The prevalence of obesity documentation in Primary Care Electronic Medical Records

PubMed Central

Mattar, Ahmed; Carlston, David; Sariol, Glen; Yu, Tongle; Almustafa, Ahmad; Melton, Genevieve B.

2017-01-01

Summary Background Although obesity is a growing problem, primary care physicians often inadequately address it. The objective of this study is to examine the prevalence of obesity documentation in the patient’s problem list for patients with eligible body mass indexes (BMI) as contained in the patients’ electronic medical record (EMR). Additionally, we examined the prevalence of selected chronic conditions across BMI levels. Method This study is a retrospective study using EMR data for adult patients visiting an outpatient clinic between June 2012 and June 2015. International Classification of Diseases, Ninth Revision, (ICD-9) codes were used to identify obesity documentation in the EMR problem list. Univariate and multivariate logistic regression analyses were used. Results Out of 10,540, a total of 3,868 patients were included in the study. 2,003 (52%) patients met the criteria for obesity (BMI ≥ 30.0); however, only 112 (5.6%) patient records included obesity in the problem list. Moreover, in a multivariate analysis, in addition to age and gender, morbid obesity and cumulative number of comorbidities were significantly associated with obesity documentation, OR=1.6 and OR=1.3, respectively, with 95% CI [1.4, 1.9] and [1.0, 1.7], respectively. For those with obesity documentation, exercise counseling was provided more often than diet counselling. Conclusion Based on EHR documentation, obesity is under coded and generally not identified as a significant problem in primary care. Physicians are more likely to document obesity in the patient record for those with higher BMI scores who are morbidly obese. Moreover, physicians more frequently provide exercise than diet counseling for the documented obese. PMID:28119990

Use of the Physician Orders for Life-Sustaining Treatment program for patients being discharged from the hospital to the nursing facility.

PubMed

Hickman, Susan E; Nelson, Christine A; Smith-Howell, Esther; Hammes, Bernard J

2014-01-01

The Physician Orders for Life-Sustaining Treatment (POLST) documents patient preferences as medical orders that transfer across settings with patients. The objectives were to pilot test methods and gather preliminary data about POLST including (1) use at time of hospital discharge, (2) transfers across settings, and (3) consistency with prior decisions. Descriptive with chart abstraction and interviews. Participants were hospitalized patients discharged to a nursing facility and/or their surrogates in La Crosse County, Wisconsin. POLST forms were abstracted from hospital records for 151 patients. Hospital and nursing facility chart data were abstracted and interviews were conducted with an additional 39 patients/surrogates. Overall, 176 patients had valid POLST forms at the time of discharge from the hospital, and many (38.6%; 68/176) only documented code status. When the whole POLST was completed, orders were more often marked as based on a discussion with the patient and/or surrogate than when the form was used just for code status (95.1% versus 13.8%, p<.001). In the follow-up and interview sample, a majority (90.6%; 29/32) of POLST forms written in the hospital were unchanged up to three weeks after nursing facility admission. Most (71.9%; 23/32) appeared consistent with patient or surrogate recall of prior treatment decisions. POLST forms generated in the hospital do transfer with patients across settings, but are often used only to document code status. POLST orders appeared largely consistent with prior treatment decisions. Further research is needed to assess the quality of POLST decisions.

[Quality of documentation of intraoperative and postoperative complications : improvement of documentation for a nationwide quality assurance program and comparison with routine data].

PubMed

Jakob, J; Marenda, D; Sold, M; Schlüter, M; Post, S; Kienle, P

2014-08-01

Complications after cholecystectomy are continuously documented in a nationwide database in Germany. Recent studies demonstrated a lack of reliability of these data. The aim of the study was to evaluate the impact of a control algorithm on documentation quality and the use of routine diagnosis coding as an additional validation instrument. Completeness and correctness of the documentation of complications after cholecystectomy was compared over a time interval of 12 months before and after implementation of an algorithm for faster and more accurate documentation. Furthermore, the coding of all diagnoses was screened to identify intraoperative and postoperative complications. The sensitivity of the documentation for complications improved from 46 % to 70 % (p = 0.05, specificity 98 % in both time intervals). A prolonged time interval of more than 6 weeks between patient discharge and documentation was associated with inferior data quality (incorrect documentation in 1.5 % versus 15 %, p < 0.05). The rate of case documentation within the 6 weeks after hospital discharge was clearly improved after implementation of the control algorithm. Sensitivity and specificity of screening for complications by evaluating routine diagnoses coding were 70 % and 85 %, respectively. The quality of documentation was improved by implementation of a simple memory algorithm.

The devil is in the details: maximizing revenue for daily trauma care.

