for CEBAF, first as a 4 GeV machine, then 6 GeV, and currently capable of 12 GeV. Lastly, we review the development, implementation, and performance of SRF systems for CEBAF from itsmore » early beginnings to the commissioning of the 12 GeV era.« less

Implementing an Open Source Electronic Health Record System in Kenyan Health Care Facilities: Case Study

PubMed Central

Magare, Steve; Monda, Jonathan; Kamau, Onesmus; Houston, Stuart; Fraser, Hamish; Powell, John; English, Mike; Paton, Chris

2018-01-01

Background The Kenyan government, working with international partners and local organizations, has developed an eHealth strategy, specified standards, and guidelines for electronic health record adoption in public hospitals and implemented two major health information technology projects: District Health Information Software Version 2, for collating national health care indicators and a rollout of the KenyaEMR and International Quality Care Health Management Information Systems, for managing 600 HIV clinics across the country. Following these projects, a modified version of the Open Medical Record System electronic health record was specified and developed to fulfill the clinical and administrative requirements of health care facilities operated by devolved counties in Kenya and to automate the process of collating health care indicators and entering them into the District Health Information Software Version 2 system. Objective We aimed to present a descriptive case study of the implementation of an open source electronic health record system in public health care facilities in Kenya. Methods We conducted a landscape review of existing literature concerning eHealth policies and electronic health record development in Kenya. Following initial discussions with the Ministry of Health, the World Health Organization, and implementing partners, we conducted a series of visits to implementing sites to conduct semistructured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation. Results This case study describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital information technology infrastructure, training users, and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was ultimately scaled back due to a complex mix of sociotechnical and administrative issues. Learning from these early challenges, the system is now being redesigned and prepared for deployment in 6 new counties across Kenya. Conclusions Implementing electronic health record systems is a challenging process in high-income settings. In low-income settings, such as Kenya, open source software may offer some respite from the high costs of software licensing, but the familiar challenges of clinical and administration buy-in, the need to adequately train users, and the need for the provision of ongoing technical support are common across the North-South divide. Strategies such as creating local support teams, using local development resources, ensuring end user buy-in, and rolling out in smaller facilities before larger hospitals are being incorporated into the project. These are positive developments to help maintain momentum as the project continues. Further integration with existing open source communities could help ongoing development and implementations of the project. We hope this case study will provide some lessons and guidance for other challenging implementations of electronic health record systems as they continue across Africa. PMID:29669709

Review and Implementation Status of Prior Defense Business Board Recommendations

DTIC Science & Technology

2007-04-01

Resource Management • Support unified models for shared services , and be prepared to adjust forward approaches for a Unified Medical Command...models for shared services – including by and between Veterans Affairs and Defense, electronic information exchange, disease treatment and prevention...www.dod.mil/dbb/pdf/DBB- Report-on-the-Military.pdf. • Continue to support unified models for shared services – including by and between Veterans Affairs

An in fiber experimental approach to photonic quantum digital signatures that does not require quantum memory

NASA Astrophysics Data System (ADS)

Collins, Robert J.; Donaldon, Ross J.; Dunjko, Vedran; Wallden, Petros; Clarke, Patrick J.; Andersson, Erika; Jeffers, John; Buller, Gerald S.

2014-10-01

Classical digital signatures are commonly used in e-mail, electronic financial transactions and other forms of electronic communications to ensure that messages have not been tampered with in transit, and that messages are transferrable. The security of commonly used classical digital signature schemes relies on the computational difficulty of inverting certain mathematical functions. However, at present, there are no such one-way functions which have been proven to be hard to invert. With enough computational resources certain implementations of classical public key cryptosystems can be, and have been, broken with current technology. It is nevertheless possible to construct information-theoretically secure signature schemes, including quantum digital signature schemes. Quantum signature schemes can be made information theoretically secure based on the laws of quantum mechanics, while classical comparable protocols require additional resources such as secret communication and a trusted authority. Early demonstrations of quantum digital signatures required quantum memory, rendering them impractical at present. Our present implementation is based on a protocol that does not require quantum memory. It also uses the new technique of unambiguous quantum state elimination, Here we report experimental results for a test-bed system, recorded with a variety of different operating parameters, along with a discussion of aspects of the system security.

Embedding care management in the medical home: a case study.

PubMed

Daaleman, Timothy P; Hay, Sherry; Prentice, Amy; Gwynne, Mark D

2014-04-01

Care managers are playing increasingly significant roles in the redesign of primary care and in the evolution of patient-centered medical homes (PCMHs), yet their adoption within day-to-day practice remains uneven and approaches for implementation have been minimally reported. We introduce a strategy for incorporating care management into the operations of a PCMH and assess the preliminary effectiveness of this approach. A case study of the University of North Carolina at Chapel Hill Family Medicine Center used an organizational model of innovation implementation to guide the parameters of implementation and evaluation. Two sources were used to determine the effectiveness of the implementation strategy: data elements from the care management informatics system in the health record and electronic survey data from the Family Medicine Center providers and care staff. A majority of physicians (75%) and support staff (82%) reported interactions with the care manager, primarily via face-to-face, telephone, or electronic means, primarily for facilitating referrals for behavioral health services and assistance with financial and social and community-based resources. Trend line suggests an absolute decrease of 8 emergency department visits per month for recipients of care management services and an absolute decrease of 7.5 inpatient admissions per month during the initial 2-year implementation period. An organizational model of innovation implementation is a potentially effective approach to guide the process of incorporating care management services into the structure and workflows of PCMHs.

Stakeholder perspectives on implementing a universal Lynch syndrome screening program: a qualitative study of early barriers and facilitators.

PubMed

Schneider, Jennifer L; Davis, James; Kauffman, Tia L; Reiss, Jacob A; McGinley, Cheryl; Arnold, Kathleen; Zepp, Jamilyn; Gilmore, Marian; Muessig, Kristin R; Syngal, Sapna; Acheson, Louise; Wiesner, Georgia L; Peterson, Susan K; Goddard, Katrina A B

2016-02-01

Evidence-based guidelines recommend that all newly diagnosed colon cancer be screened for Lynch syndrome (LS), but best practices for implementing universal tumor screening have not been extensively studied. We interviewed a range of stakeholders in an integrated health-care system to identify initial factors that might promote or hinder the successful implementation of a universal LS screening program. We conducted interviews with health-plan leaders, managers, and staff. Interviews were audio-recorded and transcribed. Thematic analysis began with a grounded approach and was also guided by the Practical Robust Implementation and Sustainability Model (PRISM). We completed 14 interviews with leaders/managers and staff representing involved clinical and health-plan departments. Although stakeholders supported the concept of universal screening, they identified several internal (organizational) and external (environment) factors that promote or hinder implementation. Facilitating factors included perceived benefits of screening for patients and organization, collaboration between departments, and availability of organizational resources. Barriers were also identified, including: lack of awareness of guidelines, lack of guideline clarity, staffing and program "ownership" concerns, and cost uncertainties. Analysis also revealed nine important infrastructure-type considerations for successful implementation. We found that clinical, laboratory, and administrative departments supported universal tumor screening for LS. Requirements for successful implementation may include interdepartmental collaboration and communication, patient and provider/staff education, and significant infrastructure and resource support related to laboratory processing and systems for electronic ordering and tracking.

Implementation of a cloud-based electronic medical record for maternal and child health in rural Kenya.

PubMed

Haskew, John; Rø, Gunnar; Saito, Kaori; Turner, Kenrick; Odhiambo, George; Wamae, Annah; Sharif, Shahnaaz; Sugishita, Tomohiko

2015-05-01

Complete and timely health information is essential to inform public health decision-making for maternal and child health, but is often lacking in resource-constrained settings. Electronic medical record (EMR) systems are increasingly being adopted to support the delivery of health care, and are particularly amenable to maternal and child health services. An EMR system could enable the mother and child to be tracked and monitored throughout maternity shared care, improve quality and completeness of data collected and enhance sharing of health information between outpatient clinic and the hospital, and between clinical and public health services to inform decision-making. This study implemented a novel cloud-based electronic medical record system in a maternal and child health outpatient setting in Western Kenya between April and June 2013 and evaluated its impact on improving completeness of data collected by clinical and public health services. The impact of the system was assessed using a two-sample test of proportions pre- and post-implementation of EMR-based data verification. Significant improvements in completeness of the antenatal record were recorded through implementation of EMR-based data verification. A difference of 42.9% in missing data (including screening for hypertension, tuberculosis, malaria, HIV status or ART status of HIV positive women) was recorded pre- and post-implementation. Despite significant impact of EMR-based data verification on data completeness, overall screening rates in antenatal care were low. This study has shown that EMR-based data verification can improve the completeness of data collected in the patient record for maternal and child health. A number of issues, including data management and patient confidentiality, must be considered but significant improvements in data quality are recorded through implementation of this EMR model. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

The feasibility of paper-based Tracking Codes and electronic medical record systems to monitor tobacco-use assessment and intervention in an Individual Practice Association (IPA) Model health maintenance organization (HMO).

PubMed

Bentz, Charles J; Davis, Nancy; Bayley, Bruce

2002-01-01

Despite evidence of its effectiveness, tobacco cessation is not systematically addressed in routine healthcare settings. Its measurement is part of the problem. A pilot study was designed to develop and implement two different tobacco tracking systems in two independent primary care offices that participated in an IPA Model health maintenance organization in Portland, Oregon. The first clinic, which utilized a paper-based charting system, implemented CPT-like tracking codes to measure and report tobacco-cessation activities, which were eventually included in the managed-care organization's (MCO) claims database. The second clinic implemented an electronic tracking system based on its computerized electronic medical record (EMR) charting system. This paper describes the pilot study, including the processes involved in building provider acceptance for the new tracking systems in these two clinics, the barriers and successes encountered during implementation, and the resources expended by the clinics and by the MCO during the pilot. The findings from the 3-month implementation period were that documentation of tobacco-use status remained stable at 42-45% in the paper-based clinic and increased from 79% to 88% in the EMR clinic. This pilot study demonstrated that Tracking Codes are a feasible preventive-care tracking system in paper-based medical offices. However, high levels of effort and support are needed, and a critical mass of insurers and health plans would need to adopt Tracking Codes before widespread use could be expected. Results of the EMR-based tracking system are also reviewed and discussed.

The Use of Quality Benchmarking in Assessing Web Resources for the Dermatology Virtual Branch Library of the National electronic Library for Health (NeLH)

PubMed Central

Roudsari, AV; Gordon, C; Gray, JA Muir

2001-01-01

Background In 1998, the U.K. National Health Service Information for Health Strategy proposed the implementation of a National electronic Library for Health to provide clinicians, healthcare managers and planners, patients and the public with easy, round the clock access to high quality, up-to-date electronic information on health and healthcare. The Virtual Branch Libraries are among the most important components of the National electronic Library for Health . They aim at creating online knowledge based communities, each concerned with some specific clinical and other health-related topics. Objectives This study is about the envisaged Dermatology Virtual Branch Libraries of the National electronic Library for Health . It aims at selecting suitable dermatology Web resources for inclusion in the forthcoming Virtual Branch Libraries after establishing preliminary quality benchmarking rules for this task. Psoriasis, being a common dermatological condition, has been chosen as a starting point. Methods Because quality is a principal concern of the National electronic Library for Health, the study includes a review of the major quality benchmarking systems available today for assessing health-related Web sites. The methodology of developing a quality benchmarking system has been also reviewed. Aided by metasearch Web tools, candidate resources were hand-selected in light of the reviewed benchmarking systems and specific criteria set by the authors. Results Over 90 professional and patient-oriented Web resources on psoriasis and dermatology in general are suggested for inclusion in the forthcoming Dermatology Virtual Branch Libraries. The idea of an all-in knowledge-hallmarking instrument for the National electronic Library for Health is also proposed based on the reviewed quality benchmarking systems. Conclusions Skilled, methodical, organized human reviewing, selection and filtering based on well-defined quality appraisal criteria seems likely to be the key ingredient in the envisaged National electronic Library for Health service. Furthermore, by promoting the application of agreed quality guidelines and codes of ethics by all health information providers and not just within the National electronic Library for Health, the overall quality of the Web will improve with time and the Web will ultimately become a reliable and integral part of the care space. PMID:11720947

Barriers and facilitators to implementing electronic prescription: a systematic review of user groups' perceptions.

PubMed

Gagnon, Marie-Pierre; Nsangou, Édith-Romy; Payne-Gagnon, Julie; Grenier, Sonya; Sicotte, Claude

2014-01-01

We conducted a systematic review identifying users groups' perceptions of barriers and facilitators to implementing electronic prescription (e-prescribing) in primary care. We included studies following these criteria: presence of an empirical design, focus on the users' experience of e-prescribing implementation, conducted in primary care, and providing data on barriers and facilitators to e-prescribing implementation. We used the Donabedian logical model of healthcare quality (adapted by Barber et al) to analyze our findings. We found 34 publications (related to 28 individual studies) eligible to be included in this review. These studies identified a total of 594 elements as barriers or facilitators to e-prescribing implementation. Most user groups perceived that e-prescribing was facilitated by design and technical concerns, interoperability, content appropriate for the users, attitude towards e-prescribing, productivity, and available resources. This review highlights the importance of technical and organizational support for the successful implementation of e-prescribing systems. It also shows that the same factor can be seen as a barrier or a facilitator depending on the project's own circumstances. Moreover, a factor can change in nature, from a barrier to a facilitator and vice versa, in the process of e-prescribing implementation. This review summarizes current knowledge on factors related to e-prescribing implementation in primary care that could support decision makers in their design of effective implementation strategies. Finally, future studies should emphasize on the perceptions of other user groups, such as pharmacists, managers, vendors, and patients, who remain neglected in the literature.

Open-source point-of-care electronic medical records for use in resource-limited settings: systematic review and questionnaire surveys

PubMed Central

Bru, Juan; Berger, Christopher A

2012-01-01

Background Point-of-care electronic medical records (EMRs) are a key tool to manage chronic illness. Several EMRs have been developed for use in treating HIV and tuberculosis, but their applicability to primary care, technical requirements and clinical functionalities are largely unknown. Objectives This study aimed to address the needs of clinicians from resource-limited settings without reliable internet access who are considering adopting an open-source EMR. Study eligibility criteria Open-source point-of-care EMRs suitable for use in areas without reliable internet access. Study appraisal and synthesis methods The authors conducted a comprehensive search of all open-source EMRs suitable for sites without reliable internet access. The authors surveyed clinician users and technical implementers from a single site and technical developers of each software product. The authors evaluated availability, cost and technical requirements. Results The hardware and software for all six systems is easily available, but they vary considerably in proprietary components, installation requirements and customisability. Limitations This study relied solely on self-report from informants who developed and who actively use the included products. Conclusions and implications of key findings Clinical functionalities vary greatly among the systems, and none of the systems yet meet minimum requirements for effective implementation in a primary care resource-limited setting. The safe prescribing of medications is a particular concern with current tools. The dearth of fully functional EMR systems indicates a need for a greater emphasis by global funding agencies to move beyond disease-specific EMR systems and develop a universal open-source health informatics platform. PMID:22763661

Database resources of the National Center for Biotechnology Information: 2002 update

PubMed Central

Wheeler, David L.; Church, Deanna M.; Lash, Alex E.; Leipe, Detlef D.; Madden, Thomas L.; Pontius, Joan U.; Schuler, Gregory D.; Schriml, Lynn M.; Tatusova, Tatiana A.; Wagner, Lukas; Rapp, Barbara A.

2002-01-01

In addition to maintaining the GenBank nucleic acid sequence database, the National Center for Biotechnology Information (NCBI) provides data analysis and retrieval resources that operate on the data in GenBank and a variety of other biological data made available through NCBI’s web site. NCBI data retrieval resources include Entrez, PubMed, LocusLink and the Taxonomy Browser. Data analysis resources include BLAST, Electronic PCR, OrfFinder, RefSeq, UniGene, HomoloGene, Database of Single Nucleotide Polymorphisms (dbSNP), Human Genome Sequencing, Human MapViewer, Human¡VMouse Homology Map, Cancer Chromosome Aberration Project (CCAP), Entrez Genomes, Clusters of Orthologous Groups (COGs) database, Retroviral Genotyping Tools, SAGEmap, Gene Expression Omnibus (GEO), Online Mendelian Inheritance in Man (OMIM), the Molecular Modeling Database (MMDB) and the Conserved Domain Database (CDD). Augmenting many of the web applications are custom implementations of the BLAST program optimized to search specialized data sets. All of the resources can be accessed through the NCBI home page at http://www.ncbi.nlm.nih.gov. PMID:11752242

Retrospective return on investment analysis of an electronic treatment adherence device piloted in the Northern Cape Province.

PubMed

Broomhead, Sean; Mars, Maurice

2012-01-01

The return on investment (ROI) for utilizing the SIMpill electronic treatment adherence solution as an adjunct to directly observed treatment short-course (DOTS) is assessed using data from a 2005 pilot of the SIMpill solution among new smear-positive tuberculosis (TB) patients in the Northern Cape Province. The value of this cost minimization analysis (CMA), for use by public health planners in low-resource settings as a precursor to more rigorous assessment, is discussed. The retrospective analysis compares the costs and health outcomes of the DOTS-SIMpill cohort with DOTS-only controls. Hypothetical 5-year cash flows are generated and discounted to estimate net present values (NPVs). Comparison between the DOTS-SIMpill pilot cohort and DOTS-only supported controls, for a hypothetical implementation of 1,000 devices, over 5 years, demonstrates positive ROI for the DOTS-SIMpill cohort based on improved health outcomes and reduced average cost per patient. The net stream is shown to be positive from the first year. Discounted NPV is ZAR 3,255,256 (US$ 493,221) for a cohort that would have started mid 2005 and ZAR 3,747,636 (US$ 487,339) starting mid 2010. This is an ROI of 23% over the 5-year period. The addition of electronic treatment adherence support technology can help to improve TB outcomes and lower average cost per patient by reducing treatment failure and the associated higher cost and burden on limited resources. CMA is an appropriate initial analysis for health planners to highlight options that may justify more sophisticated methods such as cost effectiveness analysis or full cost benefit analysis where a preferred option is immediately revealed. CMA is proposed as a tool for use by public health planners in low-resource settings to evaluate the ROI of treatment adherence technology postpilot and prior to implementation.

The role of organizational context and individual nurse characteristics in explaining variation in use of information technologies in evidence based practice

PubMed Central

2012-01-01

Background There is growing awareness of the role of information technology in evidence-based practice. The purpose of this study was to investigate the role of organizational context and nurse characteristics in explaining variation in nurses’ use of personal digital assistants (PDAs) and mobile Tablet PCs for accessing evidence-based information. The Promoting Action on Research Implementation in Health Services (PARIHS) model provided the framework for studying the impact of providing nurses with PDA-supported, evidence-based practice resources, and for studying the organizational, technological, and human resource variables that impact nurses’ use patterns. Methods A survey design was used, involving baseline and follow-up questionnaires. The setting included 24 organizations representing three sectors: hospitals, long-term care (LTC) facilities, and community organizations (home care and public health). The sample consisted of 710 participants (response rate 58%) at Time 1, and 469 for whom both Time 1 and Time 2 follow-up data were obtained (response rate 66%). A hierarchical regression model (HLM) was used to evaluate the effect of predictors from all levels simultaneously. Results The Chi square result indicated PDA users reported using their device more frequently than Tablet PC users (p = 0.001). Frequency of device use was explained by ‘breadth of device functions’ and PDA versus Tablet PC. Frequency of Best Practice Guideline use was explained by ‘willingness to implement research,’ ‘structural and electronic resources,’ ‘organizational slack time,’ ‘breadth of device functions’ (positive effects), and ‘slack staff’ (negative effect). Frequency of Nursing Plus database use was explained by ‘culture,’ ‘structural and electronic resources,’ and ‘breadth of device functions’ (positive effects), and ‘slack staff’ (negative). ‘Organizational culture’ (positive), ‘breadth of device functions’ (positive), and ‘slack staff ‘(negative) were associated with frequency of Lexi/PEPID drug dictionary use. Conclusion Access to PDAs and Tablet PCs supported nurses’ self-reported use of information resources. Several of the organizational context variables and one individual nurse variable explained variation in the frequency of information resource use. PMID:23276201

Barriers and facilitators to Electronic Medical Record (EMR) use in an urban slum.

PubMed

Jawhari, Badeia; Keenan, Louanne; Zakus, David; Ludwick, Dave; Isaac, Abraam; Saleh, Abdullah; Hayward, Robert

2016-10-01

Rapid urbanization has led to the growth of urban slums and increased healthcare burdens for vulnerable populations. Electronic Medical Records (EMRs) have the potential to improve continuity of care for slum residents, but their implementation is complicated by technical and non-technical limitations. This study sought practical insights about facilitators and barriers to EMR implementation in urban slum environments. Descriptive qualitative method was used to explore staff perceptions about a recent open-source EMR deployment in two primary care clinics in Kibera, Nairobi. Participants were interviewed using open-ended, semi-structured questions. Content analysis was used when exploring transcribed data. Three major themes - systems, software, and social considerations - emerged from content analysis, with sustainability concerns prevailing. Although participants reported many systems (e.g., power, network, Internet, hardware, interoperability) and software (e.g., data integrity, confidentiality, function) challenges, social factors (e.g., identity management, training, use incentives) appeared the most important impediments to sustainability. These findings are consistent with what others have reported, especially the importance of practical barriers to EMR deployments in resource-constrained settings. Other findings contribute unique insights about social determinants of EMR impact in slum settings, including the challenge of multiple-identity management and development of meaningful incentives to staff compliance. This study exposes front-line experiences with opportunities and shortcomings of EMR implementations in urban slum primary care clinics. Although the promise is great, there are a number of unique system, software and social challenges that EMR advocates should address before expecting sustainable EMR use in resource-constrained settings. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Pump-dump iterative squeezing of vibrational wave packets.

PubMed

Chang, Bo Y; Sola, Ignacio R

2005-12-22

The free motion of a nonstationary vibrational wave packet in an electronic potential is a source of interesting quantum properties. In this work we propose an iterative scheme that allows continuous stretching and squeezing of a wave packet in the ground or in an excited electronic state, by switching the wave function between both potentials with pi pulses at certain times. Using a simple model of displaced harmonic oscillators and delta pulses, we derive the analytical solution and the conditions for its possible implementation and optimization in different molecules and electronic states. We show that the main constraining parameter is the pulse bandwidth. Although in principle the degree of squeezing (or stretching) is not bounded, the physical resources increase quadratically with the number of iterations, while the achieved squeezing only increases linearly.

Biomedical information @ the speed of light: implementing desktop access to publishers' resources at the Paterson Institute for Cancer Research.

PubMed

Glover, S W

2001-06-01

Shortly after midnight every Thursday morning, a list server in Massachusetts delivers an electronic table of contents message to the Kostoris Medical Library at the Paterson Institute for Cancer Research in Manchester, UK. The messageins details of the latest edition of the New England Journal of Medicine, complete with hyperlinks to the full text of the content online. Publishers' electronic current awareness services have been integrated into the dissemination process of the Library service to enhance the speed of communication and access to full text content. As a means of promoting electronic journal use, a system of e-mail delivery coupled with fast Internet access has allowed a migration from paper-based current awareness alerting to a seamless online product.

Sustaining “Meaningful Use” of Health Information Technology in Low-Resource Practices

PubMed Central

Green, Lee A.; Potworowski, Georges; Day, Anya; May-Gentile, Rachelle; Vibbert, Danielle; Maki, Bruce; Kiesel, Leslie

2015-01-01

PURPOSE The implementation of electronic health records (EHRs) has been extensively studied, but their maintenance once implemented has not. The Regional Extension Center (REC) program provides implementation assistance to priority practices—those with limited financial, technical, and organizational resources—but the assistance is time limited. Our objective was to identify potential barriers to maintenance of meaningful use of EHRs in priority primary care practices using a qualitative observational study for federally qualified health centers (FQHCs) and priority practices in Michigan. METHODS We conducted cognitive task analysis (CTA) interviews and direct observations of health information technology implementation in FQHCs. In addition, we conducted semistructured interviews with implementation specialists serving priority practices to detect emergent themes relevant to maintenance. RESULTS Maintaining EHR technology will require ongoing expert technical support indefinitely beyond implementation to address upgrades and security needs. Maintaining meaningful use for quality improvement will require ongoing support for leadership and change management. Priority practices not associated with larger systems lack access to the necessary technical expertise, financial resources, and leverage with vendors to continue alone. Rural priority practices are particularly challenged, because expertise is often not available locally. CONCLUSIONS Priority practices, especially in rural areas, are at high risk for falling on the wrong side of a “digital divide” as payers and regulators enact increasing expectations for EHR use and information management. For those without affiliation to maintain the necessary expert staff, ongoing support will be needed for those practices to remain viable. PMID:25583887

Methods and implementation of a central biosample and data management in a three-centre clinical study.

PubMed

Angelow, Aniela; Schmidt, Matthias; Weitmann, Kerstin; Schwedler, Susanne; Vogt, Hannes; Havemann, Christoph; Hoffmann, Wolfgang

2008-07-01

In our report we describe concept, strategies and implementation of a central biosample and data management (CSDM) system in the three-centre clinical study of the Transregional Collaborative Research Centre "Inflammatory Cardiomyopathy - Molecular Pathogenesis and Therapy" SFB/TR 19, Germany. Following the requirements of high system resource availability, data security, privacy protection and quality assurance, a web-based CSDM was developed based on Java 2 Enterprise Edition using an Oracle database. An efficient and reliable sample documentation system using bar code labelling, a partitioning storage algorithm and an online documentation software was implemented. An online electronic case report form is used to acquire patient-related data. Strict rules for access to the online applications and secure connections are used to account for privacy protection and data security. Challenges for the implementation of the CSDM resided at project, technical and organisational level as well as at staff level.

Implementing an Open Source Electronic Health Record System in Kenyan Health Care Facilities: Case Study.

PubMed

Muinga, Naomi; Magare, Steve; Monda, Jonathan; Kamau, Onesmus; Houston, Stuart; Fraser, Hamish; Powell, John; English, Mike; Paton, Chris

2018-04-18

The Kenyan government, working with international partners and local organizations, has developed an eHealth strategy, specified standards, and guidelines for electronic health record adoption in public hospitals and implemented two major health information technology projects: District Health Information Software Version 2, for collating national health care indicators and a rollout of the KenyaEMR and International Quality Care Health Management Information Systems, for managing 600 HIV clinics across the country. Following these projects, a modified version of the Open Medical Record System electronic health record was specified and developed to fulfill the clinical and administrative requirements of health care facilities operated by devolved counties in Kenya and to automate the process of collating health care indicators and entering them into the District Health Information Software Version 2 system. We aimed to present a descriptive case study of the implementation of an open source electronic health record system in public health care facilities in Kenya. We conducted a landscape review of existing literature concerning eHealth policies and electronic health record development in Kenya. Following initial discussions with the Ministry of Health, the World Health Organization, and implementing partners, we conducted a series of visits to implementing sites to conduct semistructured individual interviews and group discussions with stakeholders to produce a historical case study of the implementation. This case study describes how consultants based in Kenya, working with developers in India and project stakeholders, implemented the new system into several public hospitals in a county in rural Kenya. The implementation process included upgrading the hospital information technology infrastructure, training users, and attempting to garner administrative and clinical buy-in for adoption of the system. The initial deployment was ultimately scaled back due to a complex mix of sociotechnical and administrative issues. Learning from these early challenges, the system is now being redesigned and prepared for deployment in 6 new counties across Kenya. Implementing electronic health record systems is a challenging process in high-income settings. In low-income settings, such as Kenya, open source software may offer some respite from the high costs of software licensing, but the familiar challenges of clinical and administration buy-in, the need to adequately train users, and the need for the provision of ongoing technical support are common across the North-South divide. Strategies such as creating local support teams, using local development resources, ensuring end user buy-in, and rolling out in smaller facilities before larger hospitals are being incorporated into the project. These are positive developments to help maintain momentum as the project continues. Further integration with existing open source communities could help ongoing development and implementations of the project. We hope this case study will provide some lessons and guidance for other challenging implementations of electronic health record systems as they continue across Africa. ©Naomi Muinga, Steve Magare, Jonathan Monda, Onesmus Kamau, Stuart Houston, Hamish Fraser, John Powell, Mike English, Chris Paton. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 18.04.2018.

As good as it gets? Managing risks of cardiovascular disease in California's top-performing physician organizations.

PubMed

Rodriguez, Hector P; Ivey, Susan L; Raffetto, Brian J; Vaughn, Jennifer; Knox, Margae; Hanley, Hattie Rees; Mangione, Carol M; Shortell, Stephen M

2014-04-01

The California Right Care Initiative (RCI) accelerates the adoption of evidence-based guidelines and improved care management practices for conditions for which the gap between science and practice is significant, resulting in preventable disability and death. Medical directors and quality improvement leaders from 11 of the 12 physician organizations that met the 2010 national 90th percentile performance benchmarks for control of hyperlipidemia and glycated hemoglobin in 2011 were interviewed in 2012. Interviews, as well as surveys, assessed performance reporting and feedback to individual physicians; medication management protocols; team-based care management; primary care team huddles; coordination of care between primary care clinicians and specialists; implementation of shared medical appointments; and telephone visits for high-risk patients. All but 1 of 11 organizations implemented electronic health records. Electronic information exchange between primary care physicians and specialists, however, was uncommon. Few organizations routinely used interdisciplinary team approaches, shared medical appointments, or telephonic strategies for managing cardiovascular risks among patients. Implementation barriers included physicians' resistance to change, limited resources and reimbursement for team approaches, and limited organizational capacity for change. Implementation facilitators included routine use of reliable data to guide improvement, leadership facilitation of change, physician buy-in, health information technology use, and financial incentives. To accelerate improvements in managing cardiovascular risks, physician organizations may need to implement strategies involving extensive practice reorganization and work flow redesign.

Implementation of Electronic Health Records and Entrepreneurial Strategic Orientation in Substance Use Disorder Treatment Organizations.

PubMed

Fields, Dail; Riesenmy, Kelly; Blum, Terry C; Roman, Paul M

2015-11-01

This research studied the relationships of the components of entrepreneurial strategic orientation (ESO) with implementation of electronic health records (EHRs) within organizations that treat patients with substance use disorders (SUDs). A national sample of 317 SUD treatment providers were studied in a period after the Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted (2009) and meaningful use EHR requirements were established (2010), but before implementation of the Affordable Care Act. The study sample was selected using stratified random sampling and was part of a longitudinal study of treatment providers across the United States. After we controlled for potentially confounding variables, four components of ESO had a significant relationship with EHR implementation. Levels of slack resources in an organization moderated the relationship of ESO with meaningful use of EHRs, increasing the strength of the relationship for some components but reducing the strength of others. From a policy and practice perspective, the results suggest that training and education to develop higher levels of ESO within SUD treatment organizations are likely to increase their level of meaningful use of EHRs, which in turn may enhance the integration of SUD treatment with primary medical providers, better preparing SUD treatment providers for the environmental changes of the Affordable Care Act.

Implementation of Electronic Health Records and Entrepreneurial Strategic Orientation in Substance Use Disorder Treatment Organizations

PubMed Central

Fields, Dail; Riesenmy, Kelly; Blum, Terry C.; Roman, Paul M.

2015-01-01

Objective: This research studied the relationships of the components of entrepreneurial strategic orientation (ESO) with implementation of electronic health records (EHRs) within organizations that treat patients with substance use disorders (SUDs). Method: A national sample of 317 SUD treatment providers were studied in a period after the Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted (2009) and meaningful use EHR requirements were established (2010), but before implementation of the Affordable Care Act. The study sample was selected using stratified random sampling and was part of a longitudinal study of treatment providers across the United States. Results: After we controlled for potentially confounding variables, four components of ESO had a significant relationship with EHR implementation. Levels of slack resources in an organization moderated the relationship of ESO with meaningful use of EHRs, increasing the strength of the relationship for some components but reducing the strength of others. Conclusions: From a policy and practice perspective, the results suggest that training and education to develop higher levels of ESO within SUD treatment organizations are likely to increase their level of meaningful use of EHRs, which in turn may enhance the integration of SUD treatment with primary medical providers, better preparing SUD treatment providers for the environmental changes of the Affordable Care Act. PMID:26562603

A case study: planning a statewide information resource for health professionals: an evidence-based approach.

PubMed

Aspinall, Erinn E; Chew, Katherine; Watson, Linda; Parker, Mary

2009-10-01

What is the best approach for implementing a statewide electronic health library (eHL) to serve all health professionals in Minnesota? The research took place at the University of Minnesota Health Sciences Libraries. In January 2008, the authors began planning a statewide eHL for health professionals following the five-step process for evidence-based librarianship: formulating the question, finding the best evidence, appraising the evidence, assessing costs and benefits, and evaluating the effectiveness of resulting actions. The authors identified best practices for developing a statewide eHL for health professionals relating to audience or population served, information resources, technology and access, funding model, and implementation and sustainability. They were compared to the mission of the eHL project to drive strategic directions by developing recommendations. EBL can guide the planning process for a statewide eHL, but findings must be tailored to the local environment to address information needs and ensure long-term sustainability.

Best practices for fungal germplasm repositories and perspectives on their implementation.

PubMed

Wiest, Aric; Schnittker, Robert; Plamann, Mike; McCluskey, Kevin

2012-02-01

In over 50 years, the Fungal Genetics Stock Center has grown to become a world-recognized biological resource center. Along with this growth comes the development and implementation of myriad practices for the management and curation of a diverse collection of filamentous fungi, yeast, and molecular genetic tools for working with the fungi. These practices include techniques for the testing, manipulation, and preservation of individual fungal isolates as well as for processing of thousands of isolates in parallel. In addition to providing accurate record keeping, an electronic managements system allows the observation of trends in strain distribution and in sample characteristics. Because many ex situ fungal germplasm repositories around the world share similar objectives, best-practice guidelines have been developed by a number of organizations such as the Organization for Economic Cooperation and Development or the International Society for Biological and Environmental Repositories. These best-practice guidelines provide a framework for the successful operation of collections and promote the development and interactions of biological resource centers around the world.

A case study: planning a statewide information resource for health professionals: an evidence-based approach

PubMed Central

Chew, Katherine; Watson, Linda; Parker, Mary

2009-01-01

Question: What is the best approach for implementing a statewide electronic health library (eHL) to serve all health professionals in Minnesota? Setting: The research took place at the University of Minnesota Health Sciences Libraries. Methods: In January 2008, the authors began planning a statewide eHL for health professionals following the five-step process for evidence-based librarianship: formulating the question, finding the best evidence, appraising the evidence, assessing costs and benefits, and evaluating the effectiveness of resulting actions. Main Results: The authors identified best practices for developing a statewide eHL for health professionals relating to audience or population served, information resources, technology and access, funding model, and implementation and sustainability. They were compared to the mission of the eHL project to drive strategic directions by developing recommendations. Conclusion: EBL can guide the planning process for a statewide eHL, but findings must be tailored to the local environment to address information needs and ensure long-term sustainability. PMID:19851487

Development of a point-of-care HIV/AIDS medication dosing support system using the Android mobile platform.

PubMed

Sadasivam, Rajani S; Gathibandhe, Vaibhav; Tanik, Murat M; Willig, James H

2012-06-01

Medication dosing errors can greatly reduce HIV treatment effectiveness as incorrect dosing leads to drug resistance and non-adherence. In order to dose correctly, HIV therapy providers must balance several patient characteristics such as renal functions and weight. In developing countries and other resource-limited settings, dosing errors are more likely because treatment is provided by mid-level providers with only basic training in HIV therapy. These providers also typically lack electronic tools informing medical decisions. Widespread adoption of mobile phones in developing nations offers an opportunity to implement a point-of-care system to help providers reduce dosing errors. We discuss the development of the mHIV-Dr system prototype using the new Android mobile platform. mHIV-Dr is being designed to provide dosing recommendations for front-line providers in developing countries. We also discuss the additional challenges in the implementation of the mHIV-Dr system in a resource limited setting.

Evaluation of a novel electronic genetic screening and clinical decision support tool in prenatal clinical settings.

PubMed

Edelman, Emily A; Lin, Bruce K; Doksum, Teresa; Drohan, Brian; Edelson, Vaughn; Dolan, Siobhan M; Hughes, Kevin; O'Leary, James; Vasquez, Lisa; Copeland, Sara; Galvin, Shelley L; DeGroat, Nicole; Pardanani, Setul; Gregory Feero, W; Adams, Claire; Jones, Renee; Scott, Joan

2014-07-01

"The Pregnancy and Health Profile" (PHP) is a free prenatal genetic screening and clinical decision support (CDS) software tool for prenatal providers. PHP collects family health history (FHH) during intake and provides point-of-care risk assessment for providers and education for patients. This pilot study evaluated patient and provider responses to PHP and effects of using PHP in practice. PHP was implemented in four clinics. Surveys assessed provider confidence and knowledge and patient and provider satisfaction with PHP. Data on the implementation process were obtained through semi-structured interviews with administrators. Quantitative survey data were analyzed using Chi square test, Fisher's exact test, paired t tests, and multivariate logistic regression. Open-ended survey questions and interviews were analyzed using qualitative thematic analysis. Of the 83% (513/618) of patients that provided feedback, 97% felt PHP was easy to use and 98% easy to understand. Thirty percent (21/71) of participating physicians completed both pre- and post-implementation feedback surveys [13 obstetricians (OBs) and 8 family medicine physicians (FPs)]. Confidence in managing genetic risks significantly improved for OBs on 2/6 measures (p values ≤0.001) but not for FPs. Physician knowledge did not significantly change. Providers reported value in added patient engagement and reported mixed feedback about the CDS report. We identified key steps, resources, and staff support required to implement PHP in a clinical setting. To our knowledge, this study is the first to report on the integration of patient-completed, electronically captured and CDS-enabled FHH software into primary prenatal practice. PHP is acceptable to patients and providers. Key to successful implementation in the future will be customization options and interoperability with electronic health records.

Evaluation of the Veterans Health Administration's Specialty Care Transformational Initiatives to Promote Patient-Centered Delivery of Specialty Care: A Mixed-Methods Approach.

PubMed

Williams, Katherine M; Kirsh, Susan; Aron, David; Au, David; Helfrich, Christian; Lambert-Kerzner, Anne; Lowery, Julie; Battaglia, Catherine; Graham, Glenn D; Doukas, Michael; Jain, Rajiv; Ho, P Michael

2017-07-01

Veteran's Affairs Office of Specialty Care (OSC) launched four national initiatives (Electronic-Consults [e-Consults], Specialty Care Access Networks-Extension for Community Healthcare Outcomes [SCAN-ECHO], Mini-Residencies, and Specialty Care Neighborhood) to improve specialty care delivery and funded a center to evaluate the initiatives. The evaluation, guided by two implementation frameworks, provides formative (administrator/provider interviews and surveys) and summative data (quantitative data on patterns of use) about the initiatives to OSC. Evaluation of initiative implementation is assessed through CFIR (Consolidated Framework for Implementation Research)-grounded qualitative interviews to identify barriers/facilitators. Depending on high or low implementation, factors such as receiving workload credit, protected time, existing workflow/systems compatibility, leadership engagement, and access to information/resources were considered implementation barriers or facilitators. Findings were shared with OSC and used to further refine implementation at additional sites. Evaluation of other initiatives is ongoing. The mixed-methods approach has provided timely information to OSC about initiative effect and impacted OSC policies on implementation at additional sites.

Barriers and facilitators to reducing frequent laboratory testing for patients who are stable on warfarin: a mixed methods study of de-implementation in five anticoagulation clinics.

PubMed

Barnes, Geoffrey D; Misirliyan, Sevan; Kaatz, Scott; Jackson, Elizabeth A; Haymart, Brian; Kline-Rogers, Eva; Kozlowski, Jay; Krol, Gregory; Froehlich, James B; Sales, Anne

2017-07-14

Patients on chronic warfarin therapy require regular laboratory monitoring to safely manage warfarin. Recent studies have challenged the need for routine monthly blood draws in the most stable warfarin-treated patients, suggesting the safety of less frequent laboratory testing (up to every 12 weeks). De-implementation efforts aim to reduce the use of low-value clinical practices. To explore barriers and facilitators of a de-implementation effort to reduce the use of frequent laboratory tests for patients with stable warfarin management in nurse/pharmacist-run anticoagulation clinics, we performed a mixed-methods study conducted within a state-wide collaborative quality improvement collaborative. Using a mixed-methods approach, we conducted post-implementation semi-structured interviews with a total of eight anticoagulation nurse or pharmacist staff members at five participating clinic sites to assess barriers and facilitators to de-implementing frequent international normalized ratio (INR) laboratory testing among patients with stable warfarin control. Interview guides were based on the Tailored Implementation for Chronic Disease (TICD) framework. Informed by interview themes, a survey was developed and administered to all anticoagulation clinical staff (n = 62) about their self-reported utilization of less frequent INR testing and specific barriers to de-implementing the standard (more frequent) INR testing practice. From the interviews, four themes emerged congruent with TICD domains: (1) staff overestimating their actual use of less frequent INR testing (individual health professional factors), (2) barriers to appropriate patient engagement (incentives and resources), (3) broad support for an electronic medical record flag to identify potentially eligible patients (incentives and resources), and (4) the importance of personalized nurse/pharmacist feedback (individual health professional factors). In the survey (65% response rate), staff report offering less frequent INR testing to 56% (46-66%) of eligible patients. Most survey responders (n = 24; 60%) agreed that an eligibility flag in the electronic medical record would be very helpful. Twenty-four (60%) respondents agreed that periodic, personalized feedback on use of less frequent INR testing would also be helpful. Leveraging information system notifications, reducing additional work load burden for participating patients and providers, and providing personalized feedback are strategies that may improve adoption and utilization new policies in anticoagulation clinics that focus on de-implementation.

Design and implementation of intelligent electronic warfare decision making algorithm

NASA Astrophysics Data System (ADS)

Peng, Hsin-Hsien; Chen, Chang-Kuo; Hsueh, Chi-Shun

2017-05-01

Electromagnetic signals and the requirements of timely response have been a rapid growth in modern electronic warfare. Although jammers are limited resources, it is possible to achieve the best electronic warfare efficiency by tactical decisions. This paper proposes the intelligent electronic warfare decision support system. In this work, we develop a novel hybrid algorithm, Digital Pheromone Particle Swarm Optimization, based on Particle Swarm Optimization (PSO), Ant Colony Optimization (ACO) and Shuffled Frog Leaping Algorithm (SFLA). We use PSO to solve the problem and combine the concept of pheromones in ACO to accumulate more useful information in spatial solving process and speed up finding the optimal solution. The proposed algorithm finds the optimal solution in reasonable computation time by using the method of matrix conversion in SFLA. The results indicated that jammer allocation was more effective. The system based on the hybrid algorithm provides electronic warfare commanders with critical information to assist commanders in effectively managing the complex electromagnetic battlefield.

Automated Transformation of CDISC ODM to OpenClinica.

PubMed

Gessner, Sophia; Storck, Michael; Hegselmann, Stefan; Dugas, Martin; Soto-Rey, Iñaki

2017-01-01

Due to the increasing use of electronic data capture systems for clinical research, the interest in saving resources by automatically generating and reusing case report forms in clinical studies is growing. OpenClinica, an open-source electronic data capture system enables the reuse of metadata in its own Excel import template, hampering the reuse of metadata defined in other standard formats. One of these standard formats is the Operational Data Model for metadata, administrative and clinical data in clinical studies. This work suggests a mapping from Operational Data Model to OpenClinica and describes the implementation of a converter to automatically generate OpenClinica conform case report forms based upon metadata in the Operational Data Model.

How primary care physicians' attitudes toward risk and uncertainty affect their use of electronic information resources.

PubMed

McKibbon, K Ann; Fridsma, Douglas B; Crowley, Rebecca S

2007-04-01

The research sought to determine if primary care physicians' attitudes toward risk taking or uncertainty affected how they sought information and used electronic information resources when answering simulated clinical questions. Using physician-supplied data collected from existing risk and uncertainty scales, twenty-five physicians were classified as risk seekers (e.g., enjoying adventure), risk neutral, or risk avoiders (e.g., cautious) and stressed or unstressed by uncertainty. The physicians then answered twenty-three multiple-choice, clinically focused questions and selected two to pursue further using their own information resources. Think-aloud protocols were used to collect searching process and outcome data (e.g., searching time, correctness of answers, searching techniques). No differences in searching outcomes were observed between the groups. Physicians who were risk avoiding and those who reported stress when faced with uncertainty each showed differences in searching processes (e.g., actively analyzing retrieval, using searching heuristics or rules). Physicians who were risk avoiding tended to use resources that provided answers and summaries, such as Cochrane or UpToDate, less than risk-seekers did. Physicians who reported stress when faced with uncertainty showed a trend toward less frequent use of MEDLINE, when compared with physicians who were not stressed by uncertainty. Physicians' attitudes towards risk taking and uncertainty were associated with different searching processes but not outcomes. Awareness of differences in physician attitudes may be key in successful design and implementation of clinical information resources.

Access, interest, and attitudes toward electronic communication for health care among patients in the medical safety net.

PubMed

Schickedanz, Adam; Huang, David; Lopez, Andrea; Cheung, Edna; Lyles, C R; Bodenheimer, Tom; Sarkar, Urmimala

2013-07-01

Electronic and internet-based tools for patient-provider communication are becoming the standard of care, but disparities exist in their adoption among patients. The reasons for these disparities are unclear, and few studies have looked at the potential communication technologies have to benefit vulnerable patient populations. To characterize access to, interest in, and attitudes toward internet-based communication in an ethnically, economically, and linguistically diverse group of patients from a large urban safety net clinic network. Observational, cross-sectional study Adult patients (≥ 18 years) in six resource-limited community clinics in the San Francisco Department of Public Health (SFDPH) MAIN MEASURES: Current email use, interest in communicating electronically with health care professionals, barriers to and facilitators of electronic health-related communication, and demographic data-all self-reported via survey. Sixty percent of patients used email, 71 % were interested in using electronic communication with health care providers, and 19 % reported currently using email informally with these providers for health care. Those already using any email were more likely to express interest in using it for health matters. Most patients agreed electronic communication would improve clinic efficiency and overall communication with clinicians. A significant majority of safety net patients currently use email, text messaging, and the internet, and they expressed an interest in using these tools for electronic communication with their medical providers. This interest is currently unmet within safety net clinics that do not offer a patient portal or secure messaging. Tools such as email encounters and electronic patient portals should be implemented and supported to a greater extent in resource-poor settings, but this will require tailoring these tools to patients' language, literacy level, and experience with communication technology.

Modeling antecedents of electronic medical record system implementation success in low-resource setting hospitals.

PubMed

Tilahun, Binyam; Fritz, Fleur

2015-08-01

With the increasing implementation of Electronic Medical Record Systems (EMR) in developing countries, there is a growing need to identify antecedents of EMR success to measure and predict the level of adoption before costly implementation. However, less evidence is available about EMR success in the context of low-resource setting implementations. Therefore, this study aims to fill this gap by examining the constructs and relationships of the widely used DeLone and MacLean (D&M) information system success model to determine whether it can be applied to measure EMR success in those settings. A quantitative cross sectional study design using self-administered questionnaires was used to collect data from 384 health professionals working in five governmental hospitals in Ethiopia. The hospitals use a comprehensive EMR system since three years. Descriptive and structural equation modeling methods were applied to describe and validate the extent of relationship of constructs and mediating effects. The findings of the structural equation modeling shows that system quality has significant influence on EMR use (β = 0.32, P < 0.05) and user satisfaction (β = 0.53, P < 0.01); information quality has significant influence on EMR use (β = 0.44, P < 0.05) and user satisfaction (β = 0.48, P < 0.01) and service quality has strong significant influence on EMR use (β = 0.36, P < 0.05) and user satisfaction (β = 0.56, P < 0.01). User satisfaction has significant influence on EMR use (β = 0.41, P < 0.05) but the effect of EMR use on user satisfaction was not significant. Both EMR use and user satisfaction have significant influence on perceived net-benefit (β = 0.31, P < 0.01; β = 0.60, P < 0.01), respectively. Additionally, computer literacy was found to be a mediating factor in the relationship between service quality and EMR use (P < 0.05) as well as user satisfaction (P < 0.01). Among all the constructs, user satisfaction showed the strongest effect on perceived net-benefit of health professionals. EMR implementers and managers in developing countries are in urgent need of implementation models to design proper implementation strategies. In this study, the constructs and relationships depicted in the updated D&M model were found to be applicable to assess the success of EMR in low resource settings. Additionally, computer literacy was found to be a mediating factor in EMR use and user satisfaction of health professionals. Hence, EMR implementers and managers in those settings should give priority in improving service quality of the hospitals like technical support and infrastructure; providing continuous basic computer trainings to health professionals; and give attention to the system and information quality of the systems they want to implement.

Implementation of a cloud-based electronic medical record exchange system in compliance with the integrating healthcare enterprise's cross-enterprise document sharing integration profile.

PubMed

Wu, Chien Hua; Chiu, Ruey Kei; Yeh, Hong Mo; Wang, Da Wei

2017-11-01

In 2011, the Ministry of Health and Welfare of Taiwan established the National Electronic Medical Record Exchange Center (EEC) to permit the sharing of medical resources among hospitals. This system can presently exchange electronic medical records (EMRs) among hospitals, in the form of medical imaging reports, laboratory test reports, discharge summaries, outpatient records, and outpatient medication records. Hospitals can send or retrieve EMRs over the virtual private network by connecting to the EEC through a gateway. International standards should be adopted in the EEC to allow users with those standards to take advantage of this exchange service. In this study, a cloud-based EMR-exchange prototyping system was implemented on the basis of the Integrating the Healthcare Enterprise's Cross-Enterprise Document Sharing integration profile and the existing EMR exchange system. RESTful services were used to implement the proposed prototyping system on the Microsoft Azure cloud-computing platform. Four scenarios were created in Microsoft Azure to determine the feasibility and effectiveness of the proposed system. The experimental results demonstrated that the proposed system successfully completed EMR exchange under the four scenarios created in Microsoft Azure. Additional experiments were conducted to compare the efficiency of the EMR-exchanging mechanisms of the proposed system with those of the existing EEC system. The experimental results suggest that the proposed RESTful service approach is superior to the Simple Object Access Protocol method currently implemented in the EEC system, according to the irrespective response times under the four experimental scenarios. Copyright © 2017 Elsevier B.V. All rights reserved.

40 CFR 256.31 - Recommendations for developing and implementing resource conservation and recovery programs.

Code of Federal Regulations, 2010 CFR

2010-07-01

... implementing resource conservation and recovery programs. 256.31 Section 256.31 Protection of Environment... SOLID WASTE MANAGEMENT PLANS Resource Conservation and Resource Recovery Programs § 256.31 Recommendations for developing and implementing resource conservation and recovery programs. (a) In order to...

Effects of Electronic Information Resources Skills Training for Lecturers on Pedagogical Practices and Research Productivity

ERIC Educational Resources Information Center

Bhukuvhani, Crispen; Chiparausha, Blessing; Zuvalinyenga, Dorcas

2012-01-01

Lecturers use various electronic resources at different frequencies. The university library's information literacy skills workshops and seminars are the main sources of knowledge of accessing electronic resources. The use of electronic resources can be said to have positively affected lecturers' pedagogical practices and their work in general. The…

From Tedious to Timely: Screencasting to Troubleshoot Electronic Resource Issues

ERIC Educational Resources Information Center

Hartnett, Eric; Thompson, Carole

2010-01-01

The shift from traditional print materials to electronic resources, in conjunction with the rise in the number of distance education programs, has left many electronic resource librarians scrambling to keep up with the resulting inundation of electronic resource problems. When it comes to diagnosing these problems, words do not always convey all…

Electronic Resources and Mission Creep: Reorganizing the Library for the Twenty-First Century

ERIC Educational Resources Information Center

Stachokas, George

2009-01-01

The position of electronic resources librarian was created to serve as a specialist in the negotiation of license agreements for electronic resources, but mission creep has added more functions to the routine work of electronic resources such as cataloging, gathering information for collection development, and technical support. As electronic…

Clinical usefulness of library and information services in Japan: The detailed use and value of information in clinical settings.