PubMed

Barnes, Stephen L; Robinson, Bryce R H; Richards, J Taliesin; Zimmerman, Cindy E; Pritts, Tim A; Tsuei, Betty J; Butler, Karyn L; Muskat, Peter C; Davis, Kenneth; Johannigman, Jay A

2008-10-01

Falling reimbursement rates for trauma care demand a concerted effort of charge capture for the fiscal survival of trauma surgeons. We compared current procedure terminology code distribution and billing patterns for Subsequent Hospital Care (SHC) before and after the institution of standardized documentation. Standardized SHC progress notes were created. The note was formulated with an emphasis on efficiency and accuracy. Documentation was completed by residents in conjunction with attendings following standard guidelines of linkage. Year-to-year patient volume, length of stay (LOS), injury severity, bills submitted, coding of service, work relative value units (wRVUs), revenue stream, and collection rate were compared with and without standardized documentation. A 394% average revenue increase was observed with the standardization of SHC documentation. Submitted charges more than doubled in the first year despite a 14% reduction in admissions and no change in length of stay. Significant increases in level II and level III billing and billing volume (P < .05) were sustainable year to year and resulted in an average per patient admission SHC income increase from $91.85 to $362.31. Use of a standardized daily progress note dramatically increases the accuracy of coding and associated billing of subsequent hospital care for trauma services.

A physician-led initiative to improve clinical documentation results in improved health care documentation, case mix index, and increased contribution margin.

PubMed

Aiello, Francesco A; Judelson, Dejah R; Durgin, Jonathan M; Doucet, Danielle R; Simons, Jessica P; Durocher, Dawn M; Flahive, Julie M; Schanzer, Andres

2018-05-04

Clinical documentation is the key determinant of inpatient acuity of illness and payer reimbursement. Every inpatient hospitalization is placed into a diagnosis related group with a relative value based on documented procedures, conditions, comorbidities and complications. The Case Mix Index (CMI) is an average of these diagnosis related groups and directly impacts physician profiling, medical center profiling, reimbursement, and quality reporting. We hypothesize that a focused, physician-led initiative to improve clinical documentation of vascular surgery inpatients results in increased CMI and contribution margin. A physician-led coding initiative to educate physicians on the documentation of comorbidities and conditions was initiated with concurrent chart review sessions with coding specialists for 3 months, and then as needed, after the creation of a vascular surgery documentation guide. Clinical documentation and billing for all carotid endarterectomy (CEA) and open infrainguinal procedures (OIPs) performed between January 2013 and July 2016 were stratified into precoding and postcoding initiative groups. Age, duration of stay, direct costs, actual reimbursements, contribution margin (CM), CMI, rate of complication or comorbidity, major complication or comorbidity, severity of illness, and risk of mortality assigned to each discharge were abstracted. Data were compared over time by standardizing Centers for Medicare and Medicaid Services (CMS) values for each diagnosis related group and using a CMS base rate reimbursement. Among 458 CEA admissions, postcoding initiative CEA patients (n = 253) had a significantly higher CMI (1.36 vs 1.25; P = .03), CM ($7859 vs $6650; P = .048), and CMS base rate reimbursement ($8955 vs $8258; P = .03) than precoding initiative CEA patients (n = 205). The proportion of admissions with a documented major complication or comorbidity and complication or comorbidity was significantly higher after the coding initiative (43% vs 27%; P < .01). Among 504 OIPs, postcoding initiative patients (n = 227) had a significantly higher CMI (2.23 vs 2.05; P < .01), actual reimbursement ($23,203 vs $19,909; P < .01), CM ($12,165 vs $8840; P < .01), and CMS base rate reimbursement ($14,649 vs $13,496; P < .01) than precoding initiative patients (n = 277). The proportion of admissions with a documented major complication or comorbidity and complication or comorbidity was significantly higher after the coding initiative (61% vs 43%; P < .01). For both CEA and OIPs, there were no differences in age, duration of stay, total direct costs, or primary insurance status between the precoding and postcoding patient groups. Accurate and detailed clinical documentation is required for key stakeholders to characterize the acuity of inpatient admissions and ensure appropriate reimbursement; it is also a key component of risk-adjustment methods for assessing quality of care. A physician-led documentation initiative significantly increased CMI and CM. Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Current issues in billing and coding in interventional pain medicine.

PubMed

Manchikanti, L

2000-10-01

Interventional pain management is a dynamic field with changes occurring on a daily basis, not only with technology but also with regulations that have a substantial financial impact on practices. Regulations are imposed not only by the federal government and other regulatory agencies, and also by a multitude of other payors, state governments and medical boards. Documentation of medical necessity with coding that correlates with multiple components of the patient's medical record, operative report, and billing statement is extremely important. Numerous changes which have occurred in the practice of interventional pain management in the new millennium continue to impact the financial viability of interventional pain practices along with patient access to these services. Thus, while complying with regulations of billing, coding and proper, effective, and ethical practice of pain management, it is also essential for physicians to understand financial aspects and the impact of various practice patterns. This article provides guidelines which are meant to provide practical considerations for billing and coding of interventional techniques in the management of chronic pain based on the current state of the art and science of interventional pain management. Hence, these guidelines do not constitute inflexible treatment, coding, billing or documentation recommendations. It is expected that a provider will establish a plan of care on a case-by-case basis taking into account an individual patient's medical condition, personal needs, and preferences, along with physician's experience and in a similar manner, billing and coding practices will be developed. Based on an individual patient's needs, treatment, billing and coding, different from what is outlined here is not only warranted but essential.