PubMed

Sakai, Yukiko; Sato, Yoko; Sato, Masae; Watanabe, Makiko

2018-01-01

Considering that there is a lack of evidence regarding the contribution of library and information services to evidence-based medicine in actual clinical practice in Japan, the purpose of the study is to explore the current status of use and value of library and information services in clinical settings to examine the usefulness of information in implementing evidence-based medicine (EBM) into practice. A Web-based survey was conducted at seven sites (hospitals with 300-1,200 beds) and interviews conducted at five sites to investigate information behavior among health professionals (physicians, residents, and nurses) in 2016, replicating the Value Study carried out in the United States in 2010 and 2011. Using a critical incident technique, respondents answered questions about their information topics, information resources used, search location, access points, and evaluation of the information. Analysis from 598 valid responses (275 physicians, 55 residents, and 268 nurses) revealed the characteristics of information use and recognition of the value of information. Physicians and residents showed their information needs regarding clinical care using PubMed (80.4%, 65.5%), Ichushi-Web (61.8%, 63.6%), and UpToDate (40.4%, 65.5%). While physicians rely more on electronic journals (37.8%), residents use more hybrid resources including Japanese print books (38.2%) and online books (30.9% for Japanese, 32.7% for English) to confirm their knowledge. Nurses need more information close to patients and explore a wider variety of information resources such as Japanese print books (60.4%), Ichushi -Web (40.3%), Japanese online books (20.5%), and websites of academic organizations (19.0%). Although the overall recognition of the value of information was relatively modest, concrete changes in clinical practice were found in some areas. Environments with insufficient information and availability of electronic resources should be improved to increase the use of library and information services for implementing EBM.

Complex adaptive systems: a tool for interpreting responses and behaviours.

PubMed

Ellis, Beverley

2011-01-01

Quality improvement is a priority for health services worldwide. There are many barriers to implementing change at the locality level and misinterpreting responses and behaviours can effectively block change. Electronic health records will influence the means by which knowledge and information are generated and sustained among those operating quality improvement programmes. To explain how complex adaptive system (CAS) theory provides a useful tool and new insight into the responses and behaviours that relate to quality improvement programmes in primary care enabled by informatics. Case studies in two English localities who participated in the implementation and development of quality improvement programmes. The research strategy included purposefully sampled case studies, conducted within a social constructionist ontological perspective. Responses and behaviours of quality improvement programmes in the two localities include both positive and negative influences associated with a networked model of governance. Pressures of time, resources and workload are common issues, along with the need for education and training about capturing, coding, recording and sharing information held within electronic health records to support various information requirements. Primary care informatics enables information symmetry among those operating quality improvement programmes by making some aspects of care explicit, allowing consensus about quality improvement priorities and implementable solutions.

A Hardware-Supported Algorithm for Self-Managed and Choreographed Task Execution in Sensor Networks.

PubMed

Bordel, Borja; Miguel, Carlos; Alcarria, Ramón; Robles, Tomás

2018-03-07

Nowadays, sensor networks are composed of a great number of tiny resource-constraint nodes, whose management is increasingly more complex. In fact, although collaborative or choreographic task execution schemes are which fit in the most perfect way with the nature of sensor networks, they are rarely implemented because of the high resource consumption of these algorithms (especially if networks include many resource-constrained devices). On the contrary, hierarchical networks are usually designed, in whose cusp it is included a heavy orchestrator with a remarkable processing power, being able to implement any necessary management solution. However, although this orchestration approach solves most practical management problems of sensor networks, a great amount of the operation time is wasted while nodes request the orchestrator to address a conflict and they obtain the required instructions to operate. Therefore, in this paper it is proposed a new mechanism for self-managed and choreographed task execution in sensor networks. The proposed solution considers only a lightweight gateway instead of traditional heavy orchestrators and a hardware-supported algorithm, which consume a negligible amount of resources in sensor nodes. The gateway avoids the congestion of the entire sensor network and the hardware-supported algorithm enables a choreographed task execution scheme, so no particular node is overloaded. The performance of the proposed solution is evaluated through numerical and electronic ModelSim-based simulations.

A Hardware-Supported Algorithm for Self-Managed and Choreographed Task Execution in Sensor Networks

PubMed Central

2018-01-01

Nowadays, sensor networks are composed of a great number of tiny resource-constraint nodes, whose management is increasingly more complex. In fact, although collaborative or choreographic task execution schemes are which fit in the most perfect way with the nature of sensor networks, they are rarely implemented because of the high resource consumption of these algorithms (especially if networks include many resource-constrained devices). On the contrary, hierarchical networks are usually designed, in whose cusp it is included a heavy orchestrator with a remarkable processing power, being able to implement any necessary management solution. However, although this orchestration approach solves most practical management problems of sensor networks, a great amount of the operation time is wasted while nodes request the orchestrator to address a conflict and they obtain the required instructions to operate. Therefore, in this paper it is proposed a new mechanism for self-managed and choreographed task execution in sensor networks. The proposed solution considers only a lightweight gateway instead of traditional heavy orchestrators and a hardware-supported algorithm, which consume a negligible amount of resources in sensor nodes. The gateway avoids the congestion of the entire sensor network and the hardware-supported algorithm enables a choreographed task execution scheme, so no particular node is overloaded. The performance of the proposed solution is evaluated through numerical and electronic ModelSim-based simulations. PMID:29518986

The most used and most helpful facilitators for patient-centered medical home implementation.

PubMed

Gale, Randall C; Asch, Steven M; Taylor, Thomas; Nelson, Karin M; Luck, Jeff; Meredith, Lisa S; Helfrich, Christian D

2015-04-19

Like other transformative healthcare initiatives, patient-centered medical home (PCMH) implementation requires substantial investments of time and resources. Even though PCMH and PCMH-like models are being implemented by multiple provider practices and health systems, little is known about what facilitates their implementation. The purpose of this study was to assess which PCMH-implementation resources are most widely used, by whom, and which resources primary care personnel find most helpful. This study is an analysis of data from a cross-sectional survey of primary care personnel in the Veterans Health Administration in 2012, in which respondents were asked to rate whether they were aware of and accessed PCMH-implementation resources, and to rate their helpfulness. Logistic regression was used to produce odds ratios for the outcomes (1) resource use and (2) resource helpfulness. Respondents were nested within clinics, nested, in turn, within 135 parent hospitals. Teamlet huddles were the most widely accessed (80.4% accessed) and most helpful (90.4% rated helpful) resource; quality-improvement methods to conduct small tests of change were the least frequently accessed (42.4% accessed) resource though two-thirds (66.7%) of users reported as helpful. Supervisors were significantly more likely (ORs, 1.46 to 1.86) to use resources than non-supervisors but were less likely to rate the majority (8 out of 10) of resources as "somewhat/very helpful" than non-supervisors (ORs, 0.72 to 0.84). Longer-tenured employees tended to rate resources as more helpful. These findings are the first in the PCMH literature that we are aware of that systematically assesses primary care staff's access to and the helpfulness of PCMH implementation resources. Supervisors generally reported greater access to resources, relative to non-supervisors, but rated resources as less helpful, suggesting that information about them may not have been optimally disseminated. Knowing what resources primary care staff use and find helpful can inform administrators' and policymakers' investments in PCMH-implementation resources. The implications of our model extend beyond just PCMH implementation but also to considerations when providing implementation resources for other complex quality-improvement initiatives.

ISS-An Electronic Syndromic Surveillance System for Infectious Disease in Rural China

PubMed Central

Yan, Weirong; Palm, Lars; Lu, Xin; Nie, Shaofa; Xu, Biao; Zhao, Qi; Tao, Tao; Cheng, Liwei; Tan, Li; Dong, Hengjin; Diwan, Vinod K.

2013-01-01

Background syndromic surveillance system has great advantages in promoting the early detection of epidemics and reducing the necessities of disease confirmation, and it is especially effective for surveillance in resource poor settings. However, most current syndromic surveillance systems are established in developed countries, and there are very few reports on the development of an electronic syndromic surveillance system in resource-constrained settings. Objective this study describes the design and pilot implementation of an electronic surveillance system (ISS) for the early detection of infectious disease epidemics in rural China, complementing the conventional case report surveillance system. Methods ISS was developed based on an existing platform ‘Crisis Information Sharing Platform’ (CRISP), combining with modern communication and GIS technology. ISS has four interconnected functions: 1) work group and communication group; 2) data source and collection; 3) data visualization; and 4) outbreak detection and alerting. Results As of Jan. 31st 2012, ISS has been installed and pilot tested for six months in four counties in rural China. 95 health facilities, 14 pharmacies and 24 primary schools participated in the pilot study, entering respectively 74256, 79701, and 2330 daily records into the central database. More than 90% of surveillance units at the study sites are able to send daily information into the system. In the paper, we also presented the pilot data from health facilities in the two counties, which showed the ISS system had the potential to identify the change of disease patterns at the community level. Conclusions The ISS platform may facilitate the early detection of infectious disease epidemic as it provides near real-time syndromic data collection, interactive visualization, and automated aberration detection. However, several constraints and challenges were encountered during the pilot implementation of ISS in rural China. PMID:23626853

ISS--an electronic syndromic surveillance system for infectious disease in rural China.

PubMed

Yan, Weirong; Palm, Lars; Lu, Xin; Nie, Shaofa; Xu, Biao; Zhao, Qi; Tao, Tao; Cheng, Liwei; Tan, Li; Dong, Hengjin; Diwan, Vinod K

2013-01-01

Syndromic surveillance system has great advantages in promoting the early detection of epidemics and reducing the necessities of disease confirmation, and it is especially effective for surveillance in resource poor settings. However, most current syndromic surveillance systems are established in developed countries, and there are very few reports on the development of an electronic syndromic surveillance system in resource-constrained settings. This study describes the design and pilot implementation of an electronic surveillance system (ISS) for the early detection of infectious disease epidemics in rural China, complementing the conventional case report surveillance system. ISS was developed based on an existing platform 'Crisis Information Sharing Platform' (CRISP), combining with modern communication and GIS technology. ISS has four interconnected functions: 1) work group and communication group; 2) data source and collection; 3) data visualization; and 4) outbreak detection and alerting. As of Jan. 31(st) 2012, ISS has been installed and pilot tested for six months in four counties in rural China. 95 health facilities, 14 pharmacies and 24 primary schools participated in the pilot study, entering respectively 74,256, 79,701, and 2330 daily records into the central database. More than 90% of surveillance units at the study sites are able to send daily information into the system. In the paper, we also presented the pilot data from health facilities in the two counties, which showed the ISS system had the potential to identify the change of disease patterns at the community level. The ISS platform may facilitate the early detection of infectious disease epidemic as it provides near real-time syndromic data collection, interactive visualization, and automated aberration detection. However, several constraints and challenges were encountered during the pilot implementation of ISS in rural China.

Mind the Gap

PubMed Central

Fairbanks, Terry; Savage, Erica; Adams, Katie; Wittie, Michael; Boone, Edna; Hayden, Andrew; Barnes, Janey; Hettinger, Zach; Gettinger, Andrew

2016-01-01

Summary Objective Decisions made during electronic health record (EHR) implementations profoundly affect usability and safety. This study aims to identify gaps between the current literature and key stakeholders’ perceptions of usability and safety practices and the challenges encountered during the implementation of EHRs. Materials and Methods Two approaches were used: a literature review and interviews with key stakeholders. We performed a systematic review of the literature to identify usability and safety challenges and best practices during implementation. A total of 55 articles were reviewed through searches of PubMed, Web of Science and Scopus. We used a qualitative approach to identify key stakeholders’ perceptions; semi-structured interviews were conducted with a diverse set of health IT stakeholders to understand their current practices and challenges related to usability during implementation. We used a grounded theory approach: data were coded, sorted, and emerging themes were identified. Conclusions from both sources of data were compared to identify areas of misalignment. Results We identified six emerging themes from the literature and stakeholder interviews: cost and resources, risk assessment, governance and consensus building, customization, clinical work-flow and usability testing, and training. Across these themes, there were misalignments between the literature and stakeholder perspectives, indicating major gaps. Discussion Major gaps identified from each of six emerging themes are discussed as critical areas for future research, opportunities for new stakeholder initiatives, and opportunities to better disseminate resources to improve the implementation of EHRs. Conclusion Our analysis identified practices and challenges across six different emerging themes, illustrated important gaps, and results suggest critical areas for future research and dissemination to improve EHR implementation. PMID:27847961

7 CFR Exhibit B to Subpart G of... - Development and Implementation of Natural Resource Management Guide

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 13 2011-01-01 2009-01-01 true Development and Implementation of Natural Resource... Implementation of Natural Resource Management Guide 1. The State Director shall complete the natural resource... and the fulfillment of the requirements of paragraph 4. of this exhibit, the natural resource...

Navigating 3D electron microscopy maps with EM-SURFER.

PubMed

Esquivel-Rodríguez, Juan; Xiong, Yi; Han, Xusi; Guang, Shuomeng; Christoffer, Charles; Kihara, Daisuke

2015-05-30

The Electron Microscopy DataBank (EMDB) is growing rapidly, accumulating biological structural data obtained mainly by electron microscopy and tomography, which are emerging techniques for determining large biomolecular complex and subcellular structures. Together with the Protein Data Bank (PDB), EMDB is becoming a fundamental resource of the tertiary structures of biological macromolecules. To take full advantage of this indispensable resource, the ability to search the database by structural similarity is essential. However, unlike high-resolution structures stored in PDB, methods for comparing low-resolution electron microscopy (EM) density maps in EMDB are not well established. We developed a computational method for efficiently searching low-resolution EM maps. The method uses a compact fingerprint representation of EM maps based on the 3D Zernike descriptor, which is derived from a mathematical series expansion for EM maps that are considered as 3D functions. The method is implemented in a web server named EM-SURFER, which allows users to search against the entire EMDB in real-time. EM-SURFER compares the global shapes of EM maps. Examples of search results from different types of query structures are discussed. We developed EM-SURFER, which retrieves structurally relevant matches for query EM maps from EMDB within seconds. The unique capability of EM-SURFER to detect 3D shape similarity of low-resolution EM maps should prove invaluable in structural biology.

Improving medical imaging report turnaround times: the role of technolgy.

PubMed

Marquez, Luis O; Stewart, Howard

2005-01-01

At Southern Ohio Medical Center (SOMC), the medical imaging department and the radiologists expressed a strong desire to improve workflow. The improved workflow was a major motivating factor toward implementing a new RIS and speech recognition technology. The need to monitor workflow in a real-time fashion and to evaluate productivity and resources necessitated that a new solution be found. A decision was made to roll out both the new RIS product and speech recognition to maximize the resources to interface and implement the new solution. Prior to implementation of the new RIS, the medical imaging department operated in a conventional electronic-order-entry to paper request manner. The paper request followed the study through exam completion to the radiologist. SOMC entered into a contract with its PACS vendor to participate in beta testing and clinical trials for a new RIS product for the US market. Backup plans were created in the event the product failed to function as planned--either during the beta testing period or during clinical trails. The last piece of the technology puzzle to improve report turnaround time was voice recognition technology. Speech recognition enhanced the RIS technology as soon as it was implemented. The results show that the project has been a success. The new RIS, combined with speech recognition and the PACS, makes for a very effective solution to patient, exam, and results management in the medical imaging department.

Formative assessment in mathematics for engineering students

NASA Astrophysics Data System (ADS)

Ní Fhloinn, Eabhnat; Carr, Michael

2017-07-01

In this paper, we present a range of formative assessment types for engineering mathematics, including in-class exercises, homework, mock examination questions, table quizzes, presentations, critical analyses of statistical papers, peer-to-peer teaching, online assessments and electronic voting systems. We provide practical tips for the implementation of such assessments, with a particular focus on time or resource constraints and large class sizes, as well as effective methods of feedback. In addition, we consider the benefits of such formative assessments for students and staff.

Database resources of the National Center for Biotechnology Information

PubMed Central

Wheeler, David L.; Church, Deanna M.; Lash, Alex E.; Leipe, Detlef D.; Madden, Thomas L.; Pontius, Joan U.; Schuler, Gregory D.; Schriml, Lynn M.; Tatusova, Tatiana A.; Wagner, Lukas; Rapp, Barbara A.

2001-01-01

In addition to maintaining the GenBank® nucleic acid sequence database, the National Center for Biotechnology Information (NCBI) provides data analysis and retrieval resources that operate on the data in GenBank and a variety of other biological data made available through NCBI’s Web site. NCBI data retrieval resources include Entrez, PubMed, LocusLink and the Taxonomy Browser. Data analysis resources include BLAST, Electronic PCR, OrfFinder, RefSeq, UniGene, HomoloGene, Database of Single Nucleotide Polymorphisms (dbSNP), Human Genome Sequencing, Human MapViewer, GeneMap’99, Human–Mouse Homology Map, Cancer Chromosome Aberration Project (CCAP), Entrez Genomes, Clusters of Orthologous Groups (COGs) database, Retroviral Genotyping Tools, Cancer Genome Anatomy Project (CGAP), SAGEmap, Gene Expression Omnibus (GEO), Online Mendelian Inheri­tance in Man (OMIM), the Molecular Modeling Database (MMDB) and the Conserved Domain Database (CDD). Augmenting many of the Web applications are custom implementations of the BLAST program optimized to search specialized data sets. All of the resources can be accessed through the NCBI home page at: http://www.ncbi.nlm.nih.gov. PMID:11125038

Emerging Roles for Pharmacists in Clinical Implementation of Pharmacogenomics

PubMed Central

Owusu-Obeng, Aniwaa; Weitzel, Kristin W.; Hatton, Randy C.; Staley, Benjamin J.; Ashton, Jennifer; Cooper-Dehoff, Rhonda M.; Johnson, Julie A.

2014-01-01

Pharmacists are uniquely qualified to play essential roles in the clinical implementation of pharmacogenomics. However, specific responsibilities and resources needed for these roles have not been defined. We describe roles for pharmacists that emerged in the clinical implementation of genotype-guided clopidogrel therapy in the University of Florida Health Personalized Medicine Program, summarize preliminary program results, and discuss education, training, and resources needed to support such programs. Planning for University of Florida Health Personalized Medicine Program began in summer 2011 under leadership of a pharmacist, with clinical launch in June 2012 of a clopidogrel-CYP2C19 pilot project aimed at tailoring antiplatelet therapies for patients undergoing percutaneous coronary intervention and stent placement. More than 1000 patients were genotyped in the pilot project in year 1. Essential pharmacist roles and responsibilities that developed and/or emerged required expertise in pharmacy informatics (development of clinical decision support in the electronic medical record), medication safety, medication-use policies and processes, development of group and individual educational strategies, literature analysis, drug information, database management, patient care in targeted areas, logistical issues in genetic testing and follow-up, research and ethical issues, and clinical precepting. In the first 2 years of the program (1 year planning and 1 year postimplementation), a total of 14 different pharmacists were directly and indirectly involved, with effort levels ranging from a few hours per month, to 25–30% effort for the director and associate director, to nearly full-time for residents. Clinical pharmacists are well positioned to implement clinical pharmacogenomics programs, with expertise in pharmacokinetics, pharmacogenomics, informatics, and patient care. Education, training, and practice-based resources are needed to support these roles and to facilitate the development of financially sustainable pharmacist-led clinical pharmacogenomics practice models. PMID:25220280

Use of Electronic Resources for Psychiatry Clerkship Learning: A Medical Student Survey.

PubMed

Snow, Caitlin E; Torous, John; Gordon-Elliott, Janna S; Penzner, Julie B; Meyer, Fermonta; Boland, Robert

2017-10-01

The primary aim of this study is to examine medical students' use patterns, preferences, and perceptions of electronic educational resources available for psychiatry clerkship learning. Eligible participants included medical students who had completed the psychiatry clerkship during a 24-month period. An internet-based questionnaire was used to collect information regarding the outcomes described above. A total of 68 medical students responded to the survey. Most respondents reported high utilization of electronic resources on an array of devices for psychiatry clerkship learning and indicated a preference for electronic over print resources. The most commonly endorsed barriers to the use of electronic resources were that the source contained irrelevant and non-specific content, access was associated with a financial cost, and faculty guidance on recommended resources was insufficient. Respondents indicated a wish for more psychiatry-specific electronic learning resources. The authors' results suggest that a demand exists for high-quality electronic and portable learning tools that are relevant to medical student education in psychiatry. Psychiatry educators are usefully positioned to be involved in the development of such resources.

Supporting research sites in resource-limited settings: Challenges in implementing IT infrastructure

PubMed Central

Whalen, Christopher; Donnell, Deborah; Tartakovsky, Michael

2014-01-01

As Information and Communication Technology infrastructure becomes more reliable, new methods of Electronic Data Capture (EDC), datamarts/Data warehouses, and mobile computing provide platforms for rapid coordination of international research projects and multisite studies. However, despite the increasing availability of internet connectivity and communication systems in remote regions of the world, there are still significant obstacles. Sites with poor infrastructure face serious challenges participating in modern clinical and basic research, particularly that relying on EDC and internet communication technologies. This report discusses our experiences in supporting research in resource-limited settings (RLS). We describe examples of the practical and ethical/regulatory challenges raised by use of these newer technologies for data collection in multisite clinical studies. PMID:24321986

A qualitative evaluation of the implementation of guidelines and a support tool for asthma management in primary care.

PubMed

Watkins, Kim; Fisher, Colleen; Misaghian, Jila; Schneider, Carl R; Clifford, Rhonda

2016-01-01

Asthma management in Australia is suboptimal. The "Guidelines for provision of a Pharmacist Only medicine: short acting beta agonists" (SABA guidelines) and a novel West Australian "Asthma Action Plan card" (AAP card) were concurrently developed to improve asthma management. The aim of this qualitative research was to evaluate the collaborative, multidisciplinary and multifaceted implementation of these asthma resources and identify the lessons learnt to inform future initiatives. Feedback was sought about the implementation of the SABA guidelines and the AAP card using focus groups with key stakeholders including pharmacists (×2), pharmacy assistants, asthma educators, general practitioners, practice nurses and people with asthma (patients). Audio recordings were transcribed verbatim. Data were analysed thematically using constant comparison. The common themes identified from the focus groups were categorised according to a taxonomy of barriers including barriers related to knowledge, attitudes and behaviour. Seven focus group sessions were held with 57 participants. Knowledge barriers were identified included a lack of awareness and lack of familiarity of the resources. There was a significant lack of awareness of the AAP card where passive implementation methods had been utilised. Pharmacists had good awareness of the SABA guidelines but pharmacy assistants were unaware of the guidelines despite significant involvement in the sale of SABAs. Environmental barriers included time and workflow issues and the role of the pharmacy assistant in the organisation workflows of the pharmacy. The attitudes and behaviours of health professionals and patients with asthma were discordant and this undermined optimal asthma management. Suggestions to improve asthma management included the use of legislation, the use of electronic resources integrated into workflows and training pharmacists or practice nurses to provide patients with written asthma action plans. Greater consideration needs to be given to implementation of resources to improve awareness and overcome barriers to utilisation. Attitudes and behaviours of both health professionals and patients with asthma need to be addressed. Interventions directed toward health professionals should focus on skills needs related to achieving improved communication and patient behaviour change.

Evaluating the implementation of "managing the risk of suicide: a suicide prevention strategy for the ACT 2009-2014".

PubMed

Sheehan, Johann; Griffiths, Kathleen; Rickwood, Debra; Carron-Arthur, Bradley

2015-01-01

Over the past two decades, governments have invested significantly in policies and strategies to prevent the tragic loss of life to suicide. However, there has been little focus on evaluating the implementation of such policies. This paper reports on the evaluation of the implementation of "Managing the Risk of Suicide: A Suicide Prevention Strategy for the ACT 2009-2014," the Australian Capital Territory's (ACT) suicide prevention strategy. We sought to answer two questions: (1) Could agencies provide data reporting on their progress in implementing the activities for which they were responsible?; and (2) Could a judgment about implementation progress be made and, if so, to what extent was the activity implemented? Individually tailored electronic surveys were sent to 18 ACT agencies annually over 4 years to measure their progress in implementing activities for which they had responsibility. By year four, full data were provided for 64% of activities, maximal partial data for 9%, and minimal partial data for 27%. Forty-two per cent of activities were fully implemented, 20% were partially implemented, and 38% were not implemented or could not be measured. It is possible to measure implementation of suicide prevention strategies, but appropriate processes and dedicated resources must be in place at the outset.

Designing and evaluating an electronic patient falls reporting system: perspectives for the implementation of health information technology in long-term residential care facilities.

PubMed

Mei, Yi You; Marquard, Jenna; Jacelon, Cynthia; DeFeo, Audrey L

2013-11-01

Patient falls are the leading cause of unintentional injury and death among older adults. In 2000, falls resulted in over 10,300 elderly deaths, costing the United States approximately $179 million in incidence and medical costs. Furthermore, non-fatal injuries caused by falls cost the United States $19 billion annually. Health information technology (IT) applications, specifically electronic falls reporting systems, can aid quality improvement efforts to prevent patient falls. Yet, long-term residential care facilities (LTRCFs) often do not have the financial resources to implement health IT, and workers in these settings are often not ready to adopt such systems. Additionally, most health IT evaluations are conducted in large acute-care settings, so LTRCF administrators currently lack evidence to support the value of health IT. In this paper, we detail the development of a novel, easy-to-use system to facilitate electronic patient falls reporting within a LTRCF using off-the-shelf technology that can be inexpensively implemented in a wide variety of settings. We report the results of four complimentary system evaluation measures that take into consideration varied organizational stakeholders' perspectives: (1) System-level benefits and costs, (2) system usability, via scenario-based use cases, (3) a holistic assessment of users' physical, cognitive, and marcoergonomic (work system) challenges in using the system, and (4) user technology acceptance. We report the viability of collecting and analyzing data specific to each evaluation measure and detail the relative merits of each measure in judging whether the system is acceptable to each stakeholder. The electronic falls reporting system was successfully implemented, with 100% reporting at 3-months post-implementation. The system-level benefits and costs approach showed that the electronic system required no initial investment costs aside from personnel costs and significant benefits accrued from user time savings. The usability analysis revealed several fixable design flaws and demonstrated the importance of scenario-based user training. The technology acceptance model showed that users perceived the reporting system to be useful and easy to use, even more so after implementation. Finally, the holistic human factors evaluation identified challenges encountered when nurses used the system as a part of their daily work, guiding further system redesign. The four-pronged evaluation framework accounted for varied stakeholder perspectives and goals and is a highly scalable framework that can be easily applied to health IT implementations in other LTRCFs. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Overcoming Barriers to Experience Benefits: A Qualitative Analysis of Electronic Health Records and Health Information Exchange Implementation in Local Health Departments

PubMed Central

Williams, Karmen S.; Shah, Gulzar H.; Leider, JP; Gupta, Akarti

2017-01-01

Introduction: Electronic Health Records (EHRs) and Health Information Exchanges (HIEs) are changing surveillance and analytic operations within local health departments (LHDs) across the United States. The objective of this study was to analyze the status, benefits, barriers, and ways of overcoming challenges in the implementation of EHRs and HIEs in LHDs. Methods: This study employed a mixed methods approach, first using the 2013 National Profile of LHDs survey to ascertain the status of EHR and HIE implementation across the US, as well as to aid in selection of respondents for the second, interview-based part of project. Next, forty-nine key-informant interviews of local health department staff were conducted. Data were coded thematically and independently by two researchers. Coding was compared and re-coded using the consensus definitions. Results: Twenty-three percent of LHDs nationwide are using EHRs and 14 percent are using HIEs. The most frequently mentioned benefits for implementation were identified as care coordination, retrieval or managing information, and the ability to track outcomes of care. A few mentioned barriers included financial resources, resistance to change, and IT related issues during implementation. Discussion: Despite financial, technical capacity, and operational constraints, leaders interviewed as part of this project were optimistic about the future of EHRs in local health departments. Recent policy changes and accreditation have implications of improving processes to affect populations served. Conclusions: Overcoming the challenges in implementing EHRs can result in increased efficiencies in surveillance and higher quality patient care and tracking. However, significant opportunity cost does exist. PMID:29881738

Assessing Ongoing Electronic Resource Purchases: Linking Tools to Synchronize Staff Workflows

ERIC Educational Resources Information Center

Carroll, Jeffrey D.; Major, Colleen; O'Neal, Nada; Tofanelli, John

2012-01-01

Ongoing electronic resource purchases represent a substantial proportion of collections budgets. Recognizing the necessity of systematic ongoing assessment with full selector engagement, Columbia University Libraries appointed an Electronic Resources Assessment Working Group to promote the inclusion of such resources within our current culture of…

High speed fault tolerant secure communication for muon chamber using FPGA based GBTx emulator

NASA Astrophysics Data System (ADS)

Sau, Suman; Mandal, Swagata; Saini, Jogender; Chakrabarti, Amlan; Chattopadhyay, Subhasis

2015-12-01

The Compressed Baryonic Matter (CBM) experiment is a part of the Facility for Antiproton and Ion Research (FAIR) in Darmstadt at the GSI. The CBM experiment will investigate the highly compressed nuclear matter using nucleus-nucleus collisions. This experiment will examine lieavy-ion collisions in fixed target geometry and will be able to measure hadrons, electrons and muons. CBM requires precise time synchronization, compact hardware, radiation tolerance, self-triggered front-end electronics, efficient data aggregation schemes and capability to handle high data rate (up to several TB/s). As a part of the implementation of read out chain of Muon Cliamber(MUCH) [1] in India, we have tried to implement FPGA based emulator of GBTx in India. GBTx is a radiation tolerant ASIC that can be used to implement multipurpose high speed bidirectional optical links for high-energy physics (HEP) experiments and is developed by CERN. GBTx will be used in highly irradiated area and more prone to be affected by multi bit error. To mitigate this effect instead of single bit error correcting RS code we have used two bit error correcting (15, 7) BCH code. It will increase the redundancy which in turn increases the reliability of the coded data. So the coded data will be less prone to be affected by noise due to radiation. The data will go from detector to PC through multiple nodes through the communication channel. The computing resources are connected to a network which can be accessed by authorized person to prevent unauthorized data access which might happen by compromising the network security. Thus data encryption is essential. In order to make the data communication secure, advanced encryption standard [2] (AES - a symmetric key cryptography) and RSA [3], [4] (asymmetric key cryptography) are used after the channel coding. We have implemented GBTx emulator on two Xilinx Kintex-7 boards (KC705). One will act as transmitter and other will act as receiver and they are connected through optical fiber through small form-factor pluggable (SFP) port. We have tested the setup in the runtime environment using Xilinx Cliipscope Pro Analyzer. We also measure the resource utilization, throughput., power optimization of implemented design.

Implementation of health information technology to maximize efficiency of resource utilization in a geographically dispersed prenatal care delivery system.

PubMed

Cochran, Marlo Baker; Snyder, Russell R; Thomas, Elizabeth; Freeman, Daniel H; Hankins, Gary D V

2012-04-01

This study investigated the utilization of health information technology (HIT) to enhance resource utilization in a geographically dispersed tertiary care system with extensive outpatient and delivery services. It was initiated as a result of a systems change implemented after Hurricane Ike devastated southeast Texas. A retrospective database and electronic medical record review was performed, which included data collection from all patients evaluated 18 months prior (epoch I) and 18 months following (epoch II) the landfall of Hurricane Ike. The months immediately following the storm were omitted from the analysis, allowing time to establish a new baseline. We analyzed a total of 21,201 patients evaluated in triage at the University of Texas Medical Branch. Epoch I consisted of 11,280 patients and epoch II consisted of 9922 patients. Using HIT, we were able to decrease the number of visits to triage while simultaneously managing more complex patients in the outpatient setting with no clinically significant change in maternal or fetal outcome. This study developed an innovated model of care using constrained resources while providing quality and safety to our patients without additional cost to the health care delivery system. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

FT3D: three-dimensional Fourier analysis on small Unix workstations for electron microscopy and tomographic studies.

PubMed

Lanzavecchia, S; Bellon, P L; Tosoni, L

1993-12-01

FT3D is a self-contained package of tools for three-dimensional Fourier analysis, written in the C language for Unix workstations. It can evaluate direct transforms of three-dimensional real functions, inverse transforms, auto- and cross-correlations and spectra. The library has been developed to support three-dimensional reconstructions of biological structures from projections obtained in the electron microscope. This paper discusses some features of the library, which has been implemented in such a way as to profit from the resources of modern workstations. A table of elapsed times for jobs of different dimensions with different RAM buffers is reported for the particular hardware used in the authors' laboratory.

Compilation and development of K-6 aerospace materials for implementation in NASA spacelink electronic information system

NASA Technical Reports Server (NTRS)

Blake, Jean A.

1987-01-01

Spacelink is an electronic information service to be operated by the Marshall Space Flight Center. It will provide NASA news and educational resources including software programs that can be accessed by anyone with a computer and modem. Spacelink is currently being installed and will soon begin service. It will provide daily updates of NASA programs, information about NASA educational services, manned space flight, unmanned space flight, aeronautics, NASA itself, lesson plans and activities, and space program spinoffs. Lesson plans and activities were extracted from existing NASA publications on aerospace activities for the elementary school. These materials were arranged into 206 documents which have been entered into the Spacelink program for use in grades K-6.

Implementation of a large-scale hospital information infrastructure for multi-unit health-care services.

PubMed

Yoo, Sun K; Kim, Dong Keun; Kim, Jung C; Park, Youn Jung; Chang, Byung Chul

2008-01-01

With the increase in demand for high quality medical services, the need for an innovative hospital information system has become essential. An improved system has been implemented in all hospital units of the Yonsei University Health System. Interoperability between multi-units required appropriate hardware infrastructure and software architecture. This large-scale hospital information system encompassed PACS (Picture Archiving and Communications Systems), EMR (Electronic Medical Records) and ERP (Enterprise Resource Planning). It involved two tertiary hospitals and 50 community hospitals. The monthly data production rate by the integrated hospital information system is about 1.8 TByte and the total quantity of data produced so far is about 60 TByte. Large scale information exchange and sharing will be particularly useful for telemedicine applications.

Information processing using a single dynamical node as complex system

PubMed Central

Appeltant, L.; Soriano, M.C.; Van der Sande, G.; Danckaert, J.; Massar, S.; Dambre, J.; Schrauwen, B.; Mirasso, C.R.; Fischer, I.

2011-01-01

Novel methods for information processing are highly desired in our information-driven society. Inspired by the brain's ability to process information, the recently introduced paradigm known as 'reservoir computing' shows that complex networks can efficiently perform computation. Here we introduce a novel architecture that reduces the usually required large number of elements to a single nonlinear node with delayed feedback. Through an electronic implementation, we experimentally and numerically demonstrate excellent performance in a speech recognition benchmark. Complementary numerical studies also show excellent performance for a time series prediction benchmark. These results prove that delay-dynamical systems, even in their simplest manifestation, can perform efficient information processing. This finding paves the way to feasible and resource-efficient technological implementations of reservoir computing. PMID:21915110

Improving efficiency and access to mental health care: combining integrated care and advanced access.

PubMed

Pomerantz, Andrew; Cole, Brady H; Watts, Bradley V; Weeks, William B

2008-01-01

To provide an example of implementation of a new program that enhances access to mental health care in primary care. A general and specialized mental health service was redesigned to introduce open access to comprehensive mental health care in a primary care clinic. Key variables measured before and after implementation of the clinic included numbers of completed referrals, waiting time for appointments and clinic productivity. Workload and pre/post-implementation waiting time data were gathered through a computerized electronic monitoring system. Waiting time for new appointments was shortened from a mean of 33 days to 19 min. Clinician productivity and evaluations of new referrals more than doubled. These improvements have been sustained for 4 years. Moving mental health services into primary care, initiating open access and increasing use of technological aids led to dramatic improvements in access to mental health care and efficient use of resources. Implementation and sustainability of the program were enhanced by using a quality improvement approach.

Secondary Use of Patients’ Electronic Records (SUPER): An Approach for Meeting Specific Data Needs of Clinical and Translational Researchers

PubMed Central

Sholle, Evan T.; Kabariti, Joseph; Johnson, Stephen B.; Leonard, John P.; Pathak, Jyotishman; Varughese, Vinay I.; Cole, Curtis L.; Campion, Thomas R.

2017-01-01

Academic medical centers commonly approach secondary use of electronic health record (EHR) data by implementing centralized clinical data warehouses (CDWs). However, CDWs require extensive resources to model data dimensions and harmonize clinical terminology, which can hinder effective support of the specific and varied data needs of investigators. We hypothesized that an approach that aggregates raw data from source systems, ignores initial modeling typical of CDWs, and transforms raw data for specific research purposes would meet investigator needs. The approach has successfully enabled multiple tools that provide utility to the institutional research enterprise. To our knowledge, this is the first complete description of a methodology for electronic patient data acquisition and provisioning that ignores data harmonization at the time of initial storage in favor of downstream transformation to address specific research questions and applications. PMID:29854228

Implementation and testing of a Neighborhood Office Center (NOC) and integration of the NOC with an administrative correspondence management information system. [for NASA

NASA Technical Reports Server (NTRS)

1977-01-01

The application of telecommunications and telecomputing was investigated as a means of reducing NASA's consumption of natural resources and the proliferation of paper copies of correspondence. The feasibility, operational advantages, and limitations of decentralized (remote) neighborhood offices (NOC) linked through an electronic network are demonstrated. These offices are joined to a management information system for correspondence tracking, and to an administrative office center service based on the use of magnetic medium word processing typewriters which handle the daily typing load. In connection with an augmented teleconference network, a uniform means is provided for creating, storing, and retrieving administrative documents, records, and data, while simultaneously permitting users of the system to track their status. Information will be transferred without using paper - merely through digital electronic communication and display, as a step toward the establishment of an agency-wide electronic mail system.

A Plan for Revolutionary Change in Gas Turbine Engine Control System Architecture

NASA Technical Reports Server (NTRS)

Culley, Dennis E.

2011-01-01

The implementation of Distributed Engine Control technology on the gas turbine engine has been a vexing challenge for the controls community. A successful implementation requires the resolution of multiple technical issues in areas such as network communications, power distribution, and system integration, but especially in the area of high temperature electronics. Impeding the achievement has been the lack of a clearly articulated message about the importance of the distributed control technology to future turbine engine system goals and objectives. To resolve these issues and bring the technology to fruition has, and will continue to require, a broad coalition of resources from government, industry, and academia. This presentation will describe the broad challenges facing the next generation of advanced control systems and the plan which is being put into action to successfully implement the technology on the next generation of gas turbine engine systems.

Scenarios for Demand Growth of Metals in Electricity Generation Technologies, Cars, and Electronic Appliances

PubMed Central

2018-01-01

This study provides scenarios toward 2050 for the demand of five metals in electricity production, cars, and electronic appliances. The metals considered are copper, tantalum, neodymium, cobalt, and lithium. The study shows how highly technology-specific data on products and material flows can be used in integrated assessment models to assess global resource and metal demand. We use the Shared Socio-economic Pathways as implemented by the IMAGE integrated assessment model as a starting point. This allows us to translate information on the use of electronic appliances, cars, and renewable energy technologies into quantitative data on metal flows, through application of metal content estimates in combination with a dynamic stock model. Results show that total demand for copper, neodymium, and tantalum might increase by a factor of roughly 2 to 3.2, mostly as a result of population and GDP growth. The demand for lithium and cobalt is expected to increase much more, by a factor 10 to more than 20, as a result of future (hybrid) electric car purchases. This means that not just demographics, but also climate policies can strongly increase metal demand. This shows the importance of studying the issues of climate change and resource depletion together, in one modeling framework. PMID:29533657

Scenarios for Demand Growth of Metals in Electricity Generation Technologies, Cars, and Electronic Appliances.

PubMed

Deetman, Sebastiaan; Pauliuk, Stefan; van Vuuren, Detlef P; van der Voet, Ester; Tukker, Arnold

2018-04-17

This study provides scenarios toward 2050 for the demand of five metals in electricity production, cars, and electronic appliances. The metals considered are copper, tantalum, neodymium, cobalt, and lithium. The study shows how highly technology-specific data on products and material flows can be used in integrated assessment models to assess global resource and metal demand. We use the Shared Socio-economic Pathways as implemented by the IMAGE integrated assessment model as a starting point. This allows us to translate information on the use of electronic appliances, cars, and renewable energy technologies into quantitative data on metal flows, through application of metal content estimates in combination with a dynamic stock model. Results show that total demand for copper, neodymium, and tantalum might increase by a factor of roughly 2 to 3.2, mostly as a result of population and GDP growth. The demand for lithium and cobalt is expected to increase much more, by a factor 10 to more than 20, as a result of future (hybrid) electric car purchases. This means that not just demographics, but also climate policies can strongly increase metal demand. This shows the importance of studying the issues of climate change and resource depletion together, in one modeling framework.

eC3--a modern telecommunications matrix for cervical cancer prevention in Zambia.

PubMed

Parham, Groesbeck P; Mwanahamuntu, Mulindi H; Pfaendler, Krista S; Sahasrabuddhe, Vikrant V; Myung, Daniel; Mkumba, Gracilia; Kapambwe, Sharon; Mwanza, Bianca; Chibwesha, Carla; Hicks, Michael L; Stringer, Jeffrey S A

2010-07-01

Low physician density, undercapacitated laboratory infrastructures, and limited resources are major limitations to the development and implementation of widely accessible cervical cancer prevention programs in sub-Saharan Africa. We developed a system operated by nonphysician health providers that used widely available and affordable communication technology to create locally adaptable and sustainable public sector cervical cancer prevention program in Zambia, one of the world's poorest countries. Nurses were trained to perform visual inspection with acetic acid aided by digital cervicography using predefined criteria. Electronic digital images (cervigrams) were reviewed with patients, and distance consultation was sought as necessary. Same-visit cryotherapy or referral for further evaluation by a gynecologist was offered. The Zambian system of "electronic cervical cancer control" bypasses many of the historic barriers to the delivery of preventive health care to women in low-resource environments while facilitating monitoring, evaluation, and continued education of primary health care providers, patient education, and medical records documentation. The electronic cervical cancer control system uses appropriate technology to bridge the gap between screening and diagnosis, thereby facilitating the conduct of "screen-and-treat" programs. The inherent flexibility of the system lends itself to the integration with future infrastructures using rapid molecular human papillomavirus-based screening approaches and wireless telemedicine communications.

Use of personal digital assistants for data collection in a multi-site AIDS stigma study in rural south Nyanza, Kenya.

PubMed

Onono, M A; Carraher, N; Cohen, R C; Bukusi, E A; Turan, J M

2011-09-01

To describe the development, cost effectiveness and implementation of a PDA based electronic system to collect, verify and manage data from a multi-site study on HIV/AIDS stigma and pregnancy in a rural, resource-poor area. We worked within a large prevention of mother-to-child-transmission (PMTCT) program in nine rural health facilities to implement a PDA-based data collection system and to study the feasibility of its use in a multisite HIV research study in rural Kenya. The PDAs were programmed for collecting screening and eligibility data, and responses to structured interviews on HIV/AIDS stigma and violence in three local languages. Between November 2007 and December 2008, nine PDAs were used by Clinic and Community Health Assistants to enrol 1,270 participants on to the PMTCT program. Successes included: capacity-building of interviewers, low cost of implementation, quick turnaround time of data entry with good data quality, and convenience. Our study demonstrated the feasibility of utilizing PDAs for data collection in a multi-site observational study on HIV/AIDS stigma conducted in remote rural health facilities in Kenya. However, appropriate and frequent data backup protocols need to be established and paper forms are still needed as backup tools in resource-poor settings.

Design and implementation of a Sun tracker with a dual-axis single motor for an optical sensor-based photovoltaic system.

PubMed

Wang, Jing-Min; Lu, Chia-Liang

2013-03-06

The dual threats of energy depletion and global warming place the development of methods for harnessing renewable energy resources at the center of public interest. Solar energy is one of the most promising renewable energy resources. Sun trackers can substantially improve the electricity production of a photovoltaic (PV) system. This paper proposes a novel design of a dual-axis solar tracking PV system which utilizes the feedback control theory along with a four-quadrant light dependent resistor (LDR) sensor and simple electronic circuits to provide robust system performance. The proposed system uses a unique dual-axis AC motor and a stand-alone PV inverter to accomplish solar tracking. The control implementation is a technical innovation that is a simple and effective design. In addition, a scaled-down laboratory prototype is constructed to verify the feasibility of the scheme. The effectiveness of the Sun tracker is confirmed experimentally. To conclude, the results of this study may serve as valuable references for future solar energy applications.

Design and Implementation of a Sun Tracker with a Dual-Axis Single Motor for an Optical Sensor-Based Photovoltaic System

PubMed Central

Wang, Jing-Min; Lu, Chia-Liang

2013-01-01

The dual threats of energy depletion and global warming place the development of methods for harnessing renewable energy resources at the center of public interest. Solar energy is one of the most promising renewable energy resources. Sun trackers can substantially improve the electricity production of a photovoltaic (PV) system. This paper proposes a novel design of a dual-axis solar tracking PV system which utilizes the feedback control theory along with a four-quadrant light dependent resistor (LDR) sensor and simple electronic circuits to provide robust system performance. The proposed system uses a unique dual-axis AC motor and a stand-alone PV inverter to accomplish solar tracking. The control implementation is a technical innovation that is a simple and effective design. In addition, a scaled-down laboratory prototype is constructed to verify the feasibility of the scheme. The effectiveness of the Sun tracker is confirmed experimentally. To conclude, the results of this study may serve as valuable references for future solar energy applications. PMID:23467030

Electronic Resource Management and Design

ERIC Educational Resources Information Center

Abrams, Kimberly R.

2015-01-01

We have now reached a tipping point at which electronic resources comprise more than half of academic library budgets. Because of the increasing work associated with the ever-increasing number of e-resources, there is a trend to distribute work throughout the library even in the presence of an electronic resources department. In 2013, the author…

Site Remediation Technology InfoBase: A Guide to Federal Programs, Information Resources, and Publications on Contaminated Site Cleanup Technologies. First Edition

NASA Technical Reports Server (NTRS)

1998-01-01

Table of Contents: Federal Cleanup Programs; Federal Site Remediation Technology Development Assistance Programs; Federal Site Remediation Technology Development Electronic Data Bases; Federal Electronic Resources for Site Remediation Technology Information; Other Electronic Resources for Site Remediation Technology Information; Other Electronic Resources for Site Remediation Technology Information; Selected Bibliography: Federal Publication on Alternative and Innovative Site Remediation; and Appendix: Technology Program Contacts.

Urban family physician plan in Iran: challenges of implementation in Kerman.

PubMed

Dehnavieh, Reza; Kalantari, Ali Reza; Jafari Sirizi, Mohammad

2015-01-01

The Family Physician Plan has recently been implemented in three provinces of Iran on a pilot basis and is going to be implemented throughout Iran in the future. Through a qualitative design, this study aims to determine probable implementation challenges of Family Physician Plan in Kerman. This study was conducted in Kerman in 2013. Data were collected through interviews with 21 experts in the field. Sampling continued until data saturation level was achieved. All interviews were recorded and then analyzed, and main themes and subgroups were extracted from them based on a framework analysis model. most prevalent establishment challenges of Family Physician Plan were classified into policy-making, financial supply, laws and resources. The urban Family Physician Plan can be carried out more effectively by implementing this plan step by step, highlighting the relationships between the related organizations, using new payment mechanisms e.g Per Capita, DRG, make national commitment and proper educational programs for providers, development the health electronic Record, justifying providers and community about advantages of this plan, clarifying regulatory status about providers' Duties and most importantly considering a specific funding source.

Cost-effectiveness of an electronic clinical decision support system for improving quality of antenatal and childbirth care in rural Tanzania: an intervention study.

PubMed

Saronga, Happiness Pius; Duysburgh, Els; Massawe, Siriel; Dalaba, Maxwell Ayindenaba; Wangwe, Peter; Sukums, Felix; Leshabari, Melkizedeck; Blank, Antje; Sauerborn, Rainer; Loukanova, Svetla

2017-08-07

QUALMAT project aimed at improving quality of maternal and newborn care in selected health care facilities in three African countries. An electronic clinical decision support system was implemented to support providers comply with established standards in antenatal and childbirth care. Given that health care resources are limited and interventions differ in their potential impact on health and costs (efficiency), this study aimed at assessing cost-effectiveness of the system in Tanzania. This was a quantitative pre- and post- intervention study involving 6 health centres in rural Tanzania. Cost information was collected from health provider's perspective. Outcome information was collected through observation of the process of maternal care. Incremental cost-effectiveness ratios for antenatal and childbirth care were calculated with testing of four models where the system was compared to the conventional paper-based approach to care. One-way sensitivity analysis was conducted to determine whether changes in process quality score and cost would impact on cost-effectiveness ratios. Economic cost of implementation was 167,318 USD, equivalent to 27,886 USD per health center and 43 USD per contact. The system improved antenatal process quality by 4.5% and childbirth care process quality by 23.3% however these improvements were not statistically significant. Base-case incremental cost-effectiveness ratios of the system were 2469 USD and 338 USD per 1% change in process quality for antenatal and childbirth care respectively. Cost-effectiveness of the system was sensitive to assumptions made on costs and outcomes. Although the system managed to marginally improve individual process quality variables, it did not have significant improvement effect on the overall process quality of care in the short-term. A longer duration of usage of the electronic clinical decision support system and retention of staff are critical to the efficiency of the system and can reduce the invested resources. Realization of gains from the system requires effective implementation and an enabling healthcare system. Registered clinical trial at www.clinicaltrials.gov ( NCT01409824 ). Registered May 2009.

Primary care physicians’ experiences with electronic medical records

PubMed Central

Ludwick, Dave; Manca, Donna; Doucette, John

2010-01-01

OBJECTIVE To understand how remuneration and care setting affect the implementation of electronic medical records (EMRs). DESIGN Semistructured interviews were used to illicit descriptions from community-based family physicians (paid on a fee-for-service basis) and from urban, hospital, and academic family physicians (remunerated via alternative payment models or sessional pay for activities pertaining to EMR implementation). SETTING Small suburban community and large urban-, hospital-, and academic-based family medicine clinics in Alberta. All participants were supported by a jurisdictional EMR certification funding mechanism. PARTICIPANTS Physicians who practised in 1 or a combination of the above settings and had experience implementing and using EMRs. METHODS Purposive and maximum variation sampling was used to obtain descriptive data from key informants through individually conducted semistructured interviews. The interview guide, which was developed from key findings of our previous literature review, was used in a previous study of community-based family physicians on this same topic. Field notes were analyzed to generate themes through a comparative immersion approach. MAIN FINDINGS Physicians in urban, hospital, and academic settings leverage professional working relationships to investigate EMRs, a resource not available to community physicians. Physicians in urban, hospital, and academic settings work in larger interdisciplinary teams with a greater need for interdisciplinary care coordination, EMR training, and technical support. These practices were able to support the cost of project management or technical support resources. These physicians followed a planned system rollout approach compared with community physicians who installed their systems quickly and required users to transition to the new system immediately. Electronic medical records did not increase, or decrease, patient throughput. Physicians developed ways of including patients in the note-taking process. CONCLUSION We studied physicians’ procurement approaches under various payment models. Our findings do not suggest that one remuneration approach supports EMR adoption any more than another. Rather, this study suggests that stronger physician professional networks used in information gathering, more complete training, and in-house technical support might be more influential than remuneration in facilitating the EMR adoption experience. PMID:20090083

Do GPs use electronic mental health resources? - a qualitative study.