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

PubMed

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

2016-01-01

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

Malnutrition coding 101: financial impact and more.

PubMed

Giannopoulos, Georgia A; Merriman, Louise R; Rumsey, Alissa; Zwiebel, Douglas S

2013-12-01

Recent articles have addressed the characteristics associated with adult malnutrition as published by the Academy of Nutrition and Dietetics (the Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). This article describes a successful interdisciplinary program developed by the Department of Food and Nutrition at New York-Presbyterian Hospital to maintain and monitor clinical documentation, ensure accurate International Classification of Diseases 9th Edition (ICD-9) coding, and identify subsequent incremental revenue resulting from the early identification, documentation, and treatment of malnutrition in an adult inpatient population. The first step in the process requires registered dietitians to identify patients with malnutrition; then clear and specifically worded diagnostic statements that include the type and severity of malnutrition are documented in the medical record by the physician, nurse practitioner, or physician's assistant. This protocol allows the Heath Information Management/Coding department to accurately assign ICD-9 codes associated with protein-energy malnutrition. Once clinical coding is complete, a final diagnosis related group (DRG) is generated to ensure appropriate hospital reimbursement. Successful interdisciplinary programs such as this can drive optimal care and ensure appropriate reimbursement.

Validation of Case Finding Algorithms for Hepatocellular Cancer from Administrative Data and Electronic Health Records using Natural Language Processing

PubMed Central

Sada, Yvonne; Hou, Jason; Richardson, Peter; El-Serag, Hashem; Davila, Jessica

2013-01-01

Background Accurate identification of hepatocellular cancer (HCC) cases from automated data is needed for efficient and valid quality improvement initiatives and research. We validated HCC ICD-9 codes, and evaluated whether natural language processing (NLP) by the Automated Retrieval Console (ARC) for document classification improves HCC identification. Methods We identified a cohort of patients with ICD-9 codes for HCC during 2005–2010 from Veterans Affairs administrative data. Pathology and radiology reports were reviewed to confirm HCC. The positive predictive value (PPV), sensitivity, and specificity of ICD-9 codes were calculated. A split validation study of pathology and radiology reports was performed to develop and validate ARC algorithms. Reports were manually classified as diagnostic of HCC or not. ARC generated document classification algorithms using the Clinical Text Analysis and Knowledge Extraction System. ARC performance was compared to manual classification. PPV, sensitivity, and specificity of ARC were calculated. Results 1138 patients with HCC were identified by ICD-9 codes. Based on manual review, 773 had HCC. The HCC ICD-9 code algorithm had a PPV of 0.67, sensitivity of 0.95, and specificity of 0.93. For a random subset of 619 patients, we identified 471 pathology reports for 323 patients and 943 radiology reports for 557 patients. The pathology ARC algorithm had PPV of 0.96, sensitivity of 0.96, and specificity of 0.97. The radiology ARC algorithm had PPV of 0.75, sensitivity of 0.94, and specificity of 0.68. Conclusion A combined approach of ICD-9 codes and NLP of pathology and radiology reports improves HCC case identification in automated data. PMID:23929403

Validation of Case Finding Algorithms for Hepatocellular Cancer From Administrative Data and Electronic Health Records Using Natural Language Processing.

PubMed

Sada, Yvonne; Hou, Jason; Richardson, Peter; El-Serag, Hashem; Davila, Jessica

2016-02-01

Accurate identification of hepatocellular cancer (HCC) cases from automated data is needed for efficient and valid quality improvement initiatives and research. We validated HCC International Classification of Diseases, 9th Revision (ICD-9) codes, and evaluated whether natural language processing by the Automated Retrieval Console (ARC) for document classification improves HCC identification. We identified a cohort of patients with ICD-9 codes for HCC during 2005-2010 from Veterans Affairs administrative data. Pathology and radiology reports were reviewed to confirm HCC. The positive predictive value (PPV), sensitivity, and specificity of ICD-9 codes were calculated. A split validation study of pathology and radiology reports was performed to develop and validate ARC algorithms. Reports were manually classified as diagnostic of HCC or not. ARC generated document classification algorithms using the Clinical Text Analysis and Knowledge Extraction System. ARC performance was compared with manual classification. PPV, sensitivity, and specificity of ARC were calculated. A total of 1138 patients with HCC were identified by ICD-9 codes. On the basis of manual review, 773 had HCC. The HCC ICD-9 code algorithm had a PPV of 0.67, sensitivity of 0.95, and specificity of 0.93. For a random subset of 619 patients, we identified 471 pathology reports for 323 patients and 943 radiology reports for 557 patients. The pathology ARC algorithm had PPV of 0.96, sensitivity of 0.96, and specificity of 0.97. The radiology ARC algorithm had PPV of 0.75, sensitivity of 0.94, and specificity of 0.68. A combined approach of ICD-9 codes and natural language processing of pathology and radiology reports improves HCC case identification in automated data.

[QR-Code based patient tracking: a cost-effective option to improve patient safety].