PubMed

Austin, David; Pier, Ciaran; Mitchell, Joanna; Schattner, Peter; Wade, Victoria; Pierce, David; Klein, Britt

2006-05-01

The Better Outcomes in Mental Health Care (BOMHC) initiative encourages general practitioners to use electronic mental health resources (EMHRs) during consultation with patients requiring psychological assistance. However, there is little data on GPs' acceptance and use of EMHRs. Semistructured interviews were conducted with 27 GPs to determine their attitude toward EMHRs, and their use during consultation with patients. Few GPs reported frequently using EMHRs in consultation. Identified barriers to use included lack of familiarity with information technology, and insufficient knowledge of available resources. Identified advantages of electronic resources included high patient acceptance, time efficiency, and improved quality of information. General practitioners recognise several advantages of utilising electronic resources for managing patients with mental illness. However, GPs are not sufficiently familiar with electronic resources to use them effectively. This could be overcome by education.

Making sense of the electronic resource marketplace: trends in health-related electronic resources.

PubMed Central

Blansit, B D; Connor, E

1999-01-01

Changes in the practice of medicine and technological developments offer librarians unprecedented opportunities to select and organize electronic resources, use the Web to deliver content throughout the organization, and improve knowledge at the point of need. The confusing array of available products, access routes, and pricing plans makes it difficult to anticipate the needs of users, identify the top resources, budget effectively, make sound collection management decisions, and organize the resources effectively and seamlessly. The electronic resource marketplace requires much vigilance, considerable patience, and continuous evaluation. There are several strategies that librarians can employ to stay ahead of the electronic resource curve, including taking advantage of free trials from publishers; marketing free trials and involving users in evaluating new products; watching and testing products marketed to the clientele; agreeing to beta test new products and services; working with aggregators or republishers; joining vendor advisory boards; benchmarking institutional resources against five to eight competitors; and forming or joining a consortium for group negotiating and purchasing. This article provides a brief snapshot of leading biomedical resources; showcases several libraries that have excelled in identifying, acquiring, and organizing electronic resources; and discusses strategies and trends of potential interest to biomedical librarians, especially those working in hospital settings. PMID:10427421

Making sense of the electronic resource marketplace: trends in health-related electronic resources.

PubMed

Blansit, B D; Connor, E

1999-07-01

Changes in the practice of medicine and technological developments offer librarians unprecedented opportunities to select and organize electronic resources, use the Web to deliver content throughout the organization, and improve knowledge at the point of need. The confusing array of available products, access routes, and pricing plans makes it difficult to anticipate the needs of users, identify the top resources, budget effectively, make sound collection management decisions, and organize the resources effectively and seamlessly. The electronic resource marketplace requires much vigilance, considerable patience, and continuous evaluation. There are several strategies that librarians can employ to stay ahead of the electronic resource curve, including taking advantage of free trials from publishers; marketing free trials and involving users in evaluating new products; watching and testing products marketed to the clientele; agreeing to beta test new products and services; working with aggregators or republishers; joining vendor advisory boards; benchmarking institutional resources against five to eight competitors; and forming or joining a consortium for group negotiating and purchasing. This article provides a brief snapshot of leading biomedical resources; showcases several libraries that have excelled in identifying, acquiring, and organizing electronic resources; and discusses strategies and trends of potential interest to biomedical librarians, especially those working in hospital settings.

The essential role of reconfiguration capabilities in the implementation of HIV-related health information exchanges.

PubMed

Steward, Wayne T; Koester, Kimberly A; Collins, Shane P; Maiorana, Andre; Myers, Janet J

2012-10-01

To understand the dynamic capabilities that enabled the six demonstration projects of the Information Technology Networks of Care Initiative to implement health information exchanges (HIEs) tailored to their local HIV epidemics and regional care systems. We conducted 111 semi-structured interviews with project staff and information technology (IT) specialists associated with the demonstration projects, staff from community-based organizations and public health agencies collaborating in the design and implementation of the HIEs, and providers who used each HIE. The dynamic capability framework guided analyses. In the context of a HIE, the framework's components include information systems (the actual technological exchange systems and capacity to update them), absorptive capacity (the ability to implement an operating HIE), reconfiguration capacity (the ability to adapt workflows and clinical practices in response to a HIE), and organizational size and human resources (characteristics likely to affect a clinic's ability to respond). Across the projects, we found evidence for the importance of three dynamic capabilities: information systems, reconfiguration capacity, and organizational size and human resources. However, of these three, reconfiguration capacity was the most salient. Implementation outcomes at all six of the projects were shaped substantially by the degree of attention dedicated to reworking procedures and practices so that HIE usage became routine. Electronic information exchange offers the promise of improved coordination of care. However, implementation of HIEs goes beyond programing and hardware installation challenges, and requires close attention to the needs of the HIEs end-users. Providers need to discern value from a HIE because their active participation is essential to ensuring that clinic and agency practices and procedures are reconfigured to incorporate new systems into daily work processes. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Dynamic electronic institutions in agent oriented cloud robotic systems.

PubMed

Nagrath, Vineet; Morel, Olivier; Malik, Aamir; Saad, Naufal; Meriaudeau, Fabrice

2015-01-01

The dot-com bubble bursted in the year 2000 followed by a swift movement towards resource virtualization and cloud computing business model. Cloud computing emerged not as new form of computing or network technology but a mere remoulding of existing technologies to suit a new business model. Cloud robotics is understood as adaptation of cloud computing ideas for robotic applications. Current efforts in cloud robotics stress upon developing robots that utilize computing and service infrastructure of the cloud, without debating on the underlying business model. HTM5 is an OMG's MDA based Meta-model for agent oriented development of cloud robotic systems. The trade-view of HTM5 promotes peer-to-peer trade amongst software agents. HTM5 agents represent various cloud entities and implement their business logic on cloud interactions. Trade in a peer-to-peer cloud robotic system is based on relationships and contracts amongst several agent subsets. Electronic Institutions are associations of heterogeneous intelligent agents which interact with each other following predefined norms. In Dynamic Electronic Institutions, the process of formation, reformation and dissolution of institutions is automated leading to run time adaptations in groups of agents. DEIs in agent oriented cloud robotic ecosystems bring order and group intellect. This article presents DEI implementations through HTM5 methodology.

Cooperative business management strategies for the U.S. integrated textile complex

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

Washington, K.E.

1995-12-31

The mission of the American Textile (AMTEX{trademark}) Partnership is to engage the unique technical resources of the Department of Energy National Laboratories to work with the US Integrated Textile Complex (US ITC) and research universities to develop and deploy technologies that will increase the competitiveness of the US ITC. The objectives of the Demand Activated Manufacturing Architecture (DAMA) project of AMTEX are: (1) to determine strategic business structure changes for the US ITC; (2) to establish a textile industry electronic marketplace, (3) to provide methods for US ITC education ad implementation of an electronic marketplace. The Enterprise Modeling and Simulationmore » Task of DAMA is focusing on the first DAMA goal as described in another paper of this conference. The Cooperative Business Management (CBM) Task of DAMA is developing computer-based tools that will render system-wide information accessible for improved decision making. Three CBM strategies and the associated computer tools being developed to support their implementation are described in this paper. This effort is addressing the second DAMA goal to establish a textile industry electronic marketplace in concert with the Connectivity and Infrastructure Task of DAMA. As the CBM tools mature, they will be commercialized through the DAMA Education, Outreach and Commercialization Task of DAMA to achieve the third and final DAMA goal.« less

Analysis of Human Resources Management Strategy in China Electronic Commerce Enterprises

NASA Astrophysics Data System (ADS)

Shao, Fang

The paper discussed electronic-commerce's influence on enterprise human resources management, proposed and proved the human resources management strategy which electronic commerce enterprise should adopt from recruitment strategy to training strategy, keeping talent strategy and other ways.

Implementation of an integrated preoperative care pathway and regional electronic clinical portal for preoperative assessment.

PubMed

Bouamrane, Matt-Mouley; Mair, Frances S

2014-11-19

Effective surgical pre-assessment will depend upon the collection of relevant medical information, good data management and communication between the members of the preoperative multi-disciplinary team. NHS Greater Glasgow and Clyde has implemented an electronic preoperative integrated care pathway (eForm) allowing all hospitals to access a comprehensive patient medical history via a clinical portal on the health-board intranet. We conducted six face-to-face semi-structured interviews and participated in one focus group and two workshops with key stakeholders involved in the Planned Care Improvement (PCIP) and Electronic Patient Record programmes. We used qualitative methods and Normalisation Process Theory in order to identify the key factors which led to the successful deployment of the preoperative eForm in the health-board. In January 2013, more than 90,000 patient preoperative assessments had been completed via the electronic portal. Two complementary strategic efforts were instrumental in the successful deployment of the preoperative eForm. At the local health-board level: the PCIP led to the rationalisation of surgical pre-assessment clinics and the standardisation of preoperative processes. At the national level: the eHealth programme selected portal technology as an iterative strategic technology solution towards a virtual electronic patient record. Our study has highlighted clear synergies between these two standardisation efforts. The adoption of the eForm into routine preoperative work practices can be attributed to: (i) a policy context - including performance targets - promoting the rationalisation of surgical pre-assessment pathways, (ii) financial and organisational resources to support service redesign and the use of information technology for operationalising the standardisation of preoperative processes, (iii) a sustained engagement with stakeholders throughout the iterative phases of the preoperative clinics redesign, guidelines standardisation and the eForm development, (iv) the use of a pragmatic and domain-agnostic technology solution and finally: (v) a consensual and contextualised implementation.

Electron Transfer Mechanism in Gold Surface Modified with Self-Assembly Monolayers from First Principles

NASA Astrophysics Data System (ADS)

Lima, Filipe C. D. A.; Iost, Rodrigo M.; Crespilho, Frank N.; Caldas, Marília J.; Calzolari, Arrigo; Petrilli, Helena M.

2013-03-01

We report the investigation of electron tunneling mechanism of peptide ferrocenyl-glycylcystamine self-assembled monolayers (SAMs) onto Au (111) electrode surfaces. Recent experimental investigations showed that electron transfer in peptides can occur across long distances by separating the donor from the acceptor. This mechanism can be further fostered by the presence of electron donor terminations of Fc terminal units on SAMs but the charge transfer mechanism is still not clear. We study the interaction of the peptide ferrocenyl-glycylcystamine on the Au (111) from first principles calculations to evaluate the electron transfer mechanism. For this purpose, we used the Kohn Sham (KS) scheme for the Density Functional Theory (DFT) as implemented in the Quantum-ESPRESSO suit of codes, using Vandebilt ultrasoft pseudopotentials and GGA-PBE exchange correlation functional to evaluate the ground-state atomic and electronic structure of the system. The analysis of KS orbital at the Fermi Energy showed high electronic density localized in Fc molecules and the observation of a minor contribution from the solvent and counter ion. Based on the results, we infer evidences of electron tunneling mechanism from the molecule to the Au(111). We acknowledge FAPESP for grant support. Also, LCCA/USP, RICE and CENAPAD for computational resources.

Electronic prescribing in ambulatory practice: promises, pitfalls, and potential solutions.

PubMed

Papshev, D; Peterson, A M

2001-07-01

To examine advantages of and obstacles to electronic prescribing in the ambulatory care environment. MEDLINE and International Pharmaceutical Abstract searches were conducted for the period from January 1980 to September 2000. Key words were electronic prescribing, computerized physician order entry, prior authorization, drug utilization review, and consumer satisfaction. In September 2000, a public search engine (www.google.com) was used to find additional technical information. In addition, pertinent articles were cross-referenced to identify other resources. Articles, symposia proceedings, and organizational position statements published in the United States on electronic prescribing and automation in healthcare are cited. Electronic prescribing can eliminate the time gap between point of care and point of service, reduce medication errors, improve quality of care, and increase patient satisfaction. Considerable funding requirements, segmentation of healthcare markets, lack of technology standardization, providers' resistance to change, and regulatory indecisiveness create boundaries to the widespread use of automated prescribing. The potential solutions include establishing a standardizing warehouse or a router and gaining stakeholder support in implementation of the technology. Electronic prescribing can provide immense benefits to healthcare providers, patients, and managed care. Resolution of several obstacles that limit feasibility of this technology will determine its future.

Integrating all medical records to an enterprise viewer.

PubMed

Li, Haomin; Duan, Huilong; Lu, Xudong; Zhao, Chenhui; An, Jiye

2005-01-01

The idea behind hospital information systems is to make all of a patient's medical reports, lab results, and images electronically available to clinicians, instantaneously, wherever they are. But the higgledy-piggledy evolution of most hospital computer systems makes it hard to integrate all these clinical records. Although several integration standards had been proposed to meet this challenger, none of them is fit to Chinese hospitals. In this paper, we introduce our work of implementing a three-tiered architecture enterprise viewer in Huzhou Central Hospital to integration all existing medical information systems using limited resource.

System-on-Chip Data Processing and Data Handling Spaceflight Electronics

NASA Technical Reports Server (NTRS)

Kleyner, I.; Katz, R.; Tiggeler, H.

1999-01-01

This paper presents a methodology and a tool set which implements automated generation of moderate-size blocks of customized intellectual property (IP), thus effectively reusing prior work and minimizing the labor intensive, error-prone parts of the design process. Customization of components allows for optimization for smaller area and lower power consumption, which is an important factor given the limitations of resources available in radiation-hardened devices. The effects of variations in HDL coding style on the efficiency of synthesized code for various commercial synthesis tools are also discussed.

Database resources of the National Center for Biotechnology Information

PubMed Central

Wheeler, David L.; Barrett, Tanya; Benson, Dennis A.; Bryant, Stephen H.; Canese, Kathi; Chetvernin, Vyacheslav; Church, Deanna M.; DiCuccio, Michael; Edgar, Ron; Federhen, Scott; Geer, Lewis Y.; Helmberg, Wolfgang; Kapustin, Yuri; Kenton, David L.; Khovayko, Oleg; Lipman, David J.; Madden, Thomas L.; Maglott, Donna R.; Ostell, James; Pruitt, Kim D.; Schuler, Gregory D.; Schriml, Lynn M.; Sequeira, Edwin; Sherry, Stephen T.; Sirotkin, Karl; Souvorov, Alexandre; Starchenko, Grigory; Suzek, Tugba O.; Tatusov, Roman; Tatusova, Tatiana A.; Wagner, Lukas; Yaschenko, Eugene

2006-01-01

In addition to maintaining the GenBank(R) nucleic acid sequence database, the National Center for Biotechnology Information (NCBI) provides analysis and retrieval resources for the data in GenBank and other biological data made available through NCBI's Web site. NCBI resources include Entrez, the Entrez Programming Utilities, MyNCBI, PubMed, PubMed Central, Entrez Gene, the NCBI Taxonomy Browser, BLAST, BLAST Link (BLink), Electronic PCR, OrfFinder, Spidey, Splign, RefSeq, UniGene, HomoloGene, ProtEST, dbMHC, dbSNP, Cancer Chromosomes, Entrez Genomes and related tools, the Map Viewer, Model Maker, Evidence Viewer, Clusters of Orthologous Groups, Retroviral Genotyping Tools, HIV-1, Human Protein Interaction Database, SAGEmap, Gene Expression Omnibus, Entrez Probe, GENSAT, Online Mendelian Inheritance in Man, Online Mendelian Inheritance in Animals, the Molecular Modeling Database, the Conserved Domain Database, the Conserved Domain Architecture Retrieval Tool and the PubChem suite of small molecule databases. Augmenting many of the Web applications are custom implementations of the BLAST program optimized to search specialized datasets. All of the resources can be accessed through the NCBI home page at: . PMID:16381840

Database resources of the National Center for Biotechnology

PubMed Central

Wheeler, David L.; Church, Deanna M.; Federhen, Scott; Lash, Alex E.; Madden, Thomas L.; Pontius, Joan U.; Schuler, Gregory D.; Schriml, Lynn M.; Sequeira, Edwin; Tatusova, Tatiana A.; Wagner, Lukas

2003-01-01

In addition to maintaining the GenBank(R) nucleic acid sequence database, the National Center for Biotechnology Information (NCBI) provides data analysis and retrieval resources for the data in GenBank and other biological data made available through NCBI's Web site. NCBI resources include Entrez, PubMed, PubMed Central (PMC), LocusLink, the NCBITaxonomy Browser, BLAST, BLAST Link (BLink), Electronic PCR (e-PCR), Open Reading Frame (ORF) Finder, References Sequence (RefSeq), UniGene, HomoloGene, ProtEST, Database of Single Nucleotide Polymorphisms (dbSNP), Human/Mouse Homology Map, Cancer Chromosome Aberration Project (CCAP), Entrez Genomes and related tools, the Map Viewer, Model Maker (MM), Evidence Viewer (EV), Clusters of Orthologous Groups (COGs) database, Retroviral Genotyping Tools, SAGEmap, Gene Expression Omnibus (GEO), Online Mendelian Inheritance in Man (OMIM), the Molecular Modeling Database (MMDB), the Conserved Domain Database (CDD), and the Conserved Domain Architecture Retrieval Tool (CDART). Augmenting many of the Web applications are custom implementations of the BLAST program optimized to search specialized data sets. All of the resources can be accessed through the NCBI home page at: http://www.ncbi.nlm.nih.gov. PMID:12519941

Implementing a regional oncology information system: approach and lessons learned.

PubMed

Evans, W K; Ashbury, F D; Hogue, G L; Smith, A; Pun, J

2014-10-01

Paper-based medical record systems are known to have major problems of inaccuracy, incomplete data, poor accessibility, and challenges to patient confidentiality. They are also an inefficient mechanism of record-sharing for interdisciplinary patient assessment and management, and represent a major problem for keeping current and monitoring quality control to facilitate improvement. To address those concerns, national, regional, and local health care authorities have increased the pressure on oncology practices to upgrade from paper-based systems to electronic health records. Here, we describe and discuss the challenges to implementing a region-wide oncology information system across four independent health care organizations, and we describe the lessons learned from the initial phases that are now being applied in subsequent activities of this complex project. The need for change must be shared across centres to increase buy-in, adoption, and implementation. It is essential to establish physician leadership, commitment, and engagement in the process. Work processes had to be revised to optimize use of the new system. Culture change must be included in the change management strategy. Furthermore, training and resource requirements must be thoroughly planned, implemented, monitored, and modified as required for effective adoption of new work processes and technology. Interfaces must be established with multiple existing electronic systems across the region to ensure appropriate patient flow. Periodic assessment of the existing project structure is necessary, and adjustments are often required to ensure that the project meets its objectives. The implementation of region-wide oncology information systems across different health practice locations has many challenges. Leadership is essential. A strong, collaborative information-sharing strategy across the region and with the supplier is essential to identify, discuss, and resolve implementation problems. A structure that supports project management and accountability contributes to success.

Electronic Library: A TERI Experiment.

ERIC Educational Resources Information Center

Kar, Debal C.; Deb, Subrata; Kumar, Satish

2003-01-01

Discusses the development of Electronic Library at TERI (The Energy and Resources Institute, New Delhi). Highlights include: hardware and software used; the digital library/Virtual Electronic Library; directory of Internet journals; virtual reference resources; electronic collection/Physical Electronic Library; downloaded online full-length…

Database resources of the National Center for Biotechnology Information.

PubMed

Wheeler, David L; Barrett, Tanya; Benson, Dennis A; Bryant, Stephen H; Canese, Kathi; Chetvernin, Vyacheslav; Church, Deanna M; DiCuccio, Michael; Edgar, Ron; Federhen, Scott; Geer, Lewis Y; Kapustin, Yuri; Khovayko, Oleg; Landsman, David; Lipman, David J; Madden, Thomas L; Maglott, Donna R; Ostell, James; Miller, Vadim; Pruitt, Kim D; Schuler, Gregory D; Sequeira, Edwin; Sherry, Steven T; Sirotkin, Karl; Souvorov, Alexandre; Starchenko, Grigory; Tatusov, Roman L; Tatusova, Tatiana A; Wagner, Lukas; Yaschenko, Eugene

2007-01-01

In addition to maintaining the GenBank nucleic acid sequence database, the National Center for Biotechnology Information (NCBI) provides analysis and retrieval resources for the data in GenBank and other biological data made available through NCBI's Web site. NCBI resources include Entrez, the Entrez Programming Utilities, My NCBI, PubMed, PubMed Central, Entrez Gene, the NCBI Taxonomy Browser, BLAST, BLAST Link(BLink), Electronic PCR, OrfFinder, Spidey, Splign, RefSeq, UniGene, HomoloGene, ProtEST, dbMHC, dbSNP, Cancer Chromosomes, Entrez Genome, Genome Project and related tools, the Trace and Assembly Archives, the Map Viewer, Model Maker, Evidence Viewer, Clusters of Orthologous Groups (COGs), Viral Genotyping Tools, Influenza Viral Resources, HIV-1/Human Protein Interaction Database, Gene Expression Omnibus (GEO), Entrez Probe, GENSAT, Online Mendelian Inheritance in Man (OMIM), Online Mendelian Inheritance in Animals (OMIA), the Molecular Modeling Database (MMDB), the Conserved Domain Database (CDD), the Conserved Domain Architecture Retrieval Tool (CDART) and the PubChem suite of small molecule databases. Augmenting many of the Web applications are custom implementations of the BLAST program optimized to search specialized data sets. These resources can be accessed through the NCBI home page at www.ncbi.nlm.nih.gov.

Database resources of the National Center for Biotechnology Information

PubMed Central

Wheeler, David L.; Barrett, Tanya; Benson, Dennis A.; Bryant, Stephen H.; Canese, Kathi; Chetvernin, Vyacheslav; Church, Deanna M.; DiCuccio, Michael; Edgar, Ron; Federhen, Scott; Feolo, Michael; Geer, Lewis Y.; Helmberg, Wolfgang; Kapustin, Yuri; Khovayko, Oleg; Landsman, David; Lipman, David J.; Madden, Thomas L.; Maglott, Donna R.; Miller, Vadim; Ostell, James; Pruitt, Kim D.; Schuler, Gregory D.; Shumway, Martin; Sequeira, Edwin; Sherry, Steven T.; Sirotkin, Karl; Souvorov, Alexandre; Starchenko, Grigory; Tatusov, Roman L.; Tatusova, Tatiana A.; Wagner, Lukas; Yaschenko, Eugene

2008-01-01

In addition to maintaining the GenBank(R) nucleic acid sequence database, the National Center for Biotechnology Information (NCBI) provides analysis and retrieval resources for the data in GenBank and other biological data available through NCBI's web site. NCBI resources include Entrez, the Entrez Programming Utilities, My NCBI, PubMed, PubMed Central, Entrez Gene, the NCBI Taxonomy Browser, BLAST, BLAST Link, Electronic PCR, OrfFinder, Spidey, Splign, RefSeq, UniGene, HomoloGene, ProtEST, dbMHC, dbSNP, Cancer Chromosomes, Entrez Genome, Genome Project and related tools, the Trace, Assembly, and Short Read Archives, the Map Viewer, Model Maker, Evidence Viewer, Clusters of Orthologous Groups, Influenza Viral Resources, HIV-1/Human Protein Interaction Database, Gene Expression Omnibus, Entrez Probe, GENSAT, Database of Genotype and Phenotype, Online Mendelian Inheritance in Man, Online Mendelian Inheritance in Animals, the Molecular Modeling Database, the Conserved Domain Database, the Conserved Domain Architecture Retrieval Tool and the PubChem suite of small molecule databases. Augmenting the web applications are custom implementations of the BLAST program optimized to search specialized data sets. These resources can be accessed through the NCBI home page at www.ncbi.nlm.nih.gov. PMID:18045790

Development of Electronic Resources across Networks in Thailand.

ERIC Educational Resources Information Center

Ratchatavorn, Phandao

2002-01-01

Discusses the development of electronic resources across library networks in Thailand to meet user needs, particularly electronic journals. Topics include concerns about journal access; limited budgets for library acquisitions of journals; and sharing resources through a centralized database system that allows Web access to journals via Internet…

Electronic Resource Management 2.0: Using Web 2.0 Technologies as Cost-Effective Alternatives to an Electronic Resource Management System

ERIC Educational Resources Information Center

Murray, Adam

2008-01-01

Designed to assist with the management of e-resources, electronic resource management (ERM) systems are time- and fund-consuming to purchase and maintain. Questions of system compatibility, data population, and workflow design/redesign can be difficult to answer; sometimes those answers are not what we'd prefer to hear. The two primary functions…

Why sub-Saharan Africa lags in electronic health record adoption and possible strategies to increase its adoption in this region

PubMed Central

Odekunle, Florence Femi; Odekunle, Raphael Oluseun; Shankar, Srinivasan

2017-01-01

Poor health information system has been identified as a major challenge in the health-care system in many developing countries including sub-Saharan African countries. Electronic health record (EHR) has been shown as an important tool to improve access to patient information with attendance improved quality of care. However, EHR has not been widely implemented/adopted in sub-Saharan Africa. This study sought to identify factors that affect the adoption of an EHR in sub-Saharan Africa and strategies to improve its adoption in this region. A comprehensive literature search was conducted on three electronic databases: PubMed, Medline, and Google Scholar. Articles of interest were those published in English that contained information on factors that limit the adoption of an EHR as well as strategies that improve its adoption in sub-Saharan African countries. The available evidence indicated that there were many factors that hindered the widespread adoption of an EHR in sub-Saharan Africa. These were high costs of procurement and maintenance of the EHR system, lack of financial incentives and priorities, poor electricity supply and internet connectivity, and primary user’s limited computer skills. However, strategies such as implementation planning, financial supports, appropriate EHR system selection, training of primary users, and the adoption of the phased implementation process have been identified to facilitate the use of an EHR. Wide adoption of an EHR in sub-Saharan Africa region requires a lot more effort than what is assumed because of the current poor level of technological development, lack of required computer skills, and limited resources. PMID:29085270

The electronic patient record: a strategic planning framework.

PubMed

Gordon, D B; Marafioti, S; Carter, M; Kunov, H; Dolan, A

1995-01-01

Sunnybrook Health Science Center (Sunnybrook) is a multifacility academic teaching center. In May 1994, Sunnybrook struck an electronic patient record taskforce to develop a strategic plan for the implementation of a comprehensive, facility wide electronic patient record (EPR). The taskforce sought to create a conceptual framework which provides context and integrates decision-making related to the comprehensive electronic patient record. The EPR is very much broader in scope than the traditional paper-based record. It is not restricted to simply reporting individual patient data. By the Institute of Medicine's definition, the electronic patient record resides in a system specifically designed to support users through availability of complete and accurate data, practitioner reminders and alerts, clinical decision support systems, links to bodies of medical knowledge, and other aids [1]. It is a comprehensive resource for patient care. The taskforce proposed a three domain model for determining how the EPR affects Sunnybrook. The EPR enables Sunnybrook to have a high performance team structure (domain 1), to function as an integrated organization (domain 2), and to reach out and develop new relationships with external organizations to become an extended enterprise (domain 3) [2]. Domain 1: Sunnybrook's high performance teams or patient service units' (PSUs) are decentralized, autonomous operating units that provide care to patients grouped by 'like' diagnosis and resource needs. The EPR must provide functions and applications which promote patient focused care, such as cross functional charting and care maps, group scheduling, clinical email, and a range of enabling technologies for multiskilled workers. Domain 2: In the integrated organization domain, the EPR should facilitate closer linkages between the arrangement of PSUs into clinical teams and with other facilities within the center in order to provide a longitudinal record that covers a continuum of care. Domain 3: In the inter-enterprise domain, the EPR must allow for patient information to be exchanged with external providers including referring doctors, laboratories, and other hospitals via community health information networks (CHINs). Sunnybrook will prioritize the development of first domain functionality within the corporate constraints imposed by the integrated organization domain. Inter-enterprise computing will be less of a priority until Sunnybrook has developed a critical mass of the electronic patient record internally. The three domain description is a useful model for describing the relationship between the electronic patient record enabling technologies and the Sunnybrook organizational structures. The taskforce has used this model to determine EPR development guidelines and implementation priorities.

Improving antiretroviral therapy adherence in resource-limited settings at scale: a discussion of interventions and recommendations.

PubMed

Haberer, Jessica E; Sabin, Lora; Amico, K Rivet; Orrell, Catherine; Galárraga, Omar; Tsai, Alexander C; Vreeman, Rachel C; Wilson, Ira; Sam-Agudu, Nadia A; Blaschke, Terrence F; Vrijens, Bernard; Mellins, Claude A; Remien, Robert H; Weiser, Sheri D; Lowenthal, Elizabeth; Stirratt, Michael J; Sow, Papa Salif; Thomas, Bruce; Ford, Nathan; Mills, Edward; Lester, Richard; Nachega, Jean B; Bwana, Bosco Mwebesa; Ssewamala, Fred; Mbuagbaw, Lawrence; Munderi, Paula; Geng, Elvin; Bangsberg, David R

2017-01-01

Introduction : Successful population-level antiretroviral therapy (ART) adherence will be necessary to realize both the clinical and prevention benefits of antiretroviral scale-up and, ultimately, the end of AIDS. Although many people living with HIV are adhering well, others struggle and most are likely to experience challenges in adherence that may threaten virologic suppression at some point during lifelong therapy. Despite the importance of ART adherence, supportive interventions have generally not been implemented at scale. The objective of this review is to summarize the recommendations of clinical, research, and public health experts for scalable ART adherence interventions in resource-limited settings. Methods : In July 2015, the Bill and Melinda Gates Foundation convened a meeting to discuss the most promising ART adherence interventions for use at scale in resource-limited settings. This article summarizes that discussion with recent updates. It is not a systematic review, but rather provides practical considerations for programme implementation based on evidence from individual studies, systematic reviews, meta-analyses, and the World Health Organization Consolidated Guidelines for HIV, which include evidence from randomized controlled trials in low- and middle-income countries. Interventions are categorized broadly as education and counselling; information and communication technology-enhanced solutions; healthcare delivery restructuring; and economic incentives and social protection interventions. Each category is discussed, including descriptions of interventions, current evidence for effectiveness, and what appears promising for the near future. Approaches to intervention implementation and impact assessment are then described. Results and discussion : The evidence base is promising for currently available, effective, and scalable ART adherence interventions for resource-limited settings. Numerous interventions build on existing health care infrastructure and leverage available resources. Those most widely studied and implemented to date involve peer counselling, adherence clubs, and short message service (SMS). Many additional interventions could have an important impact on ART adherence with further development, including standardized counselling through multi-media technology, electronic dose monitoring, decentralized and differentiated models of care, and livelihood interventions. Optimal targeting and tailoring of interventions will require improved adherence measurement. Conclusions : The opportunity exists today to address and resolve many of the challenges to effective ART adherence, so that they do not limit the potential of ART to help bring about the end of AIDS.

Shaping the Electronic Library--The UW-Madison Approach.

ERIC Educational Resources Information Center

Dean, Charles W., Ed.; Frazier, Ken; Pope, Nolan F.; Gorman, Peter C.; Dentinger, Sue; Boston, Jeanne; Phillips, Hugh; Daggett, Steven C.; Lundquist, Mitch; McClung, Mark; Riley, Curran; Allan, Craig; Waugh, David

1998-01-01

This special theme section describes the University of Wisconsin-Madison's experience building its Electronic Library. Highlights include integrating resources and services; the administrative framework; the public electronic library, including electronic publishing capability and access to World Wide Web-based and other electronic resources;…

Melinda – A custom search engine that provides access to locally-developed content using the HL7 Infobutton standard

PubMed Central

Wan, Yik-Ki J.; Staes, Catherine J.

2016-01-01

Healthcare organizations use care pathways to standardize care, but once developed, adoption rates often remain low. One challenge for usage concerns clinicians’ difficulty in accessing guidance when it is most needed. Although the HL7 ‘Infobutton Standard’ allows clinicians easier access to external references, access to locally-developed resources often requires clinicians to deviate from their normal electronic health record (EHR) workflow to use another application. To address this gap between internal and external resources, we reviewed the literature and existing practices at the University of Utah Health Care. We identify the requirements to meet the needs of a healthcare enterprise and clinicians, describe the design and development of a prototype to aggregate both internal and external resources from within or outside the EHR, and evaluated strengths and limitations of the prototype. The system is functional but not implemented in a live EHR environment. We suggest next steps and enhancements. PMID:28269964

Prototype of a Standards-Based EHR and Genetic Test Reporting Tool Coupled with HL7-Compliant Infobuttons

PubMed Central

Crump, Jacob K.; Del Fiol, Guilherme; Williams, Marc S.; Freimuth, Robert R.

2018-01-01

Integration of genetic information is becoming increasingly important in clinical practice. However, genetic information is often ambiguous and difficult to understand, and clinicians have reported low-self-efficacy in integrating genetics into their care routine. The Health Level Seven (HL7) Infobutton standard helps to integrate online knowledge resources within Electronic Health Records (EHRs) and is required for EHR certification in the US. We implemented a prototype of a standards-based genetic reporting application coupled with infobuttons leveraging the Infobutton and Fast Healthcare Interoperability Resources (FHIR) Standards. Infobutton capabilities were provided by Open Infobutton, an open source package compliant with the HL7 Infobutton Standard. The resulting prototype demonstrates how standards-based reporting of genetic results, coupled with curated knowledge resources, can provide dynamic access to clinical knowledge on demand at the point of care. The proposed functionality can be enabled within any EHR system that has been certified through the US Meaningful Use program.

Building and Managing Electronic Resources in Digital Era in India with Special Reference to IUCAA and NIV, Pune: A Comparative Case Study

NASA Astrophysics Data System (ADS)

Sahu, H. K.; Singh, S. N.

2015-04-01

This paper discusses and presents a comparative case study of two libraries in Pune, India, Inter-University Centre for Astronomy and Astrophysics and Information Centre and Library of National Institute of Virology (Indian Council of Medical Research). It compares how both libraries have managed their e-resource collections, including acquisitions, subscriptions, and consortia arrangements, while also developing a collection of their own resources, including pre-prints and publications, video lectures, and other materials in an institutional repository. This study illustrates how difficult it is to manage electronic resources in a developing country like India, even though electronic resources are used more than print resources. Electronic resource management can be daunting, but with a systematic approach, various problems can be solved, and use of the materials will be enhanced.

Implementing partnership-driven clinical federated electronic health record data sharing networks.

PubMed

Stephens, Kari A; Anderson, Nicholas; Lin, Ching-Ping; Estiri, Hossein

2016-09-01

Building federated data sharing architectures requires supporting a range of data owners, effective and validated semantic alignment between data resources, and consistent focus on end-users. Establishing these resources requires development methodologies that support internal validation of data extraction and translation processes, sustaining meaningful partnerships, and delivering clear and measurable system utility. We describe findings from two federated data sharing case examples that detail critical factors, shared outcomes, and production environment results. Two federated data sharing pilot architectures developed to support network-based research associated with the University of Washington's Institute of Translational Health Sciences provided the basis for the findings. A spiral model for implementation and evaluation was used to structure iterations of development and support knowledge share between the two network development teams, which cross collaborated to support and manage common stages. We found that using a spiral model of software development and multiple cycles of iteration was effective in achieving early network design goals. Both networks required time and resource intensive efforts to establish a trusted environment to create the data sharing architectures. Both networks were challenged by the need for adaptive use cases to define and test utility. An iterative cyclical model of development provided a process for developing trust with data partners and refining the design, and supported measureable success in the development of new federated data sharing architectures. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

eC3—A Modern Telecommunications Matrix for Cervical Cancer Prevention in Zambia

PubMed Central

Parham, Groesbeck P.; Mwanahamuntu, Mulindi H.; Pfaendler, Krista S.; Sahasrabuddhe, Vikrant V.; Myung, Daniel; Mkumba, Gracilia; Kapambwe, Sharon; Mwanza, Bianca; Chibwesha, Carla; Hicks, Michael L.; Stringer, Jeffrey S.A.

2013-01-01

Objectives Low physician density, undercapacitated laboratory infrastructures, and limited resources are major limitations to the development and implementation of widely accessible cervical cancer prevention programs in sub-Saharan Africa. Materials and Methods We developed a system operated by nonphysician health providers that used widely available and affordable communication technology to create locally adaptable and sustainable public sector cervical cancer prevention program in Zambia, one of the world’s poorest countries. Results Nurses were trained to perform visual inspection with acetic acid aided by digital cervicography using predefined criteria. Electronic digital images (cervigrams) were reviewed with patients, and distance consultation was sought as necessary. Same-visit cryotherapy or referral for further evaluation by a gynecologist was offered. The Zambian system of “electronic cervical cancer control” bypasses many of the historic barriers to the delivery of preventive health care to women in low-resource environments while facilitating monitoring, evaluation, and continued education of primary health care providers, patient education, and medical records documentation. Conclusions The electronic cervical cancer control system uses appropriate technology to bridge the gap between screening and diagnosis, thereby facilitating the conduct of “screen-and-treat” programs. The inherent flexibility of the system lends itself to the integration with future infrastructures using rapid molecular human papillomavirus–based screening approaches and wireless telemedicine communications. PMID:20592550

Developing Humanities Collections in the Digital Age: Exploring Humanities Faculty Engagement with Electronic and Print Resources

ERIC Educational Resources Information Center

Kachaluba, Sarah Buck; Brady, Jessica Evans; Critten, Jessica

2014-01-01

This article is based on quantitative and qualitative research examining humanities scholars' understandings of the advantages and disadvantages of print versus electronic information resources. It explores how humanities' faculty members at Florida State University (FSU) use print and electronic resources, as well as how they perceive these…

Using a Decision Grid Process to Build Consensus in Electronic Resources Cancellation Decisions

ERIC Educational Resources Information Center

Foudy, Gerri; McManus, Alesia

2005-01-01

Many libraries are expending an increasing part of their collections budgets on electronic resources. At the same time many libraries, especially those which are state funded, face diminishing budgets and high rates of inflation for serials subscriptions in all formats, including electronic resources. Therefore, many libraries need to develop ways…

Human Resource Development Issues in the Implementation of the Western China Development Strategy

ERIC Educational Resources Information Center

Xiao, Mingzheng

2007-01-01

This paper systematically illustrates the value and role of human resource development in the implementation of the Western China development strategy. It analyzes in details some current human resource issues constraining the implementation of the Western China development strategy and those on the sustainable development process of economic…

An Untapped Resource: Patient and Public Involvement in Implementation Comment on "Knowledge Mobilization in Healthcare Organizations: A View From the Resource-Based View of the Firm".

PubMed

Burton, Christopher; Rycroft-Malone, Jo

2015-08-07

This commentary considers the potential role of patient and public involvement in implementation. Developing an analytical thread from the resource-based view of the Firm, we argue that this involvement may create unique resources that have the capacity to enhance the impact of implementation activity for healthcare organisations. © 2015 by Kerman University of Medical Sciences.

VLSI neuroprocessors

NASA Technical Reports Server (NTRS)

Kemeny, Sabrina E.

1994-01-01

Electronic and optoelectronic hardware implementations of highly parallel computing architectures address several ill-defined and/or computation-intensive problems not easily solved by conventional computing techniques. The concurrent processing architectures developed are derived from a variety of advanced computing paradigms including neural network models, fuzzy logic, and cellular automata. Hardware implementation technologies range from state-of-the-art digital/analog custom-VLSI to advanced optoelectronic devices such as computer-generated holograms and e-beam fabricated Dammann gratings. JPL's concurrent processing devices group has developed a broad technology base in hardware implementable parallel algorithms, low-power and high-speed VLSI designs and building block VLSI chips, leading to application-specific high-performance embeddable processors. Application areas include high throughput map-data classification using feedforward neural networks, terrain based tactical movement planner using cellular automata, resource optimization (weapon-target assignment) using a multidimensional feedback network with lateral inhibition, and classification of rocks using an inner-product scheme on thematic mapper data. In addition to addressing specific functional needs of DOD and NASA, the JPL-developed concurrent processing device technology is also being customized for a variety of commercial applications (in collaboration with industrial partners), and is being transferred to U.S. industries. This viewgraph p resentation focuses on two application-specific processors which solve the computation intensive tasks of resource allocation (weapon-target assignment) and terrain based tactical movement planning using two extremely different topologies. Resource allocation is implemented as an asynchronous analog competitive assignment architecture inspired by the Hopfield network. Hardware realization leads to a two to four order of magnitude speed-up over conventional techniques and enables multiple assignments, (many to many), not achievable with standard statistical approaches. Tactical movement planning (finding the best path from A to B) is accomplished with a digital two-dimensional concurrent processor array. By exploiting the natural parallel decomposition of the problem in silicon, a four order of magnitude speed-up over optimized software approaches has been demonstrated.

Improving rates of cotrimoxazole prophylaxis in resource-limited settings: implementation of a quality improvement approach.

PubMed

Bardfield, J; Agins, B; Palumbo, M; Wei, A L; Morris, J; Marston, B

2014-12-01

To demonstrate the effectiveness of quality improvement methods to monitor and improve administration of cotrimoxazole (CTX) prophylaxis to improve health outcomes among adults living with HIV/AIDS in low resource countries. Program evaluation. HIV/AIDS health care facilities in Uganda, Mozambique, Namibia and Haiti. Performance measures based on national guidelines are developed in each country. These may include CD4 monitoring, ART adherence and uptake of CTX prophylaxis. CTX prophylaxis is routinely selected, because it has been shown to reduce HIV-related morbidity and mortality. Patient records are sampled using a standard statistical table to achieve a minimum confidence interval of 90% with a spread of ±8% in participating clinics. If an electronic medical record is available, all patients are reviewed. Routine review of performance measures, usually every 6 months, is conducted to identify gaps in care. Improvement interventions are developed and implemented at health facilities, informed by performance results, and local/national public health priorities. Median clinic rates of CTX prophylaxis. Median performance rates of CTX prophylaxis generally improved for adult HIV+ patients between 2006 and 2013 across countries, with median clinic rates higher than baseline at follow-up in 16 of 18 groups of clinics implementing CTX -focused improvement projects. Quality management offers a data-driven method to improve the quality of HIV care in low resource countries. Application of improvement principles has been shown to be effective to increase the rates of CTX prophylaxis in national HIV programs in multiple countries. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Implementing clinical guidelines for chronic obstructive pulmonary disease: barriers and solutions

PubMed Central

Overington, Jeff D.; Huang, Yao C.; Abramson, Michael J.; Brown, Juliet L.; Goddard, John R.; Bowman, Rayleen V.; Fong, Kwun M.

2014-01-01

Chronic obstructive pulmonary disease (COPD) is a complex chronic lung disease characterised by progressive fixed airflow limitation and acute exacerbations that frequently require hospitalisation. Evidence-based clinical guidelines for the diagnosis and management of COPD are now widely available. However, the uptake of these COPD guidelines in clinical practice is highly variable, as is the case for many other chronic disease guidelines. Studies have identified many barriers to implementation of COPD and other guidelines, including factors such as lack of familiarity with guidelines amongst clinicians and inadequate implementation programs. Several methods for enhancing adherence to clinical practice guidelines have been evaluated, including distribution methods, professional education sessions, electronic health records (EHR), point of care reminders and computer decision support systems (CDSS). Results of these studies are mixed to date, and the most effective ways to implement clinical practice guidelines remain unclear. Given the significant resources dedicated to evidence-based medicine, effective dissemination and implementation of best practice at the patient level is an important final step in the process of guideline development. Future efforts should focus on identifying optimal methods for translating the evidence into everyday clinical practice to ensure that patients receive the best care. PMID:25478199

Urban family physician plan in Iran: challenges of implementation in Kerman

PubMed Central

Dehnavieh, Reza; Kalantari, Ali Reza; Jafari Sirizi, Mohammad

2015-01-01

Background: The Family Physician Plan has recently been implemented in three provinces of Iran on a pilot basis and is going to be implemented throughout Iran in the future. Through a qualitative design, this study aims to determine probable implementation challenges of Family Physician Plan in Kerman. Methods: This study was conducted in Kerman in 2013. Data were collected through interviews with 21 experts in the field. Sampling continued until data saturation level was achieved. All interviews were recorded and then analyzed, and main themes and subgroups were extracted from them based on a framework analysis model. Results: most prevalent establishment challenges of Family Physician Plan were classified into policy-making, financial supply, laws and resources. Conclusion: The urban Family Physician Plan can be carried out more effectively by implementing this plan step by step, highlighting the relationships between the related organizations, using new payment mechanisms e.g Per Capita, DRG, make national commitment and proper educational programs for providers, development the health electronic Record, justifying providers and community about advantages of this plan, clarifying regulatory status about providers' Duties and most importantly considering a specific funding source. PMID:26913266

The utilization of poisons information resources in Australasia.

PubMed

Fountain, J S; Reith, D M; Holt, A

2014-02-01

To identify poisons information resources most commonly utilized by Australasian Emergency Department staff, and examine attitudes regarding the benefits and user experience of the electronic products used. A survey tool was mailed to six Emergency Departments each in New Zealand and Australia to be answered by medical and nursing staff. Eighty six (71.7%) responses were received from the 120 survey forms sent: 70 (81%) responders were medical staff, the remainder nursing. Electronic resources were the most accessed poisons information resource in New Zealand; Australians preferring discussion with a colleague; Poisons Information Centers were the least utilized resource in both countries. With regard to electronic resources, further differences were recognized between countries in: ease of access, ease of use, quality of information and quantity of information, with New Zealand better in all four themes. New Zealand ED staff favored electronic poisons information resources while Australians preferred discussion with a colleague. That Poisons Information Centers were the least utilized resource was surprising. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Computational investigation and experimental considerations for the classical implementation of a full adder on SO2 by optical pump-probe schemes.

PubMed

Bomble, L; Lavorel, B; Remacle, F; Desouter-Lecomte, M

2008-05-21

Following the scheme recently proposed by Remacle and Levine [Phys. Rev. A 73, 033820 (2006)], we investigate the concrete implementation of a classical full adder on two electronic states (X 1A1 and C 1B2) of the SO2 molecule by optical pump-probe laser pulses using intuitive and counterintuitive (stimulated Raman adiabatic passage) excitation schemes. The resources needed for providing the inputs and reading out are discussed, as well as the conditions for achieving robustness in both the intuitive and counterintuitive pump-dump sequences. The fidelity of the scheme is analyzed with respect to experimental noise and two kinds of perturbations: The coupling to the neighboring rovibrational states and a finite rotational temperature that leads to a mixture for the initial state. It is shown that the logic processing of a full addition cycle can be realistically experimentally implemented on a picosecond time scale while the readout takes a few nanoseconds.

Analog synthetic biology.

PubMed

Sarpeshkar, R

2014-03-28

We analyse the pros and cons of analog versus digital computation in living cells. Our analysis is based on fundamental laws of noise in gene and protein expression, which set limits on the energy, time, space, molecular count and part-count resources needed to compute at a given level of precision. We conclude that analog computation is significantly more efficient in its use of resources than deterministic digital computation even at relatively high levels of precision in the cell. Based on this analysis, we conclude that synthetic biology must use analog, collective analog, probabilistic and hybrid analog-digital computational approaches; otherwise, even relatively simple synthetic computations in cells such as addition will exceed energy and molecular-count budgets. We present schematics for efficiently representing analog DNA-protein computation in cells. Analog electronic flow in subthreshold transistors and analog molecular flux in chemical reactions obey Boltzmann exponential laws of thermodynamics and are described by astoundingly similar logarithmic electrochemical potentials. Therefore, cytomorphic circuits can help to map circuit designs between electronic and biochemical domains. We review recent work that uses positive-feedback linearization circuits to architect wide-dynamic-range logarithmic analog computation in Escherichia coli using three transcription factors, nearly two orders of magnitude more efficient in parts than prior digital implementations.

Analog synthetic biology

PubMed Central

Sarpeshkar, R.

2014-01-01

We analyse the pros and cons of analog versus digital computation in living cells. Our analysis is based on fundamental laws of noise in gene and protein expression, which set limits on the energy, time, space, molecular count and part-count resources needed to compute at a given level of precision. We conclude that analog computation is significantly more efficient in its use of resources than deterministic digital computation even at relatively high levels of precision in the cell. Based on this analysis, we conclude that synthetic biology must use analog, collective analog, probabilistic and hybrid analog–digital computational approaches; otherwise, even relatively simple synthetic computations in cells such as addition will exceed energy and molecular-count budgets. We present schematics for efficiently representing analog DNA–protein computation in cells. Analog electronic flow in subthreshold transistors and analog molecular flux in chemical reactions obey Boltzmann exponential laws of thermodynamics and are described by astoundingly similar logarithmic electrochemical potentials. Therefore, cytomorphic circuits can help to map circuit designs between electronic and biochemical domains. We review recent work that uses positive-feedback linearization circuits to architect wide-dynamic-range logarithmic analog computation in Escherichia coli using three transcription factors, nearly two orders of magnitude more efficient in parts than prior digital implementations. PMID:24567476

Checklist Manifesto for Electronic Resources: Getting Ready for the Fiscal Year and Beyond

ERIC Educational Resources Information Center

England, Lenore; Fu, Li; Miller, Stephen

2011-01-01

Organization of electronic resources workflow is critical in the increasingly complicated and complex world of library management. A simple organizational tool that can be readily applied to electronic resources management (ERM) is the use of checklists. Based on the principles discussed in The Checklist Manifesto: How to Get Things Right, the…

Comparing Public and Private Institutions That Have and Have Not Implemented Enterprise Resource Planning (ERP) Systems: A Resource Dependence Perspective

ERIC Educational Resources Information Center

Sendhil, Geetha R.

2012-01-01

The purpose of this national study was to utilize quantitative methods to examine institutional characteristics, financial resource variables, personnel variables, and customer variables of public and private institutions that have and have not implemented enterprise resource planning (ERP) systems, from a resource dependence perspective.…

E-waste management and resources recovery in France.

PubMed

Vadoudi, Kiyan; Kim, Junbeum; Laratte, Bertrand; Lee, Seung-Jin; Troussier, Nadège

2015-10-01

There are various issues of concern regarding electronic waste management, such as the toxicity of hazardous materials and the collection, recycling and recovery of useful resources. To understand the fate of electronic waste after collection and recycling, a products and materials flow analysis should be performed. This is a critical need, as material resources are becoming increasingly scarce and recycling may be able to provide secondary sources for new materials in the future. In this study, we investigate electronic waste systems, specifically the resource recovery or recycling aspects, as well as mapping electronic waste flows based on collection data in France. Approximately 1,588,453 t of new electrical and electronic equipment were sold in the French market in 2010. Of this amount, 430,000 t of electronic waste were collected, with the remaining 1,128,444 t remaining in stock. Furthermore, the total recycled amounts were 354,106 t and 11,396 t, respectively. The main electronic waste materials were ferrous metals (37%), plastic (22%), aluminium (12%), copper (11%) and glass (7%). This study will contribute to developing sustainable electronic waste and resource recycling systems in France. © The Author(s) 2015.

Design and implementation of a hospital-based usability laboratory: insights from a Department of Veterans Affairs laboratory for health information technology.