PubMed

Fischer, M; Rybitskiy, D; Strauß, G; Dietz, A; Dressler, C R

2013-03-01

Hospitals are implementing a risk management system to avoid patient or surgery mix-ups. The trend is to use preoperative checklists. This work deals specifically with a type of patient identification, which is realized by storing patient data on a patient-fixed medium. In 127 ENT surgeries data relevant for patient identification were encrypted in a 2D-QR-Code. The code, as a separate document coming with the patient chart or as a patient wristband, has been decrypted in the OR and the patient data were presented visible for all persons. The decoding time, the compliance of the patient data, as well as the duration of the patient identification was compared with the traditional patient identification by inspection of the patient chart. A total of 125 QR codes were read. The time for the decrypting of QR-Code was 5.6 s, the time for the screen view for patient identification was 7.9 s, and for a comparison group of 75 operations traditional patient identification was 27.3 s. Overall, there were 6 relevant information errors in the two parts of the experiment. This represents a ratio of 0.6% for 8 relevant classes per each encrypted QR code. This work allows a cost effective way to technically support patient identification based on electronic patient data. It was shown that the use in the clinical routine is possible. The disadvantage is a potential misinformation from incorrect or missing information in the HIS, or due to changes of the data after the code was created. The QR-code-based patient tracking is seen as a useful complement to the already widely used identification wristband. © Georg Thieme Verlag KG Stuttgart · New York.

[Differentiation of coding quality in orthopaedics by special, illustration-oriented case group analysis in the G-DRG System 2005].

PubMed

Schütz, U; Reichel, H; Dreinhöfer, K

2007-01-01

We introduce a grouping system for clinical practice which allows the separation of DRG coding in specific orthopaedic groups based on anatomic regions, operative procedures, therapeutic interventions and morbidity equivalent diagnosis groups. With this, a differentiated aim-oriented analysis of illustrated internal DRG data becomes possible. The group-specific difference of the coding quality between the DRG groups following primary coding by the orthopaedic surgeon and final coding by the medical controlling is analysed. In a consecutive series of 1600 patients parallel documentation and group-specific comparison of the relevant DRG parameters were carried out in every case after primary and final coding. Analysing the group-specific share in the additional CaseMix coding, the group "spine surgery" dominated, closely followed by the groups "arthroplasty" and "surgery due to infection, tumours, diabetes". Altogether, additional cost-weight-relevant coding was necessary most frequently in the latter group (84%), followed by group "spine surgery" (65%). In DRGs representing conservative orthopaedic treatment documented procedures had nearly no influence on the cost weight. The introduced system of case group analysis in internal DRG documentation can lead to the detection of specific problems in primary coding and cost-weight relevant changes of the case mix. As an instrument for internal process control in the orthopaedic field, it can serve as a communicative interface between an economically oriented classification of the hospital performance and a specific problem solution of the medical staff involved in the department management.

Combining dictionary techniques with extensible markup language (XML)--requirements to a new approach towards flexible and standardized documentation.

PubMed Central

Altmann, U.; Tafazzoli, A. G.; Noelle, G.; Huybrechts, T.; Schweiger, R.; Wächter, W.; Dudeck, J. W.

1999-01-01

In oncology various international and national standards exist for the documentation of different aspects of a disease. Since elements of these standards are repeated in different contexts, a common data dictionary could support consistent representation in any context. For the construction of such a dictionary existing documents have to be worked up in a complex procedure, that considers aspects of hierarchical decomposition of documents and of domain control as well as aspects of user presentation and models of the underlying model of patient data. In contrast to other thesauri, text chunks like definitions or explanations are very important and have to be preserved, since oncologic documentation often means coding and classification on an aggregate level and the safe use of coding systems is an important precondition for comparability of data. This paper discusses the potentials of the use of XML in combination with a dictionary for the promotion and development of standard conformable applications for tumor documentation. PMID:10566311

Electronic Nursing Documentation: Patient Care Continuity Using the Clinical Care Classification System (CCC).

PubMed

Whittenburg, Luann; Meetim, Aunchisa

2016-01-01

An innovative nursing documentation project conducted at Bumrungrad International Hospital in Bangkok, Thailand demonstrated patient care continuity between nursing patient assessments and nursing Plans of Care using the Clinical Care Classification System (CCC). The project developed a new generation of interactive nursing Plans of Care using the six steps of the American Nurses Association (ANA) Nursing process and the MEDCIN^® clinical knowledgebase to present CCC coded concepts as a natural by-product of a nurse's documentation process. The MEDCIN^® clinical knowledgebase is a standardized point-of-care terminology intended for use in electronic health record systems. The CCC is an ANA recognized nursing terminology.

Miscoding and other user errors: importance of ongoing education for proper blood glucose monitoring procedures.