PubMed

Russ, Alissa L; Weiner, Michael; Russell, Scott A; Baker, Darrell A; Fahner, W Jeffrey; Saleem, Jason J

2012-12-01

Although the potential benefits of more usable health information technologies (HIT) are substantial-reduced HIT support costs, increased work efficiency, and improved patient safety--human factors methods to improve usability are rarely employed. The US Department of Veterans Affairs (VA) has emerged as an early leader in establishing usability laboratories to inform the design of HIT, including its electronic health record. Experience with a usability laboratory at a VA Medical Center provides insights on how to design, implement, and leverage usability laboratories in the health care setting. The VA Health Services Research and Development Service Human-Computer Interaction & Simulation Laboratory emerged as one of the first VA usability laboratories and was intended to provide research-based findings about HIT designs. This laboratory supports rapid prototyping, formal usability testing, and analysis tools to assess existing technologies, alternative designs, and potential future technologies. RESULTS OF IMPLEMENTATION: Although the laboratory has maintained a research focus, it has become increasingly integrated with VA operations, both within the medical center and on a national VA level. With this resource, data-driven recommendations have been provided for the design of HIT applications before and after implementation. The demand for usability testing of HIT is increasing, and information on how to develop usability laboratories for the health care setting is often needed. This article may assist other health care organizations that want to invest in usability resources to improve HIT. The establishment and utilization of usability laboratories in the health care setting may improve HIT designs and promote safe, high-quality care for patients.

18 CFR 390.1 - Electronic registration.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 18 Conservation of Power and Water Resources 1 2013-04-01 2013-04-01 false Electronic registration. 390.1 Section 390.1 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY PROCEDURAL RULES ELECTRONIC REGISTRATION § 390.1 Electronic registration. Any person who...

18 CFR 390.1 - Electronic registration.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 18 Conservation of Power and Water Resources 1 2011-04-01 2011-04-01 false Electronic registration. 390.1 Section 390.1 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY PROCEDURAL RULES ELECTRONIC REGISTRATION § 390.1 Electronic registration. Any person who...

18 CFR 390.1 - Electronic registration.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Electronic registration. 390.1 Section 390.1 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY PROCEDURAL RULES ELECTRONIC REGISTRATION § 390.1 Electronic registration. Any person who...

18 CFR 390.1 - Electronic registration.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 18 Conservation of Power and Water Resources 1 2014-04-01 2014-04-01 false Electronic registration. 390.1 Section 390.1 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY PROCEDURAL RULES ELECTRONIC REGISTRATION § 390.1 Electronic registration. Any person who...

18 CFR 390.1 - Electronic registration.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 18 Conservation of Power and Water Resources 1 2012-04-01 2012-04-01 false Electronic registration. 390.1 Section 390.1 Conservation of Power and Water Resources FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY PROCEDURAL RULES ELECTRONIC REGISTRATION § 390.1 Electronic registration. Any person who...

Accelerating electron tomography reconstruction algorithm ICON with GPU.

PubMed

Chen, Yu; Wang, Zihao; Zhang, Jingrong; Li, Lun; Wan, Xiaohua; Sun, Fei; Zhang, Fa

2017-01-01

Electron tomography (ET) plays an important role in studying in situ cell ultrastructure in three-dimensional space. Due to limited tilt angles, ET reconstruction always suffers from the "missing wedge" problem. With a validation procedure, iterative compressed-sensing optimized NUFFT reconstruction (ICON) demonstrates its power in the restoration of validated missing information for low SNR biological ET dataset. However, the huge computational demand has become a major problem for the application of ICON. In this work, we analyzed the framework of ICON and classified the operations of major steps of ICON reconstruction into three types. Accordingly, we designed parallel strategies and implemented them on graphics processing units (GPU) to generate a parallel program ICON-GPU. With high accuracy, ICON-GPU has a great acceleration compared to its CPU version, up to 83.7×, greatly relieving ICON's dependence on computing resource.

Translating 10 lessons from lean six sigma project in paper-based training site to electronic health record-based primary care practice: challenges and opportunities.

PubMed

Aleem, Sohaib

2013-01-01

Lean Six Sigma is a well-proven methodology to enhance the performance of any business, including health care. The strategy focuses on cutting out waste and variation from the processes to improve the value and efficiency of work. This article walks through the journey of "green belt" training using a Lean Six Sigma approach and the implementation of a process improvement project that focused on wait time for patients to be examined in an urban academic primary care clinic without requiring added resources. Experiences of the training and the project at an urban paper-based satellite clinic have informed the planning efforts of a data and performance team, including implementing a 15-minute nurse "pre-visit" at primary care sites of an accountable care organization.

Lessons learned from implementing service-oriented clinical decision support at four sites: A qualitative study.

PubMed

Wright, Adam; Sittig, Dean F; Ash, Joan S; Erickson, Jessica L; Hickman, Trang T; Paterno, Marilyn; Gebhardt, Eric; McMullen, Carmit; Tsurikova, Ruslana; Dixon, Brian E; Fraser, Greg; Simonaitis, Linas; Sonnenberg, Frank A; Middleton, Blackford

2015-11-01

To identify challenges, lessons learned and best practices for service-oriented clinical decision support, based on the results of the Clinical Decision Support Consortium, a multi-site study which developed, implemented and evaluated clinical decision support services in a diverse range of electronic health records. Ethnographic investigation using the rapid assessment process, a procedure for agile qualitative data collection and analysis, including clinical observation, system demonstrations and analysis and 91 interviews. We identified challenges and lessons learned in eight dimensions: (1) hardware and software computing infrastructure, (2) clinical content, (3) human-computer interface, (4) people, (5) workflow and communication, (6) internal organizational policies, procedures, environment and culture, (7) external rules, regulations, and pressures and (8) system measurement and monitoring. Key challenges included performance issues (particularly related to data retrieval), differences in terminologies used across sites, workflow variability and the need for a legal framework. Based on the challenges and lessons learned, we identified eight best practices for developers and implementers of service-oriented clinical decision support: (1) optimize performance, or make asynchronous calls, (2) be liberal in what you accept (particularly for terminology), (3) foster clinical transparency, (4) develop a legal framework, (5) support a flexible front-end, (6) dedicate human resources, (7) support peer-to-peer communication, (8) improve standards. The Clinical Decision Support Consortium successfully developed a clinical decision support service and implemented it in four different electronic health records and four diverse clinical sites; however, the process was arduous. The lessons identified by the Consortium may be useful for other developers and implementers of clinical decision support services. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Determining the level of awareness of the physicians in using the variety of electronic information resources and the effecting factors.

PubMed

Papi, Ahmad; Ghazavi, Roghayeh; Moradi, Salimeh

2015-01-01

Understanding of the medical society's from the types of information resources for quick and easy access to information is an imperative task in medical researches and management of the treatment. The present study was aimed to determine the level of awareness of the physicians in using various electronic information resources and the factors affecting it. This study was a descriptive survey. The data collection tool was a researcher-made questionnaire. The study population included all the physicians and specialty physicians of the teaching hospitals affiliated to Isfahan University of Medical Sciences and numbered 350. The sample size based on Morgan's formula was set at 180. The content validity of the tool was confirmed by the library and information professionals and the reliability was 95%. Descriptive statistics were used including the SPSS software version 19. On reviewing the need of the physicians to obtain the information on several occasions, the need for information in conducting the researches was reported by the maximum number of physicians (91.9%) and the usage of information resources, especially the electronic resources, formed 65.4% as the highest rate with regard to meeting the information needs of the physicians. Among the electronic information databases, the maximum awareness was related to Medline with 86.5%. Among the various electronic information resources, the highest awareness (43.3%) was related to the E-journals. The highest usage (36%) was also from the same source. The studied physicians considered the most effective deterrent in the use of electronic information resources as being too busy and lack of time. Despite the importance of electronic information resources for the physician's community, there was no comprehensive knowledge of these resources. This can lead to less usage of these resources. Therefore, careful planning is necessary in the hospital libraries in order to introduce the facilities and full capabilities of the mentioned resources and methods of information retrieval.

Implementing Electronic Data Interchange (EDI) with Small Business Suppliers in the Pre-Award Acquisition Process

DTIC Science & Technology

1993-06-01

initiative " Electronic Commerce through EDI." Consistent with the DoD initiative to implement EDI with industry, participation of small businesses in the pre...paperwork associated with the pre-award acquisition process, electronic commerce is being integrated with EDI through electronic bulletin boards...This thesis will explore the issues surrounding DoD’s successfully implementing the use of Electronic Commerce / Electronic Data Interchange (EC/EDI

Toward an integrated computerized patient record.

PubMed

Dole, T R; Luberti, A A

2000-04-01

Developing a comprehensive electronic medical record system to serve ambulatory care providers in a large health care enterprise requires significant time and resources. One approach to achieving this system is to devise a series of short-term, workable solutions until a complete system is designed and implemented. The initial solution introduced a basic (mini) medical record system that provided an automated problem/summary sheet and decentralization of ambulatory-based medical records. The next step was to partner with an information system vendor committed to continued development of the long-term system capable of supporting the health care organization well into the future.

Smart homes for people with neurological disability: state of the art.

PubMed

Gentry, Tony

2009-01-01

Smart home technology can include environmental adaptations that allow remote control of home appliances, electronic communication, safety monitoring and automated task cueing, any of which may prove useful for people with neurological disability. This article outlines currently available smart home technologies, examines the burgeoning research in this area, discusses clinical and consumer resources and reviews ethical, funding and professional training considerations for smart home applications. I conclude that more outcomes-based research and collaboration among stakeholders is essential in order to establish guidance for designing, selecting and implementing individualized smart home solutions for those with neurological disability.

Characteristics and critical success factors for implementing problem-based learning in a human resource-constrained country.

PubMed

Giva, Karen R N; Duma, Sinegugu E

2015-08-31

Problem-based learning (PBL) was introduced in Malawi in 2002 in order to improve the nursing education system and respond to the acute nursing human resources shortage. However, its implementation has been very slow throughout the country. The objectives of the study were to explore and describe the goals that were identified by the college to facilitate the implementation of PBL, the resources of the organisation that facilitated the implementation of PBL, the factors related to sources of students that facilitated the implementation of PBL, and the influence of the external system of the organisation on facilitating the implementation of PBL, and to identify critical success factors that could guide the implementation of PBL in nursing education in Malawi. This is an ethnographic, exploratory and descriptive qualitative case study. Purposive sampling was employed to select the nursing college, participants and documents for review.Three data collection methods, including semi-structured interviews, participant observation and document reviews, were used to collect data. The four steps of thematic analysis were used to analyse data from all three sources. Four themes and related subthemes emerged from the triangulated data sources. The first three themes and their subthemes are related to the characteristics related to successful implementation of PBL in a human resource-constrained nursing college, whilst the last theme is related to critical success factors that contribute to successful implementation of PBL in a human resource-constrained country like Malawi. This article shows that implementation of PBL is possible in a human resource-constrained country if there is political commitment and support.

The Relevancy of Graduate Curriculum to Human Resource Professionals' Electronic Communication.

ERIC Educational Resources Information Center

Hoell, Robert C.; Henry, Gordon O.

2003-01-01

Electronic communications of human resource professionals and the content of 23 university human resource management courses were categorized using the Human Resource Certification Institute's body of knowledge. Differences between proportion of topics discussed and topics covered in curricula suggest some topics are over- or undertaught.…

Electronic Information Standards to Support Obesity Prevention and Bridge Services Across Systems, 2010-2015.

PubMed

Wiltz, Jennifer L; Blanck, Heidi M; Lee, Brian; Kocot, S Lawrence; Seeff, Laura; McGuire, Lisa C; Collins, Janet

2017-10-26

Electronic information technology standards facilitate high-quality, uniform collection of data for improved delivery and measurement of health care services. Electronic information standards also aid information exchange between secure systems that link health care and public health for better coordination of patient care and better-informed population health improvement activities. We developed international data standards for healthy weight that provide common definitions for electronic information technology. The standards capture healthy weight data on the "ABCDs" of a visit to a health care provider that addresses initial obesity prevention and care: assessment, behaviors, continuity, identify resources, and set goals. The process of creating healthy weight standards consisted of identifying needs and priorities, developing and harmonizing standards, testing the exchange of data messages, and demonstrating use-cases. Healthy weight products include 2 message standards, 5 use-cases, 31 LOINC (Logical Observation Identifiers Names and Codes) question codes, 7 healthy weight value sets, 15 public-private engagements with health information technology implementers, and 2 technical guides. A logic model and action steps outline activities toward better data capture, interoperable systems, and information use. Sharing experiences and leveraging this work in the context of broader priorities can inform the development of electronic information standards for similar core conditions and guide strategic activities in electronic systems.

Electronic Information Standards to Support Obesity Prevention and Bridge Services Across Systems, 2010–2015

PubMed Central

Blanck, Heidi M.; Lee, Brian; Kocot, S. Lawrence; Seeff, Laura; McGuire, Lisa C.; Collins, Janet

2017-01-01

Electronic information technology standards facilitate high-quality, uniform collection of data for improved delivery and measurement of health care services. Electronic information standards also aid information exchange between secure systems that link health care and public health for better coordination of patient care and better-informed population health improvement activities. We developed international data standards for healthy weight that provide common definitions for electronic information technology. The standards capture healthy weight data on the “ABCDs” of a visit to a health care provider that addresses initial obesity prevention and care: assessment, behaviors, continuity, identify resources, and set goals. The process of creating healthy weight standards consisted of identifying needs and priorities, developing and harmonizing standards, testing the exchange of data messages, and demonstrating use-cases. Healthy weight products include 2 message standards, 5 use-cases, 31 LOINC (Logical Observation Identifiers Names and Codes) question codes, 7 healthy weight value sets, 15 public–private engagements with health information technology implementers, and 2 technical guides. A logic model and action steps outline activities toward better data capture, interoperable systems, and information use. Sharing experiences and leveraging this work in the context of broader priorities can inform the development of electronic information standards for similar core conditions and guide strategic activities in electronic systems. PMID:29072985

Availability, Level of Use and Constraints to Use of Electronic Resources by Law Lecturers in Public Universities in Nigeria

ERIC Educational Resources Information Center

Amusa, Oyintola Isiaka; Atinmo, Morayo

2016-01-01

(Purpose) This study surveyed the level of availability, use and constraints to use of electronic resources among law lecturers in Nigeria. (Methodology) Five hundred and fifty-two law lecturers were surveyed and four hundred and forty-two responded. (Results) Data analysis revealed that the level of availability of electronic resources for the…

Effective Knowledge Development in Secondary Schools Educational Level in Contemporary Information Age: Assessment of Availability of Electronic Information Resources in Nigerian School Libraries

ERIC Educational Resources Information Center

Bello, Stephen Adeyemi; Ojo, Funmilayo Roseline; Ocheje, Charles Bala

2015-01-01

Relevant electronic information resources in contemporary information age are necessity to buttress teaching and learning for effective knowledge development in educational institutions. The purpose of the study is to know the state of availability of electronic information resources in government owned secondary school libraries in Ijumu Local…

Are the resources adoptive for conducting team-based diabetes management clinics? An explorative study at primary health care centers in Muscat, Oman.

PubMed

Al-Alawi, Kamila; Johansson, Helene; Al Mandhari, Ahmed; Norberg, Margareta

2018-05-08

AimThe aim of this study is to explore the perceptions among primary health center staff concerning competencies, values, skills and resources related to team-based diabetes management and to describe the availability of needed resources for team-based approaches. The diabetes epidemic challenges services available at primary health care centers in the Middle East. Therefore, there is a demand for evaluation of the available resources and team-based diabetes management in relation to the National Diabetes Management Guidelines. A cross-sectional study was conducted with 26 public primary health care centers in Muscat, the capital of Oman. Data were collected from manual and electronic resources as well as a questionnaire that was distributed to the physician-in-charge and diabetes management team members.FindingsThe study revealed significant differences between professional groups regarding how they perceived their own competencies, values and skills as well as available resources related to team-based diabetes management. The perceived competencies were high among all professions. The perceived team-related values and skills were also generally high but with overall lower recordings among the nurses. This pattern, along with the fact that very few nurses have specialized qualifications, is a barrier to providing team-based diabetes management. Participants indicated that there were sufficient laboratory resources; however, reported that pharmacological, technical and human resources were lacking. Further work should be done at public primary diabetes management clinics in order to fully implement team-based diabetes management.

Perceived Use and Acceptance of Cloud Enterprise Resource Planning (ERP) Implementation in the Manufacturing Industries

ERIC Educational Resources Information Center

Adeboje, Adewale

2015-01-01

The purpose of this study was to gain an insight into perceived use and acceptance for implementing an enterprise resource planning system and the decision whether to contract out the enterprise resource planning (ERP) service to a cloud provider. Cloud-based ERP systems can provide many advantages to the normal implementation of the same systems…

Impact of e-alert systems on the care of patients with acute kidney injury.

PubMed

Breighner, Crystal M; Kashani, Kianoush B

2017-09-01

With the recent advancement in electronic health record systems and meaningful use of information technology incentive programs (i.e., the American Recovery and Reinvestment Act, the Health Information Technology for Economic and Clinical Health Act, and the Centers for Medicare & Medicaid Services), interest in clinical decision support systems has risen. These systems have been used to examine a variety of different syndromes with variable reported effects. In recent years, electronic alerts (e-alerts) have been implemented at various institutions to decrease the morbidity associated with acute kidney injury (AKI). AKI is common, accounting for 1 in 7 hospital admissions, and is associated with increased length of hospital stay and mortality. AKI is often underrecognized, causing delayed intervention. The use of e-alerts may result in earlier recognition and intervention, as well as decreased morbidity and mortality. This must be balanced with the possibility of increased resource utilization that e-alerts may cause. Before widespread implementation, the ethical and legal consequences of not following e-alert recommendations must be established, and the optimal algorithm for AKI e-alert detection must be determined. Copyright © 2017 Elsevier Ltd. All rights reserved.

Introduction of the American Academy of Facial Plastic and Reconstructive Surgery FACE TO FACE Database.

PubMed

Abraham, Manoj T; Rousso, Joseph J; Hu, Shirley; Brown, Ryan F; Moscatello, Augustine L; Finn, J Charles; Patel, Neha A; Kadakia, Sameep P; Wood-Smith, Donald

2017-07-01

The American Academy of Facial Plastic and Reconstructive Surgery FACE TO FACE database was created to gather and organize patient data primarily from international humanitarian surgical mission trips, as well as local humanitarian initiatives. Similar to cloud-based Electronic Medical Records, this web-based user-generated database allows for more accurate tracking of provider and patient information and outcomes, regardless of site, and is useful when coordinating follow-up care for patients. The database is particularly useful on international mission trips as there are often different surgeons who may provide care to patients on subsequent missions, and patients who may visit more than 1 mission site. Ultimately, by pooling data across multiples sites and over time, the database has the potential to be a useful resource for population-based studies and outcome data analysis. The objective of this paper is to delineate the process involved in creating the AAFPRS FACE TO FACE database, to assess its functional utility, to draw comparisons to electronic medical records systems that are now widely implemented, and to explain the specific benefits and disadvantages of the use of the database as it was implemented on recent international surgical mission trips.

Canadian Otolaryngology - Head and Neck Surgery clerkship curricula: evolving toward tomorrow’s learners

PubMed Central

2013-01-01

Background Increasing focus is being placed on Clerkship curriculum design and implementation in light of new undergraduate medical education research and accreditation standards. Canadian Otolaryngology-Head and Neck Surgery (OTOHNS) Clerkship programs are continually but independently evolving towards a common goal of improving Clerkship curriculum. Methods An electronic survey was sent to undergraduate OTOHNS directors at all Canadian medical schools (n = 17) examining their Clerkship curricula. Themes included Clerkship format, teaching methods, faculty support and development, program strengths, and barriers. Results Survey response rate was 76%. All responding schools had OTOHNS Clerkship programs ranging in type (mandatory, selective or elective) and length (<1 to 4 weeks). Learning modalities varied. Electronic learning tools were identified as increasingly important to curriculum delivery. Common strengths included wide clinical exposure and one-on-one mentoring. Multiple challenges were identified in curriculum implementation and evaluation. All schools expressed interest in developing national standards, objectives and e-learning resources. Conclusions Significant variation exists in OTOHNS Clerkship experiences between Canadian medical schools. Many schools perceive barriers of insufficient time, space and curriculum standardization. Interested Canadian OTOHNS educators are eager to collaborate to improve the collective OTOHNS Clerkship experience. PMID:23663703

Addressing the business of discharge: building a case for an electronic discharge summary.

PubMed

Mourad, Michelle; Cucina, Russell; Ramanathan, Rajiv; Vidyarthi, Arpana R

2011-01-01

Hospitalists are increasingly involved in implementing quality improvement initiatives around patient safety, clinical informatics, and transitions of care, but may lack expertise in promoting these important interventions. Developing a sound business case is essential to garnering support and resources for any quality improvement initiative. We present a framework for developing a business case using a structured approach to exploring qualitative and quantitative costs and benefits and describe its application in the experience of developing an electronic discharge summary at the University of California San Francisco (UCSF). At our institution, we found that the primary financial benefits are the cost reductions in eliminating transcription needs and decreasing billing delays, as well as reducing the cost of tracking completion of and dissemination of discharge summaries. Costs incurred from a new information technology (IT) infrastructure, programmer time, maintenance and training must also be accounted for. While benefits may be apparent to front line providers (improved communication, efficiency of data transfer, and increased referring physician satisfaction), implementing and sustaining such an innovation depends on articulating a sound business case with a detailed cost-benefit analysis to institutional decision making. Copyright © 2010 Society of Hospital Medicine.

77 FR 2734 - Health Information Technology Implementation

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-19

... Information Technology Implementation AGENCY: Health Resources and Services Administration, HHS. ACTION... Technology Implementation for Health Center Controlled Networks (HCCN) funds originally awarded to Community... advance information technology resources of the Tennessee's medically underserved communities, TPCA has...

Integrated Circuit Chip Improves Network Efficiency

NASA Technical Reports Server (NTRS)

2008-01-01

Prior to 1999 and the development of SpaceWire, a standard for high-speed links for computer networks managed by the European Space Agency (ESA), there was no high-speed communications protocol for flight electronics. Onboard computers, processing units, and other electronics had to be designed for individual projects and then redesigned for subsequent projects, which increased development periods, costs, and risks. After adopting the SpaceWire protocol in 2000, NASA implemented the standard on the Swift mission, a gamma ray burst-alert telescope launched in November 2004. Scientists and developers on the James Webb Space Telescope further developed the network version of SpaceWire. In essence, SpaceWire enables more science missions at a lower cost, because it provides a standard interface between flight electronics components; new systems need not be custom built to accommodate individual missions, so electronics can be reused. New protocols are helping to standardize higher layers of computer communication. Goddard Space Flight Center improved on the ESA-developed SpaceWire by enabling standard protocols, which included defining quality of service and supporting plug-and-play capabilities. Goddard upgraded SpaceWire to make the routers more efficient and reliable, with features including redundant cables, simultaneous discrete broadcast pulses, prevention of network blockage, and improved verification. Redundant cables simplify management because the user does not need to worry about which connection is available, and simultaneous broadcast signals allow multiple users to broadcast low-latency side-band signal pulses across the network using the same resources for data communication. Additional features have been added to the SpaceWire switch to prevent network blockage so that more robust networks can be designed. Goddard s verification environment for the link-and-switch implementation continuously randomizes and tests different parts, constantly anticipating situations, which helps improve communications reliability. It has been tested in many different implementations for compatibility.

Use of traditional versus electronic medical-information resources by residents and interns.

PubMed

Phua, Jason; Lim, T K

2007-05-01

Little is known about the information-seeking behaviour of junior doctors, with regard to their use of traditional versus electronic sources of information. To evaluate the amount of time junior doctors spent using various medical-information resources and how useful they perceived these resources to be. A questionnaire study of all residents and interns in a tertiary teaching hospital in July and August 2004. In total, 134 doctors returned the completed questionnaires (response rate 79.8%). They spent the most time using traditional resources like teaching sessions and print textbooks, rating them as most useful. However, electronic resources like MEDLINE, UpToDate, and online review articles also ranked highly. Original research articles were less popular. Residents and interns prefer traditional sources of medical information. Meanwhile, though some electronic resources are rated highly, more work is required to remove the barriers to evidence-based medicine.

Resource selection for an interdisciplinary field: a methodology.

PubMed

Jacoby, Beth E; Murray, Jane; Alterman, Ina; Welbourne, Penny

2002-10-01

The Health Sciences and Human Services Library of the University of Maryland developed and implemented a methodology to evaluate print and digital resources for social work. Although this methodology was devised for the interdisciplinary field of social work, the authors believe it may lend itself to resource selection in other interdisciplinary fields. The methodology was developed in response to the results of two separate surveys conducted in late 1999, which indicated improvement was needed in the library's graduate-level social work collections. Library liaisons evaluated the print collection by identifying forty-five locally relevant Library of Congress subject headings and then using these subjects or synonymous terms to compare the library's titles to collections of peer institutions, publisher catalogs, and Amazon.com. The collection also was compared to social work association bibliographies, ISI Journal Citation Reports, and major social work citation databases. An approval plan for social work books was set up to assist in identifying newly published titles. The library acquired new print and digital social work resources as a result of the evaluation, thus improving both print and digital collections for its social work constituents. Visibility of digital resources was increased by cataloging individual titles in aggregated electronic journal packages and listing each title on the library Web page.

Resource selection for an interdisciplinary field: a methodology*

PubMed Central

Jacoby, Beth E.; Murray, Jane; Alterman, Ina; Welbourne, Penny

2002-01-01

The Health Sciences and Human Services Library of the University of Maryland developed and implemented a methodology to evaluate print and digital resources for social work. Although this methodology was devised for the interdisciplinary field of social work, the authors believe it may lend itself to resource selection in other interdisciplinary fields. The methodology was developed in response to the results of two separate surveys conducted in late 1999, which indicated improvement was needed in the library's graduate-level social work collections. Library liaisons evaluated the print collection by identifying forty-five locally relevant Library of Congress subject headings and then using these subjects or synonymous terms to compare the library's titles to collections of peer institutions, publisher catalogs, and Amazon.com. The collection also was compared to social work association bibliographies, ISI Journal Citation Reports, and major social work citation databases. An approval plan for social work books was set up to assist in identifying newly published titles. The library acquired new print and digital social work resources as a result of the evaluation, thus improving both print and digital collections for its social work constituents. Visibility of digital resources was increased by cataloging individual titles in aggregated electronic journal packages and listing each title on the library Web page. PMID:12398245

Exploring the business case for ambulatory electronic health record system adoption.

PubMed

Song, Paula H; McAlearney, Ann Scheck; Robbins, Julie; McCullough, Jeffrey S

2011-01-01

Widespread implementation and use of electronic health record (EHR) systems has been recognized by healthcare leaders as a cornerstone strategy for systematically reducing medical errors and improving clinical quality. However, EHR adoption requires a significant capital investment for healthcare providers, and cost is often cited as a barrier. Despite the capital requirements, a true business case for EHR system adoption and implementation has not been made. This is of concern, as the lack of a business case can influence decision making about EHR investments. The purpose of this study was to examine the role of business case analysis in healthcare organizations' decisions to invest in ambulatory EHR systems, and to identify what factors organizations considered when justifying an ambulatory EHR. Using a qualitative case study approach, we explored how five organizations that are considered to have best practices in ambulatory EHR system implementation had evaluated the business case for EHR adoption. We found that although the rigor of formal business case analysis was highly variable, informants across these organizations consistently reported perceiving that a positive business case for EHR system adoption existed, especially when they considered both financial and non-financial benefits. While many consider EHR system adoption inevitable in healthcare, this viewpoint should not deter managers from conducting a business case analysis. Results of such an analysis can inform healthcare organizations' understanding about resource allocation needs, help clarify expectations about financial and clinical performance metrics to be monitored through EHR systems, and form the basis for ongoing organizational support to ensure successful system implementation.

Understanding key factors affecting electronic medical record implementation: a sociotechnical approach.

PubMed

Cucciniello, Maria; Lapsley, Irvine; Nasi, Greta; Pagliari, Claudia

2015-07-17

Recent health care policies have supported the adoption of Information and Communication Technologies (ICT) but examples of failed ICT projects in this sector have highlighted the need for a greater understanding of the processes used to implement such innovations in complex organizations. This study examined the interaction of sociological and technological factors in the implementation of an Electronic Medical Record (EMR) system by a major national hospital. It aimed to obtain insights for managers planning such projects in the future and to examine the usefulness of Actor Network Theory (ANT) as a research tool in this context. Case study using documentary analysis, interviews and observations. Qualitative thematic analysis drawing on ANT. Qualitative analyses revealed a complex network of interactions between organizational stakeholders and technology that helped to shape the system and influence its acceptance and adoption. The EMR clearly emerged as a central 'actor' within this network. The results illustrate how important it is to plan innovative and complex information systems with reference to (i) the expressed needs and involvement of different actors, starting from the initial introductory phase; (ii) promoting commitment to the system and adopting a participative approach; (iii) defining and resourcing new roles within the organization capable of supporting and sustaining the change and (iv) assessing system impacts in order to mobilize the network around a common goal. The paper highlights the organizational, cultural, technological, and financial considerations that should be taken into account when planning strategies for the implementation of EMR systems in hospital settings. It also demonstrates how ANT may be usefully deployed in evaluating such projects.

Cardiovascular disease prevention in low resource settings: lessons from the Heartfile experience in Pakistan.

PubMed

Nishtar, Sania

2003-01-01

This paper outlines activities of the Heartfile Program in Pakistan (http://heartfile.org). The program focuses on cardiovascular disease prevention and health promotion, and includes several initiatives that encompass building policy, reorienting health services, and developing community interventions that utilize the print and electronic media and outreach at the grass-root level to incorporate social marketing approaches. Initiated by the nonprofit private sector, the program now links with major public sector primary healthcare programs, and is currently spearheading formulation of the National Action Plan on Noncommunicable Disease Prevention and Control in Pakistan. In addition, the program is being refined, validated, and packaged as a replicable model for other developing countries and in low resource settings, utilizing appropriate principles of franchising with inbuilt components sensitive to cultural and social adaptations. A review of the planning process, implementation strategy, and fund-raising experience is presented. Strategies unique to low resource settings, such as the development of cost- and time-efficient strategic alliances and partnerships, have also been highlighted. In addition, specific caveats are identified as being helpful to private sector development of chronic disease prevention programs in resource-constrained settings, and a road map to a sustainable public-private sector partnership is provided.

Database resources of the National Center for Biotechnology Information.

PubMed

Sayers, Eric W; Barrett, Tanya; Benson, Dennis A; Bryant, Stephen H; Canese, Kathi; Chetvernin, Vyacheslav; Church, Deanna M; DiCuccio, Michael; Edgar, Ron; Federhen, Scott; Feolo, Michael; Geer, Lewis Y; Helmberg, Wolfgang; Kapustin, Yuri; Landsman, David; Lipman, David J; Madden, Thomas L; Maglott, Donna R; Miller, Vadim; Mizrachi, Ilene; Ostell, James; Pruitt, Kim D; Schuler, Gregory D; Sequeira, Edwin; Sherry, Stephen T; Shumway, Martin; Sirotkin, Karl; Souvorov, Alexandre; Starchenko, Grigory; Tatusova, Tatiana A; Wagner, Lukas; Yaschenko, Eugene; Ye, Jian

2009-01-01

In addition to maintaining the GenBank nucleic acid sequence database, the National Center for Biotechnology Information (NCBI) provides analysis and retrieval resources for the data in GenBank and other biological data made available through the NCBI web site. NCBI resources include Entrez, the Entrez Programming Utilities, MyNCBI, PubMed, PubMed Central, Entrez Gene, the NCBI Taxonomy Browser, BLAST, BLAST Link (BLink), Electronic PCR, OrfFinder, Spidey, Splign, RefSeq, UniGene, HomoloGene, ProtEST, dbMHC, dbSNP, Cancer Chromosomes, Entrez Genomes and related tools, the Map Viewer, Model Maker, Evidence Viewer, Clusters of Orthologous Groups (COGs), Retroviral Genotyping Tools, HIV-1/Human Protein Interaction Database, Gene Expression Omnibus (GEO), Entrez Probe, GENSAT, Online Mendelian Inheritance in Man (OMIM), Online Mendelian Inheritance in Animals (OMIA), the Molecular Modeling Database (MMDB), the Conserved Domain Database (CDD), the Conserved Domain Architecture Retrieval Tool (CDART) and the PubChem suite of small molecule databases. Augmenting many of the web applications is custom implementation of the BLAST program optimized to search specialized data sets. All of the resources can be accessed through the NCBI home page at www.ncbi.nlm.nih.gov.

The development of a highly constrained health level 7 implementation guide to facilitate electronic laboratory reporting to ambulatory electronic health record systems.

PubMed

Sujansky, Walter V; Overhage, J Marc; Chang, Sophia; Frohlich, Jonah; Faus, Samuel A

2009-01-01

Electronic laboratory interfaces can significantly increase the value of ambulatory electronic health record (EHR) systems by providing laboratory result data automatically and in a computable form. However, many ambulatory EHRs cannot implement electronic laboratory interfaces despite the existence of messaging standards, such as Health Level 7, version 2 (HL7). Among several barriers to implementing laboratory interfaces is the extensive optionality within the HL7 message standard. This paper describes the rationale for and development of an HL7 implementation guide that seeks to eliminate most of the optionality inherent in HL7, but retain the information content required for reporting outpatient laboratory results. A work group of heterogeneous stakeholders developed the implementation guide based on a set of design principles that emphasized parsimony, practical requirements, and near-term adoption. The resulting implementation guide contains 93% fewer optional data elements than HL7. This guide was successfully implemented by 15 organizations during an initial testing phase and has been approved by the HL7 standards body as an implementation guide for outpatient laboratory reporting. Further testing is required to determine whether widespread adoption of the implementation guide by laboratories and EHR systems can facilitate the implementation of electronic laboratory interfaces.

You Have "How Many" Spreadsheets? Rethinking Electronic Resource Management

ERIC Educational Resources Information Center

Rux, Erika; Borchert, Theresa

2010-01-01

As libraries face a veritable explosion of electronic resources and as the interconnectedness of print and online resources becomes increasingly complicated, many librarians are challenged to find efficient and cost-friendly ways to manage these resources. In this article, the authors describe how a team of people from various library departments…

Understanding barriers to implementation of an adaptive land management program

USGS Publications Warehouse

Jacobson, S.K.; Morris, J.K.; Sanders, J.S.; Wiley, E.N.; Brooks, M.; Bennetts, R.E.; Percival, H.F.; Marynowski, S.

2006-01-01

The Florida Fish and Wildlife Conservation Commission manages over 650,000 ha, including 26 wildlife management and environmental areas. To improve management, they developed an objective-based vegetation management (OBVM) process that focuses on desired conditions of plant communities through an adaptive management framework. Our goals were to understand potential barriers to implementing OBVM and to recommend strategies to overcome barriers. A literature review identified 47 potential barriers in six categories to implementation of adaptive and ecosystem management: logistical, communication, attitudinal, institutional, conceptual, and educational. We explored these barriers through a bureau-wide survey of 90 staff involved in OBVM and personal interviews with area managers, scientists, and administrators. The survey incorporated an organizational culture assessment instrument to gauge how institutional factors might influence OBVM implementation. The survey response rate was 69%. Logistics and communications were the greatest barriers to implementing OBVM. Respondents perceived that the agency had inadequate resources for implementing OBVM and provided inadequate information. About one-third of the respondents believed OBVM would decrease their job flexibility and perceived greater institutional barriers to the approach. The 43% of respondents who believed they would have more responsibility under OBVM also had greater attitudinal barriers. A similar percentage of respondents reported OBVM would not give enough priority to wildlife. Staff believed that current agency culture was hierarchical but preferred a culture that would provide more flexibility for adaptive management and would foster learning from land management activities. In light of the barriers to OBVM, we recommend the following: (1) mitigation of logistical barriers by addressing real and perceived constraints of staff, funds, and other resources in a participatory manner; (2) mitigation of communication barriers through interpersonal and electronic communication channels; (3) development of an OBVM external advisory committee; and (4) adoption of characteristics of an organizational culture that promotes flexibility and learning. ??2006 Society for Conservation Biology.

Understanding barriers to implementation of an adaptive land management program.

PubMed

Jacobson, Susan K; Morris, Julie K; Sanders, J Scott; Wiley, Eugene N; Brooks, Michael; Bennetts, Robert E; Percival, H Franklin; Marynowski, Susan

2006-10-01

The Florida Fish and Wildlife Conservation Commission manages over 650,000 ha, including 26 wildlife management and environmental areas. To improve management, they developed an objective-based vegetation management (OBVM) process that focuses on desired conditions of plant communities through an adaptive management framework. Our goals were to understand potential barriers to implementing OBVM and to recommend strategies to overcome barriers. A literature review identified 47 potential barriers in six categories to implementation of adaptive and ecosystem management: logistical, communication, attitudinal, institutional, conceptual, and educational. We explored these barriers through a bureau-wide survey of 90 staff involved in OBVM and personal interviews with area managers, scientists, and administrators. The survey incorporated an organizational culture assessment instrument to gauge how institutional factors might influence OBVM implementation. The survey response rate was 69%. Logistics and communications were the greatest barriers to implementing OBVM. Respondents perceived that the agency had inadequate resources for implementing OBVM and provided inadequate information. About one-third of the respondents believed OBVM would decrease their job flexibility and perceived greater institutional barriers to the approach. The 43% of respondents who believed they would have more responsibility under OBVM also had greater attitudinal barriers. A similar percentage of respondents reported OBVM would not give enough priority to wildlife. Staff believed that current agency culture was hierarchical but preferred a culture that would provide more flexibility for adaptive management and would foster learning from land management activities. In light of the barriers to OBVM, we recommend the following: (1) mitigation of logistical barriers by addressing real and perceived constraints of staff, funds, and other resources in a participatory manner; (2) mitigation of communication barriers through interpersonal and electronic communication channels; (3) development of an OBVM external advisory committee; and (4) adoption of characteristics of an organizational culture that promotes flexibility and learning.

Value-based resource management: a model for best value nursing care.

PubMed

Caspers, Barbara A; Pickard, Beth

2013-01-01

With the health care environment shifting to a value-based payment system, Catholic Health Initiatives nursing leadership spearheaded an initiative with 14 hospitals to establish best nursing care at a lower cost. The implementation of technology-enabled business processes at point of care led to a new model for best value nursing care: Value-Based Resource Management. The new model integrates clinical patient data from the electronic medical record and embeds the new information in care team workflows for actionable real-time decision support and predictive forecasting. The participating hospitals reported increased patient satisfaction and cost savings in the reduction of overtime and improvement in length of stay management. New data generated by the initiative on nursing hours and cost by patient and by population (Medicare severity diagnosis-related groups), and patient health status outcomes across the acute care continuum expanded business intelligence for a value-based population health system.

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

PubMed

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

2015-08-01

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

User involvement in the implementation of clinical guidelines for common mental health disorders: a review and compilation of strategies and resources.

PubMed

Moreno, Eliana M; Moriana, Juan Antonio

2016-08-09

There is now broad consensus regarding the importance of involving users in the process of implementing guidelines. Few studies, however, have addressed this issue, let alone the implementation of guidelines for common mental health disorders. The aim of this study is to compile and describe implementation strategies and resources related to common clinical mental health disorders targeted at service users. The literature was reviewed and resources for the implementation of clinical guidelines were compiled using the PRISMA model. A mixed qualitative and quantitative analysis was performed based on a series of categories developed ad hoc. A total of 263 items were included in the preliminary analysis and 64 implementation resources aimed at users were analysed in depth. A wide variety of types, sources and formats were identified, including guides (40%), websites (29%), videos and leaflets, as well as instruments for the implementation of strategies regarding information and education (64%), self-care, or users' assessment of service quality. The results reveal the need to establish clear criteria for assessing the quality of implementation materials in general and standardising systems to classify user-targeted strategies. The compilation and description of key elements of strategies and resources for users can be of interest in designing materials and specific actions for this target audience, as well as improving the implementation of clinical guidelines.

Diabetes Patient Tracker, a personal digital assistant-based diabetes management system for primary care practices in Oklahoma.

PubMed

Nagykaldi, Zsolt; Mold, James W

2003-01-01

It has been demonstrated that electronic patient registries combined with a clinical decision support system have a significant positive impact on the documentation and delivery of services provided by health care professionals. While implementation of available commercial systems has not always been proven effective in a number of primary care practices, development and implementation of such a system in a practice-based research network might enhance successful implementation. Physicians in our practice-based research network (Oklahoma Physicians Resource/Research Network) initiated a project that aimed at designing, testing, and implementing a personal digital assistant-based diabetes management system. We utilized the "best practice" approach to determine the principles on which the application must operate. System development and beta testing were also accomplished based on the direct feedback of user clinicians. Practice Enhancement Assistants (PEAs) were available in the practices for assistance with implementation. Implementation of the Diabetes Patient Tracker (DPT) resulted in a significant improvement (p<0.05) in nine of 10 diabetic quality of care measures compared with pre-intervention levels in 20 primary care practices. Regular PEA visits similarly increased the number of foot exams and retinal exams performed in the last year (p=0.03 and 0.02, respectively). DPT is a low-cost, feasible, easily implementable, and very effective paper-less tool that significantly improves patient care and documentation in primary care practices.

Characteristics of Local Health Departments Associated with Implementation of Electronic Health Records and Other Informatics Systems.

PubMed

Shah, Gulzar H; Leider, Jonathon P; Castrucci, Brian C; Williams, Karmen S; Luo, Huabin

2016-01-01

Assessing local health departments' (LHDs') informatics capacities is important, especially within the context of broader, systems-level health reform. We assessed a nationally representative sample of LHDs' adoption of information systems and the factors associated with adoption and implementation by examining electronic health records, health information exchange, immunization registry, electronic disease reporting system, and electronic laboratory reporting. We used data from the National Association of County and City Health Officials' 2013 National Profile of LHDs. We performed descriptive statistics and multinomial logistic regression for the five implementation-oriented outcome variables of interest, with three levels of implementation (implemented, plan to implement, and no activity). Independent variables included infrastructural and financial capacity and other characteristics associated with informatics capacity. Of 505 LHDs that responded to the survey, 69 (13.5%) had implemented health information exchanges, 122 (22.2%) had implemented electronic health records, 245 (47.5%) had implemented electronic laboratory reporting, 368 (73.0%) had implemented an electronic disease reporting system, and 416 (83.8%) had implemented an immunization registry. LHD characteristics associated with health informatics adoption included provision of greater number of clinical services, greater per capita public health expenditures, health information systems specialists on staff, larger population size, decentralized governance system, one or more local boards of health, metropolitan jurisdiction, and top executive with more years in the job. Many LHDs lack health informatics capacity, particularly in smaller, rural jurisdictions. Cross-jurisdictional sharing, investment in public health informatics infrastructure, and additional training may help address these shortfalls.

Implementing Human Resources Management (HRM) within Dutch VET Institutions: Examining the Fostering and Hindering Factors

ERIC Educational Resources Information Center

Runhaar, Piety; Sanders, Karin

2013-01-01

Vocational Education and Training (VET) Institutions face serious challenges, like the implementation of competence-based education and upcoming teacher shortages, which urge them to implement Human Resources Management policy and practices (HRM). The implementation of HRM, however, often stagnates. This paper describes a qualitative study--in…

Employing the FITT framework to explore HIV case managers' perceptions of two electronic clinical data (ECD) summary systems.

PubMed

Schnall, Rebecca; Smith, Ann B; Sikka, Manik; Gordon, Peter; Camhi, Eli; Kanter, Timothy; Bakken, Suzanne

2012-10-01

Case managers facilitate continuity of care for persons living with HIV (PLWH) by coordination of resources and referrals to social services and medical care. The complexity of HIV care and associated comorbidities drives the need for medical and psychosocial care coordination, which may be achieved through health information exchange (HIE) systems. However, the use of HIE has not been well studied in the context of HIV services. The purpose of this descriptive qualitative study is to explore factors influencing case managers' adoption of electronic clinical data (ECD) summaries as an HIE strategy in HIV care through application of the "fit between individuals, task and technology" (FITT) framework. Focus group methodology was used to gather perceptions from 48 participants who provided direct case management services for PLWH in New York City. Questions addressed current quality and efficiency challenges to HIE utilization in the context of case management of PLWH as well as barriers and enablers to use of an ECD summary. Analysis of the data was guided by the FITT framework. Major themes by interaction type were: (1) task-technology fit - resources, time and workflow; (2) individual-task fit - training and technical support; and 3) individual-technology fit - ECD summary functionality, technical difficulties and the need of a computer for each end-user. Our findings provide evidence for the applicability of the FITT framework to explore case managers' perceptions of factors influencing the adoption of ECD summary systems for HIV care prior to actual implementation. Assessment of fit among individual, task, and technology and addressing the concerns identified prior to implementation is critical to successful adoption of health information technology as a strategy to improve quality and efficiency in health care. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Open-Source Electronic Health Record Systems for Low-Resource Settings: Systematic Review

PubMed Central

Zolfo, Maria; Diro, Ermias

2017-01-01

Background Despite the great impact of information and communication technologies on clinical practice and on the quality of health services, this trend has been almost exclusive to developed countries, whereas countries with poor resources suffer from many economic and social issues that have hindered the real benefits of electronic health (eHealth) tools. As a component of eHealth systems, electronic health records (EHRs) play a fundamental role in patient management and effective medical care services. Thus, the adoption of EHRs in regions with a lack of infrastructure, untrained staff, and ill-equipped health care providers is an important task. However, the main barrier to adopting EHR software in low- and middle-income countries is the cost of its purchase and maintenance, which highlights the open-source approach as a good solution for these underserved areas. Objective The aim of this study was to conduct a systematic review of open-source EHR systems based on the requirements and limitations of low-resource settings. Methods First, we reviewed existing literature on the comparison of available open-source solutions. In close collaboration with the University of Gondar Hospital, Ethiopia, we identified common limitations in poor resource environments and also the main requirements that EHRs should support. Then, we extensively evaluated the current open-source EHR solutions, discussing their strengths and weaknesses, and their appropriateness to fulfill a predefined set of features relevant for low-resource settings. Results The evaluation methodology allowed assessment of several key aspects of available solutions that are as follows: (1) integrated applications, (2) configurable reports, (3) custom reports, (4) custom forms, (5) interoperability, (6) coding systems, (7) authentication methods, (8) patient portal, (9) access control model, (10) cryptographic features, (11) flexible data model, (12) offline support, (13) native client, (14) Web client,(15) other clients, (16) code-based language, (17) development activity, (18) modularity, (19) user interface, (20) community support, and (21) customization. The quality of each feature is discussed for each of the evaluated solutions and a final comparison is presented. Conclusions There is a clear demand for open-source, reliable, and flexible EHR systems in low-resource settings. In this study, we have evaluated and compared five open-source EHR systems following a multidimensional methodology that can provide informed recommendations to other implementers, developers, and health care professionals. We hope that the results of this comparison can guide decision making when needing to adopt, install, and maintain an open-source EHR solution in low-resource settings. PMID:29133283

Open-source mobile digital platform for clinical trial data collection in low-resource settings.

PubMed

van Dam, Joris; Omondi Onyango, Kevin; Midamba, Brian; Groosman, Nele; Hooper, Norman; Spector, Jonathan; Pillai, Goonaseelan Colin; Ogutu, Bernhards

2017-02-01

Governments, universities and pan-African research networks are building durable infrastructure and capabilities for biomedical research in Africa. This offers the opportunity to adopt from the outset innovative approaches and technologies that would be challenging to retrofit into fully established research infrastructures such as those regularly found in high-income countries. In this context we piloted the use of a novel mobile digital health platform, designed specifically for low-resource environments, to support high-quality data collection in a clinical research study. Our primary aim was to assess the feasibility of a using a mobile digital platform for clinical trial data collection in a low-resource setting. Secondarily, we sought to explore the potential benefits of such an approach. The investigative site was a research institute in Nairobi, Kenya. We integrated an open-source platform for mobile data collection commonly used in the developing world with an open-source, standard platform for electronic data capture in clinical trials. The integration was developed using common data standards (Clinical Data Interchange Standards Consortium (CDISC) Operational Data Model), maximising the potential to extend the approach to other platforms. The system was deployed in a pharmacokinetic study involving healthy human volunteers. The electronic data collection platform successfully supported conduct of the study. Multidisciplinary users reported high levels of satisfaction with the mobile application and highlighted substantial advantages when compared with traditional paper record systems. The new system also demonstrated a potential for expediting data quality review. This pilot study demonstrated the feasibility of using a mobile digital platform for clinical research data collection in low-resource settings. Sustainable scientific capabilities and infrastructure are essential to attract and support clinical research studies. Since many research structures in Africa are being developed anew, stakeholders should consider implementing innovative technologies and approaches.

The Michigan Electronic Library.

ERIC Educational Resources Information Center

Davidsen, Susanna L.

1997-01-01

Describes the Michigan Electronic Library (MEL), the largest evaluated and organized Web-based library of Internet resources, that was designed to provide a library of electronic information resources selected by librarians. MEL's partnership is explained, the collection is described, and future developments are considered. (LRW)

Toward systematic reviews to understand the determinants of wait time management success to help decision-makers and managers better manage wait times

PubMed Central

2013-01-01

Background Long waits for core specialized services have consistently been identified as a key barrier to access. Governments and organizations at all levels have responded with strategies for better wait list management. While these initiatives are promising, insufficient attention has been paid to factors influencing the implementation and sustainability of wait time management strategies (WTMS) implemented at the organizational level. Methods A systematic review was conducted using the main electronic databases, such as CINAHL, MEDLINE, and Cochrane Database of Systematic Reviews, to identify articles published between 1990 and 2011 on WTMS for scheduled care implemented at the organizational level or higher and on frameworks for analyzing factors influencing their success. Data was extracted on governance, culture, resources, and tools. We organized a workshop with Canadian healthcare policy-makers and managers to compare our initial findings with their experience. Results Our systematic review included 47 articles: 36 related to implementation and 11 to sustainability. From these, we identified a variety of WTMS initiated at the organizational level or higher, and within these, certain factors that were specific to either implementation or sustainability and others common to both. The main common factors influencing success at the contextual level were stakeholder engagement and strong funding, and at the organizational level, physician involvement, human resources capacity, and information management systems. Specific factors for successful implementation at the contextual level were consultation with front-line actors and common standards and guidelines, and at the organizational level, financial incentives and dedicated staffing. For sustainability, we found no new factors. The workshop participants identified the same major factors as found in the articles and added others, such as information sharing between physicians and managers. Conclusions Factors related to implementation were studied more than those related to sustainability. However, this finding was useful in developing a tool to help managers at the local level monitor the implementation of WTMS and highlighted the need for more research on specific factors for sustainability and to assess the unintended consequences of introducing WTMS in healthcare organizations. PMID:23742217

Toward systematic reviews to understand the determinants of wait time management success to help decision-makers and managers better manage wait times.

PubMed

Pomey, Marie-Pascale; Forest, Pierre-Gerlier; Sanmartin, Claudia; Decoster, Carolyn; Clavel, Nathalie; Warren, Elaine; Drew, Madeleine; Noseworthy, Tom

2013-06-06

Long waits for core specialized services have consistently been identified as a key barrier to access. Governments and organizations at all levels have responded with strategies for better wait list management. While these initiatives are promising, insufficient attention has been paid to factors influencing the implementation and sustainability of wait time management strategies (WTMS) implemented at the organizational level. A systematic review was conducted using the main electronic databases, such as CINAHL, MEDLINE, and Cochrane Database of Systematic Reviews, to identify articles published between 1990 and 2011 on WTMS for scheduled care implemented at the organizational level or higher and on frameworks for analyzing factors influencing their success. Data was extracted on governance, culture, resources, and tools. We organized a workshop with Canadian healthcare policy-makers and managers to compare our initial findings with their experience. Our systematic review included 47 articles: 36 related to implementation and 11 to sustainability. From these, we identified a variety of WTMS initiated at the organizational level or higher, and within these, certain factors that were specific to either implementation or sustainability and others common to both. The main common factors influencing success at the contextual level were stakeholder engagement and strong funding, and at the organizational level, physician involvement, human resources capacity, and information management systems. Specific factors for successful implementation at the contextual level were consultation with front-line actors and common standards and guidelines, and at the organizational level, financial incentives and dedicated staffing. For sustainability, we found no new factors. The workshop participants identified the same major factors as found in the articles and added others, such as information sharing between physicians and managers. Factors related to implementation were studied more than those related to sustainability. However, this finding was useful in developing a tool to help managers at the local level monitor the implementation of WTMS and highlighted the need for more research on specific factors for sustainability and to assess the unintended consequences of introducing WTMS in healthcare organizations.

Towards an electronic national injury surveillance system in Saudi Arabia.

PubMed

Alanazi, F; Hussain, S A; Mandil, A; Alamro, N

2015-04-02

Given the need for a uniform, comprehensive, electronic nationwide surveillance system for injuries in Saudi Arabia, a system was designed with the objectives of establishing an epidemiologic profile of injuries in the country; evaluating injury indicators on an ongoing basis; identifying high-risk groups requiring specific interventions; monitoring and evaluating interventions for effectiveness; and producing reports to assist in planning and resource allocation. A special form for this purpose was designed, modified from validated forms used elsewhere for injury surveillance. This initiative of the Ministry of Health is also expected to help validate data collected by other sectors, such as the Ministry of Interior. This paper reviews the milestones of building the system and aims to prompt a debate within the scientific community, especially within the Eastern Mediterranean Region, about the best way to design injury surveillance systems for the Region in order to fine-tune the proposed system before its full-scale implementation.

Integrating experiential learning into a double degree masters program in nursing and health informatics.

PubMed

Borycki, Elizabeth M; Frisch, Noreen; Kushniruk, Andre W; McIntyre, Marjorie; Hutchinson, David

2012-01-01

In Canada there are few nurses who have advanced practice competencies in nursing informatics. This is a significant issue for regional health authorities, governments and electronic health record vendors in Canada who are implementing electronic health records. Few Schools of Nursing provide formalized opportunities for nurses to develop informatics competencies. Many of these opportunities take the form of post-baccalaureate certificate programs or individual undergraduate or graduate level courses in nursing. The purpose of this paper will be to: (1) describe the health and human resource issues in this area in Canada, (2) provide a brief overview of the design and development of a new, innovative double degree program at the intersection of nursing and health informatics that interleaves cooperative learning, (3) describe the integration of cooperative learning into this new program, and (4) outline the lessons learned in integrating cooperative education into such a graduate program.

Ethical considerations in the conduct of electronic surveillance research.

PubMed

Bharucha, Ashok J; London, Alex John; Barnard, David; Wactlar, Howard; Dew, Mary Amanda; Reynolds, Charles F

2006-01-01

The extant clinical literature indicates profound problems in the assessment, monitoring, and documentation of care in long-term care facilities. The lack of adequate resources to accommodate higher staff-to-resident ratios adds additional urgency to the goal of identifying more cost-effective mechanisms to provide care oversight. The ever expanding array of electronic monitoring technologies in the clinical research arena demands a conceptual and pragmatic framework for the resolution of ethical tensions inherent in the use of such innovative tools. CareMedia is a project that explores the utility of video, audio and sensor technologies as a continuous real-time assessment and outcomes measurement tool. In this paper, the authors describe the seminal ethical challenges encountered during the implementation phase of this project, namely privacy and confidentiality protection, and the strategies employed to resolve the ethical tensions by applying principles of the interest theory of rights.

The OptIPuter microscopy demonstrator: enabling science through a transatlantic lightpath

PubMed Central

Ellisman, M.; Hutton, T.; Kirkland, A.; Lin, A.; Lin, C.; Molina, T.; Peltier, S.; Singh, R.; Tang, K.; Trefethen, A.E.; Wallom, D.C.H.; Xiong, X.

2009-01-01

The OptIPuter microscopy demonstrator project has been designed to enable concurrent and remote usage of world-class electron microscopes located in Oxford and San Diego. The project has constructed a network consisting of microscopes and computational and data resources that are all connected by a dedicated network infrastructure using the UK Lightpath and US Starlight systems. Key science drivers include examples from both materials and biological science. The resulting system is now a permanent link between the Oxford and San Diego microscopy centres. This will form the basis of further projects between the sites and expansion of the types of systems that can be remotely controlled, including optical, as well as electron, microscopy. Other improvements will include the updating of the Microsoft cluster software to the high performance computing (HPC) server 2008, which includes the HPC basic profile implementation that will enable the development of interoperable clients. PMID:19487201

The OptIPuter microscopy demonstrator: enabling science through a transatlantic lightpath.

PubMed

Ellisman, M; Hutton, T; Kirkland, A; Lin, A; Lin, C; Molina, T; Peltier, S; Singh, R; Tang, K; Trefethen, A E; Wallom, D C H; Xiong, X

2009-07-13

The OptIPuter microscopy demonstrator project has been designed to enable concurrent and remote usage of world-class electron microscopes located in Oxford and San Diego. The project has constructed a network consisting of microscopes and computational and data resources that are all connected by a dedicated network infrastructure using the UK Lightpath and US Starlight systems. Key science drivers include examples from both materials and biological science. The resulting system is now a permanent link between the Oxford and San Diego microscopy centres. This will form the basis of further projects between the sites and expansion of the types of systems that can be remotely controlled, including optical, as well as electron, microscopy. Other improvements will include the updating of the Microsoft cluster software to the high performance computing (HPC) server 2008, which includes the HPC basic profile implementation that will enable the development of interoperable clients.

EHR Safety: The Way Forward to Safe and Effective Systems

PubMed Central

Walker, James M.; Carayon, Pascale; Leveson, Nancy; Paulus, Ronald A.; Tooker, John; Chin, Homer; Bothe, Albert; Stewart, Walter F.

2008-01-01

Diverse stakeholders—clinicians, researchers, business leaders, policy makers, and the public—have good reason to believe that the effective use of electronic health care records (EHRs) is essential to meaningful advances in health care quality and patient safety. However, several reports have documented the potential of EHRs to contribute to health care system flaws and patient harm. As organizations (including small hospitals and physician practices) with limited resources for care-process transformation, human-factors engineering, software safety, and project management begin to use EHRs, the chance of EHR-associated harm may increase. The authors propose a coordinated set of steps to advance the practice and theory of safe EHR design, implementation, and continuous improvement. These include setting EHR implementation in the context of health care process improvement, building safety into the specification and design of EHRs, safety testing and reporting, and rapid communication of EHR-related safety flaws and incidents. PMID:18308981

Counterfactual distributed controlled-phase gate for quantum-dot spin qubits in double-sided optical microcavities

NASA Astrophysics Data System (ADS)

Guo, Qi; Cheng, Liu-Yong; Chen, Li; Wang, Hong-Fu; Zhang, Shou

2014-10-01

The existing distributed quantum gates required physical particles to be transmitted between two distant nodes in the quantum network. We here demonstrate the possibility to implement distributed quantum computation without transmitting any particles. We propose a scheme for a distributed controlled-phase gate between two distant quantum-dot electron-spin qubits in optical microcavities. The two quantum-dot-microcavity systems are linked by a nested Michelson-type interferometer. A single photon acting as ancillary resource is sent in the interferometer to complete the distributed controlled-phase gate, but it never enters the transmission channel between the two nodes. Moreover, we numerically analyze the effect of experimental imperfections and show that the present scheme can be implemented with high fidelity in the ideal asymptotic limit. The scheme provides further evidence of quantum counterfactuality and opens promising possibilities for distributed quantum computation.

A new Gaussian MCTDH program: Implementation and validation on the levels of the water and glycine molecules

NASA Astrophysics Data System (ADS)

Skouteris, D.; Barone, V.

2014-06-01

We report the main features of a new general implementation of the Gaussian Multi-Configuration Time-Dependent Hartree model. The code allows effective computations of time-dependent phenomena, including calculation of vibronic spectra (in one or more electronic states), relative state populations, etc. Moreover, by expressing the Dirac-Frenkel variational principle in terms of an effective Hamiltonian, we are able to provide a new reliable estimate of the representation error. After validating the code on simple one-dimensional systems, we analyze the harmonic and anharmonic vibrational spectra of water and glycine showing that reliable and converged energy levels can be obtained with reasonable computing resources. The data obtained on water and glycine are compared with results of previous calculations using the vibrational second-order perturbation theory method. Additional features and perspectives are also shortly discussed.

Private and Public Sector Enterprise Resource Planning System Post-Implementation Practices: A Comparative Mixed Method Investigation

ERIC Educational Resources Information Center

Bachman, Charles A.

2010-01-01

While private sector organizations have implemented enterprise resource planning (ERP) systems since the mid 1990s, ERP implementations within the public sector lagged by several years. This research conducted a mixed method, comparative assessment of post "go-live" ERP implementations between public and private sector organization. Based on a…

How do health care organizations take on best practices? A scoping literature review.

PubMed

Innis, Jennifer; Dryden-Palmer, Karen; Perreira, Tyrone; Berta, Whitney

2015-12-01

The aims of this scoping literature review are to examine and summarize the organizational-level factors, context, and processes that influence the use of evidence-based practice in healthcare organizations. A scoping literature review was done to answer the question: What is known from the existing empirical literature about factors, context, and processes that influence the uptake, implementation, and sustainability of evidence-based practice in healthcare organizations? This review used the Arksey and O'Malley framework to describe findings and to identify gaps in the existing research literature. Inclusion and exclusion criteria were developed to screen studies. Relevant studies published between January 1991 and March 2014 were identified using four electronic databases. Study abstracts were screened for eligibility by two reviewers. Following this screening process, full-text articles were reviewed to determine the eligibility of the studies by the primary author. Eligible studies were then analyzed by coding findings with descriptive labels to distinguish elements that appeared relevant to this literature review. Coding was used to form categories, and these categories led to the development of themes. Thirty studies met the eligibility criteria for this literature review. The themes identified were: the process organizations use to select evidence-based practices for adoption, use of a needs assessment, linkage to the organization's strategic direction, organizational culture, the organization's internal social networks, resources (including education and training, presence of information technology, financial resources, resources for patient care, and staff qualifications), leadership, the presence of champions, standardization of processes, role clarity of staff, and the presence of social capital. Several gaps were identified by this review. There is a lack of research on how evidence-based practices may be sustained by organizations. Most of the research done to date has been cross-sectional. Longitudinal research would give insight into the relationship between organizational characteristics and the uptake, implementation, and sustainability of evidence-based practice. In addition, although it is clear that financial resources are required to implement evidence-based practice, existing studies contain a lack of detail about the cost of adopting and using new practices. This scoping review contains a number of implications for healthcare administrators, managers, and providers to consider when adopting and implementing evidence-based practices in healthcare organizations.

Implementation of quality management for clinical bacteriology in low-resource settings.

PubMed

Barbé, B; Yansouni, C P; Affolabi, D; Jacobs, J

2017-07-01

The declining trend of malaria and the recent prioritization of containment of antimicrobial resistance have created a momentum to implement clinical bacteriology in low-resource settings. Successful implementation relies on guidance by a quality management system (QMS). Over the past decade international initiatives were launched towards implementation of QMS in HIV/AIDS, tuberculosis and malaria. To describe the progress towards accreditation of medical laboratories and to identify the challenges and best practices for implementation of QMS in clinical bacteriology in low-resource settings. Published literature, online reports and websites related to the implementation of laboratory QMS, accreditation of medical laboratories and initiatives for containment of antimicrobial resistance. Apart from the limitations of infrastructure, equipment, consumables and staff, QMS are challenged with the complexity of clinical bacteriology and the healthcare context in low-resource settings (small-scale laboratories, attitudes and perception of staff, absence of laboratory information systems). Likewise, most international initiatives addressing laboratory health strengthening have focused on public health and outbreak management rather than on hospital based patient care. Best practices to implement quality-assured clinical bacteriology in low-resource settings include alignment with national regulations and public health reference laboratories, participating in external quality assurance programmes, support from the hospital's management, starting with attainable projects, conducting error review and daily bench-side supervision, looking for locally adapted solutions, stimulating ownership and extending existing training programmes to clinical bacteriology. The implementation of QMS in clinical bacteriology in hospital settings will ultimately boost a culture of quality to all sectors of healthcare in low-resource settings. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Strategic Planning for Electronic Resources Management: A Case Study at Gustavus Adolphus College

ERIC Educational Resources Information Center

Hulseberg, Anna; Monson, Sarah

2009-01-01

Electronic resources, the tools we use to manage them, and the needs and expectations of our users are constantly evolving; at the same time, the roles, responsibilities, and workflow of the library staff who manage e-resources are also in flux. Recognizing a need to be more intentional and proactive about how we manage e-resources, the…

Experience in Implementing Resource-Based Learning in Agrarian College of Management and Law Poltava State Agrarian Academy

ERIC Educational Resources Information Center

Kononets, Natalia

2015-01-01

The introduction of resource-based learning disciplines of computer cycles in Agrarian College. The article focused on the issue of implementation of resource-based learning courses in the agricultural cycle computer college. Tested approach to creating elearning resources through free hosting and their further use in the classroom. Noted that the…

Towards prediction of correlated material properties using quantum Monte Carlo methods

NASA Astrophysics Data System (ADS)

Wagner, Lucas

Correlated electron systems offer a richness of physics far beyond noninteracting systems. If we would like to pursue the dream of designer correlated materials, or, even to set a more modest goal, to explain in detail the properties and effective physics of known materials, then accurate simulation methods are required. Using modern computational resources, quantum Monte Carlo (QMC) techniques offer a way to directly simulate electron correlations. I will show some recent results on a few extremely challenging materials including the metal-insulator transition of VO2, the ground state of the doped cuprates, and the pressure dependence of magnetic properties in FeSe. By using a relatively simple implementation of QMC, at least some properties of these materials can be described truly from first principles, without any adjustable parameters. Using the QMC platform, we have developed a way of systematically deriving effective lattice models from the simulation. This procedure is particularly attractive for correlated electron systems because the QMC methods treat the one-body and many-body components of the wave function and Hamiltonian on completely equal footing. I will show some examples of using this downfolding technique and the high accuracy of QMC to connect our intuitive ideas about interacting electron systems with high fidelity simulations. The work in this presentation was supported in part by NSF DMR 1206242, the U.S. Department of Energy, Office of Science, Office of Advanced Scientific Computing Research, Scientific Discovery through Advanced Computing (SciDAC) program under Award Number FG02-12ER46875, and the Center for Emergent Superconductivity, Department of Energy Frontier Research Center under Grant No. DEAC0298CH1088. Computing resources were provided by a Blue Waters Illinois grant and INCITE PhotSuper and SuperMatSim allocations.

The influence of standards and clinical guidelines on prosthetic and orthotic service quality: a scoping review.

PubMed

Sadeghi-Demneh, Ebrahim; Forghany, Saeed; Onmanee, Pornsuree; Trinler, Ursula; Dillon, Michael P; Baker, Richard

2017-06-20

Standards and guidelines are an integral part of prosthetic and orthotic service delivery in the developed world underpinned by an assumption that they lead to improved services. Implementing them has a cost, however, and that cost needs to be justified, particularly in resource-limited environments. This scoping review thus asks the question, "What is the evidence of the impact of standards and guidelines on service delivery outcomes in prosthetics and orthotics?" A structured search of three electronic databases (Medline, Scopus and Web of Science) followed by manual searching of title, abstract and full text, yielded 29 articles. Four categories of papers were identified: Descriptions and Commentaries (17 papers), Guideline Development (7), Guideline Testing (2) and Standards implementation (3). No articles were explicitly designed to assess the impact of standards and guidelines on service delivery outcomes in prosthetics and orthotics. Studies tended to be commentaries on or descriptions of guideline development, testing or implementation of standards. The literature is not sufficiently well developed to warrant the cost and effort of a systematic review. Future primary research should seek to demonstrate whether and how guidelines and standards improve the outcomes for people that require prostheses, orthoses and other assistive devices. Implications for Rehabilitation International Standards and Clinical Guidelines are now an integral part of clinical service provision in prosthetics and orthotics in the developed world. Complying with standards and guidelines has a cost and, particularly in resource-limited environments, it should be possible to justify this in terms of the resulting benefits. This scoping review concludes that there have been no previous studies designed to directly quantify the effects of implementing standards and guidelines on service delivery.

ERM Ideas and Innovations: Digital Repository Management as ERM

ERIC Educational Resources Information Center

Pinkas, María M.; Lin, Na

2014-01-01

This article describes the application of electronic resources management (ERM) to digital repository management at the Health Sciences and Human Services Library at the University of Maryland, Baltimore. The authors discuss electronic resources management techniques, through the application of "Techniques for Electronic Management,"…

Implementation science in low-resource settings: using the interactive systems framework to improve hand hygiene in a tertiary hospital in Ghana.

PubMed

Kallam, Brianne; Pettitt-Schieber, Christie; Owen, Medge; Agyare Asante, Rebecca; Darko, Elizabeth; Ramaswamy, Rohit

2018-05-19

Low-resource clinical settings often face obstacles that challenge the implementation of recommended evidence-based practices (EBPs). Implementation science approaches are useful in identifying barriers and developing strategies to address them. Ridge Regional Hospital (RRH), a tertiary referral hospital in Accra, Ghana experienced a spike in rates of neonatal sepsis and launched a quality improvement (QI) initiative that identified poor adherence to hand hygiene in the neonatal intensive care unit as a potential source of infections. A multi-modal change package of World Health Organization-recommended solutions was created to address this issue. To ensure that the outputs of the QI effort were adopted within the organization, leaders at RRH and Kybele, Inc. used an implementation science framework called the 'Interactive Systems Framework for Dissemination and Implementation' (ISF) to create a package of locally acceptable implementation strategies. The ISF has never been used before to guide implementation in low-resource settings. Hand hygiene compliance rose from 67% to 92% overall, including a 36% increase during the night shifts-a group of healthcare workers with typically very low levels of compliance. The drastic improvement in adherence to hand hygiene suggests the potential value of the joint use of QI and implementation science to promote the creation and application of contextually appropriate EBPs in low-resource settings. Our results also suggest that using an implementation framework such as the ISF could rapidly increase the uptake of other evidence-based interventions in low-resource settings.

Information standards for recording alcohol use in electronic health records: findings from a national consultation.

PubMed

Haroon, Shamil; Wooldridge, Darren; Hoogewerf, Jan; Nirantharakumar, Krishnarajah; Williams, John; Martino, Lina; Bhala, Neeraj

2018-06-07

Alcohol misuse is an important cause of premature disability and death. While clinicians are recommended to ask patients about alcohol use and provide brief interventions and specialist referral, this is poorly implemented in routine practice. We undertook a national consultation to ascertain the appropriateness of proposed standards for recording information about alcohol use in electronic health records (EHRs) in the UK and to identify potential barriers and facilitators to their implementation in practice. A wide range of stakeholders in the UK were consulted about the appropriateness of proposed information standards for recording alcohol use in EHRs via a multi-disciplinary stakeholder workshop and online survey. Responses to the survey were thematically analysed using the Consolidated Framework for Implementation Research. Thirty-one stakeholders participated in the workshop and 100 in the online survey. This included patients and carers, healthcare professionals, researchers, public health specialists, informaticians, and clinical information system suppliers. There was broad consensus that the Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-Consumption (AUDIT-C) questionnaires were appropriate standards for recording alcohol use in EHRs but that the standards should also address interventions for alcohol misuse. Stakeholders reported a number of factors that might influence implementation of the standards, including having clear care pathways and an implementation guide, sharing information about alcohol use between health service providers, adequately resourcing the implementation process, integrating alcohol screening with existing clinical pathways, having good clinical information systems and IT infrastructure, providing financial incentives, having sufficient training for healthcare workers, and clinical leadership and engagement. Implementation of the standards would need to ensure patients are not stigmatised and that patient confidentiality is robustly maintained. A wide range of stakeholders agreed that use of AUDIT-C and AUDIT are appropriate standards for recording alcohol use in EHRs in addition to recording interventions for alcohol misuse. The findings of this consultation will be used to develop an appropriate information model and implementation guide. Further research is needed to pilot the standards in primary and secondary care.

The Instant Glidein; A generic approach for the late binding of jobs to various resource types

NASA Astrophysics Data System (ADS)

Field, Laurence; Steers, Iain

2017-10-01

High-throughput computing requires resources to be allocated so that jobs can be run. In a highly distributed environment that may be comprised of multiple levels of queueing, it may not be certain where, what and when jobs will run. It is therefore desirable to first acquire the resource before assigning it a job. This late binding approach has been implemented in resources managed by batch systems using the pilot jobs paradigm, with the HTCondor glidein being a reference implementation. For resources that are managed by other means such as the IaaS, alternative approaches for late binding may be required. This contribution describes one such approach, the instant glidein, as a generic method for implementing late binding to various resource types.

Managing Tradeoffs in the Electronic Age.

ERIC Educational Resources Information Center

Wagner, A. Ben

2003-01-01

Provides an overview of the development of electronic resources over the past three decades, discussing key features, disadvantages, and benefits of traditional online databases and CD-ROM and Web-based resources. Considers the decision to shift collections and resources toward purely digital formats, ownership of content, licensing, and user…

Enhancing the routine health information system in rural southern Tanzania: successes, challenges and lessons learned.

PubMed

Maokola, W; Willey, B A; Shirima, K; Chemba, M; Armstrong Schellenberg, J R M; Mshinda, H; Alonso, P; Tanner, M; Schellenberg, D

2011-06-01

To describe and evaluate the use of handheld computers for the management of Health Management Information System data. Electronic data capture took place in 11 sentinel health centres in rural southern Tanzania. Information from children attending the outpatient department (OPD) and the Expanded Program on Immunization vaccination clinic was captured by trained local school-leavers, supported by monthly supervision visits. Clinical data included malaria blood slides and haemoglobin colour scale results. Quality of captured data was assessed using double data entry. Malaria blood slide results from health centre laboratories were compared to those from the study's quality control laboratory. The system took 5 months to implement, and few staffings or logistical problems were encountered. Over the following 12 months (April 2006-March 2007), 7056 attendances were recorded in 9880 infants aged 2-11 months, 50% with clinical malaria. Monthly supervision visits highlighted incomplete recording of information between OPD and laboratory records, where on average 40% of laboratory visits were missing the record of their corresponding OPD visit. Quality of microscopy from health facility laboratories was lower overall than that from the quality assurance laboratory. Electronic capture of HMIS data was rapidly and successfully implemented in this resource-poor setting. Electronic capture alone did not resolve issues of data completeness, accuracy and reliability, which are essential for management, monitoring and evaluation; suggestions to monitor and improve data quality are made. © 2011 Blackwell Publishing Ltd.

The ADIPS pilot National Diabetes in Pregnancy Audit Project.

PubMed

Simmons, David; Cheung, N Wah; McIntyre, H David; Flack, Jeff R; Lagstrom, Janet; Bond, Dianne; Johnson, Elizabeth; Wolmarans, Louise; Wein, Peter; Sinha, Ashim K

2007-06-01

Limited resources are available to compare outcomes of pregnancies complicated by diabetes across different centres. To compare the use of paper, stand alone and networked electronic processes for a sustainable, systematic international audit of diabetes in pregnancy care. Development of diabetes in pregnancy minimum dataset using nominal group technique, email user survey of difficulties with audit tools and collation of audit data from nine pilot sites across Australia and New Zealand. Seventy-nine defined data items were collected: 33 were for all women, nine for those with gestational diabetes (GDM) and 37 for women with pregestational diabetes. After the pilot, four new fields were requested and 18 fields had queries regarding utility or definition. A range of obstacles hampered the implementation of the audit including Medical Records Committee processes, other medical/non-medical staff not initially involved, temporary staff, multiple clinical records used by different parts of the health service, difficulty obtaining the postnatal test results and time constraints. Implementation of electronic audits in both the networked and the stand-alone settings had additional problems relating to the need to nest within pre-existing systems. Among the 496 women (45 type 1; 43 type 2; 399 GDM) across the nine centres, there were substantial differences in key quality and outcome indicators between sites. We conclude that an international, multicentre audit and benchmarking program is feasible and sustainable, but can be hampered by pre-existing processes, particularly in the initial introduction of electronic methods.

Implantable electronics: emerging design issues and an ultra light-weight security solution.

PubMed

Narasimhan, Seetharam; Wang, Xinmu; Bhunia, Swarup

2010-01-01

Implantable systems that monitor biological signals require increasingly complex digital signal processing (DSP) electronics for real-time in-situ analysis and compression of the recorded signals. While it is well-known that such signal processing hardware needs to be implemented under tight area and power constraints, new design requirements emerge with their increasing complexity. Use of nanoscale technology shows tremendous benefits in implementing these advanced circuits due to dramatic improvement in integration density and power dissipation per operation. However, it also brings in new challenges such as reliability and large idle power (due to higher leakage current). Besides, programmability of the device as well as security of the recorded information are rapidly becoming major design considerations of such systems. In this paper, we analyze the emerging issues associated with the design of the DSP unit in an implantable system. Next, we propose a novel ultra light-weight solution to address the information security issue. Unlike the conventional information security approaches like data encryption, which come at large area and power overhead and hence are not amenable for resource-constrained implantable systems, we propose a multilevel key-based scrambling algorithm, which exploits the nature of the biological signal to effectively obfuscate it. Analysis of the proposed algorithm in the context of neural signal processing and its hardware implementation shows that we can achieve high level of security with ∼ 13X lower power and ∼ 5X lower area overhead than conventional cryptographic solutions.

The use of open source electronic health records within the federal safety net.

PubMed

Goldwater, Jason C; Kwon, Nancy J; Nathanson, Ashley; Muckle, Alison E; Brown, Alexa; Cornejo, Kerri

2014-01-01

To conduct a federally funded study that examines the acquisition, implementation and operation of open source electronic health records (EHR) within safety net medical settings, such as federally qualified health centers (FQHC). The study was conducted by the National Opinion Research Center (NORC) at the University of Chicago from April to September 2010. The NORC team undertook a comprehensive environmental scan, including a literature review, a dozen key informant interviews using a semistructured protocol, and a series of site visits to West Virginia, California and Arizona FQHC that were currently using an open source EHR. Five of the six sites that were chosen as part of the study found a number of advantages in the use of their open source EHR system, such as utilizing a large community of users and developers to modify their EHR to fit the needs of their provider and patient communities, and lower acquisition and implementation costs as compared to a commercial system. Despite these advantages, many of the informants and site visit participants felt that widespread dissemination and use of open source was restrained due to a negative connotation regarding this type of software. In addition, a number of participants stated that there is a necessary level of technical acumen needed within the FQHC to make an open source EHR effective. An open source EHR provides advantages for FQHC that have limited resources to acquire and implement an EHR, but additional study is needed to evaluate its overall effectiveness.

High-fidelity projective read-out of a solid-state spin quantum register.

PubMed

Robledo, Lucio; Childress, Lilian; Bernien, Hannes; Hensen, Bas; Alkemade, Paul F A; Hanson, Ronald

2011-09-21

Initialization and read-out of coupled quantum systems are essential ingredients for the implementation of quantum algorithms. Single-shot read-out of the state of a multi-quantum-bit (multi-qubit) register would allow direct investigation of quantum correlations (entanglement), and would give access to further key resources such as quantum error correction and deterministic quantum teleportation. Although spins in solids are attractive candidates for scalable quantum information processing, their single-shot detection has been achieved only for isolated qubits. Here we demonstrate the preparation and measurement of a multi-spin quantum register in a low-temperature solid-state system by implementing resonant optical excitation techniques originally developed in atomic physics. We achieve high-fidelity read-out of the electronic spin associated with a single nitrogen-vacancy centre in diamond, and use this read-out to project up to three nearby nuclear spin qubits onto a well-defined state. Conversely, we can distinguish the state of the nuclear spins in a single shot by mapping it onto, and subsequently measuring, the electronic spin. Finally, we show compatibility with qubit control: we demonstrate initialization, coherent manipulation and single-shot read-out in a single experiment on a two-qubit register, using techniques suitable for extension to larger registers. These results pave the way for a test of Bell's inequalities on solid-state spins and the implementation of measurement-based quantum information protocols. © 2011 Macmillan Publishers Limited. All rights reserved

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

PubMed

Rangachari, Pavani

2014-12-01

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

Probability calculations for three-part mineral resource assessments

USGS Publications Warehouse

Ellefsen, Karl J.

2017-06-27

Three-part mineral resource assessment is a methodology for predicting, in a specified geographic region, both the number of undiscovered mineral deposits and the amount of mineral resources in those deposits. These predictions are based on probability calculations that are performed with computer software that is newly implemented. Compared to the previous implementation, the new implementation includes new features for the probability calculations themselves and for checks of those calculations. The development of the new implementation lead to a new understanding of the probability calculations, namely the assumptions inherent in the probability calculations. Several assumptions strongly affect the mineral resource predictions, so it is crucial that they are checked during an assessment. The evaluation of the new implementation leads to new findings about the probability calculations,namely findings regarding the precision of the computations,the computation time, and the sensitivity of the calculation results to the input.

Generalized Bell states map physical systems’ quantum evolution into a grammar for quantum information processing

NASA Astrophysics Data System (ADS)

Delgado, Francisco

2017-12-01

Quantum information processing should be generated through control of quantum evolution for physical systems being used as resources, such as superconducting circuits, spinspin couplings in ions and artificial anyons in electronic gases. They have a quantum dynamics which should be translated into more natural languages for quantum information processing. On this terrain, this language should let to establish manipulation operations on the associated quantum information states as classical information processing does. This work shows how a kind of processing operations can be settled and implemented for quantum states design and quantum processing for systems fulfilling a SU(2) reduction in their dynamics.

Comparing Architectural Styles for Service-Oriented Architectures - a REST vs. SOAP Case Study

NASA Astrophysics Data System (ADS)

Becker, Jörg; Matzner, Martin; Müller, Oliver

Two architectural styles are currently heavily discussed regarding the design of service-oriented architectures (SOA). Within this chapter we have compared those two alternative styles - the SOAP-style with procedural designs similar to remote procedure calls and the REST-style with loosely coupled services similar to resources of the World Wide Web. We introduce the case of a business network consisting of manufacturers and service providers of the electronics industry for deriving a set of requirements towards a specific SOA implementation. For each architectural style we present a concrete SOA design and evaluate it against the defined set of requirements.

The Internet School of Medicine: use of electronic resources by medical trainees and the reliability of those resources.

PubMed

Egle, Jonathan P; Smeenge, David M; Kassem, Kamal M; Mittal, Vijay K

2015-01-01

Electronic sources of medical information are plentiful, and numerous studies have demonstrated the use of the Internet by patients and the variable reliability of these sources. Studies have investigated neither the use of web-based resources by residents, nor the reliability of the information available on these websites. A web-based survey was distributed to surgical residents in Michigan and third- and fourth-year medical students at an American allopathic and osteopathic medical school and a Caribbean allopathic school regarding their preferred sources of medical information in various situations. A set of 254 queries simulating those faced by medical trainees on rounds, on a written examination, or during patient care was developed. The top 5 electronic resources cited by the trainees were evaluated for their ability to answer these questions accurately, using standard textbooks as the point of reference. The respondents reported a wide variety of overall preferred resources. Most of the 73 responding medical trainees favored textbooks or board review books for prolonged studying, but electronic resources are frequently used for quick studying, clinical decision-making questions, and medication queries. The most commonly used electronic resources were UpToDate, Google, Medscape, Wikipedia, and Epocrates. UpToDate and Epocrates had the highest percentage of correct answers (47%) and Wikipedia had the lowest (26%). Epocrates also had the highest percentage of wrong answers (30%), whereas Google had the lowest percentage (18%). All resources had a significant number of questions that they were unable to answer. Though hardcopy books have not been completely replaced by electronic resources, more than half of medical students and nearly half of residents prefer web-based sources of information. For quick questions and studying, both groups prefer Internet sources. However, the most commonly used electronic resources fail to answer clinical queries more than half of the time and have an alarmingly high rate of inaccurate information. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

JSC earth resources data analysis capabilities available to EOD revision B

NASA Technical Reports Server (NTRS)

1974-01-01

A list and summary description of all Johnson Space Center electronic laboratory and photographic laboratory capabilities available to earth resources division personnel for processing earth resources data are provided. The electronic capabilities pertain to those facilities and systems that use electronic and/or photographic products as output. The photographic capabilities pertain to equipment that uses photographic images as input and electronic and/or table summarizes processing steps. A general hardware description is presented for each of the data processing systems, and the titles of computer programs are used to identify the capabilities and data flow.

30 CFR 1210.54 - Must I submit this royalty report electronically?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 3 2011-07-01 2011-07-01 false Must I submit this royalty report electronically? 1210.54 Section 1210.54 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR Natural Resources Revenue FORMS AND REPORTS Royalty Reports-Oil, Gas, and...

Model for Presenting Resources in Scholar's Portal

ERIC Educational Resources Information Center

Feeney, Mary; Newby, Jill

2005-01-01

Presenting electronic resources to users through a federated search engine introduces unique opportunities and challenges to libraries. This article reports on the decision-making tools and processes used for selecting collections of electronic resources by a project team at the University of Arizona (UA) Libraries for the Association of Research…

Evidence and resources to implement Pharmacogenetic Knowledge for Precision Medicine

PubMed Central

Caudle, Kelly E.; Gammal, Roseann S.; Whirl-Carrillo, Michelle; Hoffman, James M.; Relling, Mary V.; Klein, Teri E.

2016-01-01

Purpose Implementation of pharmacogenetics into clinical practice has been relatively slow despite substantial scientific progress over the last decade. One barrier that inhibits uptake of pharmacogenetics into routine clinical practice is the lack of knowledge of how to translate a genetic test into a clinical action based on current evidence. The purpose of this paper is to describe the current state of pharmacogenetic evidence and evidence-based resources that facilitate the uptake of pharmacogenetics into clinical practice. Summary Controversy exists over the required evidence threshold needed for routine clinical implementation of pharmacogenetics. Large randomized controlled trials are not clinically feasible or necessary for many pharmacogenetic applications. Online resources exist like the Clinical Pharmacogenetics Implementation Consortium (CPIC) and the Pharmacogenomics Knowledgebase (PharmGKB) that provide freely available, evidence-based resources that facilitate the translation of genetic laboratory test results into actionable prescribing recommendations for specific drugs. Conclusion Resources provided by organizations such as CPIC and PharmGKB that use standardized approaches to evaluate the literature and provide clinical guidance are essential for the implementation of pharmacogenetics into routine clinical practice. PMID:27864205

Childcare Service Centers’ Preferences and Intentions to Use a Web-Based Program to Implement Healthy Eating and Physical Activity Policies and Practices: A Cross-Sectional Study

PubMed Central

Williams, Christopher Michael; Finch, Meghan; Wyse, Rebecca; Jones, Jannah; Freund, Megan; Wiggers, John Henry; Nathan, Nicole; Dodds, Pennie; Wolfenden, Luke

2015-01-01

Background Overweight and obesity is a significant public health problem that impacts a large number of children globally. Supporting childcare centers to deliver healthy eating and physical activity-promoting policies and practices is a recommended strategy for obesity prevention, given that such services provide access to a substantial proportion of children during a key developmental period. Electronic Web-based interventions represent a novel way to support childcare service providers to implement such policies and practices. Objective This study aimed to assess: (1) childcare centers’ current use of technology, (2) factors associated with intention to use electronic Web-based interventions, and (3) Web-based features that managers rated as useful to support staff with implementing healthy eating and physical activity-promoting policies and practices. Methods A computer-assisted telephone interview (CATI) was conducted with service managers from long day care centers and preschools. The CATI assessed the following: (1) childcare center characteristics, (2) childcare centers’ use of electronic devices, (3) intention to use a hypothetical electronic Web-based program—assessed using the Technology Acceptance Model (TAM) with ratings between 1 (strongly disagree) and 7 (strongly agree), and (4) features rated as useful to include in a Web-based program. Results Overall, 214 service centers out of 277 (77.3%) consented to participate. All service centers except 2 reported using computers (212/214, 99.1%), whereas 40.2% (86/214) used portable tablets. A total of 71.9% (151/210) of childcare service managers reported a score of 6 or more for intention to use a hypothetical electronic Web-based program. In a multivariable logistic regression analysis, intention to use the program was significantly associated with perceived ease of use (P=.002, odds ratio [OR] 3.9, 95% CI 1.6-9.2) and perceived usefulness (P<.001, OR 28,95% CI 8.0-95.2). Features reported by service managers as useful or very useful for a Web-based program included decision-support tools to support staff with menu planning (117/129, 90.7%), links to relevant resources (212/212, 100%), updated information on guidelines (208/212, 98.1%), and feedback regarding childcare center performance in relation to other childcare centers (212/212, 100%). Conclusions Childcare service managers reported high intention to use a Web-based program and identified several useful features to support staff to implement healthy eating and physical activity policies and practices. Further descriptive and intervention research examining the development and use of such a program to support childcare centers with the implementation of healthy eating and physical activity-promoting policies and practices is warranted. PMID:25931430

Childcare service centers' preferences and intentions to use a web-based program to implement healthy eating and physical activity policies and practices: a cross-sectional study.

PubMed

Yoong, Sze Lin; Williams, Christopher Michael; Finch, Meghan; Wyse, Rebecca; Jones, Jannah; Freund, Megan; Wiggers, John Henry; Nathan, Nicole; Dodds, Pennie; Wolfenden, Luke

2015-04-30

Overweight and obesity is a significant public health problem that impacts a large number of children globally. Supporting childcare centers to deliver healthy eating and physical activity-promoting policies and practices is a recommended strategy for obesity prevention, given that such services provide access to a substantial proportion of children during a key developmental period. Electronic Web-based interventions represent a novel way to support childcare service providers to implement such policies and practices. This study aimed to assess: (1) childcare centers' current use of technology, (2) factors associated with intention to use electronic Web-based interventions, and (3) Web-based features that managers rated as useful to support staff with implementing healthy eating and physical activity-promoting policies and practices. A computer-assisted telephone interview (CATI) was conducted with service managers from long day care centers and preschools. The CATI assessed the following: (1) childcare center characteristics, (2) childcare centers' use of electronic devices, (3) intention to use a hypothetical electronic Web-based program-assessed using the Technology Acceptance Model (TAM) with ratings between 1 (strongly disagree) and 7 (strongly agree), and (4) features rated as useful to include in a Web-based program. Overall, 214 service centers out of 277 (77.3%) consented to participate. All service centers except 2 reported using computers (212/214, 99.1%), whereas 40.2% (86/214) used portable tablets. A total of 71.9% (151/210) of childcare service managers reported a score of 6 or more for intention to use a hypothetical electronic Web-based program. In a multivariable logistic regression analysis, intention to use the program was significantly associated with perceived ease of use (P=.002, odds ratio [OR] 3.9, 95% CI 1.6-9.2) and perceived usefulness (P<.001, OR 28,95% CI 8.0-95.2). Features reported by service managers as useful or very useful for a Web-based program included decision-support tools to support staff with menu planning (117/129, 90.7%), links to relevant resources (212/212, 100%), updated information on guidelines (208/212, 98.1%), and feedback regarding childcare center performance in relation to other childcare centers (212/212, 100%). Childcare service managers reported high intention to use a Web-based program and identified several useful features to support staff to implement healthy eating and physical activity policies and practices. Further descriptive and intervention research examining the development and use of such a program to support childcare centers with the implementation of healthy eating and physical activity-promoting policies and practices is warranted.

Electronic health records and patient safety: co-occurrence of early EHR implementation with patient safety practices in primary care settings.

PubMed

Tanner, C; Gans, D; White, J; Nath, R; Pohl, J

2015-01-01

The role of electronic health records (EHR) in enhancing patient safety, while substantiated in many studies, is still debated. This paper examines early EHR adopters in primary care to understand the extent to which EHR implementation is associated with the workflows, policies and practices that promote patient safety, as compared to practices with paper records. Early adoption is defined as those who were using EHR prior to implementation of the Meaningful Use program. We utilized the Physician Practice Patient Safety Assessment (PPPSA) to compare primary care practices with fully implemented EHR to those utilizing paper records. The PPPSA measures the extent of adoption of patient safety practices in the domains: medication management, handoffs and transition, personnel qualifications and competencies, practice management and culture, and patient communication. Data from 209 primary care practices responding between 2006-2010 were included in the analysis: 117 practices used paper medical records and 92 used an EHR. Results showed that, within all domains, EHR settings showed significantly higher rates of having workflows, policies and practices that promote patient safety than paper record settings. While these results were expected in the area of medication management, EHR use was also associated with adoption of patient safety practices in areas in which the researchers had no a priori expectations of association. Sociotechnical models of EHR use point to complex interactions between technology and other aspects of the environment related to human resources, workflow, policy, culture, among others. This study identifies that among primary care practices in the national PPPSA database, having an EHR was strongly empirically associated with the workflow, policy, communication and cultural practices recommended for safe patient care in ambulatory settings.

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.

Electronic Reference Works and Library Budgeting Dilemma

ERIC Educational Resources Information Center

Lawal, Ibironke O.

2007-01-01

The number of electronic resources has climbed up steadily in recent times. Some of these e-resources are reference sources, mostly in Science, Technology and Medicine (STM), which publishers convert to electronic for obvious reasons. The library budgets for materials usually have two main lines, budget for one time purchase (monographs) and…

Electronic Information Resources in Undergraduate Education: An Exploratory Study of Opportunities for Student Learning and Independence.

ERIC Educational Resources Information Center

McDowell, Liz

2002-01-01

This qualitative interview-based study examines lecturer perspectives on the roles of electronic information resources in undergraduate education. Highlights include electronic academic libraries; changes toward more constructivist approaches to learning; information quality on the Web; plagiarism; information use; information literacy; and…

NASA In-Situ Resource Utilization Project-and Seals Challenges

NASA Technical Reports Server (NTRS)

Sacksteder, Kurt; Linne, Diane

2006-01-01

A viewgraph presentation on NASA's In-Situ Resource Utilization Project and Seals Challenges is shown. The topics include: 1) What Are Space Resources?; 2) Space Resource Utilization for Exploration; 3) ISRU Enables Affordable, Sustainable & Flexible Exploration; 4) Propellant from the Moon Could Revolutionize Space Transportation; 5) NASA ISRU Capability Roadmap Study, 2005; 6) Timeline for ISRU Capability Implementation; 7) Lunar ISRU Implementation Approach; 8) ISRU Technical-to-Mission Capability Roadmap; 9) ISRU Resources & Products of Interest; and 10) Challenging Seals Requirements for ISRU.

Clinical bacteriology in low-resource settings: today's solutions.

PubMed

Ombelet, Sien; Ronat, Jean-Baptiste; Walsh, Timothy; Yansouni, Cedric P; Cox, Janneke; Vlieghe, Erika; Martiny, Delphine; Semret, Makeda; Vandenberg, Olivier; Jacobs, Jan

2018-03-05

Low-resource settings are disproportionately burdened by infectious diseases and antimicrobial resistance. Good quality clinical bacteriology through a well functioning reference laboratory network is necessary for effective resistance control, but low-resource settings face infrastructural, technical, and behavioural challenges in the implementation of clinical bacteriology. In this Personal View, we explore what constitutes successful implementation of clinical bacteriology in low-resource settings and describe a framework for implementation that is suitable for general referral hospitals in low-income and middle-income countries with a moderate infrastructure. Most microbiological techniques and equipment are not developed for the specific needs of such settings. Pending the arrival of a new generation diagnostics for these settings, we suggest focus on improving, adapting, and implementing conventional, culture-based techniques. Priorities in low-resource settings include harmonised, quality assured, and tropicalised equipment, consumables, and techniques, and rationalised bacterial identification and testing for antimicrobial resistance. Diagnostics should be integrated into clinical care and patient management; clinically relevant specimens must be appropriately selected and prioritised. Open-access training materials and information management tools should be developed. Also important is the need for onsite validation and field adoption of diagnostics in low-resource settings, with considerable shortening of the time between development and implementation of diagnostics. We argue that the implementation of clinical bacteriology in low-resource settings improves patient management, provides valuable surveillance for local antibiotic treatment guidelines and national policies, and supports containment of antimicrobial resistance and the prevention and control of hospital-acquired infections. Copyright © 2018 Elsevier Ltd. All rights reserved.

Development, implementation, and evaluation of an integrated multidisciplinary Objective Structured Clinical Examination (OSCE) in primary health care settings within limited resources.

PubMed

Abdelaziz, Adel; Hany, Mohamed; Atwa, Hani; Talaat, Wagdy; Hosny, Somaya

2016-01-01

In ordinary circumstances, objective structured clinical examination (OSCE) is a resource-intensive assessment method. In case of developing and implementing multidisciplinary OSCE, there is no doubt that the cost will be greater. Through this study a research project was conducted to develop, implement and evaluate a multidisciplinary OSCE model within limited resources. This research project went through the steps of blueprinting, station writing, resources reallocation, implementation and finally evaluation. The developed model was implemented in the Primary Health Care (PHC) program which is one of the pillars of the Community-Based undergraduate curriculum of the Faculty of Medicine, Suez Canal University (FOM-SCU). Data for evaluation of the implemented OSCE model were derived from two resources. First, feedback of the students and assessors through self-administered questionnaires was obtained. Second, evaluation of the OSCE psychometrics was done. The deliverables of this research project included a set of validated integrated multi-disciplinary and low cost OSCE stations with an estimated reliability index of 0.6. After having this experience, we have a critical mass of faculty members trained on blueprinting and station writing and a group of trained assessors, facilitators and role players. Also there is a state of awareness among students on how to proceed in this type of OSCE which renders future implementation more feasible.

Laser doppler blood flow imaging using a CMOS imaging sensor with on-chip signal processing.

PubMed

He, Diwei; Nguyen, Hoang C; Hayes-Gill, Barrie R; Zhu, Yiqun; Crowe, John A; Gill, Cally; Clough, Geraldine F; Morgan, Stephen P

2013-09-18

The first fully integrated 2D CMOS imaging sensor with on-chip signal processing for applications in laser Doppler blood flow (LDBF) imaging has been designed and tested. To obtain a space efficient design over 64 × 64 pixels means that standard processing electronics used off-chip cannot be implemented. Therefore the analog signal processing at each pixel is a tailored design for LDBF signals with balanced optimization for signal-to-noise ratio and silicon area. This custom made sensor offers key advantages over conventional sensors, viz. the analog signal processing at the pixel level carries out signal normalization; the AC amplification in combination with an anti-aliasing filter allows analog-to-digital conversion with a low number of bits; low resource implementation of the digital processor enables on-chip processing and the data bottleneck that exists between the detector and processing electronics has been overcome. The sensor demonstrates good agreement with simulation at each design stage. The measured optical performance of the sensor is demonstrated using modulated light signals and in vivo blood flow experiments. Images showing blood flow changes with arterial occlusion and an inflammatory response to a histamine skin-prick demonstrate that the sensor array is capable of detecting blood flow signals from tissue.

"Current topics in health sciences librarianship": a pilot program for network-based lifelong learning.

PubMed Central

Brandt, K A; Sapp, J R; Campbell, J M

1996-01-01

The long-term objective of this project is to make health sciences librarians more effective in their role by using emerging technologies to deliver timely continuing education (CE) programs to them regardless of their physical location. The goals of the one-year planning project at the William H. Welch Medical Library are to plan, implement, and evaluate a pilot CE program that includes (1) a three-day general-interest session organized in four tracks: Market Forces and Management, Information Technology and the Internet, Publishing and Copyright, and Education; (2) a one-day special topic session on the Informatics of the Human Genome Project; and (3) an electronic poster session in parallel with the general-interest session. The program will be offered in three simultaneous formats: (1) on-site, in a distance-learning classroom in Baltimore; (2) as a telecourse, in a similar classroom outside Washington, DC; and (3) online, via the World Wide Web. An electronic proceedings of the entire program will be published on the Web to serve as a continuously available CE resource for health sciences librarians. This paper gives an overview of the planning process, presents a status report on the programmatic and technical implementation of the pilot project at its midpoint, and discusses future directions for the program. PMID:8913554

Impact of Knowledge Resources Linked to an Electronic Health Record on Frequency of Unnecessary Tests and Treatments

ERIC Educational Resources Information Center

Goodman, Kenneth; Grad, Roland; Pluye, Pierre; Nowacki, Amy; Hickner, John

2012-01-01

Introduction: Electronic knowledge resources have the potential to rapidly provide answers to clinicians' questions. We sought to determine clinicians' reasons for searching these resources, the rate of finding relevant information, and the perceived clinical impact of the information they retrieved. Methods: We asked general internists, family…

Infrastructure and Resources of Private Schools in Cali and the Implementation of the Bilingual Colombia Program

ERIC Educational Resources Information Center

Miranda, Norbella; Echeverry, Ángela Patricia

2010-01-01

Institutional factors affect the implementation of educational policies. Physical school infrastructure and the availability of resources determine to a certain extent whether a policy may be successfully transformed into practice. This article provides a description and analysis of school infrastructure and resources of private institutions of…

A Meta-Data Driven Approach to Searching for Educational Resources in a Global Context.

ERIC Educational Resources Information Center

Wade, Vincent P.; Doherty, Paul

This paper presents the design of an Internet-enabled search service that supports educational resource discovery within an educational brokerage service. More specifically, it presents the design and implementation of a metadata-driven approach to implementing the distributed search and retrieval of Internet-based educational resources and…

Common Core State Standards: Implementation Tools and Resources

ERIC Educational Resources Information Center

Council of Chief State School Officers, 2013

2013-01-01

The Council of Chief State School Officers (CCSSO or the Council) developed this list of free tools and resources to support state education agencies, districts, and educators during the process of implementing the Common Core State Standards (CCSS). This document primarily lists resources developed by CCSSO and other leading organizations and is…

Post-Implementation Success Factors for Enterprise Resource Planning Student Administration Systems in Higher Education Institutions

ERIC Educational Resources Information Center

Sullivan, Linda; Bozeman, William

2010-01-01

Enterprise Resource Planning (ERP) systems can represent one of the largest investments of human and financial resources by a higher education institution. They also bring a significant process reengineering aspect to the institution and the associated implementation project through the integration of compiled industry best practices into the…

A Toolkit for Designing and Implementing Effective Title I Schoolwide Programs

ERIC Educational Resources Information Center

New, Wendy Jo; Rhines, Chris; Walter, Fran; Klekotka, Peggie

2005-01-01

This toolkit is designed to provide educational leaders with information, tools, resources, and practical examples to help schools to effectively implement Title I schoolwide programs. It is intended to serve as a useful resource for states, districts, and schools to use, along with other resources and technical support, to create or refine…

78 FR 18241 - Approval and Promulgation of Air Quality Implementation Plans; Minnesota; Flint Hills Resources...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-26

... ENVIRONMENTAL PROTECTION AGENCY 40 CFR Part 52 [EPA-R05-OAR-2011-0328; FRL-9792-8] Approval and Promulgation of Air Quality Implementation Plans; Minnesota; Flint Hills Resources Pine Bend AGENCY... rule approving a revision to the the Minnesota sulfur dioxide SIP for Flint Hills Resources Pine Bend...

Essential Resources for Implementation and Sustainability of Evidence-Based Health Promotion Programs: A Mixed Methods Multi-Site Case Study.