PubMed

Schrock, Linda E

2008-07-01

This article reviews the literature to date and reports on a new study that documented the frequency of manual code-requiring blood glucose (BG) meters that were miscoded at the time of the patient's initial appointment in a hospital-based outpatient diabetes education program. Between January 1 and May 31, 2007, the type of BG meter and the accuracy of the patient's meter code (if required) and procedure for checking BG were checked during the initial appointment with the outpatient diabetes educator. If indicated, reeducation regarding the procedure for the BG meter code entry and/or BG test was provided. Of the 65 patients who brought their meter requiring manual entry of a code number or code chip to the initial appointment, 16 (25%) were miscoded at the time of the appointment. Two additional problems, one of dead batteries and one of improperly stored test strips, were identified and corrected at the first appointment. These findings underscore the importance of checking the patient's BG meter code (if required) and procedure for testing BG at each encounter with a health care professional or providing the patient with a meter that does not require manual entry of a code number or chip to match the container of test strips (i.e., an autocode meter).

The importance of KMR completion for dermatology income in secondary care in the UK.

PubMed

Hague, J; Nichols, H; Klimmeck, J; Lanigan, S

2007-05-01

In the UK, a Korner Medical Record (KMR) document is completed for each inpatient discharged from hospital. The number and type of medical conditions entered onto this record are used to determine the income the department will receive for that individual patient. We set out to audit the accuracy of the KMR documentation of our dermatology ward, and to assess what impact improving these records would have on the department's income. The audit standard was that KMRs should be completed accurately and contain all of the relevant information. KMRs from May 2005, which had been completed initially by the ward clerk, and later by the junior medical staff, were reviewed. They were then completed by the main auditor, who had received training in KMR completion from the coding department. All three sets of KMRs were reviewed by the coding officer, and their respective income calculated. In total, 20 patients were discharged from the dermatology ward during April 2005. The main diagnosis given for two patients was initially incorrect, and in another eight cases it could have been more accurate than was originally documented. The total number of comorbid or 'secondary' diagnoses (for all 20 patients) reported by the ward clerk was 5. Junior staff added a further 36 secondary diagnoses. The main auditor identified an additional 35 secondary diagnoses. In total, an extra pound 9211 would have been paid to the department if KMRs had been completed by the main auditor rather than the ward clerk. On an annual basis, a potential pound 110,532 would remain unclaimed if KMR completion continued to be performed by the ward clerk. This audit shows that KMR completion is inadequate when performed by a nonmedical practitioner. Training of medical staff in KMR completion by the coding department also significantly increases the accuracy and completeness of documentation. Dermatologists of all grades need to be aware of the importance and process of KMR completion, and routine training of medical staff by their coding department in KMR completion is recommended.

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

PubMed

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

2013-01-01

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

Billing, coding, and documentation in the critical care environment.

PubMed

Fakhry, S M

2000-06-01

Optimal conduct of modern-day physician practices involves a thorough understanding and application of the principles of documentation, coding, and billing. Physicians' role in these activities can no longer be secondary. Surgeons practicing critical care must be well versed in these concepts and their effective application to ensure that they are competitive in an increasingly difficult and demanding environment. Health care policies and regulations continue to evolve, mandating constant education of practicing physicians and their staffs and surgical residents who also will have to function in this environment. Close, collaborative relationships between physicians and individuals well versed in the concepts of documentation, coding, and billing are indispensable. Similarly, ongoing educational and review processes (whether internal or consultative from outside sources) not only can decrease the possibility of unfavorable outcomes from audit but also will likely enhance practice efficiency and cash flow. A financially viable practice is certainly a prerequisite for a surgical critical care practice to achieve its primary goal of excellence in patient care.

"There are too many, but never enough": qualitative case study investigating routine coding of clinical information in depression.

PubMed

Cresswell, Kathrin; Morrison, Zoe; Kalra, Dipak; Sheikh, Aziz

2012-01-01

We sought to understand how clinical information relating to the management of depression is routinely coded in different clinical settings and the perspectives of and implications for different stakeholders with a view to understanding how these may be aligned. Qualitative investigation exploring the views of a purposefully selected range of healthcare professionals, managers, and clinical coders spanning primary and secondary care. Our dataset comprised 28 semi-structured interviews, a focus group, documents relating to clinical coding standards and participant observation of clinical coding activities. We identified a range of approaches to coding clinical information including templates and order entry systems. The challenges inherent in clearly establishing a diagnosis, identifying appropriate clinical codes and possible implications of diagnoses for patients were particularly prominent in primary care. Although a range of managerial and research benefits were identified, there were no direct benefits from coded clinical data for patients or professionals. Secondary care staff emphasized the role of clinical coders in ensuring data quality, which was at odds with the policy drive to increase real-time clinical coding. There was overall no evidence of clear-cut direct patient care benefits to inform immediate care decisions, even in primary care where data on patients with depression were more extensively coded. A number of important secondary uses were recognized by healthcare staff, but the coding of clinical data to serve these ends was often poorly aligned with clinical practice and patient-centered considerations. The current international drive to encourage clinical coding by healthcare professionals during the clinical encounter may need to be critically examined.

Document image retrieval through word shape coding.

PubMed

Lu, Shijian; Li, Linlin; Tan, Chew Lim

2008-11-01

This paper presents a document retrieval technique that is capable of searching document images without OCR (optical character recognition). The proposed technique retrieves document images by a new word shape coding scheme, which captures the document content through annotating each word image by a word shape code. In particular, we annotate word images by using a set of topological shape features including character ascenders/descenders, character holes, and character water reservoirs. With the annotated word shape codes, document images can be retrieved by either query keywords or a query document image. Experimental results show that the proposed document image retrieval technique is fast, efficient, and tolerant to various types of document degradation.

17 CFR 232.106 - Prohibition against electronic submissions containing executable code.

Code of Federal Regulations, 2010 CFR

2010-04-01

... executable code will be suspended, unless the executable code is contained only in one or more PDF documents, in which case the submission will be accepted but the PDF document(s) containing executable code will...

Administrative database concerns: accuracy of International Classification of Diseases, Ninth Revision coding is poor for preoperative anemia in patients undergoing spinal fusion.

PubMed

Golinvaux, Nicholas S; Bohl, Daniel D; Basques, Bryce A; Grauer, Jonathan N

2014-11-15

Cross-sectional study. To objectively evaluate the ability of International Classification of Diseases, Ninth Revision (ICD-9) codes, which are used as the foundation for administratively coded national databases, to identify preoperative anemia in patients undergoing spinal fusion. National database research in spine surgery continues to rise. However, the validity of studies based on administratively coded data, such as the Nationwide Inpatient Sample, are dependent on the accuracy of ICD-9 coding. Such coding has previously been found to have poor sensitivity to conditions such as obesity and infection. A cross-sectional study was performed at an academic medical center. Hospital-reported anemia ICD-9 codes (those used for administratively coded databases) were directly compared with the chart-documented preoperative hematocrits (true laboratory values). A patient was deemed to have preoperative anemia if the preoperative hematocrit was less than the lower end of the normal range (36.0% for females and 41.0% for males). The study included 260 patients. Of these, 37 patients (14.2%) were anemic; however, only 10 patients (3.8%) received an "anemia" ICD-9 code. Of the 10 patients coded as anemic, 7 were anemic by definition, whereas 3 were not, and thus were miscoded. This equates to an ICD-9 code sensitivity of 0.19, with a specificity of 0.99, and positive and negative predictive values of 0.70 and 0.88, respectively. This study uses preoperative anemia to demonstrate the potential inaccuracies of ICD-9 coding. These results have implications for publications using databases that are compiled from ICD-9 coding data. Furthermore, the findings of the current investigation raise concerns regarding the accuracy of additional comorbidities. Although administrative databases are powerful resources that provide large sample sizes, it is crucial that we further consider the quality of the data source relative to its intended purpose.

Financial and clinical governance implications of clinical coding accuracy in neurosurgery: a multidisciplinary audit.

PubMed

Haliasos, N; Rezajooi, K; O'neill, K S; Van Dellen, J; Hudovsky, Anita; Nouraei, Sar

2010-04-01

Clinical coding is the translation of documented clinical activities during an admission to a codified language. Healthcare Resource Groupings (HRGs) are derived from coding data and are used to calculate payment to hospitals in England, Wales and Scotland and to conduct national audit and benchmarking exercises. Coding is an error-prone process and an understanding of its accuracy within neurosurgery is critical for financial, organizational and clinical governance purposes. We undertook a multidisciplinary audit of neurosurgical clinical coding accuracy. Neurosurgeons trained in coding assessed the accuracy of 386 patient episodes. Where clinicians felt a coding error was present, the case was discussed with an experienced clinical coder. Concordance between the initial coder-only clinical coding and the final clinician-coder multidisciplinary coding was assessed. At least one coding error occurred in 71/386 patients (18.4%). There were 36 diagnosis and 93 procedure errors and in 40 cases, the initial HRG changed (10.4%). Financially, this translated to pound111 revenue-loss per patient episode and projected to pound171,452 of annual loss to the department. 85% of all coding errors were due to accumulation of coding changes that occurred only once in the whole data set. Neurosurgical clinical coding is error-prone. This is financially disadvantageous and with the coding data being the source of comparisons within and between departments, coding inaccuracies paint a distorted picture of departmental activity and subspecialism in audit and benchmarking. Clinical engagement improves accuracy and is encouraged within a clinical governance framework.

Reimbursement Policies for Carotid Duplex Ultrasound that are Based on International Classification of Diseases Codes May Discourage Testing in High-Yield Groups.