PubMed

Dattalo, M; Wise, M; Ford Ii, J H; Abramson, B; Mahoney, J

2017-04-01

As of October 2016, use of federal Older Americans Act funds for health promotion and disease prevention will be restricted to the Administration on Aging's criteria for high-level evidence-based health promotion programs. Dissemination of these programs to rural communities remains limited. Therefore a strong need exists to identify strategies that facilitate program implementation and sustainability. The objective of this study was to compare organizational readiness and implementation strategies used by rural communities that achieved varying levels of success in sustaining evidence-based health promotion programs for older adults. We utilized a qualitative multi-site case study design to analyze the longitudinal experiences of eight rural sites working to implement evidence-based health promotion program over 3 years (8/2012-7/2015). Multiple sources of data (interviews, documents, reports, surveys) from each site informed the analysis. We used conventional content analysis to conduct a cross-case comparison to identify common features of rural counties that successfully implemented and sustained their target evidence-based health promotion program. Readiness to implement evidence-based programs as low at baseline as all site leaders described needing to secure additional resources for program implementation. Sites that successfully utilized six essential resources implemented and sustained greater numbers of workshops: (1) External Partnerships, (2) Agency Leadership Commitment, (3) Ongoing Source of Workshop Leaders, (4) Health Promotion Coordination Tasks Assigned to Specific Staff, (5) Organizational Stability, and (6) Change Team Engagement. The six essential resources described in this study can help rural communities assess their readiness to implement health promotion programs and work secure the resources necessary for successful implementation.

Biometric Methods for Secure Communications in Body Sensor Networks: Resource-Efficient Key Management and Signal-Level Data Scrambling

NASA Astrophysics Data System (ADS)

Bui, Francis Minhthang; Hatzinakos, Dimitrios

2007-12-01

As electronic communications become more prevalent, mobile and universal, the threats of data compromises also accordingly loom larger. In the context of a body sensor network (BSN), which permits pervasive monitoring of potentially sensitive medical data, security and privacy concerns are particularly important. It is a challenge to implement traditional security infrastructures in these types of lightweight networks since they are by design limited in both computational and communication resources. A key enabling technology for secure communications in BSN's has emerged to be biometrics. In this work, we present two complementary approaches which exploit physiological signals to address security issues: (1) a resource-efficient key management system for generating and distributing cryptographic keys to constituent sensors in a BSN; (2) a novel data scrambling method, based on interpolation and random sampling, that is envisioned as a potential alternative to conventional symmetric encryption algorithms for certain types of data. The former targets the resource constraints in BSN's, while the latter addresses the fuzzy variability of biometric signals, which has largely precluded the direct application of conventional encryption. Using electrocardiogram (ECG) signals as biometrics, the resulting computer simulations demonstrate the feasibility and efficacy of these methods for delivering secure communications in BSN's.

Database resources of the National Center for Biotechnology Information.

PubMed

Sayers, Eric W; Barrett, Tanya; Benson, Dennis A; Bolton, Evan; Bryant, Stephen H; Canese, Kathi; Chetvernin, Vyacheslav; Church, Deanna M; DiCuccio, Michael; Federhen, Scott; Feolo, Michael; Fingerman, Ian M; Geer, Lewis Y; Helmberg, Wolfgang; Kapustin, Yuri; Landsman, David; Lipman, David J; Lu, Zhiyong; Madden, Thomas L; Madej, Tom; Maglott, Donna R; Marchler-Bauer, Aron; Miller, Vadim; Mizrachi, Ilene; Ostell, James; Panchenko, Anna; Phan, Lon; Pruitt, Kim D; Schuler, Gregory D; Sequeira, Edwin; Sherry, Stephen T; Shumway, Martin; Sirotkin, Karl; Slotta, Douglas; Souvorov, Alexandre; Starchenko, Grigory; Tatusova, Tatiana A; Wagner, Lukas; Wang, Yanli; Wilbur, W John; Yaschenko, Eugene; Ye, Jian

2011-01-01

In addition to maintaining the GenBank® nucleic acid sequence database, the National Center for Biotechnology Information (NCBI) provides analysis and retrieval resources for the data in GenBank and other biological data made available through the NCBI Web site. NCBI resources include Entrez, the Entrez Programming Utilities, MyNCBI, PubMed, PubMed Central (PMC), Entrez Gene, the NCBI Taxonomy Browser, BLAST, BLAST Link (BLink), Primer-BLAST, COBALT, Electronic PCR, OrfFinder, Splign, ProSplign, RefSeq, UniGene, HomoloGene, ProtEST, dbMHC, dbSNP, dbVar, Epigenomics, Cancer Chromosomes, Entrez Genomes and related tools, the Map Viewer, Model Maker, Evidence Viewer, Trace Archive, Sequence Read Archive, Retroviral Genotyping Tools, HIV-1/Human Protein Interaction Database, Gene Expression Omnibus (GEO), Entrez Probe, GENSAT, Online Mendelian Inheritance in Man (OMIM), Online Mendelian Inheritance in Animals (OMIA), the Molecular Modeling Database (MMDB), the Conserved Domain Database (CDD), the Conserved Domain Architecture Retrieval Tool (CDART), IBIS, Biosystems, Peptidome, OMSSA, Protein Clusters and the PubChem suite of small molecule databases. Augmenting many of the Web applications are custom implementations of the BLAST program optimized to search specialized data sets. All of these resources can be accessed through the NCBI home page at www.ncbi.nlm.nih.gov.

Leading toward value: the role of strategic human resource management in health system adaptability.

PubMed

Garman, Andrew N; Polavarapu, Nandakishor; Grady, Jane C; Canar, W Jeffrey

2013-01-01

Personnel costs typically account for 60% or more of total operating expenses in health systems, and as such become a necessary focus in most if not all substantive health reform adaptations. This study sought to assess whether strategic alignment of the human resource (HR) and learning functions was associated with greater adaptive capacity in U.S. health systems. Data were gathered using a survey that was distributed electronically to chief human resource officers from two U.S.-based associations. The survey included questions about organizational structure, strategic human resource management, strategic learning, and organizational response to health reform. Significant correlations were found between strategic alignment of HR and HR's involvement in responses related to cost control (r = 0.46, p < 0.01); quality improvement (r = 0.45, p < 0.01), and patient access (r = 0.39, p < 0.01). However, no significant relationships were found between strategic alignment of organizational learning and HR involvement with these responses. Results suggest that HR structure may affect an organization's capacity for adaptive response. Top-management teams in health systems should consider positioning HR as part of the core leadership team, with a reporting relationship that allows HR to maximally participate in formulating and implementing organizational adaptation.

The utah beacon experience: integrating quality improvement, health information technology, and practice facilitation to improve diabetes outcomes in small health care facilities.

PubMed

Tennison, Janet; Rajeev, Deepthi; Woolsey, Sarah; Black, Jeff; Oostema, Steven J; North, Christie

2014-01-01

The Utah Improving Care through Connectivity and Collaboration (IC3) Beacon community (2010-2013) was spearheaded by HealthInsight, a nonprofit, community-based organization. One of the main objectives of IC(3) was to improve health care provided to patients with diabetes in three Utah counties, collaborating with 21 independent smaller clinics and two large health care enterprises. This paper will focus on the use of health information technology (HIT) and practice facilitation to develop and implement new care processes to improve clinic workflow and ultimately improve patients' diabetes outcomes at 21 participating smaller, independent clinics. Early in the project, we learned that most of the 21 clinics did not have the resources needed to successfully implement quality improvement (QI) initiatives. IC(3) helped clinics effectively use data generated from their electronic health records (EHRs) to design and implement interventions to improve patients' diabetes outcomes. This close coupling of HIT, expert practice facilitation, and Learning Collaboratives was found to be especially valuable in clinics with limited resources. Through this process we learned that (1) an extensive readiness assessment improved clinic retention, (2) clinic champions were important for a successful collaboration, and (3) current EHR systems have limited functionality to assist in QI initiatives. In general, smaller, independent clinics lack knowledge and experience with QI and have limited HIT experience to improve patient care using electronic clinical data. Additionally, future projects like IC(3) Beacon will be instrumental in changing clinic culture so that QI is integrated into routine workflow. Our efforts led to significant changes in how practice staff optimized their EHRs to manage and improve diabetes care, while establishing the framework for sustainability. Some of the IC(3) Beacon practices are currently smoothly transitioning to new models of care such as Patient-Centered Medical Homes. Thus, IC(3) Beacon has been instrumental in creating a strong community partnership among various organizations to meet the shared vision of better health and lower costs, and the experience over the last few years has helped the community prepare for the changing health care landscape.

The Utah Beacon Experience: Integrating Quality Improvement, Health Information Technology, and Practice Facilitation to Improve Diabetes Outcomes in Small Health Care Facilities

PubMed Central

Tennison, Janet; Rajeev, Deepthi; Woolsey, Sarah; Black, Jeff; Oostema, Steven J.; North, Christie

2014-01-01

Purpose: The Utah Improving Care through Connectivity and Collaboration (IC3) Beacon community (2010–2013) was spearheaded by HealthInsight, a nonprofit, community-based organization. One of the main objectives of IC3 was to improve health care provided to patients with diabetes in three Utah counties, collaborating with 21 independent smaller clinics and two large health care enterprises. This paper will focus on the use of health information technology (HIT) and practice facilitation to develop and implement new care processes to improve clinic workflow and ultimately improve patients’ diabetes outcomes at 21 participating smaller, independent clinics. Innovation: Early in the project, we learned that most of the 21 clinics did not have the resources needed to successfully implement quality improvement (QI) initiatives. IC3 helped clinics effectively use data generated from their electronic health records (EHRs) to design and implement interventions to improve patients’ diabetes outcomes. This close coupling of HIT, expert practice facilitation, and Learning Collaboratives was found to be especially valuable in clinics with limited resources. Findings: Through this process we learned that (1) an extensive readiness assessment improved clinic retention, (2) clinic champions were important for a successful collaboration, and (3) current EHR systems have limited functionality to assist in QI initiatives. In general, smaller, independent clinics lack knowledge and experience with QI and have limited HIT experience to improve patient care using electronic clinical data. Additionally, future projects like IC3 Beacon will be instrumental in changing clinic culture so that QI is integrated into routine workflow. Conclusion and Discussion: Our efforts led to significant changes in how practice staff optimized their EHRs to manage and improve diabetes care, while establishing the framework for sustainability. Some of the IC3 Beacon practices are currently smoothly transitioning to new models of care such as Patient-Centered Medical Homes. Thus, IC3 Beacon has been instrumental in creating a strong community partnership among various organizations to meet the shared vision of better health and lower costs, and the experience over the last few years has helped the community prepare for the changing health care landscape. PMID:25848624

The Resource Manager the ATLAS Trigger and Data Acquisition System

NASA Astrophysics Data System (ADS)

Aleksandrov, I.; Avolio, G.; Lehmann Miotto, G.; Soloviev, I.

2017-10-01

The Resource Manager is one of the core components of the Data Acquisition system of the ATLAS experiment at the LHC. The Resource Manager marshals the right for applications to access resources which may exist in multiple but limited copies, in order to avoid conflicts due to program faults or operator errors. The access to resources is managed in a manner similar to what a lock manager would do in other software systems. All the available resources and their association to software processes are described in the Data Acquisition configuration database. The Resource Manager is queried about the availability of resources every time an application needs to be started. The Resource Manager’s design is based on a client-server model, hence it consists of two components: the Resource Manager “server” application and the “client” shared library. The Resource Manager server implements all the needed functionalities, while the Resource Manager client library provides remote access to the “server” (i.e., to allocate and free resources, to query about the status of resources). During the LHC’s Long Shutdown period, the Resource Manager’s requirements have been reviewed at the light of the experience gained during the LHC’s Run 1. As a consequence, the Resource Manager has undergone a full re-design and re-implementation cycle with the result of a reduction of the code base by 40% with respect to the previous implementation. This contribution will focus on the way the design and the implementation of the Resource Manager could leverage the new features available in the C++11 standard, and how the introduction of external libraries (like Boost multi-container) led to a more maintainable system. Additionally, particular attention will be given to the technical solutions adopted to ensure the Resource Manager could effort the typical requests rates of the Data Acquisition system, which is about 30000 requests in a time window of few seconds coming from more than 1000 clients.

I've got 99 problems but a phone ain't one: Electronic and mobile health in low and middle income countries.

PubMed

Kumar, Pratap; Paton, Chris; Kirigia, Doris

2016-10-01

Mobile technology is very prevalent in Kenya-mobile phone penetration is at 88% and mobile data subscriptions form 99% of all internet subscriptions. While there is great potential for such ubiquitous technology to revolutionise access and quality of healthcare in low-resource settings, there have been few successes at scale. Implementations of electronic health (e-Health) and mobile health (m-Health) technologies in countries like Kenya are yet to tackle human resource constraints or the political, ethical and financial considerations of such technologies. We outline recent innovations that could improve access and quality while considering the costs of healthcare. One is an attempt to create a scalable clinical decision support system by engaging a global network of specialist doctors and reversing some of the damaging effects of medical brain drain. The other efficiently extracts digital information from paper-based records using low-cost and locally produced tools such as rubber stamps to improve adherence to clinical practice guidelines. By bringing down the costs of remote consultations and clinical audit, respectively, these projects offer the potential for clinics in resource-limited settings to deliver high-quality care. This paper makes a case for continued and increased investment in social enterprises that bridge academia, public and private sectors to deliver sustainable and scalable e-Health and m-Health solutions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Study and analysis of information technology in dentistry in Latin American countries.

PubMed

López Jordi, María Del C; Figueiredo, Marcia Ç; Barone, Dante; Pereira, Carolina

2016-04-01

Dentistry increasingly uses Information and Communication Technology (ICT), which has impact on teaching, research, the profession and dental care in general. However, there is a lack of valid information on ICT resources and use in Latin America. This was a descriptive, cross-sectional, multi-center, interdisciplinary study, the aim of which was to conduct a survey on how extensively ICT is used in Dentistry in Latin American countries by enquiring into two primary components: 1) use of ICT in student training and 2) use of ICT by professionals in consulting rooms and services. Two questionnaires on ICT were prepared: one for teachers/researchers and another for students/professionals. We received 94 answers from teachers/researchers at universities in the region providing information on ICT resources for teaching (type and implementation) and 221 answers from professionals (personal use and use in healthcare). Data are presented as absolute relative frequencies and analyzed quantitatively as percentages. 1) Teachers highlight ICT as an instrument for development, democratization and fairness in access to knowledge for higher education. 2) ICT supports collaborative learning and generates other innovative resources (e.g. simulators). 3) Innovations in telemedicine and experiences with electronic clinical history were identified in Brazil, Uruguay and Colombia. These results are a basis upon which to reach a consensus regarding a set of ICT indicators which are comparable at regional level and serve as input to unify the design and implementation of ICTs experiences in both teaching and dental care in Latin America. Sociedad Argentina de Investigación Odontológica.

[Medical human resources planning in Europe: A literature review of the forecasting models].

PubMed

Benahmed, N; Deliège, D; De Wever, A; Pirson, M

2018-02-01

Healthcare is a labor-intensive sector in which half of the expenses are dedicated to human resources. Therefore, policy makers, at national and internal levels, attend to the number of practicing professionals and the skill mix. This paper aims to analyze the European forecasting model for supply and demand of physicians. To describe the forecasting tools used for physician planning in Europe, a grey literature search was done in the OECD, WHO, and European Union libraries. Electronic databases such as Pubmed, Medine, Embase and Econlit were also searched. Quantitative methods for forecasting medical supply rely mainly on stock-and-flow simulations and less often on systemic dynamics. Parameters included in forecasting models exhibit wide variability for data availability and quality. The forecasting of physician needs is limited to healthcare consumption and rarely considers overall needs and service targets. Besides quantitative methods, horizon scanning enables an evaluation of the changes in supply and demand in an uncertain future based on qualitative techniques such as semi-structured interviews, Delphi Panels, or focus groups. Finally, supply and demand forecasting models should be regularly updated. Moreover, post-hoc analyze is also needed but too rarely implemented. Medical human resource planning in Europe is inconsistent. Political implementation of the results of forecasting projections is essential to insure efficient planning. However, crucial elements such as mobility data between Member States are poorly understood, impairing medical supply regulation policies. These policies are commonly limited to training regulations, while horizontal and vertical substitution is less frequently taken into consideration. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Building laboratory capacity to support HIV care in Nigeria: Harvard/APIN PEPFAR, 2004-2012.

PubMed

Hamel, Donald J; Sankalé, Jean-Louis; Samuels, Jay Osi; Sarr, Abdoulaye D; Chaplin, Beth; Ofuche, Eke; Meloni, Seema T; Okonkwo, Prosper; Kanki, Phyllis J

From 2004-2012, the Harvard/AIDS Prevention Initiative in Nigeria, funded through the US President's Emergency Plan for AIDS Relief programme, scaled up HIV care and treatment services in Nigeria. We describe the methodologies and collaborative processes developed to improve laboratory capacity significantly in a resource-limited setting. These methods were implemented at 35 clinic and laboratory locations. Systems were established and modified to optimise numerous laboratory processes. These included strategies for clinic selection and management, equipment and reagent procurement, supply chains, laboratory renovations, equipment maintenance, electronic data management, quality development programmes and trainings. Over the eight-year programme, laboratories supported 160 000 patients receiving HIV care in Nigeria, delivering over 2.5 million test results, including regular viral load quantitation. External quality assurance systems were established for CD4+ cell count enumeration, blood chemistries and viral load monitoring. Laboratory equipment platforms were improved and standardised and use of point-of-care analysers was expanded. Laboratory training workshops supported laboratories toward increasing staff skills and improving overall quality. Participation in a World Health Organisation-led African laboratory quality improvement system resulted in significant gains in quality measures at five laboratories. Targeted implementation of laboratory development processes, during simultaneous scale-up of HIV treatment programmes in a resource-limited setting, can elicit meaningful gains in laboratory quality and capacity. Systems to improve the physical laboratory environment, develop laboratory staff, create improvements to reduce costs and increase quality are available for future health and laboratory strengthening programmes. We hope that the strategies employed may inform and encourage the development of other laboratories in resource-limited settings.

Estimating the Cost of Providing Foundational Public Health Services.

PubMed

Mamaril, Cezar Brian C; Mays, Glen P; Branham, Douglas Keith; Bekemeier, Betty; Marlowe, Justin; Timsina, Lava

2017-12-28

To estimate the cost of resources required to implement a set of Foundational Public Health Services (FPHS) as recommended by the Institute of Medicine. A stochastic simulation model was used to generate probability distributions of input and output costs across 11 FPHS domains. We used an implementation attainment scale to estimate costs of fully implementing FPHS. We use data collected from a diverse cohort of 19 public health agencies located in three states that implemented the FPHS cost estimation methodology in their agencies during 2014-2015. The average agency incurred costs of $48 per capita implementing FPHS at their current attainment levels with a coefficient of variation (CV) of 16 percent. Achieving full FPHS implementation would require $82 per capita (CV=19 percent), indicating an estimated resource gap of $34 per capita. Substantial variation in costs exists across communities in resources currently devoted to implementing FPHS, with even larger variation in resources needed for full attainment. Reducing geographic inequities in FPHS may require novel financing mechanisms and delivery models that allow health agencies to have robust roles within the health system and realize a minimum package of public health services for the nation. © Health Research and Educational Trust.

Successful Deployment of High Flow Nasal Cannula in a Peruvian Pediatric Intensive Care Unit Using Implementation Science-Lessons Learned.

PubMed

Nielsen, Katie R; Becerra, Rosario; Mallma, Gabriela; Tantaleán da Fieno, José

2018-01-01

Acute lower respiratory infections are the leading cause of death outside the neonatal period for children less than 5 years of age. Widespread availability of invasive and non-invasive mechanical ventilation in resource-rich settings has reduced mortality rates; however, these technologies are not always available in many low- and middle-income countries due to the high cost and trained personnel required to implement and sustain their use. High flow nasal cannula (HFNC) is a form of non-invasive respiratory support with growing evidence for use in pediatric respiratory failure. Its simple interface makes utilization in resource-limited settings appealing, although widespread implementation in these settings lags behind resource-rich settings. Implementation science is an emerging field dedicated to closing the know-do gap by incorporating evidence-based interventions into routine care, and its principles have guided the scaling up of many global health interventions. In 2016, we introduced HFNC use for respiratory failure in a pediatric intensive care unit in Lima, Peru using implementation science methodology. Here, we review our experience in the context of the principles of implementation science to serve as a guide for others considering HFNC implementation in resource-limited settings.

Implementation of Open Educational Resources in a Nursing Programme: Experiences and Reflections

ERIC Educational Resources Information Center

Elf, Marie; Ossiannilsson, Ebba; Neljesjö, Maria; Jansson, Monika

2015-01-01

The IMPOER project (implementation of open educational resources, OER) aimed to implement OER in a nursing programme at Dalarna University, Sweden. The university and its nursing programme have long engaged in e-learning, and the nursing programme has recently been awarded the European Association of Distance Teaching Universities E-xcellence…

Integrating Spatial Components into FIA Models of Forest Resources: Some Technical Aspects

Treesearch

Pat Terletzky; Tracey Frescino

2005-01-01

We examined two software packages to determine their feasibility of implementing spatially explicit, forest resource models that integrate Forest Inventory and Analysis data (FIA). ARCINFO and Interactive Data Language (IDL) were examined for their input requirements, speed of processing, storage requirements, and flexibility of implementing. Implementations of two...

Human Resources Task Group Report Task 3

DTIC Science & Technology

2002-12-18

AND ADDRESS(ES) Defense Business Board,1155 Defense Pentagon,Washington,DC,20301-1155 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING...2002 DEFENSE BUSINESS PRACTICE IMPLEMENTATION BOARD Defense Business Practice Implementation Board Human Resources Task Group...their hiring success and reduced attrition through use of aptitude and motivational testing. Defense Business Practice Implementation Board Human

NASA Parts Selection List (NPSL) WWW Site http://nepp.nasa.gov/npsl

NASA Technical Reports Server (NTRS)

Brusse, Jay

2000-01-01

The NASA Parts Selection List (NPSL) is an on-line resource for electronic parts selection tailored for use by spaceflight projects. The NPSL provides a list of commonly used electronic parts that have a history of satisfactory use in spaceflight applications. The objective of this www site is to provide NASA projects, contractors, university experimenters, et al with an easy to use resource that provides a baseline of electronic parts from which designers are encouraged to select. The NPSL is an ongoing resource produced by Code 562 in support of the NASA HQ funded NASA Electronic Parts and Packaging (NEPP) Program. The NPSL is produced as an electronic format deliverable made available via the referenced www site administered by Code 562. The NPSL does not provide information pertaining to patented or proprietary information. All of the information contained in the NPSL is available through various other public domain resources such as US Military procurement specifications for electronic parts, NASA GSFC's Preferred Parts List (PPL-21), and NASA's Standard Parts List (MIL-STD975).

Clearing Hurdles: The Challenges of Implementation of Mental Health Evidence-Based Practices in Under-resourced Schools.

PubMed

Eiraldi, Ricardo; Wolk, Courtney Benjamin; Locke, Jill; Beidas, Rinad

Schools have become the main provider of services to children with mental health needs. Although there is substantial literature on barriers to implementation of evidence-based practices (EBPs) in under-resourced school districts, less has been written on how to overcome those barriers. Providing mental health services in the school setting presents a tremendous opportunity to increase access to quality mental health care for underserved youth. This review provides a brief overview of the barriers to successful implementation and sustainment of EBPs in under-resourced public schools and provides recommendations for overcoming them. The discussion is organized around an established conceptual framework adapted for the delivery of services in under-resourced schools that focuses on interdependent factors that exist at the individual-, team, school-, and macro-levels. This manuscript explores some recommendations and strategies for effectively addressing challenges related to implementation of EBPs. Research ideas are offered to bridge the research-to-practice gap that impacts many under-resourced public school districts.

Clearing Hurdles: The Challenges of Implementation of Mental Health Evidence-Based Practices in Under-resourced Schools

PubMed Central

Eiraldi, Ricardo; Wolk, Courtney Benjamin; Locke, Jill; Beidas, Rinad

2015-01-01

Schools have become the main provider of services to children with mental health needs. Although there is substantial literature on barriers to implementation of evidence-based practices (EBPs) in under-resourced school districts, less has been written on how to overcome those barriers. Providing mental health services in the school setting presents a tremendous opportunity to increase access to quality mental health care for underserved youth. This review provides a brief overview of the barriers to successful implementation and sustainment of EBPs in under-resourced public schools and provides recommendations for overcoming them. The discussion is organized around an established conceptual framework adapted for the delivery of services in under-resourced schools that focuses on interdependent factors that exist at the individual-, team, school-, and macro-levels. This manuscript explores some recommendations and strategies for effectively addressing challenges related to implementation of EBPs. Research ideas are offered to bridge the research-to-practice gap that impacts many under-resourced public school districts. PMID:26336512

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…

Simulation analysis of resource flexibility on healthcare processes

PubMed Central

Simwita, Yusta W; Helgheim, Berit I

2016-01-01

Purpose This paper uses discrete event simulation to explore the best resource flexibility scenario and examine the effect of implementing resource flexibility on different stages of patient treatment process. Specifically we investigate the effect of resource flexibility on patient waiting time and throughput in an orthopedic care process. We further seek to explore on how implementation of resource flexibility on patient treatment processes affects patient access to healthcare services. We focus on two resources, namely, orthopedic surgeon and operating room. Methods The observational approach was used to collect process data. The developed model was validated by comparing the simulation output with actual patient data collected from the studied orthopedic care process. We developed different scenarios to identify the best resource flexibility scenario and explore the effect of resource flexibility on patient waiting time, throughput, and future changes in demand. The developed scenarios focused on creating flexibility on service capacity of this care process by altering the amount of additional human resource capacity at different stages of patient care process and extending the use of operating room capacity. Results The study found that resource flexibility can improve responsiveness to patient demand in the treatment process. Testing different scenarios showed that the introduction of resource flexibility reduces patient waiting time and improves throughput. The simulation results show that patient access to health services can be improved by implementing resource flexibility at different stages of the patient treatment process. Conclusion This study contributes to the current health care literature by explaining how implementing resource flexibility at different stages of patient care processes can improve ability to respond to increasing patients demands. This study was limited to a single patient process; studies focusing on additional processes are recommended. PMID:27785046

Simulation analysis of resource flexibility on healthcare processes.

PubMed

Simwita, Yusta W; Helgheim, Berit I

2016-01-01

This paper uses discrete event simulation to explore the best resource flexibility scenario and examine the effect of implementing resource flexibility on different stages of patient treatment process. Specifically we investigate the effect of resource flexibility on patient waiting time and throughput in an orthopedic care process. We further seek to explore on how implementation of resource flexibility on patient treatment processes affects patient access to healthcare services. We focus on two resources, namely, orthopedic surgeon and operating room. The observational approach was used to collect process data. The developed model was validated by comparing the simulation output with actual patient data collected from the studied orthopedic care process. We developed different scenarios to identify the best resource flexibility scenario and explore the effect of resource flexibility on patient waiting time, throughput, and future changes in demand. The developed scenarios focused on creating flexibility on service capacity of this care process by altering the amount of additional human resource capacity at different stages of patient care process and extending the use of operating room capacity. The study found that resource flexibility can improve responsiveness to patient demand in the treatment process. Testing different scenarios showed that the introduction of resource flexibility reduces patient waiting time and improves throughput. The simulation results show that patient access to health services can be improved by implementing resource flexibility at different stages of the patient treatment process. This study contributes to the current health care literature by explaining how implementing resource flexibility at different stages of patient care processes can improve ability to respond to increasing patients demands. This study was limited to a single patient process; studies focusing on additional processes are recommended.

Implementation of Electronic Commerce in the Department of Defense and the National Aeronautics and Space Administration.

DTIC Science & Technology

1996-12-01

President Clinton’s Executive Memorandum of 26 October 1993 mandated that all Federal Government agencies implement Electronic Commerce (EC) in order... Electronic Commerce /Electronic Data Interchange (EC/EDI) architecture. The NASA employed an Internet based tool, the NASA Acquisition Internet Service

An emulator for minimizing finite element analysis implementation resources

NASA Technical Reports Server (NTRS)

Melosh, R. J.; Utku, S.; Salama, M.; Islam, M.

1982-01-01

A finite element analysis emulator providing a basis for efficiently establishing an optimum computer implementation strategy when many calculations are involved is described. The SCOPE emulator determines computer resources required as a function of the structural model, structural load-deflection equation characteristics, the storage allocation plan, and computer hardware capabilities. Thereby, it provides data for trading analysis implementation options to arrive at a best strategy. The models contained in SCOPE lead to micro-operation computer counts of each finite element operation as well as overall computer resource cost estimates. Application of SCOPE to the Memphis-Arkansas bridge analysis provides measures of the accuracy of resource assessments. Data indicate that predictions are within 17.3 percent for calculation times and within 3.2 percent for peripheral storage resources for the ELAS code.

Video Killed the Radio Star: Language Students' Use of Electronic Resources-Reading or Viewing?

ERIC Educational Resources Information Center

Kiliçkaya, Ferit

2016-01-01

The current study aimed to investigate language students' use of print and electronic resources for their research papers required in research techniques class, focusing on which reading strategies they used while reading these resources. The participants of the study were 90 sophomore students enrolled in the research techniques class offered at…

Managing Selection for Electronic Resources: Kent State University Develops a New System to Automate Selection

ERIC Educational Resources Information Center

Downey, Kay

2012-01-01

Kent State University has developed a centralized system that manages the communication and work related to the review and selection of commercially available electronic resources. It is an automated system that tracks the review process, provides selectors with price and trial information, and compiles reviewers' feedback about the resource. It…

Using Current Resources to Implement Wellness Programming for Preschoolers

ERIC Educational Resources Information Center

Cirignano, Sherri M.

2013-01-01

Currently, there is a nationwide effort to include preschool-aged children in wellness efforts for the prevention of obesity. National resources include guidelines, best practices, and tip sheets to assist in the implementation of these interventions. The Let's Move! Child Care Checklist is a resource that can be used to assess the level at…

A Review of Computer Science Resources for Learning and Teaching with K-12 Computing Curricula: An Australian Case Study

ERIC Educational Resources Information Center

Falkner, Katrina; Vivian, Rebecca

2015-01-01

To support teachers to implement Computer Science curricula into classrooms from the very first year of school, teachers, schools and organisations seek quality curriculum resources to support implementation and teacher professional development. Until now, many Computer Science resources and outreach initiatives have targeted K-12 school-age…

Exploring the Factors of an Enterprise Resource Planning System in a Local Government Organization

ERIC Educational Resources Information Center

Shaw, Bryan T.

2012-01-01

The enterprise resource planning (ERP) system industry accounts for $8.8 billion annually. Enterprise resource planning systems are not performing as expected due to implementation barriers, changes in job responsibilities, and access to information; 50% of all information technology failures are due to the implementation of ERP systems. Guided by…

The Centrality of the "Mediation" Concept in the Participatory Management of Water Resources

ERIC Educational Resources Information Center

dos Santos, Irenilda Angela; Berlinck, Christian Niel; de Santana Araujo, Symone Christine; Steinke, Ercilia Torres; Steinke, Valdir Adilson; Pianta, Taissa Ferreira; Graebner, Ivete Teresinha; Saito, Carlos Hiroo

2005-01-01

This work presents questions related to the viability and the requirements for the implementation of a National Policy of Water Resources in Brazil, and identifies the means to bring about active participation by the population in the management of water resources. While social inequalities may be an impediment to the implementation of full…

Building a house on shifting sand: methodological considerations when evaluating the implementation and adoption of national electronic health record systems

PubMed Central

2012-01-01

Background A commitment to Electronic Health Record (EHR) systems now constitutes a core part of many governments’ healthcare reform strategies. The resulting politically-initiated large-scale or national EHR endeavors are challenging because of their ambitious agendas of change, the scale of resources needed to make them work, the (relatively) short timescales set, and the large number of stakeholders involved, all of whom pursue somewhat different interests. These initiatives need to be evaluated to establish if they improve care and represent value for money. Methods Critical reflections on these complexities in the light of experience of undertaking the first national, longitudinal, and sociotechnical evaluation of the implementation and adoption of England’s National Health Service’s Care Records Service (NHS CRS). Results/discussion We advance two key arguments. First, national programs for EHR implementations are likely to take place in the shifting sands of evolving sociopolitical and sociotechnical and contexts, which are likely to shape them in significant ways. This poses challenges to conventional evaluation approaches which draw on a model of baseline operations → intervention → changed operations (outcome). Second, evaluation of such programs must account for this changing context by adapting to it. This requires careful and creative choice of ontological, epistemological and methodological assumptions. Summary New and significant challenges are faced in evaluating national EHR implementation endeavors. Based on experiences from this national evaluation of the implementation and adoption of the NHS CRS in England, we argue for an approach to these evaluations which moves away from seeing EHR systems as Information and Communication Technologies (ICT) projects requiring an essentially outcome-centred assessment towards a more interpretive approach that reflects the situated and evolving nature of EHR seen within multiple specific settings and reflecting a constantly changing milieu of policies, strategies and software, with constant interactions across such boundaries. PMID:22545646

Building a house on shifting sand: methodological considerations when evaluating the implementation and adoption of national electronic health record systems.

PubMed

Takian, Amirhossein; Petrakaki, Dimitra; Cornford, Tony; Sheikh, Aziz; Barber, Nicholas

2012-04-30

A commitment to Electronic Health Record (EHR) systems now constitutes a core part of many governments' healthcare reform strategies. The resulting politically-initiated large-scale or national EHR endeavors are challenging because of their ambitious agendas of change, the scale of resources needed to make them work, the (relatively) short timescales set, and the large number of stakeholders involved, all of whom pursue somewhat different interests. These initiatives need to be evaluated to establish if they improve care and represent value for money. Critical reflections on these complexities in the light of experience of undertaking the first national, longitudinal, and sociotechnical evaluation of the implementation and adoption of England's National Health Service's Care Records Service (NHS CRS). We advance two key arguments. First, national programs for EHR implementations are likely to take place in the shifting sands of evolving sociopolitical and sociotechnical and contexts, which are likely to shape them in significant ways. This poses challenges to conventional evaluation approaches which draw on a model of baseline operations → intervention → changed operations (outcome). Second, evaluation of such programs must account for this changing context by adapting to it. This requires careful and creative choice of ontological, epistemological and methodological assumptions. New and significant challenges are faced in evaluating national EHR implementation endeavors. Based on experiences from this national evaluation of the implementation and adoption of the NHS CRS in England, we argue for an approach to these evaluations which moves away from seeing EHR systems as Information and Communication Technologies (ICT) projects requiring an essentially outcome-centred assessment towards a more interpretive approach that reflects the situated and evolving nature of EHR seen within multiple specific settings and reflecting a constantly changing milieu of policies, strategies and software, with constant interactions across such boundaries.

Real-time database drawn from an electronic health record for a thoracic surgery unit: high-quality clinical data saving time and human resources.

PubMed

Salati, Michele; Pompili, Cecilia; Refai, Majed; Xiumè, Francesco; Sabbatini, Armando; Brunelli, Alessandro

2014-06-01

The aim of the present study was to verify whether the implementation of an electronic health record (EHR) in our thoracic surgery unit allows creation of a high-quality clinical database saving time and costs. Before August 2011, multiple individuals compiled the on-paper documents/records and a single data manager inputted selected data into the database (traditional database, tDB). Since the adoption of an EHR in August 2011, multiple individuals have been responsible for compiling the EHR, which automatically generates a real-time database (EHR-based database, eDB), without the need for a data manager. During the initial period of implementation of the EHR, periodic meetings were held with all physicians involved in the use of the EHR in order to monitor and standardize the data registration process. Data quality of the first 100 anatomical lung resections recorded in the eDB was assessed by measuring the total number of missing values (MVs: existing non-reported value) and inaccurate values (wrong data) occurring in 95 core variables. The average MV of the eDB was compared with the one occurring in the same variables of the last 100 records registered in the tDB. A learning curve was constructed by plotting the number of MVs in the electronic database and tDB with the patients arranged by the date of registration. The tDB and eDB had similar MVs (0.74 vs 1, P = 0.13). The learning curve showed an initial phase including about 35 records, where MV in the eDB was higher than that in the tDB (1.9 vs 0.74, P = 0.03), and a subsequent phase, where the MV was similar in the two databases (0.7 vs 0.74, P = 0.6). The inaccuracy rate of these two phases in the eDB was stable (0.5 vs 0.3, P = 0.3). Using EHR saved an average of 9 min per patient, totalling 15 h saved for obtaining a dataset of 100 patients with respect to the tDB. The implementation of EHR allowed streamlining the process of clinical data recording. It saved time and human resource costs, without compromising the quality of data. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

The Challenges of Electronic Health Records and Diabetes Electronic Prescribing: Implications for Safety Net Care for Diverse Populations

PubMed Central

Chan, Lenny L. S.; Fouts, Michelle M.; Murphy, Elizabeth J.

2017-01-01

Widespread electronic health record (EHR) implementation creates new challenges in the diabetes care of complex and diverse populations, including safe medication prescribing for patients with limited health literacy and limited English proficiency. This review highlights how the EHR electronic prescribing transformation has affected diabetes care for vulnerable patients and offers recommendations for improving patient safety through EHR electronic prescribing design, implementation, policy, and research. Specifically, we present evidence for (1) the adoption of RxNorm; (2) standardized naming and picklist options for high alert medications such as insulin; (3) the widespread implementation of universal medication schedule and language-concordant labels, with the expansion of electronic prescription 140-character limit; (4) enhanced bidirectional communication with pharmacy partners; and (5) informatics and implementation research in safety net healthcare systems to examine how EHR tools and practices affect diverse vulnerable populations. PMID:28197420

The Challenges of Electronic Health Records and Diabetes Electronic Prescribing: Implications for Safety Net Care for Diverse Populations.

PubMed

Ratanawongsa, Neda; Chan, Lenny L S; Fouts, Michelle M; Murphy, Elizabeth J

2017-01-01

Widespread electronic health record (EHR) implementation creates new challenges in the diabetes care of complex and diverse populations, including safe medication prescribing for patients with limited health literacy and limited English proficiency. This review highlights how the EHR electronic prescribing transformation has affected diabetes care for vulnerable patients and offers recommendations for improving patient safety through EHR electronic prescribing design, implementation, policy, and research. Specifically, we present evidence for (1) the adoption of RxNorm; (2) standardized naming and picklist options for high alert medications such as insulin; (3) the widespread implementation of universal medication schedule and language-concordant labels, with the expansion of electronic prescription 140-character limit; (4) enhanced bidirectional communication with pharmacy partners; and (5) informatics and implementation research in safety net healthcare systems to examine how EHR tools and practices affect diverse vulnerable populations.

Clinical outcomes and mortality before and after implementation of a pediatric sepsis protocol in a limited resource setting: A retrospective cohort study in Bangladesh.

PubMed

Kortz, Teresa Bleakly; Axelrod, David M; Chisti, Mohammod J; Kache, Saraswati

2017-01-01

Pediatric sepsis has a high mortality rate in limited resource settings. Sepsis protocols have been shown to be a cost-effective strategy to improve morbidity and mortality in a variety of populations and settings. At Dhaka Hospital in Bangladesh, mortality from pediatric sepsis in high-risk children previously approached 60%, which prompted the implementation of an evidenced-based protocol in 2010. The clinical effectiveness of this protocol had not been measured. We hypothesized that implementation of a pediatric sepsis protocol improved clinical outcomes, including reducing mortality and length of hospital stay. This was a retrospective cohort study of children 1-59 months old with a diagnosis of sepsis, severe sepsis or septic shock admitted to Dhaka Hospital from 10/25/2009-10/25/2011. The primary outcome was inpatient mortality pre- and post-protocol implementation. Secondary outcomes included fluid overload, heart failure, respiratory insufficiency, length of hospital stay, and protocol compliance, as measured by antibiotic and fluid bolus administration within 60 minutes of hospital presentation. 404 patients were identified by a key-word search of the electronic medical record; 328 patients with a primary diagnosis of sepsis, severe sepsis, or septic shock were included (143 pre- and185 post-protocol) in the analysis. Pre- and post-protocol mortality were similar and not statistically significant (32.17% vs. 34.59%, p = 0.72). The adjusted odds ratio (AOR) for post-protocol mortality was 1.55 (95% CI, 0.88-2.71). The odds for developing fluid overload were significantly higher post-protocol (AOR 3.45, 95% CI, 2.04-5.85), as were the odds of developing heart failure (AOR 4.52, 95% CI, 1.43-14.29) and having a longer median length of stay (AOR 1.81, 95% CI 1.10-2.96). There was no statistically significant difference in respiratory insufficiency (pre- 65.7% vs. post- 70.3%, p = 0.4) or antibiotic administration between the cohorts (pre- 16.08% vs. post- 12.43%, p = 0.42). Implementation of a pediatric sepsis protocol did not improve all-cause mortality or length of stay and may have been associated with increased fluid overload and heart failure during the study period in a large, non-governmental hospital in Bangladesh. Similar rates of early antibiotic administration may indicate poor protocol compliance. Though evidenced-based protocols are a potential cost-effective strategy to improve outcomes, future studies should focus on optimal implementation of context-relevant sepsis protocols in limited resource settings.

Resource Consumption of a Diffusion Model for Prevention Programs: The PROSPER Delivery System

PubMed Central

Crowley, Daniel M.; Jones, Damon E.; Greenberg, Mark T.; Feinberg, Mark E.; Spoth, Richard L.

2012-01-01

Purpose To prepare public systems to implement evidence-based prevention programs for adolescents, it is necessary to have accurate estimates of programs’ resource consumption. When evidence-based programs are implemented through a specialized prevention delivery system, additional costs may be incurred during cultivation of the delivery infrastructure. Currently, there is limited research on the resource consumption of such delivery systems and programs. In this article, we describe the resource consumption of implementing the PROSPER (PROmoting School–Community–University Partnerships to Enhance Resilience) delivery system for a period of 5 years in one state, and how the financial and economic costs of its implementation affect local communities as well as the Cooperative Extension and University systems. Methods We used a six-step framework for conducting cost analysis, using a Cost–Procedure–Process–Outcome Analysis model (Yates, Analyzing costs, procedures, processes, and outcomes in human services: An introduction, 1996; Yates, 2009). This method entails defining the delivery System; bounding cost parameters; identifying, quantifying, and valuing systemic resource Consumption, and conducting sensitivity analysis of the cost estimates. Results Our analyses estimated both the financial and economic costs of the PROSPER delivery system. Evaluation of PROSPER illustrated how costs vary over time depending on the primacy of certain activities (e.g., team development, facilitator training, program implementation). Additionally, this work describes how the PROSPER model cultivates a complex resource infrastructure and provides preliminary evidence of systemic efficiencies. Conclusions This work highlights the need to study the costs of diffusion across time and broadens definitions of what is essential for successful implementation. In particular, cost analyses offer innovative methodologies for analyzing the resource needs of prevention systems. PMID:22325131

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

PubMed

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

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

Connecting Print and Electronic Titles: An Integrated Approach at the University of Nebraska-Lincoln

ERIC Educational Resources Information Center

Wolfe, Judith; Konecky, Joan Latta; Boden, Dana W. R.

2011-01-01

Libraries make heavy investments in electronic resources, with many of these resources reflecting title changes, bundled subsets, or content changes of formerly print material. These changes can distance the electronic format from its print origins, creating discovery and access issues. A task force was formed to explore the enhancement of catalog…

Library Instruction in the Electronic Library: The University of Arizona's Electronic Library Education Centers.

ERIC Educational Resources Information Center

Glogoff, Stuart

1995-01-01

Discusses two Electronic Library Education Centers (ELECs) created at the University of Arizona to improve library instruction in the use of online resources. Examines costs of developing ELECs; technical changes experienced; and benefits to users and librarians. A sidebar by Abbie J. Basile identifies Internet resources for planning and/or…

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.

Open-Source Electronic Health Record Systems for Low-Resource Settings: Systematic Review.

PubMed

Syzdykova, Assel; Malta, André; Zolfo, Maria; Diro, Ermias; Oliveira, José Luis

2017-11-13

Despite the great impact of information and communication technologies on clinical practice and on the quality of health services, this trend has been almost exclusive to developed countries, whereas countries with poor resources suffer from many economic and social issues that have hindered the real benefits of electronic health (eHealth) tools. As a component of eHealth systems, electronic health records (EHRs) play a fundamental role in patient management and effective medical care services. Thus, the adoption of EHRs in regions with a lack of infrastructure, untrained staff, and ill-equipped health care providers is an important task. However, the main barrier to adopting EHR software in low- and middle-income countries is the cost of its purchase and maintenance, which highlights the open-source approach as a good solution for these underserved areas. The aim of this study was to conduct a systematic review of open-source EHR systems based on the requirements and limitations of low-resource settings. First, we reviewed existing literature on the comparison of available open-source solutions. In close collaboration with the University of Gondar Hospital, Ethiopia, we identified common limitations in poor resource environments and also the main requirements that EHRs should support. Then, we extensively evaluated the current open-source EHR solutions, discussing their strengths and weaknesses, and their appropriateness to fulfill a predefined set of features relevant for low-resource settings. The evaluation methodology allowed assessment of several key aspects of available solutions that are as follows: (1) integrated applications, (2) configurable reports, (3) custom reports, (4) custom forms, (5) interoperability, (6) coding systems, (7) authentication methods, (8) patient portal, (9) access control model, (10) cryptographic features, (11) flexible data model, (12) offline support, (13) native client, (14) Web client,(15) other clients, (16) code-based language, (17) development activity, (18) modularity, (19) user interface, (20) community support, and (21) customization. The quality of each feature is discussed for each of the evaluated solutions and a final comparison is presented. There is a clear demand for open-source, reliable, and flexible EHR systems in low-resource settings. In this study, we have evaluated and compared five open-source EHR systems following a multidimensional methodology that can provide informed recommendations to other implementers, developers, and health care professionals. We hope that the results of this comparison can guide decision making when needing to adopt, install, and maintain an open-source EHR solution in low-resource settings. ©Assel Syzdykova, André Malta, Maria Zolfo, Ermias Diro, José Luis Oliveira. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 13.11.2017.

Library use and information-seeking behavior of veterinary medical students revisited in the electronic environment.

PubMed

Pelzer, N L; Wiese, W H; Leysen, J M

1998-07-01

Veterinary medical students at Iowa State University were surveyed in January of 1997 to determine their general use of the Veterinary Medical Library and how they sought information in an electronic environment. Comparisons were made between this study and one conducted a decade ago to determine the effect of the growth in electronic resources on student library use and information-seeking behavior. The basic patterns of student activities in the library, resources used to find current information, and resources anticipated for future education needs remained unchanged. The 1997 students used the library most frequently for photocopying, office supplies, and studying coursework; they preferred textbooks and handouts as sources of current information. However, when these students went beyond textbooks and handouts to seek current information, a major shift was seen from the use of print indexes and abstracts in 1987 towards the use of computerized indexes and other electronic resources in 1997. Almost 60% of the students reported using the Internet for locating current information. Overall use of electronic materials was highest among a group of students receiving the problem-based learning method of instruction. Most of the students surveyed in 1997 indicated that electronic resources would have some degree of importance to them for future education needs. The electronic environment has provided new opportunities for information professionals to help prepare future veterinarians, some of whom will be practicing in remote geographical locations, to access the wealth of information and services available on the Internet and Web.

[Design and implementation of data reporting system for Chinese materia medica resources survey].

PubMed

Wang, Hui; Zhang, Xiao-Bo; Ge, Xiao-Guang; Jing, Zhi-Xian; Wang, Ling; Zhao, Yu-Ping; Guo, Lan-Ping; Huang, Lu-Qi

2017-11-01

The collection, summary and sharing of all kinds of survey data are one of the main tasks and achievements in the national census of Chinese materia medica resources organized and implemented by the State Administration of Traditional Chinese Medicine. It is a key link in the implementation of the national census of Chinese materia medica resources. Based on the client / server architecture, the data reporting system for Chinese materia medica resources survey has been established for reporting system application model of geospatial data service based on Web implementation, through the SOA framework, to achieve the data collection summary of the seven aspects of the local data configuration, data reporting, data verification, data reporting, PDA data import and export, APP data import, track instrument data import. The system services include the general investigation, the focus of investigation, specimen information, herbs sample information, market research, germplasm survey, traditional knowledge survey of these seven aspects of the 312 indicators of the report, serving the Chinese materia medica resource survey of field survey data collection and internal data collation. The system provides the technical support for the national census of Chinese materia medica resources, improves the efficiency of the census of Chinese materia medica resources, and is conducive to the long-term preservation of the data of Chinese materia medica resources census, the transformation and sharing of the results. Copyright© by the Chinese Pharmaceutical Association.

[Human resources for health in Ecuador's new model of care].

PubMed

Espinosa, Verónica; de la Torre, Daniel; Acuña, Cecilia; Cadena, Cristina

2017-06-08

Describe strategies implemented by Ecuador's Ministry of Public Health (MPH) to strengthen human resources for health leadership and respond to the new model of care, as a part of the reform process in the period 2012-2015. A documentary review was carried out of primary and secondary sources on development of human resources for health before and after the reform. In the study period, Ecuador developed a new institutional and regulatory framework for developing human resources for health to respond to the requirements of a model of care based on primary health care. The MPH consolidated its steering role by forging strategic partnerships, implementing human resources planning methods, and making an unprecedented investment in health worker training, hiring, and wage increases. These elements constitute the initial core for development of human resources for health policy and a health-services study program consistent with the reform's objectives. Within the framework of the reform carried out from 2012 to 2015, intersectoral work by the MPH has led to considerable achievements in development of human resources for health. Notable achievements include strengthening of the steering role, development and implementation of standards and regulatory instruments, creation of new professional profiles, and hiring of professionals to implement the comprehensive health care model, which helped to solve problems carried over from the years prior to the reform.

Implementation of transportation asset management in Grandview, Missouri : final report.

DOT National Transportation Integrated Search

2017-02-01

The successful implementation of transportation asset management (TAM) by local governments facilitates the optimization of limited resources. The use of a data-driven TAM program helps to identify and prioritize needs, identify and dedicate resource...

Implementation of Strategies to Leverage Public and Private Resources for National Security Workforce Development

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

None

2009-04-01

This report documents implementation strategies to leverage public and private resources for the development of an adequate national security workforce as part of the National Security Preparedness Project (NSPP), being performed under a U.S. Department of Energy (DOE)/National Nuclear Security Administration (NNSA) grant. There are numerous efforts across the United States to develop a properly skilled and trained national security workforce. Some of these efforts are the result of the leveraging of public and private dollars. As budget dollars decrease and the demand for a properly skilled and trained national security workforce increases, it will become even more important tomore » leverage every education and training dollar. This report details some of the efforts that have been implemented to leverage public and private resources, as well as implementation strategies to further leverage public and private resources.« less

Mandatory and Location-Aware Access Control for Relational Databases

NASA Astrophysics Data System (ADS)

Decker, Michael

Access control is concerned with determining which operations a particular user is allowed to perform on a particular electronic resource. For example, an access control decision could say that user Alice is allowed to perform the operation read (but not write) on the resource research report. With conventional access control this decision is based on the user's identity whereas the basic idea of Location-Aware Access Control (LAAC) is to evaluate also a user's current location when making the decision if a particular request should be granted or denied. LAAC is an interesting approach for mobile information systems because these systems are exposed to specific security threads like the loss of a device. Some data models for LAAC can be found in literature, but almost all of them are based on RBAC and none of them is designed especially for Database Management Systems (DBMS). In this paper we therefore propose a LAAC-approach for DMBS and describe a prototypical implementation of that approach that is based on database triggers.

Designing and examining e-waste recycling process: methodology and case studies.