PubMed

Go, Michael R; Masterson, Loren; Veerman, Brent; Satiani, Bhagwan

2016-02-01

To curb increasing volumes of diagnostic imaging and costs, reimbursement for carotid duplex ultrasound (CDU) is dependent on "appropriate" indications as documented by International Classification of Diseases (ICD) codes entered by ordering physicians. Historically, asymptomatic indications for CDU yield lower rates of abnormal results than symptomatic indications, and consensus documents agree that most asymptomatic indications for CDU are inappropriate. In our vascular laboratory, we perceived an increased rate of incorrect or inappropriate ICD codes. We therefore sought to determine if ICD codes were useful in predicting the frequency of abnormal CDU. We hypothesized that asymptomatic or nonspecific ICD codes would yield a lower rate of abnormal CDU than symptomatic codes, validating efforts to limit reimbursement in asymptomatic, low-yield groups. We reviewed all outpatient CDU done in 2011 at our institution. ICD codes were recorded, and each medical record was then reviewed by a vascular surgeon to determine if the assigned ICD code appropriately reflected the clinical scenario. CDU findings categorized as abnormal (>50% stenosis) or normal (<50% stenosis) were recorded. Each individual ICD code and group 1 (asymptomatic), group 2 (nonhemispheric symptoms), group 3 (hemispheric symptoms), group 4 (preoperative cardiovascular examination), and group 5 (nonspecific) ICD codes were analyzed for correlation with CDU results. Nine hundred ninety-four patients had 74 primary ICD codes listed as indications for CDU. Of assigned ICD codes, 17.4% were deemed inaccurate. Overall, 14.8% of CDU were abnormal. Of the 13 highest frequency ICD codes, only 433.10, an asymptomatic code, was associated with abnormal CDU. Four symptomatic codes were associated with normal CDU; none of the other high frequency codes were associated with CDU result. Patients in group 1 (asymptomatic) were significantly more likely to have an abnormal CDU compared to each of the other groups (P < 0.001, P < 0.001, P = 0.020, P = 0.002) and to all other groups combined (P < 0.001). Asymptomatic indications by ICD codes yielded higher rates of abnormal CDU than symptomatic indications. This finding is inconsistent with clinical experience and historical data, and we suggest that inaccurate coding may play a role. Limiting reimbursement for CDU in low-yield groups is reasonable. However, reimbursement policies based on ICD coding, for example, limiting payment for asymptomatic ICD codes, may impede use of CDU in high-yield patient groups. Copyright © 2016 Elsevier Inc. All rights reserved.

[Implementation of a patient data management system. Effects on intensive care documentation].

PubMed

Castellanos, I; Ganslandt, T; Prokosch, H U; Schüttler, J; Bürkle, T

2013-11-01

Patient data management systems (PDMS) enable digital documentation on intensive care units (ICU). A commercial PDMS was implemented in a 25-bed ICU replacing paper-based patient charting. The ICU electronic patient record is completely managed inside the PDMS. It compiles data from vital signs monitors, ventilators and further medical devices and facilitates some drug dose and fluid balance calculations as well as data reuse for administrative purposes. Ventilation time and patient severity scoring as well as coding of diagnoses and procedures is supported. Billing data transferred via interface to the central billing system of the hospital. Such benefits should show in measurable parameters, such as documented ventilator time, number of coded diagnoses and procedures and others. These parameters influence reimbursement in the German DRG system. Therefore, measurable changes in cost and reimbursement data of the ICU were expected. A retrospective analysis of documentation quality parameters, cost data and mortality rate of a 25-bed surgical ICU within a German university hospital 3 years before (2004-2006) and 5 years after (2007-2011) PDMS implementation. Selected parameters were documented electronically, consistently and reproducibly for the complete time span of 8 years including those years where no electronic patient recording was available. The following parameters were included: number of cleared DRG, cleared ventilator time, case mix (CM), case mix index (CMI), length of stay, number of coded diagnoses and procedures, detailed overview of a specific procedure code based on daily Apache II and TISS Core 10 scores, mortality, total ICU costs and revenues and partial profits for specific ICU procedures, such as renal replacement therapy and blood products. Systematic shifts were detected over the study period, such as increasing case numbers and decreasing length of stay as well as annual fluctuations in severity of disease seen in the CM and CMI. After PDMS introduction, the total number of coded diagnoses increased but the proportion of DRG relevant diagnoses dropped significantly. The number of procedures increased (not significantly) and the number of procedures per case did not rise significantly. The procedure 8-980 showed a significant increase after PDMS introduction whereas the DRG-relevant proportion of those procedures dropped insignificantly. The number of ventilator-associated DRG cases as well as the total ventilator time increased but not significantly. Costs and revenues increased slightly but profit varied considerably from year to year in the 5 years after system implementation. A small increase was observed per case, per nursing day and per case mix point. Additional revenues for specific ICU procedures increased in the years before and dropped after PDMS implementation. There was an insignificant increase in ICU mortality rate from 7.4 % in the year 2006 (before) to 8.5 % in 2007 (after PDMS implementation). In the following years mortality dropped below the base level. The implementation of the PDMS showed only small effects on documentation of reimbursement-relevant parameters which were too small to set off against the total investment. The method itself, a long-term follow-up of different parameters proved successful and can be adapted by other organizations. The quality of results depends on the availability of long-term parameters in good quality. No significant influence of PDMS on mortality was found.