PubMed

Li, Jinhui; He, Xin; Zeng, Xianlai

2017-03-01

Increasing concerns on resource depletion and environmental pollution have largely obliged electrical and electronic waste (e-waste) should be tackled in an environmentally sound manner. Recycling process development is regarded as the most effective and fundamental to solve the e-waste problem. Based on global achievements related to e-waste recycling in the past 15 years, we first propose a theory to design an e-waste recycling process, including measuring e-waste recyclability and selection of recycling process. And we summarize the indicators and tools in terms of resource dimension, environmental dimension, and economic dimension, to examine the e-waste recycling process. Using the sophisticated experience and adequate information of e-waste management, spent lithium-ion batteries and waste printed circuit boards are chosen as case studies to implement and verify the proposed method. All the potential theory and obtained results in this work can contribute to future e-waste management toward best available techniques and best environmental practices.

A robust nonlinear stabilizer as a controller for improving transient stability in micro-grids.

PubMed

Azimi, Seyed Mohammad; Afsharnia, Saeed

2017-01-01

This paper proposes a parametric-Lyapunov approach to the design of a stabilizer aimed at improving the transient stability of micro-grids (MGs). This strategy is applied to electronically-interfaced distributed resources (EI-DRs) operating with a unified control configuration applicable to all operational modes (i.e. grid-connected mode, islanded mode, and mode transitions). The proposed approach employs a simple structure compared with other nonlinear controllers, allowing ready implementation of the stabilizer. A new parametric-Lyapunov function is proposed rendering the proposed stabilizer more effective in damping system transition transients. The robustness of the proposed stabilizer is also verified based on both time-domain simulations and mathematical proofs, and an ultimate bound has been derived for the frequency transition transients. The proposed stabilizer operates by deploying solely local information and there are no needs for communication links. The deteriorating effects of the primary resource delays on the transient stability are also treated analytically. Finally, the effectiveness of the proposed stabilizer is evaluated through time-domain simulations and compared with the recently-developed stabilizers performed on a multi-resource MG. Copyright © 2016 ISA. Published by Elsevier Ltd. All rights reserved.

E-health systems for management of MDR-TB in resource-poor environments: a decade of experience and recommendations for future work.

PubMed

Fraser, Hamish S F; Habib, Ali; Goodrich, Mark; Thomas, David; Blaya, Joaquin A; Fils-Aime, Joseph Reginald; Jazayeri, Darius; Seaton, Michael; Khan, Aamir J; Choi, Sharon S; Kerrison, Foster; Falzon, Dennis; Becerra, Mercedes C

2013-01-01

Multi-drug resistant TB (MDR-TB) is a complex infectious disease that is a growing threat to global health. It requires lengthy treatment with multiple drugs and specialized laboratory testing. To effectively scale up treatment to thousands of patients requires good information systems to support clinical care, reporting, drug forecasting, supply chain management and monitoring. Over the last decade we have developed the PIH-EMR electronic medical record system, and subsequently OpenMRS-TB, to support the treatment of MDR-TB in Peru, Haiti, Pakistan, and other resource-poor environments. We describe here the experience with implementing these systems and evaluating many aspects of their performance, and review other systems for MDR-TB management. We recommend a new approach to information systems to address the barriers to scale up MDR-TB treatment, particularly access to the appropriate drugs and lab data. We propose moving away from fragmented, vertical systems to focus on common platforms, addressing all stages of TB care, support for open data standards and interoperability, care for a wide range of diseases including HIV, integration with mHealth applications, and ability to function in resource-poor environments.

The ambulance services in northern Norway 2004–2008: improved competence, more tasks, better logistics and increased costs

PubMed Central

Elsbak, Trond M.

2010-01-01

Background The ambulance services in northern Norway have undergone significant development during recent years. Aims The objective of this study was to describe these changes in terms of tasks performed, distance driven, resources spent and level of competence in terms of education. Methods A retrospective analysis was performed. The ambulance fleet’s activity during the time period 2004–2008 was analysed. The subject was the ambulance fleet in northern Norway and its crew members. Tasks done, kilometres driven, resources spent per thousand inhabitants and level of competence were the main outcome measures. Results The major findings were almost doubled costs (92%), increasing number of tasks performed (13%) and a stable situation concerning kilometres driven. We also revealed improving competence in terms of education. A 20% absolute increase in crew members having a certificate of competence (fagbrev) was observed. Conclusions Significant economic resources have been invested in the fleet. Improved level of competence and an upgraded coordination system have improved logistics and hopefully treatment outcome. The latter should be further elucidated when the electronic patient record (EPR) system has been implemented. PMID:20606813

CommunityRx: A Population Health Improvement Innovation That Connects Clinics To Communities.

PubMed

Lindau, Stacy T; Makelarski, Jennifer; Abramsohn, Emily; Beiser, David G; Escamilla, Veronica; Jerome, Jessica; Johnson, Daniel; Kho, Abel N; Lee, Karen K; Long, Timothy; Miller, Doriane C

2016-11-01

The CommunityRx system, a population health innovation, combined an e-prescribing model and community engagement to strengthen links between clinics and community resources for basic, wellness, and disease self-management needs in Chicago. The components of CommunityRx were a youth workforce, whose members identified 19,589 public-serving entities in the 106-square-mile implementation region between 2012 and 2014; community health information specialists, who used the workforce's findings to generate an inventory of 14,914 health-promoting resources; and a health information technology (IT) platform that was integrated with three electronic health record systems at thirty-three clinical sites. By mapping thirty-seven prevalent social and medical conditions to community resources, CommunityRx generated 253,479 personalized HealtheRx prescriptions for more than 113,000 participants. Eighty-three percent of the recipients found the HealtheRx very useful, and 19 percent went to a place they learned about from the HealtheRx. All but one organization continued using the CommunityRx system after the study period ended. This study demonstrates the feasibility of using health IT and workforce innovation to bridge the gap between clinical and other health-promoting sectors. Project HOPE—The People-to-People Health Foundation, Inc.

Decision support system for health care resources allocation

PubMed Central

Sebaa, Abderrazak; Nouicer, Amina; Tari, AbdelKamel; Tarik, Ramtani; Abdellah, Ouhab

2017-01-01

Background A study about healthcare resources can improve decisions regarding the allotment and mobilization of medical resources and to better guide future investment in the health sector. Aim The aim of this work was to design and implement a decision support system to improve medical resources allocation of Bejaia region. Methods To achieve the retrospective cohort study, we integrated existing clinical databases from different Bejaia department health sector institutions (an Algerian department) to collect information about patients from January 2015 through December 2015. Data integration was performed in a data warehouse using the multi-dimensional model and OLAP cube. During implementation, we used Microsoft SQL server 2012 and Microsoft Excel 2010. Results A medical decision support platform was introduced, and was implemented during the planning stages allowing the management of different medical orientations, it provides better apportionment and allotment of medical resources, and ensures that the allocation of health care resources has optimal effects on improving health. Conclusion In this study, we designed and implemented a decision support system which would improve health care in Bejaia department to especially assist in the selection of the optimum location of health center and hospital, the specialty of the health center, the medical equipment and the medical staff. PMID:28848645

Decision support system for health care resources allocation.

PubMed

Sebaa, Abderrazak; Nouicer, Amina; Tari, AbdelKamel; Tarik, Ramtani; Abdellah, Ouhab

2017-06-01

A study about healthcare resources can improve decisions regarding the allotment and mobilization of medical resources and to better guide future investment in the health sector. The aim of this work was to design and implement a decision support system to improve medical resources allocation of Bejaia region. To achieve the retrospective cohort study, we integrated existing clinical databases from different Bejaia department health sector institutions (an Algerian department) to collect information about patients from January 2015 through December 2015. Data integration was performed in a data warehouse using the multi-dimensional model and OLAP cube. During implementation, we used Microsoft SQL server 2012 and Microsoft Excel 2010. A medical decision support platform was introduced, and was implemented during the planning stages allowing the management of different medical orientations, it provides better apportionment and allotment of medical resources, and ensures that the allocation of health care resources has optimal effects on improving health. In this study, we designed and implemented a decision support system which would improve health care in Bejaia department to especially assist in the selection of the optimum location of health center and hospital, the specialty of the health center, the medical equipment and the medical staff.

Design and implementation of population-based specialty care programs.

PubMed

Botts, Sheila R; Gee, Michael T; Chang, Christopher C; Young, Iris; Saito, Logan; Lyman, Alfred E

2017-09-15

The development, implementation, and scaling of 3 population-based specialty care programs in a large integrated healthcare system are reviewed, and the role of clinical pharmacy services in ensuring safe, effective, and affordable care is highlighted. The Kaiser Permanente (KP) integrated healthcare delivery model allows for rapid development and expansion of innovative population management programs involving pharmacy services. Clinical pharmacists have assumed integral roles in improving the safety and effectiveness of high-complexity, high-cost care for specialty populations. These roles require an appropriate practice scope and are supported by an advanced electronic health record with disease registries and electronic surveillance tools for care-gap identification. The 3 specialty population programs described were implemented to address variation or unrecognized gaps in care for at-risk specialty populations. The Home Phototherapy Program has leveraged internal partnerships with clinical pharmacists to improve access to cost-effective nonpharmacologic interventions for psoriasis and other skin disorders. The Multiple Sclerosis Care Program has incorporated clinical pharmacists into neurology care in order to apply clinical guidelines in a systematic manner. The KP SureNet program has used clinical pharmacists and data analytics to identify opportunities to prevent drug-related adverse outcomes and ensure timely follow-up. Specialty care programs improve quality, cost outcomes, and the patient experience by appropriating resources to provide systematic and targeted care to high-risk patients. KP leverages an integration of people, processes, and technology to develop and scale population-based specialty care. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

The use of open source electronic health records within the federal safety net

PubMed Central

Goldwater, Jason C; Kwon, Nancy J; Nathanson, Ashley; Muckle, Alison E; Brown, Alexa; Cornejo, Kerri

2014-01-01

Objective To conduct a federally funded study that examines the acquisition, implementation and operation of open source electronic health records (EHR) within safety net medical settings, such as federally qualified health centers (FQHC). Methods and materials The study was conducted by the National Opinion Research Center (NORC) at the University of Chicago from April to September 2010. The NORC team undertook a comprehensive environmental scan, including a literature review, a dozen key informant interviews using a semistructured protocol, and a series of site visits to West Virginia, California and Arizona FQHC that were currently using an open source EHR. Results Five of the six sites that were chosen as part of the study found a number of advantages in the use of their open source EHR system, such as utilizing a large community of users and developers to modify their EHR to fit the needs of their provider and patient communities, and lower acquisition and implementation costs as compared to a commercial system. Discussion Despite these advantages, many of the informants and site visit participants felt that widespread dissemination and use of open source was restrained due to a negative connotation regarding this type of software. In addition, a number of participants stated that there is a necessary level of technical acumen needed within the FQHC to make an open source EHR effective. Conclusions An open source EHR provides advantages for FQHC that have limited resources to acquire and implement an EHR, but additional study is needed to evaluate its overall effectiveness. PMID:23744787

Real-Time Electronic Dashboard Technology and Its Use to Improve Pediatric Radiology Workflow.

PubMed

Shailam, Randheer; Botwin, Ariel; Stout, Markus; Gee, Michael S

The purpose of our study was to create a real-time electronic dashboard in the pediatric radiology reading room providing a visual display of updated information regarding scheduled and in-progress radiology examinations that could help radiologists to improve clinical workflow and efficiency. To accomplish this, a script was set up to automatically send real-time HL7 messages from the radiology information system (Epic Systems, Verona, WI) to an Iguana Interface engine, with relevant data regarding examinations stored in an SQL Server database for visual display on the dashboard. Implementation of an electronic dashboard in the reading room of a pediatric radiology academic practice has led to several improvements in clinical workflow, including decreasing the time interval for radiologist protocol entry for computed tomography or magnetic resonance imaging examinations as well as fewer telephone calls related to unprotocoled examinations. Other advantages include enhanced ability of radiologists to anticipate and attend to examinations requiring radiologist monitoring or scanning, as well as to work with technologists and operations managers to optimize scheduling in radiology resources. We foresee increased utilization of electronic dashboard technology in the future as a method to improve radiology workflow and quality of patient care. Copyright © 2017 Elsevier Inc. All rights reserved.

Program Implementation Approaches to Build and Sustain Health Care Coordination for Type 2 Diabetes.

PubMed

Fitzgerald, Tania M; Williams, Pam A; Dodge, Julia A; Quinn, Martha; Heminger, Christina L; Moultrie, Rebecca; Taylor, Olivia; Nelson, Belinda W; Lewis, Megan A

2017-03-01

As more people enter the U.S. health care system under the Affordable Care Act (ACA), it is increasingly critical to deliver coordinated, high-quality health care. The ACA supports implementation and sustainability of efficient health care models, given expected limits in available resources. This article highlights implementation strategies to build and sustain care coordination, particularly ones consistent with and reinforced by the ACA. It focuses on disease self-management programs to improve the health of patients with type 2 diabetes, exemplified by grantees of the Alliance to Reduce Disparities in Diabetes. We conducted interviews with grantee program representatives throughout their 5-year programs and conducted a qualitative framework analysis of data to identify key themes related to care coordination. The most promising care coordination strategies that grantee programs described included establishing clinic-community collaborations, embedding community health workers within care management teams, and sharing electronic data. Establishing provider buy-in was crucial for these strategies to be effective. This article adds new insights into strategies promoting effective care coordination. The strategies that grantees implemented throughout the program align with ACA requirements, underscoring their relevance to the changing U.S. health care environment and the likelihood of further support for program sustainability.

Enhancing capacity among faith-based organizations to implement evidence-based cancer control programs: a community-engaged approach.

PubMed

Leyva, Bryan; Allen, Jennifer D; Ospino, Hosffman; Tom, Laura S; Negrón, Rosalyn; Buesa, Richard; Torres, Maria Idalí

2017-09-01

Evidence-based interventions (EBIs) to promote cancer control among Latinos have proliferated in recent years, though adoption and implementation of these interventions by faith-based organizations (FBOs) is limited. Capacity building may be one strategy to promote implementation. In this qualitative study, 18 community key informants were interviewed to (a) understand existing capacity for health programming among Catholic parishes, (b) characterize parishes' resource gaps and capacity-building needs implementing cancer control EBIs, and (c) elucidate strategies for delivering capacity-building assistance to parishes to facilitate implementation of EBIs. Semi-structured qualitative interviews were conducted. Key informants concurred about the capacity of Catholic parishes to deliver health programs, and described attributes of parishes that make them strong partners in health promotion initiatives, including a mission to address physical and mental health, outreach to marginalized groups, altruism among members, and existing engagement in health programming. However, resource gaps and capacity building needs were also identified. Specific recommendations participants made about how existing resources might be leveraged to address challenges include to: establish parish wellness committees; provide "hands-on" learning opportunities for parishioners to gain program planning skills; offer continuous, tailored, on-site technical assistance; facilitate relationships between parishes and community resources; and provide financial support for parishes. Leveraging parishes' existing resources and addressing their implementation needs may improve adoption of cancer control EBIs.

Multi-service terminal adapter based on IP technology applications in rural area

NASA Astrophysics Data System (ADS)

Gao, Li; Li, Xiaobo; Yan, Juntao; Ren, Xupeng

Take advantage of ample modern existing telecom network resources to rural areas may achieve it's information society gradually. This includes the establishment of integrated rural information service platform, modern remote education center and electronic administration management platform for rural areas. The geographical and economic constraints must be overcome for structuring the rural service support system, in order to provide technical support, information products and information services to modern rural information service system. It is important that development an access platform based IP technology, which supports multi-service access in order to implement a variety of types of mobile terminal equipment adapter access and to reduce restrictions on mobile terminal equipment.

Accreditation of Individualized Quality Control Plans by the College of American Pathologists.

PubMed

Hoeltge, Gerald A

2017-03-01

The Laboratory Accreditation Program of the College of American Pathologists (CAP) began in 2015 to allow accredited laboratories to devise their own strategies for quality control of laboratory testing. Participants now have the option to implement individualized quality control plans (IQCPs). Only nonwaived testing that features an internal control (built-in, electronic, or procedural) is eligible for IQCP accreditation. The accreditation checklists that detail the requirements have been peer-reviewed by content experts on CAP's scientific resource committees and by a panel of accreditation participants. Training and communication have been key to the successful introduction of the new IQCP requirements. Copyright © 2016 Elsevier Inc. All rights reserved.

Energy-tunable sources of entangled photons: a viable concept for solid-state-based quantum relays.

PubMed

Trotta, Rinaldo; Martín-Sánchez, Javier; Daruka, Istvan; Ortix, Carmine; Rastelli, Armando

2015-04-17

We propose a new method of generating triggered entangled photon pairs with wavelength on demand. The method uses a microstructured semiconductor-piezoelectric device capable of dynamically reshaping the electronic properties of self-assembled quantum dots (QDs) via anisotropic strain engineering. Theoretical models based on k·p theory in combination with finite-element calculations show that the energy of the polarization-entangled photons emitted by QDs can be tuned in a range larger than 100 meV without affecting the degree of entanglement of the quantum source. These results pave the way towards the deterministic implementation of QD entanglement resources in all-electrically-controlled solid-state-based quantum relays.

Energy-Tunable Sources of Entangled Photons: A Viable Concept for Solid-State-Based Quantum Relays

NASA Astrophysics Data System (ADS)

Trotta, Rinaldo; Martín-Sánchez, Javier; Daruka, Istvan; Ortix, Carmine; Rastelli, Armando

2015-04-01

We propose a new method of generating triggered entangled photon pairs with wavelength on demand. The method uses a microstructured semiconductor-piezoelectric device capable of dynamically reshaping the electronic properties of self-assembled quantum dots (QDs) via anisotropic strain engineering. Theoretical models based on k .p theory in combination with finite-element calculations show that the energy of the polarization-entangled photons emitted by QDs can be tuned in a range larger than 100 meV without affecting the degree of entanglement of the quantum source. These results pave the way towards the deterministic implementation of QD entanglement resources in all-electrically-controlled solid-state-based quantum relays.

Emergent Imaging and Geospatial Technologies for Soil Investigations

NASA Technical Reports Server (NTRS)

DeGloria, Stephen D.; Beaudette, Dylan E.; Irons, James R.; Libohova, Zamir; O'Neill, Peggy E.; Owens, Phillip R.; Schoeneberger, Philip J.; West, Larry T.; Wysocki, Douglas A.

2014-01-01

Soil survey investigations and inventories form the scientific basis for a wide spectrum of agronomic and environmental management programs. Soil data and information help formulate resource conservation policies of federal, state, and local governments that seek to sustain our agricultural production system while enhancing environmental quality on both public and private lands. The dual challenges of increasing agricultural production and ensuring environmental integrity require electronically available soil inventory data with both spatial and attribute quality. Meeting this societal need in part depends on development and evaluation of new methods for updating and maintaining soil inventories for sophisticated applications, and implementing an effective framework to conceptualize and communicate tacit knowledge from soil scientists to numerous stakeholders.

The Northern California Perinatal Research Unit: A Hybrid Model Bridging Research, Quality Improvement and Clinical Practice

PubMed Central

Garrido, Terhilda; Barbeau, Rosemarie

2010-01-01

Kaiser Permanente (KP) has a long-standing commitment to conduct research and report publicly. Simultaneously, it faces a different imperative: harnessing information systems to leverage internal improvements in outcomes, efficiency, and costs. Now that KP HealthConnect, the KP electronic health record, is fully implemented, research challenges at KP are moving away from issues of data access and toward the mechanisms through which raw data create meaningful clinical knowledge that is based on rigorous research. In this report we describe a model for research—the Northern California Division of Research Perinatal Research Unit—that leverages internal and external resources to fulfill these twin missions. PMID:20844705

Release 0.0: clinical information technology in the real world.

PubMed

Kleinke, J D

1998-01-01

The industrialization of medical care delivery, compelled by fifteen years of reimbursement reform, has given rise to a commercial health information technology (HIT) industry. Well financed by Wall Street, the HIT industry offers a variety of ready-made solutions designed to transform a health care organization's raw data resources into useful clinical information. Many of the resulting clinical decision-support products are encumbered by numerous insurmountable intellectual and technical problems and, as a consequence, meet with cultural resistance from physicians. The long-awaited but costly implementation of electronic medical records (EMRs) will make these pioneering but flawed efforts obsolete, if EMR development successfully exploits recent technological breakthroughs and the ongoing consolidation of health care organizations.

IMPLEMENTING AND AUDITING ELECTRONIC RECORDKEEPING SYSTEMS USED IN SCIENTIFIC RESEARCH AND DEVELOPMENT

EPA Science Inventory

Electronic recordkeeping is increasingly replacing hadwritten records in the course of "normal business." As this trend continues, it is important that organizations develop and implement electronic recordkeeping policies and procedures. This is especially true for Research and...

Realizing what's essential: a case study on integrating electronic journal management into a print-centric technical services department.

PubMed

Dollar, Daniel M; Gallagher, John; Glover, Janis; Marone, Regina Kenny; Crooker, Cynthia

2007-04-01

To support migration from print to electronic resources, the Cushing/Whitney Medical Library at Yale University reorganized its Technical Services Department to focus on managing electronic resources. The library hired consultants to help plan the changes and to present recommendations for integrating electronic resource management into every position. The library task force decided to focus initial efforts on the periodical collection. To free staff time to devote to electronic journals, most of the print subscriptions were switched to online only and new workflows were developed for e-journals. Staff learned new responsibilities such as activating e-journals, maintaining accurate holdings information in the online public access catalog and e-journals database ("electronic shelf reading"), updating the link resolver knowledgebase, and troubleshooting. All of the serials team members now spend significant amounts of time managing e-journals. The serials staff now spends its time managing the materials most important to the library's clientele (e-journals and databases). The team's proactive approach to maintenance work and rapid response to reported problems should improve patrons' experiences using e-journals. The library is taking advantage of new technologies such as an electronic resource management system, and library workflows and procedures will continue to evolve as technology changes.

Realizing what's essential: a case study on integrating electronic journal management into a print-centric technicalservices department

PubMed Central

Dollar, Daniel M.; Gallagher, John; Glover, Janis; Marone, Regina Kenny; Crooker, Cynthia

2007-01-01

Objective: To support migration from print to electronic resources, the Cushing/Whitney Medical Library at Yale University reorganized its Technical Services Department to focus on managing electronic resources. Methods: The library hired consultants to help plan the changes and to present recommendations for integrating electronic resource management into every position. The library task force decided to focus initial efforts on the periodical collection. To free staff time to devote to electronic journals, most of the print subscriptions were switched to online only and new workflows were developed for e-journals. Results: Staff learned new responsibilities such as activating e-journals, maintaining accurate holdings information in the online public access catalog and e-journals database (“electronic shelf reading”), updating the link resolver knowledgebase, and troubleshooting. All of the serials team members now spend significant amounts of time managing e-journals. Conclusions: The serials staff now spends its time managing the materials most important to the library's clientele (e-journals and databases). The team's proactive approach to maintenance work and rapid response to reported problems should improve patrons' experiences using e-journals. The library is taking advantage of new technologies such as an electronic resource management system, and library workflows and procedures will continue to evolve as technology changes. PMID:17443247

Health information technology and implementation science: partners in progress in the VHA.

PubMed

Hynes, Denise M; Whittier, Erika R; Owens, Arika

2013-03-01

The Department of Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) has demonstrated how implementation science can enhance the quality of health care. During this time an increasing number of implementation research projects have developed or utilized health information technology (HIT) innovations to leverage the VA's electronic health record and information systems. To describe the HIT approaches used and to characterize the facilitators and barriers to progress within implementation research projects in the VA QUERI program. Nine case studies were selected from among 88 projects and represented 8 of 14 HIT categories identified. Each case study included key informants whose roles on the project were principal investigator, implementation science and informatics development. We conducted documentation analysis and semistructured in-person interviews with key informants for each of the 9 case studies. We used qualitative analysis software to identify and thematically code information and interview responses. : Thematic analyses revealed 3 domains or pathways critical to progression through the QUERI steps. These pathways addressed: (1) compliance and collaboration with information technology policies and procedures; (2) operating within organizational policies and building collaborations with end users, clinicians, and administrators; and (3) obtaining and maintaining research resources and approvals. Sustained efforts in HIT innovation and in implementation science in the Veterans Health Administration demonstrates the interdependencies of these initiatives and the critical pathways that can contribute to progress. Other health care quality improvement efforts that rely on HIT can learn from the Veterans Health Administration experience.

Examining Perceptions over the Effectiveness of Professional Development and Available Resources on the Common Core State Standards Implementation in Arkansas

ERIC Educational Resources Information Center

Sheppard, Julie Trammell

2013-01-01

The purpose of this qualitative case study is to examine the perceptions of teachers and curriculum specialists over the effectiveness of professional development and available resources of the Common Core State Standards (CCSS) implementation process in Arkansas. Arkansas divided the implementation process into three stages: Phase I implemented…

Design and Implementation of a Pilot Obesity Prevention Program in a Low-Resource School: Lessons Learned and Research Recommendations

ERIC Educational Resources Information Center

Baskin, Monica L.; Zunker, Christie; Worley, Courtney B.; Dial, Brenda; Kimbrough, Linda

2009-01-01

Purpose: This paper seeks to describe the design, implementation, and lessons learned from an obesity prevention pilot program delivered in a low resource school in the USA. Design/methodology/approach: A planned program evaluation was conducted to: document explicitly the process of designing and implementing the program; and assess the…

Implementing an electronic hand hygiene monitoring system: Lessons learned from community hospitals.

PubMed

Edmisten, Catherine; Hall, Charles; Kernizan, Lorna; Korwek, Kimberly; Preston, Aaron; Rhoades, Evan; Shah, Shalin; Spight, Lori; Stradi, Silvia; Wellman, Sonia; Zygadlo, Scott

2017-08-01

Measuring and providing feedback about hand hygiene (HH) compliance is a complicated process. Electronic HH monitoring systems have been proposed as a possible solution; however, there is little information available about how to successfully implement and maintain these systems for maximum benefit in community hospitals. An electronic HH monitoring system was implemented in 3 community hospitals by teams at each facility with support from the system vendor. Compliance rates were measured by the electronic monitoring system. The implementation challenges, solutions, and drivers of success were monitored within each facility. The electronic HH monitoring systems tracked on average more than 220,000 compliant HH events per facility per month, with an average monthly compliance rate >85%. The sharing of best practices between facilities was valuable in addressing challenges encountered during implementation and maintaining a high rate of use. Drivers of success included a collaborative environment, leadership commitment, using data to drive improvement, consistent and constant messaging, staff empowerment, and patient involvement. Realizing the full benefit of investments in electronic HH monitoring systems requires careful consideration of implementation strategies, planning for ongoing support and maintenance, and presenting data in a meaningful way to empower and inspire staff. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Selection of Electronic Resources.

ERIC Educational Resources Information Center

Weathers, Barbara

1998-01-01

Discusses the impact of electronic resources on collection development; selection of CD-ROMs, (platform, speed, video and sound, networking capability, installation and maintenance); selection of laser disks; and Internet evaluation (accuracy of content, authority, objectivity, currency, technical characteristics). Lists Web sites for evaluating…

Implementing AIM-based monitoring for natural resource management

USDA-ARS?s Scientific Manuscript database

Successful monitoring programs are built on clearly-defined objectives, thorough planning, and organized implementation. However, natural resource management decisions need to be made at many different organizational levels and scales – from local to national. Developing separate monitoring programs...

Use of poisons information resources and satisfaction with electronic products by Victorian emergency department staff.

PubMed

Luke, Stephen; Fountain, John S; Reith, David M; Braitberg, George; Cruickshank, Jaycen

2014-10-01

ED staff use a range of poisons information resources of varying type and quality. The present study aims to identify those resources utilised in the state of Victoria, Australia, and assess opinion of the most used electronic products. A previously validated self-administered survey was conducted in 15 EDs, with 10 questionnaires sent to each. The survey was then repeated following the provision of a 4-month period of access to Toxinz™, an Internet poisons information product novel to the region. The study was conducted from December 2010 to August 2011. There were 117 (78%) and 48 (32%) responses received from the first and second surveys, respectively, a 55% overall response rate. No statistically significant differences in professional group, numbers of poisoned patients seen or resource type accessed were identified between studies. The electronic resource most used in the first survey was Poisindex® (48.68%) and Toxinz™ (64.1%) in the second. There were statistically significant (P < 0.01) improvements in satisfaction in 26 of 42 questions between surveys, and no decrements. Although the majority of responders possessed mobile devices, less than half used them for poisons information but would do so if a reputable product was available. The order of poisons information sources most utilised was: consultation with a colleague, in-house protocols and electronic resources. There was a significant difference in satisfaction with electronic poisons information resources and a movement away from existing sources when choice was provided. Interest in increased use of mobile solutions was identified. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

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.

Helping the public find information the U.S. Government Information Locator Service (GILS)

USGS Publications Warehouse

Christian, E.J.

1994-01-01

As part of the National Information Infrastructure, the U.S. federal government is establishing a Government Information Locator Service (GILS). GILS will identify and describe public information resources throughout the federal government and provide assistance in obtaining the information. It will be decentralized and will supplement other agency and commercial information dissemination mechanisms. The public will use GILS directly or through intermediaries, including the Government Printing Office and the National Technical Information Service, as well as federal depository libraries, other public libraries, and private sector information services. Direct users will have access to a GILS Core accessible on the Internet without charge. Intermediate access may include kiosks, 800 numbers, electronic mail, bulletin boards, FAX, and offline media such as floppy disks, CD-ROM, and printed works. GILS will use network technology and the American National Standards Institute Z39.50 standard for information search and retrieval so that information can be retrieved in a variety of ways. Direct users may have access to many other major federal and nonfederal information resources, linkages to data systems, and electronic delivery of information products. An Office of Management and Budget Bulletin in 1994 will provide implementing guidance to agencies. The National Institute of Standards and Technology will also establish a Federal Information Processing Standard specifying a GILS Profile and its application for agencies establishing information locators. ?? 1994.

The BRIGHTEN program: implementation and evaluation of a program to bridge resources of an interdisciplinary geriatric health team via electronic networking.

PubMed

Emery, Erin E; Lapidos, Stan; Eisenstein, Amy R; Ivan, Iulia I; Golden, Robyn L

2012-12-01

To demonstrate the feasibility of the BRIGHTEN Program (Bridging Resources of an Interdisciplinary Geriatric Health Team via Electronic Networking), an interdisciplinary team intervention for assessing and treating older adults for depression in outpatient primary and specialty medical clinics. The BRIGHTEN team collaborates "virtually" to review patient assessment results, develop a treatment plan, and refer to appropriate team members for follow-up care. Older adults in 9 academic medical center clinics and 2 community-based clinics completed screening forms for symptoms of depression and anxiety. Those with positive screens engaged in comprehensive assessment with the BRIGHTEN Program Coordinator; the BRIGHTEN virtual team provided treatment recommendations based on the results of assessment. A collaborative treatment plan was developed with each participant, who was then connected to appropriate services. Two thousand four hundred twenty-two older adults were screened in participating clinics over a 40-month period. Eight hundred fifty-nine older adults screened positive, and 150 elected to enroll in BRIGHTEN. From baseline to 6 months, significant improvements were found in depression symptoms (Geriatric Depression Scale, p < .01) and general mental health (SF-12 Mental Component, p < .01). The BRIGHTEN Program demonstrated that an interdisciplinary virtual team linked with outpatient medical clinics can be an effective, nonthreatening, and seamless approach to enable older adults to access treatment for depression.

[Current state and prospects of military personnel health monitoring].

PubMed

Rezvantsev, M V; Kuznetsov, S M; Ivanov, V V; Zakurdaev, V V

2014-01-01

The current article is dedicated to some features of the Russian Federation Armed Forces military personnel health monitoring such as legal and informational provision, methodological basis of functioning, historical aspect of formation and development of the social and hygienic monitoring in the Russian Federation Armed Forces. The term "military personnel health monitoring" is defined as an analytical system of constant and long-term observation, analysis, assessment, studying of factors determined the military personnel health, these factors correlations, health risk factors management in order to minimize them. The current state of the military personnel health monitoring allows coming to the conclusion that the military health system does have forces and resources for state policy of establishing the population health monitoring system implementation. The following directions of the militarily personnel health monitoring improvement are proposed: the Russian Federation Armed Forces medical service record and report system reorganization bringing it closer to the civilian one, implementation of the integrated approach to the medical service informatisation, namely, military personnel health status and medical service resources monitoring. The leading means in this direction are development and introduction of a military serviceman individual health status monitoring system on the basis of a serviceman electronic medical record card. Also it is proposed the current Russian Federation Armed Forces social and hygienic monitoring improvement at the expense of informational interaction between the two subsystems on the basis of unified military medical service space.

DC grid for home applications

NASA Astrophysics Data System (ADS)

Elangovan, D.; Archana, R.; Jayadeep, V. J.; Nithin, M.; Arunkumar, G.

2017-11-01

More than fifty percent Indian population do not have access to electricity in daily lives. The distance between the power generating stations and the distribution centers forms one of the main reasons for lack of electrification in rural and remote areas. Here lies the importance of decentralization of power generation through renewable energy resources. In the present world, electricity is predominantly powered by alternating current, but most day to day devices like LED lamps, computers and electrical vehicles, all run on DC power. By directly supplying DC to these loads, the number of power conversion stages was reduced, and overall system efficiency increases. Replacing existing AC network with DC is a humongous task, but with power electronic techniques, this project intends to implement DC grid at a household level in remote and rural areas. Proposed work was designed and simulated successfully for various loads amounting to 250 W through appropriate power electronic convertors. Maximum utilization of the renewable sources for domestic and commercial application was achieved with the proposed DC topology.

Evidence for electronic health record systems in physical therapy.

PubMed

Vreeman, Daniel J; Taggard, Samuel L; Rhine, Michael D; Worrell, Teddy W

2006-03-01

With increasing pressures to better manage clinical information, we investigated the role of electronic health record (EHR) systems in physical therapist practice through a critical review of the literature. We reviewed studies that met our predefined criteria after independent review by 3 authors. The investigators in all of the reviewed studies reported benefits, including improved reporting, operational efficiency, interdepartmental communication, data accuracy, and capability for future research. In 7 studies, the investigators reported barriers, including challenges with behavior modification, equipment inadequacy, and training. The investigators in all studies reported key success factors, including end-user participation, adequate training, workflow analysis, and data standardization. This review suggests that EHRs have potential benefits for physical therapists. The authors formed the following recommendations based on the studies' themes: (1) incorporate workflow analysis into system design and implementation; (2) include end users, especially clinicians, in system development; (3) devote significant resources for training; (4) plan and test carefully to ensure adequate software and hardware performance; and (5) commit to data standards.

Capturing district nursing through a knowledge-based electronic caseload analysis tool (eCAT).

PubMed

Kane, Kay

2014-03-01

The Electronic Caseload Analysis Tool (eCAT) is a knowledge-based software tool to assist the caseload analysis process. The tool provides a wide range of graphical reports, along with an integrated clinical advisor, to assist district nurses, team leaders, operational and strategic managers with caseload analysis by describing, comparing and benchmarking district nursing practice in the context of population need, staff resources, and service structure. District nurses and clinical lead nurses in Northern Ireland developed the tool, along with academic colleagues from the University of Ulster, working in partnership with a leading software company. The aim was to use the eCAT tool to identify the nursing need of local populations, along with the variances in district nursing practice, and match the workforce accordingly. This article reviews the literature, describes the eCAT solution and discusses the impact of eCAT on nursing practice, staff allocation, service delivery and workforce planning, using fictitious exemplars and a post-implementation evaluation from the trusts.

Development of Wave Turbine Emulator in a Laboratory Environment

NASA Astrophysics Data System (ADS)

Vinatha, U.; Vittal K, P.

2013-07-01

Wave turbine emulator (WTE) is an important equipment for developing wave energy conversion system. The emulator reflects the actual behavior of the wave turbine by reproducing the characteristics of real wave turbine without reliance on natural wave resources and actual wave turbine. It offers a controllable test environment that allows the evaluation and improvement of control schemes for electric generators. The emulator can be used for research applications to drive an electrical generator in a similar way as a practical wave turbine. This article presents the development of a WTE in a laboratory environment and studies on the behavior of electrical generator coupled to the emulator. The structure of a WTE consists of a PC where the characteristics of the turbine are implemented, ac drive to emulate the turbine rotor, feedback mechanism from the drive and power electronic equipment to control the drive. The feedback signal is acquired by the PC through an A/D converter, and the signal for driving the power electronic device comes from the PC through a D/A converter.

Artificial intelligence techniques used in respiratory sound analysis--a systematic review.

PubMed

Palaniappan, Rajkumar; Sundaraj, Kenneth; Sundaraj, Sebastian

2014-02-01

Artificial intelligence (AI) has recently been established as an alternative method to many conventional methods. The implementation of AI techniques for respiratory sound analysis can assist medical professionals in the diagnosis of lung pathologies. This article highlights the importance of AI techniques in the implementation of computer-based respiratory sound analysis. Articles on computer-based respiratory sound analysis using AI techniques were identified by searches conducted on various electronic resources, such as the IEEE, Springer, Elsevier, PubMed, and ACM digital library databases. Brief descriptions of the types of respiratory sounds and their respective characteristics are provided. We then analyzed each of the previous studies to determine the specific respiratory sounds/pathology analyzed, the number of subjects, the signal processing method used, the AI techniques used, and the performance of the AI technique used in the analysis of respiratory sounds. A detailed description of each of these studies is provided. In conclusion, this article provides recommendations for further advancements in respiratory sound analysis.

Commentary on the Federal Government's Role in Influencing E-prescribing Use and Research

PubMed Central

Odukoya, Olufunmilola K; Chui, Michelle A

2012-01-01

Electronic prescribing (e-prescribing) is one of the most studied areas of health information technology due to advocacy for its use by influential organizations such as the Institute of Medicine (IOM). In the United States, the federal government has played a significant role in encouraging use of e-prescribing technology and in stimulating associated research nationwide. The federal government has increased e-prescribing research initiatives through agencies such as the Agency for Healthcare Research and Quality (AHRQ) and the Health Resources and Services Administration (HRSA). Initial initiatives focused on the development of standards for e-prescribing systems and implementation. In recent times, e-prescribing research initiatives have become more focused on identifying unintended consequences of using this technology and identifying new possibilities of use that were previously not envisioned. Continuous studies of how healthcare professionals are interfacing with this new technology, how systems have been implemented, and the impact of this technology on healthcare processes and outcomes are crucial. PMID:22737095

A digital waveguide-based approach for Clavinet modeling and synthesis

NASA Astrophysics Data System (ADS)

Gabrielli, Leonardo; Välimäki, Vesa; Penttinen, Henri; Squartini, Stefano; Bilbao, Stefan

2013-12-01

The Clavinet is an electromechanical musical instrument produced in the mid-twentieth century. As is the case for other vintage instruments, it is subject to aging and requires great effort to be maintained or restored. This paper reports analyses conducted on a Hohner Clavinet D6 and proposes a computational model to faithfully reproduce the Clavinet sound in real time, from tone generation to the emulation of the electronic components. The string excitation signal model is physically inspired and represents a cheap solution in terms of both computational resources and especially memory requirements (compared, e.g., to sample playback systems). Pickups and amplifier models have been implemented which enhance the natural character of the sound with respect to previous work. A model has been implemented on a real-time software platform, Pure Data, capable of a 10-voice polyphony with low latency on an embedded device. Finally, subjective listening tests conducted using the current model are compared to previous tests showing slightly improved results.

A Practical Approach to Governance and Optimization of Structured Data Elements.

PubMed

Collins, Sarah A; Gesner, Emily; Morgan, Steven; Mar, Perry; Maviglia, Saverio; Colburn, Doreen; Tierney, Diana; Rocha, Roberto

2015-01-01

Definition and configuration of clinical content in an enterprise-wide electronic health record (EHR) implementation is highly complex. Sharing of data definitions across applications within an EHR implementation project may be constrained by practical limitations, including time, tools, and expertise. However, maintaining rigor in an approach to data governance is important for sustainability and consistency. With this understanding, we have defined a practical approach for governance of structured data elements to optimize data definitions given limited resources. This approach includes a 10 step process: 1) identification of clinical topics, 2) creation of draft reference models for clinical topics, 3) scoring of downstream data needs for clinical topics, 4) prioritization of clinical topics, 5) validation of reference models for clinical topics, and 6) calculation of gap analyses of EHR compared against reference model, 7) communication of validated reference models across project members, 8) requested revisions to EHR based on gap analysis, 9) evaluation of usage of reference models across project, and 10) Monitoring for new evidence requiring revisions to reference model.

Software-Reconfigurable Processors for Spacecraft

NASA Technical Reports Server (NTRS)

Farrington, Allen; Gray, Andrew; Bell, Bryan; Stanton, Valerie; Chong, Yong; Peters, Kenneth; Lee, Clement; Srinivasan, Jeffrey

2005-01-01

A report presents an overview of an architecture for a software-reconfigurable network data processor for a spacecraft engaged in scientific exploration. When executed on suitable electronic hardware, the software performs the functions of a physical layer (in effect, acts as a software radio in that it performs modulation, demodulation, pulse-shaping, error correction, coding, and decoding), a data-link layer, a network layer, a transport layer, and application-layer processing of scientific data. The software-reconfigurable network processor is undergoing development to enable rapid prototyping and rapid implementation of communication, navigation, and scientific signal-processing functions; to provide a long-lived communication infrastructure; and to provide greatly improved scientific-instrumentation and scientific-data-processing functions by enabling science-driven in-flight reconfiguration of computing resources devoted to these functions. This development is an extension of terrestrial radio and network developments (e.g., in the cellular-telephone industry) implemented in software running on such hardware as field-programmable gate arrays, digital signal processors, traditional digital circuits, and mixed-signal application-specific integrated circuits (ASICs).

"Just-in-time" clinical information.

PubMed

Chueh, H; Barnett, G O

1997-06-01

The just-in-time (JIT) model originated in the manufacturing industry as a way to manage parts inventories process so that specific components could be made available at the appropriate times (that is, "just in time"). This JIT model can be applied to the management of clinical information inventories, so that clinicians can have more immediate access to the most current and relevant information at the time they most need it--when making clinical care decisions. The authors discuss traditional modes of managing clinical information, and then describe how a new, JIT model may be developed and implemented. They describe three modes of clinician-information interactions that a JIT model might employ, the scope of information that may be made available in a JIT model (global information or local, case-specific information), and the challenges posed by the implementation of such an information-access model. Finally, they discuss how JIT information access may change how physicians practice medicine, various ways JIT information may be delivered, and concerns about the trustworthiness of electronically published and accessed information resources.

Optimizing the resource usage in Cloud based environments: the Synergy approach

NASA Astrophysics Data System (ADS)

Zangrando, L.; Llorens, V.; Sgaravatto, M.; Verlato, M.

2017-10-01

Managing resource allocation in a cloud based data centre serving multiple virtual organizations is a challenging issue. In fact, while batch systems are able to allocate resources to different user groups according to specific shares imposed by the data centre administrator, without a static partitioning of such resources, this is not so straightforward in the most common cloud frameworks, e.g. OpenStack. In the current OpenStack implementation, it is only possible to grant fixed quotas to the different user groups and these resources cannot be exceeded by one group even if there are unused resources allocated to other groups. Moreover in the existing OpenStack implementation, when there aren’t resources available, new requests are simply rejected: it is then up to the client to later re-issue the request. The recently started EU-funded INDIGO-DataCloud project is addressing this issue through “Synergy”, a new advanced scheduling service targeted for OpenStack. Synergy adopts a fair-share model for resource provisioning which guarantees that resources are distributed among users following the fair-share policies defined by the administrator, taken also into account the past usage of such resources. We present the architecture of Synergy, the status of its implementation, some preliminary results and the foreseen evolution of the service.

A Study on Developing Evaluation Criteria for Electronic Resources in Evaluation Indicators of Libraries

ERIC Educational Resources Information Center

Noh, Younghee

2010-01-01

This study aimed to improve the current state of electronic resource evaluation in libraries. While the use of Web DB, e-book, e-journal, and other e-resources such as CD-ROM, DVD, and micro materials is increasing in libraries, their use is not comprehensively factored into the general evaluation of libraries and may diminish the reliability of…

What to Do with the Bounty? Organizational Patterns for the Implementation of Resources Allocated by the Courage to Change (Oz Letmura) Reform

ERIC Educational Resources Information Center

Tamir, Emanuel; Shaked, Lea

2016-01-01

The research investigated the way in which school administrations implement resources provided by Israel's "Courage to Change" reform. The uniqueness of this reform stems from the fact that the allocated resources come in the form of "weekly instruction time" rather than finance, and the school management needs to decide how to…

[Family Health Program implementation in municipalities in Mato Grosso State, Brazil].

PubMed

Canesqui, Ana Maria; Spinelli, Maria Angélica do Santos

2008-04-01

This article analysis some key aspects in the implementation of the Family Health Program (FHP): results; conditions; and institutional mechanisms; flow and regularity of funding; organizational structures; and human resources availability and training. The study was conducted in seven municipalities (counties) in the State of Mato Grosso, Brazil, and used secondary data as well as primary data from interviews with different stakeholders. The research design was evaluative, using a quantitative/qualitative analysis. The results showed: varying stages in the implementation process, different FHP models, and adaptation of organizational structures; high level of human resources availability, except for nurse assistants; availability of financial resources, with some difficulties in their flow; and other institutional factors that hinder or facilitate the micro-implementation process in the municipalities.

78 FR 46621 - Status of the Office of New Reactors' Implementation of Electronic Distribution of Advanced...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-01

... of Electronic Distribution of Advanced Reactor Correspondence AGENCY: Nuclear Regulatory Commission. ACTION: Implementation of electronic distribution of advanced reactor correspondence; issuance. SUMMARY... public that, in the future, publicly available correspondence originating from the Division of Advanced...

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

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-10

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

Description of a Mobile-based Electronic Informed Consent System Development.

PubMed

Hwang, Min-A; Kwak, In Ja

2015-01-01

Seoul National University Hospital constructed and implemented a computer-based informed consent system in December 2011. As of 2013, 30% of the informed consents were still filled out manually on paper. Patients and medical staff continuously suggested the implementation of a system for electronic informed consent using portable devices. Therefore, a mobile-based system for electronic informed consent was developed in 2013 to prevent the issues that arise with computer-based systems and paper informed consent. The rate of filling out electronic informed consent increased from 69% to 95% following the implementation of the mobile-based electronic informed consent. This construction of a mobile-based electronic informed consent system would be a good reference point for the development of a mobile-based Electronic Medical Record and for various mobile system environments in medical institutions.

Crossing the quality chasm in resource-limited settings.

PubMed

Maru, Duncan Smith-Rohrberg; Andrews, Jason; Schwarz, Dan; Schwarz, Ryan; Acharya, Bibhav; Ramaiya, Astha; Karelas, Gregory; Rajbhandari, Ruma; Mate, Kedar; Shilpakar, Sona

2012-11-30

Over the last decade, extensive scientific and policy innovations have begun to reduce the "quality chasm"--the gulf between best practices and actual implementation that exists in resource-rich medical settings. While limited data exist, this chasm is likely to be equally acute and deadly in resource-limited areas. While health systems have begun to be scaled up in impoverished areas, scale-up is just the foundation necessary to deliver effective healthcare to the poor. This perspective piece describes a vision for a global quality improvement movement in resource-limited areas. The following action items are a first step toward achieving this vision: 1) revise global health investment mechanisms to value quality; 2) enhance human resources for improving health systems quality; 3) scale up data capacity; 4) deepen community accountability and engagement initiatives; 5) implement evidence-based quality improvement programs; 6) develop an implementation science research agenda.

Promoting Awareness of Key Resources for Evidence-Informed Decision-making in Public Health: An Evaluation of a Webinar Series about Knowledge Translation Methods and Tools

PubMed Central

Yost, Jennifer; Mackintosh, Jeannie; Read, Kristin; Dobbins, Maureen

2016-01-01

The National Collaborating Centre for Methods and Tools (NCCMT) has developed several resources to support evidence-informed decision-making – the process of distilling and disseminating best available evidence from research, context, and experience – and knowledge translation, applying best evidence in practice. One such resource, the Registry of Methods and Tools, is a free online database of 195 methods and tools to support knowledge translation. Building on the identification of webinars as a strategy to improve the dissemination of information, NCCMT launched the Spotlight on Knowledge Translation Methods and Tools webinar series in 2012 to promote awareness and use of the Registry. To inform continued implementation of this webinar series, NCCMT conducted an evaluation of the series’ potential to improve awareness and use of the methods/tools within the Registry, as well as identify areas for improvement and “what worked.” For this evaluation, the following data were analyzed: electronic follow-up surveys administered immediately following each webinar; an additional electronic survey administered 6 months after two webinars; and Google Analytics for each webinar. As of November 2015, there have been 22 webinars conducted, reaching 2048 people in multiple sectors across Canada and around the world. Evaluation results indicate that the webinars increase awareness about the Registry and stimulate use of the methods/tools. Although webinar attendees were significantly less likely to have used the methods/tools 6 months after webinars, this may be attributed to the lack of an identified opportunity in their work to use the method/tool. Despite technological challenges and requests for further examples of how the methods/tools have been used, there is overwhelming positive feedback that the format, presenters, content, and interaction across webinars “worked.” This evaluation supports that webinars are a valuable strategy for increasing awareness and stimulating use of resources for evidence-informed decision-making and knowledge translation in public health practice. PMID:27148518

Use of mobile technology-based participatory mapping approaches to geolocate health facility attendees for disease surveillance in low resource settings.

PubMed

Fornace, Kimberly M; Surendra, Henry; Abidin, Tommy Rowel; Reyes, Ralph; Macalinao, Maria L M; Stresman, Gillian; Luchavez, Jennifer; Ahmad, Riris A; Supargiyono, Supargiyono; Espino, Fe; Drakeley, Chris J; Cook, Jackie

2018-06-18

Identifying fine-scale spatial patterns of disease is essential for effective disease control and elimination programmes. In low resource areas without formal addresses, novel strategies are needed to locate residences of individuals attending health facilities in order to efficiently map disease patterns. We aimed to assess the use of Android tablet-based applications containing high resolution maps to geolocate individual residences, whilst comparing the functionality, usability and cost of three software packages designed to collect spatial information. Using Open Data Kit GeoODK, we designed and piloted an electronic questionnaire for rolling cross sectional surveys of health facility attendees as part of a malaria elimination campaign in two predominantly rural sites in the Rizal, Palawan, the Philippines and Kulon Progo Regency, Yogyakarta, Indonesia. The majority of health workers were able to use the tablets effectively, including locating participant households on electronic maps. For all households sampled (n = 603), health facility workers were able to retrospectively find the participant household using the Global Positioning System (GPS) coordinates and data collected by tablet computers. Median distance between actual house locations and points collected on the tablet was 116 m (IQR 42-368) in Rizal and 493 m (IQR 258-886) in Kulon Progo Regency. Accuracy varied between health facilities and decreased in less populated areas with fewer prominent landmarks. Results demonstrate the utility of this approach to develop real-time high-resolution maps of disease in resource-poor environments. This method provides an attractive approach for quickly obtaining spatial information on individuals presenting at health facilities in resource poor areas where formal addresses are unavailable and internet connectivity is limited. Further research is needed on how to integrate these with other health data management systems and implement in a wider operational context.

Implementation of an Electronic Medical Records System

DTIC Science & Technology

2008-05-07

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

Measuring the success of electronic medical record implementation using electronic and survey data.

PubMed Central

Keshavjee, K.; Troyan, S.; Holbrook, A. M.; VanderMolen, D.

2001-01-01

Computerization of physician practices is increasing. Stakeholders are demanding demonstrated value for their Electronic Medical Record (EMR) implementations. We developed survey tools to measure medical office processes, including administrative and physician tasks pre- and post-EMR implementation. We included variables that were expected to improve with EMR implementation and those that were not expected to improve, as controls. We measured the same processes pre-EMR, at six months and 18 months post-EMR. Time required for most administrative tasks decreased within six months of EMR implementation. Staff time spent on charting increased with time, in keeping with our anecdotal observations that nurses were given more responsibility for charting in many offices. Physician time to chart increased initially by 50%, but went down to original levels by 18 months. However, this may be due to the drop-out of those physicians who had a difficult time charting electronically. PMID:11825201

Multiscale Laboratory Infrastructure and Services to users: Plans within EPOS

NASA Astrophysics Data System (ADS)

Spiers, Chris; Willingshofer, Ernst; Drury, Martyn; Funiciello, Francesca; Rosenau, Matthias; Scarlato, Piergiorgio; Sagnotti, Leonardo; EPOS WG6, Corrado Cimarelli

2015-04-01

The participant countries in EPOS embody a wide range of world-class laboratory infrastructures ranging from high temperature and pressure experimental facilities, to electron microscopy, micro-beam analysis, analogue modeling and paleomagnetic laboratories. Most data produced by the various laboratory centres and networks are presently available only in limited "final form" in publications. Many data remain inaccessible and/or poorly preserved. However, the data produced at the participating laboratories are crucial to serving society's need for geo-resources exploration and for protection against geo-hazards. Indeed, to model resource formation and system behaviour during exploitation, we need an understanding from the molecular to the continental scale, based on experimental data. This contribution will describe the plans that the laboratories community in Europe is making, in the context of EPOS. The main objectives are: • To collect and harmonize available and emerging laboratory data on the properties and processes controlling rock system behaviour at multiple scales, in order to generate products accessible and interoperable through services for supporting research activities. • To co-ordinate the development, integration and trans-national usage of the major solid Earth Science laboratory centres and specialist networks. The length scales encompassed by the infrastructures included range from the nano- and micrometer levels (electron microscopy and micro-beam analysis) to the scale of experiments on centimetre sized samples, and to analogue model experiments simulating the reservoir scale, the basin scale and the plate scale. • To provide products and services supporting research into Geo-resources and Geo-storage, Geo-hazards and Earth System Evolution. If the EPOS Implementation Phase proposal presently under construction is successful, then a range of services and transnational activities will be put in place to realize these objectives.

Creating opportunities for training California's public health workforce.

PubMed

Demers, Anne L; Mamary, Edward; Ebin, Vicki J

2011-01-01

Today there are significant challenges to public health, and effective responses to them will require complex approaches and strategies implemented by a qualified workforce. An adequately prepared workforce requires long-term development; however, local health departments have limited financial and staff resources. Schools and programs accredited by the Council for Education on Public Health (CEPH) are required to provide continuing education but are constrained by the lack of resources, limited time, and geography. To meet these challenges, a statewide university/community collaborative model for delivering continuing education programs was developed. A needs assessment of California's public health workforce was conducted to identify areas of interest, and two continuing education trainings were developed and implemented using innovative distance education technology. Thirty-six percent of the participants completed electronic evaluations of learning outcomes and use of the digital technology platform. Participants indicated a significant increase in knowledge, reported that the trainings were cost effective and convenient, and said that they would participate in future online trainings. Collaborative partners found that this model provides a cost-effective, environmentally sound, and institutionally sustainable method for providing continuing education to public health professionals. Offering continuing education via distance technology requires substantial institutional infrastructure and resources that are often beyond what many public institutions can provide alone. This project provides a model for collaborating with community partners to provide trainings, using a digital technology platform that requires minimal training and allows presenters and participants to log on from anywhere there is Internet access. Copyright © 2011 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Final report and recommendations of the ESnet Authentication Pilot Project

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

Johnson, G.R.; Moore, J.P.; Athey, C.L.

1995-01-01

To conduct their work, U.S. Department of Energy (DOE) researchers require access to a wide range of computing systems and information resources outside of their respective laboratories. Electronically communicating with peers using the global Internet has become a necessity to effective collaboration with university, industrial, and other government partners. DOE`s Energy Sciences Network (ESnet) needs to be engineered to facilitate this {open_quotes}collaboratory{close_quotes} while ensuring the protection of government computing resources from unauthorized use. Sensitive information and intellectual properties must be protected from unauthorized disclosure, modification, or destruction. In August 1993, DOE funded four ESnet sites (Argonne National Laboratory, Lawrence Livermoremore » National Laboratory, the National Energy Research Supercomputer Center, and Pacific Northwest Laboratory) to begin implementing and evaluating authenticated ESnet services using the advanced Kerberos Version 5. The purpose of this project was to identify, understand, and resolve the technical, procedural, cultural, and policy issues surrounding peer-to-peer authentication in an inter-organization internet. The investigators have concluded that, with certain conditions, Kerberos Version 5 is a suitable technology to enable ESnet users to freely share resources and information without compromising the integrity of their systems and data. The pilot project has demonstrated that Kerberos Version 5 is capable of supporting trusted third-party authentication across an inter-organization internet and that Kerberos Version 5 would be practical to implement across the ESnet community within the U.S. The investigators made several modifications to the Kerberos Version 5 system that are necessary for operation in the current Internet environment and have documented other technical shortcomings that must be addressed before large-scale deployment is attempted.« less

Role of information systems in controlling costs: the electronic medical record (EMR) and the high-performance computing and communications (HPCC) efforts

NASA Astrophysics Data System (ADS)

Kun, Luis G.

1994-12-01

On October 18, 1991, the IEEE-USA produced an entity statement which endorsed the vital importance of the High Performance Computer and Communications Act of 1991 (HPCC) and called for the rapid implementation of all its elements. Efforts are now underway to develop a Computer Based Patient Record (CBPR), the National Information Infrastructure (NII) as part of the HPCC, and the so-called `Patient Card'. Multiple legislative initiatives which address these and related information technology issues are pending in Congress. Clearly, a national information system will greatly affect the way health care delivery is provided to the United States public. Timely and reliable information represents a critical element in any initiative to reform the health care system as well as to protect and improve the health of every person. Appropriately used, information technologies offer a vital means of improving the quality of patient care, increasing access to universal care and lowering overall costs within a national health care program. Health care reform legislation should reflect increased budgetary support and a legal mandate for the creation of a national health care information system by: (1) constructing a National Information Infrastructure; (2) building a Computer Based Patient Record System; (3) bringing the collective resources of our National Laboratories to bear in developing and implementing the NII and CBPR, as well as a security system with which to safeguard the privacy rights of patients and the physician-patient privilege; and (4) utilizing Government (e.g. DOD, DOE) capabilities (technology and human resources) to maximize resource utilization, create new jobs and accelerate technology transfer to address health care issues.

Building laboratory capacity to support HIV care in Nigeria: Harvard/APIN PEPFAR, 2004–2012

PubMed Central

Hamel, Donald J.; Sankalé, Jean-Louis; Samuels, Jay Osi; Sarr, Abdoulaye D.; Chaplin, Beth; Ofuche, Eke; Meloni, Seema T.; Okonkwo, Prosper; Kanki, Phyllis J.

2015-01-01

Introduction From 2004–2012, the Harvard/AIDS Prevention Initiative in Nigeria, funded through the US President’s Emergency Plan for AIDS Relief programme, scaled up HIV care and treatment services in Nigeria. We describe the methodologies and collaborative processes developed to improve laboratory capacity significantly in a resource-limited setting. These methods were implemented at 35 clinic and laboratory locations. Methods Systems were established and modified to optimise numerous laboratory processes. These included strategies for clinic selection and management, equipment and reagent procurement, supply chains, laboratory renovations, equipment maintenance, electronic data management, quality development programmes and trainings. Results Over the eight-year programme, laboratories supported 160 000 patients receiving HIV care in Nigeria, delivering over 2.5 million test results, including regular viral load quantitation. External quality assurance systems were established for CD4+ cell count enumeration, blood chemistries and viral load monitoring. Laboratory equipment platforms were improved and standardised and use of point-of-care analysers was expanded. Laboratory training workshops supported laboratories toward increasing staff skills and improving overall quality. Participation in a World Health Organisation-led African laboratory quality improvement system resulted in significant gains in quality measures at five laboratories. Conclusions Targeted implementation of laboratory development processes, during simultaneous scale-up of HIV treatment programmes in a resource-limited setting, can elicit meaningful gains in laboratory quality and capacity. Systems to improve the physical laboratory environment, develop laboratory staff, create improvements to reduce costs and increase quality are available for future health and laboratory strengthening programmes. We hope that the strategies employed may inform and encourage the development of other laboratories in resource-limited settings. PMID:26900573

Economic outcomes of a dental electronic patient record.

PubMed

Langabeer, James R; Walji, Muhammad F; Taylor, David; Valenza, John A

2008-10-01

The implementation of an electronic patient record (EPR) in many sectors of health care has been suggested to have positive relationships with both quality of care and improved pedagogy, although evaluation of actual results has been somewhat disillusioning. Evidence-based dentistry clearly suggests the need for tools and systems to improve care, and an EPR is a critical tool that has been widely proposed in recent years. In dental schools, EPR systems are increasingly being adopted, despite obstacles such as high costs, time constraints necessary for process workflow change, and overall project complexity. The increasing movement towards cost-effectiveness analyses in health and medicine suggests that the EPR should generally cover expenses, or produce total benefits greater than its combined costs, to ensure that resources are being utilized efficiently. To test the underlying economics of an EPR, we utilized a pre-post research design with a probability-based economic simulation model to analyze changes in performance and costs in one dental school. Our findings suggest that the economics are positive, but only when student fees are treated as an incremental revenue source. In addition, other performance indicators appeared to have significant changes, although most were not comprehensively measured pre-implementation, making it difficult to truly understand the performance differential-such pre-measurement of expected benefits is a key lesson learned. This article also provides recommendations for dental clinics and universities that are about to embark on this endeavor.

A new method for designing dual foil electron beam forming systems. II. Feasibility of practical implementation of the method

NASA Astrophysics Data System (ADS)

Adrich, Przemysław

2016-05-01

In Part I of this work a new method for designing dual foil electron beam forming systems was introduced. In this method, an optimal configuration of the dual foil system is found by means of a systematic, automatized scan of system performance in function of its parameters. At each point of the scan, Monte Carlo method is used to calculate the off-axis dose profile in water taking into account detailed and complete geometry of the system. The new method, while being computationally intensive, minimizes the involvement of the designer. In this Part II paper, feasibility of practical implementation of the new method is demonstrated. For this, a prototype software tools were developed and applied to solve a real life design problem. It is demonstrated that system optimization can be completed within few hours time using rather moderate computing resources. It is also demonstrated that, perhaps for the first time, the designer can gain deep insight into system behavior, such that the construction can be simultaneously optimized in respect to a number of functional characteristics besides the flatness of the off-axis dose profile. In the presented example, the system is optimized in respect to both, flatness of the off-axis dose profile and the beam transmission. A number of practical issues related to application of the new method as well as its possible extensions are discussed.

Building a national electronic medical record exchange system - experiences in Taiwan.

PubMed

Li, Yu-Chuan Jack; Yen, Ju-Chuan; Chiu, Wen-Ta; Jian, Wen-Shan; Syed-Abdul, Shabbir; Hsu, Min-Huei

2015-08-01

There are currently 501 hospitals and about 20,000 clinics in Taiwan. The National Health Insurance (NHI) system, which is operated by the NHI Administration, uses a single-payer system and covers 99.9% of the nation's total population of 23,000,000. Taiwan's NHI provides people with a high degree of freedom in choosing their medical care options. However, there is the potential concern that the available medical resources will be overused. The number of doctor consultations per person per year is about 15. Duplication of laboratory tests and prescriptions are not rare either. Building an electronic medical record exchange system is a good method of solving these problems and of improving continuity in health care. In November 2009, Taiwan's Executive Yuan passed the 'Plan for accelerating the implementation of electronic medical record systems in medical institutions' (2010-2012; a 3-year plan). According to this plan, a patient can, at any hospital in Taiwan, by using his/her health insurance IC card and physician's medical professional IC card, upon signing a written agreement, retrieve all important medical records for the past 6 months from other participating hospitals. The focus of this plan is to establish the National Electronic Medical Record Exchange Centre (EEC). A hospital's information system will be connected to the EEC through an electronic medical record (EMR) gateway. The hospital will convert the medical records for the past 6 months in its EMR system into standardized files and save them on the EMR gateway. The most important functions of the EEC are to generate an index of all the XML files on the EMR gateways of all hospitals, and to provide search and retrieval services for hospitals and clinics. The EEC provides four standard inter-institution EMR retrieval services covering medical imaging reports, laboratory test reports, discharge summaries, and outpatient records. In this system, we adopted the Health Level 7 (HL7) Clinical Document Architecture (CDA) standards to generate clinical documents and Integrating the Healthcare Enterprise (IHE) Cross-enterprise Document Sharing (XDS) profile for the communication infrastructure. By December of 2014, the number of hospitals that provide an inter-institution EMR exchange service had reached 321. Hospitals that had not joined the service were all smaller ones with less than 100 beds. Inter-institution EMR exchange can make it much easier for people to access their own medical records, reduce the waste of medical resources, and improve the quality of medical care. The implementation of an inter-institution EMR exchange system faces many challenges. This article provides Taiwan's experiences as a reference. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Clinicians’ Perceptions of Implementation Extensiveness of 100% Tobacco Free Practices: A Longitudinal Study of New York State1

PubMed Central

de Tormes Eby, Lillian Turner; Laschober, Tanja C.

2013-01-01

In 2008, New York State required substance use disorder treatment organizations to be 100% tobacco-free. This longitudinal study examined clinicians’ perceptions of the implementation extensiveness of the tobacco-free practices approximately 10–12 months (Time 1) and 20–24 months (Time 2) post regulation and investigated whether clinicians’ commitment to change and use of provided resources at Time 1 predicts perceptions of implementation extensiveness at Time 2. Clinicians (N = 287) noted a mean implementation of 5.60 patient practices (0–10 scale), 2.33 visitor practices (0–8 scale), and 6.66 employee practices (0–12 scale) at Time 1. At Time 2, clinicians perceived a mean implementation of 5.95 patient practices (no increase from Time 1), 2.89 visitor practices (increase from Time 1), and 7.12 employee practices (no increase from Time 1). Commitment to change and use of resources positively predicted perceived implementation extensiveness of visitor and employee practices. The use of resources positively predicted implementation for patient practices. PMID:23430285

Clinicians' perceptions of implementation extensiveness of 100% tobacco free practices: a longitudinal study of New York state.

PubMed

Eby, Lillian T de Tormes; Laschober, Tanja C

2014-01-01

In 2008, the state of New York required substance use disorder treatment organizations to be 100% tobacco-free. This longitudinal study examined clinicians' perceptions of the implementation extensiveness of the tobacco-free practices approximately 10-12 months (Time 1) and 20-24 months (Time 2) post regulation and investigated whether clinicians' commitment to change and use of provided resources at Time 1 predicts perceptions of implementation extensiveness at Time 2. Clinicians (N = 287) noted a mean implementation of 5.60 patient practices (0-10 scale), 2.33 visitor practices (0-8 scale), and 6.66 employee practices (0-12 scale) at Time 1. At Time 2, clinicians perceived a mean implementation of 5.95 patient practices (no increase from Time 1), 2.89 visitor practices (increase from Time 1), and 7.12 employee practices (no increase from Time 1). Commitment to change and use of resources positively predicted perceived implementation extensiveness of visitor and employee practices. The use of resources positively predicted implementation for patient practices.

Tablet computers in support of rural and frontier clinical practice.

PubMed

Anderson, Chad; Henner, Terry; Burkey, Jake

2013-11-01

Healthcare organizations are increasingly faced with an environment in which they must implement health information systems to achieve higher standards for efficiency and quality of care while at the same time being asked to provide needed services with fewer resources. This is particularly challenging for rural health systems where access to resources is often more limited. This study investigates the potential value of iPad tablets for enhancing health services delivery by primary care physicians in rural Nevada. Five physicians from rural Nevada were selected to receive iPads and funding for apps that would enhance their medical practices. Following a year of use, data was gathered on each physician's actual use and perceived value of the iPads. A case study approach was taken using both an online survey and semi-structured phone interviews to collect case data. Use and perceived usefulness of the iPad was mixed but generally positive with some physicians utilizing it much more than others. The iPads were primarily used by the physicians to access medical information through online resources (e.g. Epocrates and UpToDate) for reference and diagnostic purposes, although they were also used for some interaction with patients. All felt that resources available through the iPad were limited and that better applications would improve the usefulness of the iPad, particularly in regard to graphical and video content suitable to sharing with patients. Physicians in this study felt that the iPad could fill a need between smartphones and desktops, which were their primary technology tools prior to receiving the iPad, but that useful medical applications and resources are currently limited for the iPad. In particular, better graphical and video content would improve the usefulness of the iPad as a tool for patient interactions. Apps that store content locally would serve to mitigate inconsistent internet access that is still common in rural settings, increasing the usefulness of the iPad in that context. Tablets like the iPad also have potential for use in accessing the electronic medical record systems that are increasingly being implemented in rural hospitals and healthcare facilities. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

From EDI to Internet Commerce: The BHP Steel Experience.

ERIC Educational Resources Information Center

Chan, Caroline; Swatman, Paula M. C.

2000-01-01

Discusses the issue of business-to-business electronic commerce implementation and the factors affecting it. Discusses electronic data interchange technology, describes the results of a case study of BHP Steel (Australia), and considers paradigm shifts in implementation issues related to electronic commerce that occur over time. (Author/LRW)

Revolution or Revelation? Acquisitions for the Digital Library

ERIC Educational Resources Information Center

Morris, Kathleen; Larson, Betsy

2006-01-01

Libraries are responding to customer preferences for electronic research materials through the acquisition and management of these products. Electronic resources have significantly different characteristics than print resources when it comes to technical services management. This paper addresses aspects of a corporate research library's evaluation…

Resource and Performance Evaluations of Fixed Point QRD-RLS Systolic Array through FPGA Implementation

NASA Astrophysics Data System (ADS)

Yokoyama, Yoshiaki; Kim, Minseok; Arai, Hiroyuki

At present, when using space-time processing techniques with multiple antennas for mobile radio communication, real-time weight adaptation is necessary. Due to the progress of integrated circuit technology, dedicated processor implementation with ASIC or FPGA can be employed to implement various wireless applications. This paper presents a resource and performance evaluation of the QRD-RLS systolic array processor based on fixed-point CORDIC algorithm with FPGA. In this paper, to save hardware resources, we propose the shared architecture of a complex CORDIC processor. The required precision of internal calculation, the circuit area for the number of antenna elements and wordlength, and the processing speed will be evaluated. The resource estimation provides a possible processor configuration with a current FPGA on the market. Computer simulations assuming a fading channel will show a fast convergence property with a finite number of training symbols. The proposed architecture has also been implemented and its operation was verified by beamforming evaluation through a radio propagation experiment.

Companion of choice at birth: factors affecting implementation.

PubMed

Kabakian-Khasholian, Tamar; Portela, Anayda

2017-08-31

Two recent recommendations made by the World Health Organization confirm the benefits of companion of choice at birth on labour outcomes; however institutional practices and policies do not always support its implementation in different settings around the world. We conducted a review to determine factors that affect implementation of this intervention considering the perspectives and experiences of different stakeholders and other institutional, systemic barriers and facilitators. Forty one published studies were included in this review. Thirty one publications were identified from a 2013 Cochrane review on the effectiveness of companion of choice at birth. We also reviewed 10 qualitative studies conducted alongside the trials or other interventions on labour and birth companionship identified through electronic searches. The SURE (Supporting the Use of Research Evidence) framework was used to guide the thematic analysis of implementation factors. Women and their families expressed appreciation for the continuous presence of a person to provide support during childbirth. Health care providers were concerned about the role of the companion and possible interference with activities in the labour ward. Allocation of resources, organization of care, facility-related constraints and cultural inclinations were identified as implementation barriers. Prior to introducing companion of choice at birth, understanding providers' attitudes and sensitizing them to the evidence is necessary. The commitment of the management of health care facilities is also required to change policies, including allocation of appropriate physical space that respects women's privacy. Implementation research to develop models for different contexts which could be scaled up would be useful, including documentation of factors that affected implementation and how they were addressed. Future research should also focus on documenting the costs related to implementation, and on measuring the impact of companion of choice at birth on care-seeking behavior for subsequent births.

Implementing Trauma-Informed Partner Violence Assessment in Family Planning Clinics.

PubMed

Decker, Michele R; Flessa, Sarah; Pillai, Ruchita V; Dick, Rebecca N; Quam, Jamie; Cheng, Diana; McDonald-Mosley, Raegan; Alexander, Kamila A; Holliday, Charvonne N; Miller, Elizabeth

2017-09-01

Intimate partner violence (IPV) and reproductive coercion (RC) are associated with poor reproductive health. Little is known about how family planning clinics implement brief IPV/RC assessment interventions in practice. We describe the uptake and impact of a brief, trauma-informed, universal IPV/RC assessment and education intervention. Intervention implementation was evaluated via a mixed methods study among women ages 18 and up receiving care at one of two family planning clinics in greater Baltimore, MD. This mixed methods study entailed a quasi-experimental, single group pretest-posttest study with family planning clinic patients (baseline and exit survey n = 132; 3-month retention n = 68; retention rate = 52%), coupled with qualitative interviews with providers and patients (total n = 35). Two thirds (65%) of women reported receiving at least one element of the intervention on their exit survey immediately following the clinic-visit. Patients reported that clinic-based IPV assessment is helpful, irrespective of IPV history. Relative to those who reported neither, participants who received either intervention element reported greater perceived caring from providers, confidence in provider response to abusive relationships, and knowledge of IPV-related resources at follow-up. Providers and patients alike described the educational card as a valuable tool. Participants described trade-offs of paper versus in-person, electronic medical record-facilitated screening, and patient reluctance to disclose current situations of abuse. In real-world family planning clinic settings, a brief assessment and support intervention was successful in communicating provider caring and increasing knowledge of violence-related resources, endpoints previously deemed valuable by IPV survivors. Results emphasize the merit of universal education in IPV/RC clinical interventions over seeking IPV disclosure.

Human resource information systems in health care: a systematic evidence review

PubMed Central

Tursunbayeva, Aizhan; Bunduchi, Raluca; Franco, Massimo

2017-01-01

Objective: This systematic review aimed to: (1) determine the prevalence and scope of existing research on human resource information systems (HRIS) in health organizations; (2) analyze, classify, and synthesize evidence on the processes and impacts of HRIS development, implementation, and adoption; and (3) generate recommendations for HRIS research, practice, and policy, with reference to the needs of different stakeholders. Methods: A structured search strategy was used to interrogate 10 electronic databases indexing research from the health, social, management, technology, and interdisciplinary sciences, alongside gray literature sources and reference lists of qualifying studies. There were no restrictions on language or publication year. Two reviewers screened publications, extracted data, and coded findings according to the innovation stages covered in the studies. The Critical Appraisal Skills Program checklist was adopted to assess study quality. The process of study selection was charted using a Preferred Items for Systematic Reviews and Meta-Analysis (PRISMA) diagram. Results: Of the 6824 publications identified by the search strategy, 68, covering 42 studies, were included for final analysis. Research on HRIS in health was interdisciplinary, often atheoretical, conducted primarily in the hospital sector of high-income economies, and largely focused uncritically on use and realized benefits. Discussion and Conclusions: While studies of HRIS in health exist, the overall lack of evaluative research raises unanswered questions about their capacity to improve quality and efficiency and enable learning health systems, as well as how sociotechnical complexity influences implementation and effectiveness. We offer this analysis to decision makers and managers considering or currently implementing an HRIS, and make recommendations for further research. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO): CRD42015023581. http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015023581#.VYu1BPlVjDU. PMID:27707821

Human resource information systems in health care: a systematic evidence review.

PubMed

Tursunbayeva, Aizhan; Bunduchi, Raluca; Franco, Massimo; Pagliari, Claudia

2017-05-01

This systematic review aimed to: (1) determine the prevalence and scope of existing research on human resource information systems (HRIS) in health organizations; (2) analyze, classify, and synthesize evidence on the processes and impacts of HRIS development, implementation, and adoption; and (3) generate recommendations for HRIS research, practice, and policy, with reference to the needs of different stakeholders. A structured search strategy was used to interrogate 10 electronic databases indexing research from the health, social, management, technology, and interdisciplinary sciences, alongside gray literature sources and reference lists of qualifying studies. There were no restrictions on language or publication year. Two reviewers screened publications, extracted data, and coded findings according to the innovation stages covered in the studies. The Critical Appraisal Skills Program checklist was adopted to assess study quality. The process of study selection was charted using a Preferred Items for Systematic Reviews and Meta-Analysis (PRISMA) diagram. Of the 6824 publications identified by the search strategy, 68, covering 42 studies, were included for final analysis. Research on HRIS in health was interdisciplinary, often atheoretical, conducted primarily in the hospital sector of high-income economies, and largely focused uncritically on use and realized benefits. While studies of HRIS in health exist, the overall lack of evaluative research raises unanswered questions about their capacity to improve quality and efficiency and enable learning health systems, as well as how sociotechnical complexity influences implementation and effectiveness. We offer this analysis to decision makers and managers considering or currently implementing an HRIS, and make recommendations for further research. International Prospective Register of Systematic Reviews (PROSPERO): CRD42015023581. http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015023581#.VYu1BPlVjDU . © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Implementation of an opioid detoxification management pathway reduces emergency department length of stay.

PubMed

Bellew, Shawna D; Collins, Sean P; Barrett, Tyler W; Russ, Stephan E; Jones, Ian D; Slovis, Corey M; Self, Wesley H

2018-05-25

With the rise of opioid use in the United States, the increasing demand for treatment for opioid use disorders presents both a challenge and an opportunity to develop new care pathways for ED patients seeking opioid detoxification. We set out to improve the care of patients presenting to our ED seeking opioid detoxification by implementing a standardized management pathway and to measure the effects of this intervention. We conducted a before-after study of the effects of an opioid detoxification management pathway on ED length of stay, use of resources (social worker consultation, laboratory tests obtained), and return visits to the same ED within 30 days of discharge. All data were collected retrospectively by review of the electronic health record. Ultimately, 107 patients presented to the ED that met criteria, 52 in the intervention period and 55 in the pre-intervention period. Median ED length of stay in the intervention period was 152 (IQR 93-237) minutes compared to 312 (IQR 187-468) minutes in the pre-intervention period (p<0.001). Patients in the intervention period less frequently had a social work consultation (32.7% vs. 83.6%, p<0.001) or had laboratory tests obtained (32.7% vs 74.5%, p<0.001) and more frequently were prescribed a medication for withdrawal symptoms (57.7% vs. 29.1%, p=0.003). Implementation of an opioid detoxification management pathway reduced ED length of stay, reduced utilization of resources, and increased the proportion of patients prescribed medications for symptom relief. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Choosing Wellness: Comprehensive Health Education Planning and Implementation Handbook. A Handbook for Head Start Programs [and] Resource Guide: A Guide for Head Start Programs.

ERIC Educational Resources Information Center

Enright, Margaret; Davidson, Tasha

These materials consist of: (1) a planning and implementation handbook designed to help Head Start managers better understand, plan, and implement a more comprehensive aproach to health education and health promotion--one that addresses local needs and tailors programs to the needs of the children, parents, and staff; and (2) a resource guide that…

Implementation and Impact of Patient Lay Navigator-Led Advance Care Planning Conversations.

PubMed

Rocque, Gabrielle B; Dionne-Odom, J Nicholas; Sylvia Huang, Chao-Hui; Niranjan, Soumya J; Williams, Courtney P; Jackson, Bradford E; Halilova, Karina I; Kenzik, Kelly M; Bevis, Kerri S; Wallace, Audrey S; Lisovicz, Nedra; Taylor, Richard A; Pisu, Maria; Partridge, Edward E; Butler, Thomas W; Briggs, Linda A; Kvale, Elizabeth A

2017-04-01

Advance care planning (ACP) improves alignment between patient preferences for life-sustaining treatment and care received at end of life (EOL). To evaluate implementation of lay navigator-led ACP. A convergent, parallel mixed-methods design was used to evaluate implementation of navigator-led ACP across 12 cancer centers. Data collection included 1) electronic navigation records, 2) navigator surveys (n = 45), 3) claims-based patient outcomes (n = 820), and 4) semistructured navigator interviews (n = 26). Outcomes of interest included 1) the number of ACP conversations completed, 2) navigator self-efficacy, 3) patient resource utilization, hospice use, and chemotherapy at EOL, and 4) navigator-perceived barriers and facilitators to ACP. From June 1, 2014 to December 31, 2015, 50 navigators completed Respecting Choices ® First Steps ACP Facilitator training. Navigators approached 18% of patients (1319/8704); 481 completed; 472 in process; 366 declined. Navigators were more likely to approach African American patients than Caucasian patients (20% vs. 14%, P < 0.001). Significant increases in ACP self-efficacy were observed after training. The mean score for feeling prepared to conduct ACP conversations increased from 5.6/10 to 7.5/10 (P < 0.001). In comparison with patients declining ACP participation (n = 171), decedents in their final 30 days of life who engaged in ACP (n = 437) had fewer hospitalizations (46% vs. 56%, P = 0.02). Key facilitators of successful implementation included physician buy-in, patient readiness, and prior ACP experience; barriers included space limitations, identifying the "right" time to start conversations, and personal discomfort discussing EOL. A navigator-led ACP program was feasible and may be associated with lower rates of resource utilization near EOL. Copyright © 2017 American Academy of Hospice and Palliative Medicine. All rights reserved.

Local Implementation of Alcohol Screening and Brief Intervention at Five Veterans Health Administration Primary Care Clinics: Perspectives of Clinical and Administrative Staff.

PubMed

Williams, Emily C; Achtmeyer, Carol E; Young, Jessica P; Rittmueller, Stacey E; Ludman, Evette J; Lapham, Gwen T; Lee, Amy K; Chavez, Laura J; Berger, Douglas; Bradley, Katharine A

2016-01-01

Population-based alcohol screening, followed by brief intervention for patients who screen positive for unhealthy alcohol use, is widely recommended for primary care settings and considered a top prevention priority, but is challenging to implement. However, new policy initiatives in the U.S., including the Affordable Care Act, may help launch widespread implementation. While the nationwide Veterans Health Administration (VA) has achieved high rates of documented alcohol screening and brief intervention, research has identified quality problems with both. We conducted a qualitative key informant study to describe local implementation of alcohol screening and brief intervention from the perspectives of frontline adopters in VA primary care in order to understand the process of implementation and factors underlying quality problems. A purposive snowball sampling method was used to identify and recruit key informants from 5 VA primary care clinics in the northwestern U.S. Key informants completed 20-30 minute semi-structured interviews, which were recorded, transcribed, and qualitatively analyzed using template analysis. Key informants (N=32) included: clinical staff (n=14), providers (n=14), and administrative informants (n=4) with varying participation in implementation of and responsibility for alcohol screening and brief intervention at the medical center. Ten inter-related themes (5 a priori and 5 emergent) were identified and grouped into 3 applicable domains of Greenhalgh's conceptual framework for dissemination of innovations, including values of adopters (theme 1), processes of implementation (themes 2 and 3), and post-implementation consequences in care processes (themes 4-10). While key informants believed alcohol use was relevant to health and important to address, the process of implementation (in which no training was provided and electronic clinical reminders "just showed up") did not address critical training and infrastructure needs. Key informants lacked understanding of the goals of screening and brief intervention, believed referral to specialty addictions treatment (as opposed to offering brief intervention) was the only option for following up on a positive screen, reported concern regarding limited availability of treatment resources, and lacked optimism regarding patients' interest in seeking help. Findings suggest that the local process of implementing alcohol screening and brief intervention may have inadequately addressed important adopter needs and thus may have ultimately undermined, instead of capitalized on, staff and providers' belief in the importance of addressing alcohol use as part of primary care. Additional implementation strategies, such as training or academic detailing, may address some unmet needs and help improve the quality of both screening and brief intervention. However, these strategies may be resource-intensive and insufficient for comprehensively addressing implementation barriers. Published by Elsevier Inc.

[Design and implementation of information management system for Chinese materia medica resources survey].

PubMed

Wang, Hui; Zhang, Xiao-Bo; Ge, Xiao-Guang; Jin, Yan; Jing, Zhi-Xian; Wang, Ling; Zhao, Yu-Ping; Guo, Lan-Ping; Huang, Lu-Qi

2017-11-01

By means of the established Information Management System for Chinese materia medica resources survey, the national, provincial and county level organization, personnel and the implementation of the program of Chinese materia medica resources survey, and the survey team of medicinal plant investigation, photos, Chinese herbal medicine market survey, the traditional Chinese materia medica resources knowledge survey, germplasm resources investigation and the data collation and summary specimen have been realised. Throughout the whole working process of the fourth national Chinese materia medica resources survey, it is ensured that all data were no missing, no repeat, and well stored and managed. The Information Management System can improve the standardization degree of Chinese materia medica resources survey, and maintain the continuity. Copyright© by the Chinese Pharmaceutical Association.

Design & implementation of distributed spatial computing node based on WPS

NASA Astrophysics Data System (ADS)

Liu, Liping; Li, Guoqing; Xie, Jibo

2014-03-01

Currently, the research work of SIG (Spatial Information Grid) technology mostly emphasizes on the spatial data sharing in grid environment, while the importance of spatial computing resources is ignored. In order to implement the sharing and cooperation of spatial computing resources in grid environment, this paper does a systematical research of the key technologies to construct Spatial Computing Node based on the WPS (Web Processing Service) specification by OGC (Open Geospatial Consortium). And a framework of Spatial Computing Node is designed according to the features of spatial computing resources. Finally, a prototype of Spatial Computing Node is implemented and the relevant verification work under the environment is completed.

Strategic implementation and accountability: the case of the long-term care alliance.

PubMed

Seaman, Al; Elias, Maria; O'Neill, Bill; Yatabe, Karen

2010-01-01

A group of chief executives of long-term care homes formed an alliance in order to tap the resources residing within their management teams. Adopting a strategic implementation project based on a framework of accountability, the executives were able to better understand the uncertainties of the environment and potentially structure their strategic implementation to best use scarce resources. The framework of accountability allowed the homes to recognize the need for a strong business approach to long-term care. Communication improved throughout the organizations while systems and resources showed improved utilization. Quality became the driving force for all actions taken to move the organizations toward achieving their visions.

Barriers and Facilitators Affecting Patient Portal Implementation from an Organizational Perspective: Qualitative Study.

PubMed Central

Kooij, Laura; Groen, Wim G

2018-01-01

Background The number of patient portals is rising, and although portals can have positive effects, their implementation has major impacts on the providing health care institutions. However, little is known about the organizational factors affecting successful implementation. Knowledge of the specific barriers to and facilitators of various stakeholders is likely to be useful for future implementations. Objective The objective of this study was to identify the barriers to and facilitators of patient portal implementation facing various stakeholders within hospital organizations in the Netherlands. Methods Purposive sampling was used to select hospitals of various types. A total of 2 university medical centers, 3 teaching hospitals, and 2 general hospitals were included. For each, 3 stakeholders were interviewed: (1) medical professionals, (2) managers, and (3) information technology employees. In total, 21 semistructured interviews were conducted using the Grol and Wensing model, which describes barriers to and facilitators of change in health care practice at 6 levels: (1) innovation; (2) individual professional; (3) patient; (4) social context; (5) organizational context; and (6) economic and political context. Two researchers independently selected and coded quotes by applying this model using a (deductive) directed content approach. Additional factors related to technical and portal characteristics were added using the model of McGinn et al, developed for implementation of electronic health records. Results In total, we identified 376 quotes, 26 barriers, and 28 facilitators. Thirteen barriers and 12 facilitators were common for all stakeholder groups. The facilitators’ perceived usefulness (especially less paperwork) was mentioned by all the stakeholders, followed by subjects’ positive attitude. The main barriers were lack of resources (namely, lack of staff and materials), financial difficulties (especially complying with high costs, lack of reimbursements), and guaranteeing privacy and security (eg, strict regulations). Both similarities and differences were found between stakeholder groups and hospital types. For example, managers and information technology employees mainly considered guaranteeing privacy and security as a predominant barrier. Financial difficulties were particularly mentioned by medical professionals and managers. Conclusions Patient portal implementation is a complex process and is not only a technical process but also affects the organization and its staff. Barriers and facilitators occurred at various levels and differed among hospital types (eg, lack of accessibility) and stakeholder groups (eg, sufficient resources) in terms of several factors. Our findings underscore the importance of involving multiple stakeholders in portal implementations. We identified a set of barriers and facilitators that are likely to be useful in making strategic and efficient implementation plans. PMID:29752253

76 FR 57100 - Natural Resource Plan

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-15

..., Water Resource Protection and Improvement, Sustainable Land Use, and Natural Resource Management, are... for the management of biological, cultural, and water resources, recreation, reservoir lands planning... implementation of resource management programs and activities and approaches to planning the use of TVA reservoir...

Symbolic Algebra Development for Higher-Order Electron Propagator Formulation and Implementation.

PubMed

Tamayo-Mendoza, Teresa; Flores-Moreno, Roberto

2014-06-10

Through the use of symbolic algebra, implemented in a program, the algebraic expression of the elements of the self-energy matrix for the electron propagator to different orders were obtained. In addition, a module for the software package Lowdin was automatically generated. Second- and third-order electron propagator results have been calculated to test the correct operation of the program. It was found that the Fortran 90 modules obtained automatically with our algorithm succeeded in calculating ionization energies with the second- and third-order electron propagator in the diagonal approximation. The strategy for the development of this symbolic algebra program is described in detail. This represents a solid starting point for the automatic derivation and implementation of higher-order electron propagator methods.

Electronic Resources: Selection and Bibliographic Control.

ERIC Educational Resources Information Center

Pattie, Ling-yuh W., Ed.; Cox, Bonnie Jean, Ed.

This book is a baseline guide for professionals and library school students on issues that concern the selection and bibliographic control of electronic resources, from both conceptual and pragmatic standpoints. The book includes the following articles: (1) "Foreward" (Lois Mai Chan); (2) "Introduction" (Ling-yuh W. (Miko)…

Licensing and Negotiations for Electronic Content

ERIC Educational Resources Information Center

Crawford, Amy R.

2008-01-01

This article provides an overview of the basic characteristics of database, or eContent, license agreements, defines general licensing terms, maps the anatomy of an electronic resources subscription agreement, and discusses negotiating skills and techniques for library staff. (Contains a list of additional resources and a sample agreement.)

A Resource Guide Identifying Technology Tools for Schools. Appendix

ERIC Educational Resources Information Center

Fox, Christine; Jones, Rachel

2009-01-01

SETDA and NASTID's "Technology Tools for Schools Resource Guide" provides definitions of key technology components and relevant examples, where appropriate as a glossary for educators. The guide also presents essential implementation and infrastructure considerations that decision makers should think about when implementing technology in schools.…

Introducing RFID at Middlesex University Learning Resources

ERIC Educational Resources Information Center

Hopkinson, Alan; Chandrakar, Rajesh

2006-01-01

Purpose: To describe the first year of the implementation of radio frequency identification (RFID) in Middlesex University Learning Resources. Design/methodology/approach: The technology is explained in detail to set the scene. Information on the implementation is presented in chronological order. Findings: Problems which would generally be…

40 CFR 256.31 - Recommendations for developing and implementing resource conservation and recovery programs.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 26 2013-07-01 2013-07-01 false Recommendations for developing and implementing resource conservation and recovery programs. 256.31 Section 256.31 Protection of Environment... are identified. These studies should review various technological approaches, environmental...

40 CFR 256.31 - Recommendations for developing and implementing resource conservation and recovery programs.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Recommendations for developing and implementing resource conservation and recovery programs. 256.31 Section 256.31 Protection of Environment... are identified. These studies should review various technological approaches, environmental...

40 CFR 256.31 - Recommendations for developing and implementing resource conservation and recovery programs.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 25 2014-07-01 2014-07-01 false Recommendations for developing and implementing resource conservation and recovery programs. 256.31 Section 256.31 Protection of Environment... are identified. These studies should review various technological approaches, environmental...

40 CFR 256.31 - Recommendations for developing and implementing resource conservation and recovery programs.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommendations for developing and implementing resource conservation and recovery programs. 256.31 Section 256.31 Protection of Environment... are identified. These studies should review various technological approaches, environmental...

Evaluating the data completeness in the Electronic Health Record after the Implementation of an Outpatient Electronic Health Record.

PubMed

Soto, Mauricio; Capurro, Daniel; Catalán, Silvia

2015-01-01

Electronic health records (EHRs) present an opportunity for quality improvement in health organitations, particularly at the primary health level. However, EHR implementation impacts clinical workflows, and physicians frequently prefer to document in a non-structured way, which ultimately hinders the ability to measure quality indicators. We present an assessment of data completeness-a key data quality indicator-during the first 12 months after the implementation of an EHR at a teaching outpatient center in Santiago, Chile.

How Does Scale of Implementation Impact the Environmental Sustainability of Wastewater Treatment Integrated with Resource Recovery?

PubMed

Cornejo, Pablo K; Zhang, Qiong; Mihelcic, James R

2016-07-05

Energy and resource consumptions required to treat and transport wastewater have led to efforts to improve the environmental sustainability of wastewater treatment plants (WWTPs). Resource recovery can reduce the environmental impact of these systems; however, limited research has considered how the scale of implementation impacts the sustainability of WWTPs integrated with resource recovery. Accordingly, this research uses life cycle assessment (LCA) to evaluate how the scale of implementation impacts the environmental sustainability of wastewater treatment integrated with water reuse, energy recovery, and nutrient recycling. Three systems were selected: a septic tank with aerobic treatment at the household scale, an advanced water reclamation facility at the community scale, and an advanced water reclamation facility at the city scale. Three sustainability indicators were considered: embodied energy, carbon footprint, and eutrophication potential. This study determined that as with economies of scale, there are benefits to centralization of WWTPs with resource recovery in terms of embodied energy and carbon footprint; however, the community scale was shown to have the lowest eutrophication potential. Additionally, technology selection, nutrient control practices, system layout, and topographical conditions may have a larger impact on environmental sustainability than the implementation scale in some cases.

A cluster-randomized controlled trial to evaluate the effects of a simplified cardiovascular management program in Tibet, China and Haryana, India: study design and rationale.

PubMed

Ajay, Vamadevan S; Tian, Maoyi; Chen, Hao; Wu, Yangfeng; Li, Xian; Dunzhu, Danzeng; Ali, Mohammed K; Tandon, Nikhil; Krishnan, Anand; Prabhakaran, Dorairaj; Yan, Lijing L

2014-09-06

In resource-poor areas of China and India, the cardiovascular disease burden is high, but availability of and access to quality healthcare is limited. Establishing a management scheme that utilizes the local infrastructure and builds healthcare capacity is essential for cardiovascular disease prevention and management. The study aims to develop, implement, and evaluate the feasibility and effectiveness of a simplified, evidence-based cardiovascular management program delivered by community healthcare workers in resource-constrained areas in Tibet, China and Haryana, India. This yearlong cluster-randomized controlled trial will be conducted in 20 villages in Tibet and 20 villages in Haryana. Randomization of villages to usual care or intervention will be stratified by country. High cardiovascular disease risk individuals (aged 40 years or older, history of heart disease, stroke, diabetes, or measured systolic blood pressure of 160 mmHg or higher) will be screened at baseline. Community health workers in the intervention villages will be trained to manage and follow up high-risk patients on a monthly basis following a simplified '2+2' intervention model involving two lifestyle recommendations and the appropriate prescription of two medications. A customized electronic decision support system based on the intervention strategy will be developed to assist the community health workers with patient management. Baseline and follow-up surveys will be conducted in a standardized fashion in all villages. The primary outcome will be the net difference between-group in the proportion of high-risk patients taking antihypertensive medication pre- and post-intervention. Secondary outcomes will include the proportion of patients taking aspirin and changes in blood pressure. Process and economic evaluations will also be conducted. To our knowledge, this will be the first study to evaluate the effect of a simplified management program delivered by community health workers with the help of electronic decision support system on improving the health of high cardiovascular disease risk patients. If effective, this intervention strategy can serve as a model that can be implemented, where applicable, in rural China, India, and other resource-constrained areas. The trial was registered in the clinicaltrials.gov database on 30 December, 2011 and the registration number is NCT01503814.

Dispersion-based Fresh-slice Scheme for Free-Electron Lasers

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

Guetg, Marc

The Fresh-slice technique improved the performance of several Self-Amplified Spontaneous Emission Free-Electron laser schemes by granting selective control on the temporal lasing slice without spoiling the other electron bunch slices. So far, the implementation required a special insertion device to create the beam yaw, called dechirper. We demonstrate a novel scheme to enable Freshslice operation based on electron energy chirp and orbit dispersion that can be implemented at any free-electron laser facility without additional hardware.

49 CFR Appendix C to Part 224 - Guidelines for Electronic Submission of Reflectorization Implementation Compliance Reports

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 4 2011-10-01 2011-10-01 false Guidelines for Electronic Submission of Reflectorization Implementation Compliance Reports C Appendix C to Part 224 Transportation Other Regulations... REFLECTORIZATION OF RAIL FREIGHT ROLLING STOCK Pt. 224, App. C Appendix C to Part 224—Guidelines for Electronic...

Problems in Learning of Electronic Filing at Vocational School in Yogyakarta Special Region, Indonesia

ERIC Educational Resources Information Center

Sutirman; Muhyadi; Surjono, Herman Dwi

2017-01-01

This study aims to investigate the learning implementation of electronic filing and problems faced by teachers in learning implementing of electronic filing. This study is a descriptive research with qualitative approach. Collecting data used interview and documentation techniques. The research subjects consisted of 29 teachers who teach Filing…

49 CFR Appendix C to Part 224 - Guidelines for Electronic Submission of Reflectorization Implementation Compliance Reports

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 4 2014-10-01 2014-10-01 false Guidelines for Electronic Submission of Reflectorization Implementation Compliance Reports C Appendix C to Part 224 Transportation Other Regulations... REFLECTORIZATION OF RAIL FREIGHT ROLLING STOCK Pt. 224, App. C Appendix C to Part 224—Guidelines for Electronic...

49 CFR Appendix C to Part 224 - Guidelines for Electronic Submission of Reflectorization Implementation Compliance Reports

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 4 2013-10-01 2013-10-01 false Guidelines for Electronic Submission of Reflectorization Implementation Compliance Reports C Appendix C to Part 224 Transportation Other Regulations... REFLECTORIZATION OF RAIL FREIGHT ROLLING STOCK Pt. 224, App. C Appendix C to Part 224—Guidelines for Electronic...

49 CFR Appendix C to Part 224 - Guidelines for Electronic Submission of Reflectorization Implementation Compliance Reports

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Guidelines for Electronic Submission of Reflectorization Implementation Compliance Reports C Appendix C to Part 224 Transportation Other Regulations... REFLECTORIZATION OF RAIL FREIGHT ROLLING STOCK Pt. 224, App. C Appendix C to Part 224—Guidelines for Electronic...

Connecting GEON: Making sense of the myriad resources, researchers and concepts that comprise a geoscience cyberinfrastructure

NASA Astrophysics Data System (ADS)

Gahegan, Mark; Luo, Junyan; Weaver, Stephen D.; Pike, William; Banchuen, Tawan

2009-04-01

Simply placing electronic geoscience resources such as datasets, methods, ontologies, workflows and articles in a digital library or cyberinfrastructure does not mean that they will be used successfully by other researchers or educators. It is also necessary to provide the means to locate potentially useful content, and to understand it. Without suitable provision for these needs, many useful resources will go undiscovered, or else will be found but used inappropriately. In this article, we describe an approach to discovering, describing and understanding e-resources based on the notion that meaning is carried in the interconnections between resources and the actors in the cyberinfrastructure (including individuals, groups, organizations), as well as by ontologies and conventional metadata. Navigation around this universe is achieved by implementing the idea of perspectives as dynamic, conceptual views (defined by SPARQL-like queries against an OWL schema) that not only act as filters, but also dynamically promote and demote concepts, relationships and properties according to their immediate relevance. We describe a means to represent a wide variety of interactions between resources using the notion of a knowledge nexus, and we illustrate its use with resources and actors from the Geosciences Network (GEON) cyberinfrastructure community. We also closely link browsing and visualizing strategies to our nexus, drawing on ideas from semiotics to move resources and connections not currently of interest from the foreground to the background, and vice versa, using a new form of adaptive perspective. We illustrate our ideas via ConceptVista, an open-source concept mapping application that provides rich, visual depictions of the resources, cyber-community and myriad connections between them. Examples are presented that show how geoscientific knowledge can be explored not only via ontological structure, but also by use cases, social networks, citation graphs and organization charts; all of which may carry some aspects of meaning for the user.

Limitations of opto-electronic neural networks

NASA Technical Reports Server (NTRS)

Yu, Jeffrey; Johnston, Alan; Psaltis, Demetri; Brady, David

1989-01-01

Consideration is given to the limitations of implementing neurons, weights, and connections in neural networks for electronics and optics. It is shown that the advantages of each technology are utilized when electronically fabricated neurons are included and a combination of optics and electronics are employed for the weights and connections. The relationship between the types of neural networks being constructed and the choice of technologies to implement the weights and connections is examined.

Development of paper-based wireless communication modules for point-of-care diagnostic applications

NASA Astrophysics Data System (ADS)

Smith, Suzanne; Bezuidenhout, Petroné H.; Land, Kevin; Korvink, Jan G.; Mager, Dario

2016-02-01

We present an ultra-high frequency radio frequency identification based wireless communication set-up for paper-based point-of-care diagnostic applications, based on a sensing radio frequency identification chip. Paper provides a low-cost, disposable platform for ease of fluidic handling without bulky instrumentation, and is thus ideally suited for point-ofcare applications; however, result communication - a crucial aspect for healthcare to be implemented effectively - is still lacking. Printing of radio frequency identification antennas and electronic circuitry for sensing on paper are presented, with read out of the results using a radio frequency identification reader illustrated, demonstrating the feasibility of developing integrated, all-printed solutions for point-of-care diagnosis in resource-limited settings.

Strategic partnerships: bridging the collaboration gap.

PubMed

Weinstein, Sharon M

2004-01-01

"Teambuilding," "partnering," "outreach," and "collaboration" all are terms of the new millennium. Such terms suggest a continuing trend in healthcare. Partnering and collaboration are the hallmark of many successful models implemented by practice and academic healthcare settings worldwide. Strategic partnering, within and beyond institutions, provides opportunities for personal and professional growth, outreach, and collaboration. Within the global nursing community, cross-national partnerships represent a vehicle for extending knowledge sharing, and for using on-site visits, tele- and videoconferencing, electronic mail, and other resources. The World Wide Web has opened doors to distance learning programs that were once a dream, and that now represent reality. The author addresses the partnering concept and applications within the local healthcare community, within the country, and worldwide.

Environmental Assessment for the Implementation of the Integrated Natural Resources Management Plan for 45th Space Wing

DTIC Science & Technology

2008-08-01

the Proposed Action and as a basis for assessing the significance of potential impacts. The areas of environmental consideration were air quality... ENVIRONMENTAL ASSESSMENT FOR THE IMPLEMENTATION OF THE INTEGRATED NATURAL RESOURCES MANAGEMENT PLAN FOR 45th SPACE WING August...DATE AUG 2008 2. REPORT TYPE 3. DATES COVERED 00-00-2008 to 00-00-2008 4. TITLE AND SUBTITLE Environmental Assessment for the Implementation of