“There Are Too Many, but Never Enough": Qualitative Case Study Investigating Routine Coding of Clinical Information in Depression

PubMed Central

Cresswell, Kathrin; Morrison, Zoe; Sheikh, Aziz; Kalra, Dipak

2012-01-01

Background We sought to understand how clinical information relating to the management of depression is routinely coded in different clinical settings and the perspectives of and implications for different stakeholders with a view to understanding how these may be aligned. Materials and Methods Qualitative investigation exploring the views of a purposefully selected range of healthcare professionals, managers, and clinical coders spanning primary and secondary care. Results Our dataset comprised 28 semi-structured interviews, a focus group, documents relating to clinical coding standards and participant observation of clinical coding activities. We identified a range of approaches to coding clinical information including templates and order entry systems. The challenges inherent in clearly establishing a diagnosis, identifying appropriate clinical codes and possible implications of diagnoses for patients were particularly prominent in primary care. Although a range of managerial and research benefits were identified, there were no direct benefits from coded clinical data for patients or professionals. Secondary care staff emphasized the role of clinical coders in ensuring data quality, which was at odds with the policy drive to increase real-time clinical coding. Conclusions There was overall no evidence of clear-cut direct patient care benefits to inform immediate care decisions, even in primary care where data on patients with depression were more extensively coded. A number of important secondary uses were recognized by healthcare staff, but the coding of clinical data to serve these ends was often poorly aligned with clinical practice and patient-centered considerations. The current international drive to encourage clinical coding by healthcare professionals during the clinical encounter may need to be critically examined. PMID:22937106

DataRocket: Interactive Visualisation of Data Structures

NASA Astrophysics Data System (ADS)

Parkes, Steve; Ramsay, Craig

2010-08-01

CodeRocket is a software engineering tool that provides cognitive support to the software engineer for reasoning about a method or procedure and for documenting the resulting code [1]. DataRocket is a software engineering tool designed to support visualisation and reasoning about program data structures. DataRocket is part of the CodeRocket family of software tools developed by Rapid Quality Systems [2] a spin-out company from the Space Technology Centre at the University of Dundee. CodeRocket and DataRocket integrate seamlessly with existing architectural design and coding tools and provide extensive documentation with little or no effort on behalf of the software engineer. Comprehensive, abstract, detailed design documentation is available early on in a project so that it can be used for design reviews with project managers and non expert stakeholders. Code and documentation remain fully synchronised even when changes are implemented in the code without reference to the existing documentation. At the end of a project the press of a button suffices to produce the detailed design document. Existing legacy code can be easily imported into CodeRocket and DataRocket to reverse engineer detailed design documentation making legacy code more manageable and adding substantially to its value. This paper introduces CodeRocket. It then explains the rationale for DataRocket and describes the key features of this new tool. Finally the major benefits of DataRocket for different stakeholders are considered.

Actual and Potential Effects of Medical Resident Coverage on Reimbursement for Inpatient Visits by Attending Physicians

PubMed Central

Shine, Daniel; Jessen, Laurie; Bajaj, Jasmeet; Pencak, Dorothy; Panush, Richard

2002-01-01

CONTEXT The impact of residents on hospital finance has been studied; there are no data describing the economic effect of residents on attending physicians. OBJECTIVE In a community teaching hospital, we compared allowable inpatient visit codes and payments (based on documentation in the daily progress notes) between a general medicine teaching unit and nonteaching general medicine units. DESIGN Retrospective chart review, matched cohort study. SETTING Six hundred fifty–bed community teaching hospital. PATIENTS Patients were discharged July 1998 through February 1999 from Saint Barnabas Medical Center. We randomly selected 200 patients in quartets. Each quartet consisted of a pair of patients cared for by residents and a pair cared for only by an attending physician. In each pair, 1 of the patients was under the care of an attending physician who usually admitted to the teaching service, and 1 was under the care of a usually nonteaching attending. Within each quartet, patients were matched for diagnosis-related group, length of stay, and discharge date. MAIN OUTCOME MEASURES We assigned the highest daily visit code justifiable by resident and attending chart documentation, determining relative value units (RVUs) and reimbursements allowed by each patient's insurance company. RESULTS Although more seriously ill, teaching-unit patients generated a mean 1.75 RVUs daily, compared with 1.84 among patients discharged from nonteaching units (P = .3). Median reimbursement, daily and per hospitalization, was similar on teaching and nonteaching units. Nonteaching attendings documented higher mean daily RVUs than teaching attendings (1.83 vs 1.76, P = .2). Median allowable reimbursements were $267 per case ($53 daily) among teaching attendings compared with $294 per case ($58 daily) among nonteaching attendings (Z = 1.54, P = .1). When only the resident note was considered, mean daily RVUs increased 39% and median allowable dollars per day 27% (Z = 4.21, P < .001). CONCLUSIONS Nonteaching attendings appear to document their visits more carefully from a billing perspective than do teaching attendings. Properly counter-documented, resident notes could substantially increase payments to attending physicians. PMID:12133156

Patient health record on a smart card.

PubMed

Naszlady, A; Naszlady, J

1998-02-01

A validated health questionnaire has been used for the documentation of a patient's history (826 items) and of the findings from physical examination (591 items) in our clinical ward for 25 years. This computerized patient record has been completed in EUCLIDES code (CEN TC/251) for laboratory tests and an ATC and EAN code listing for the names of the drugs permanently required by the patient. In addition, emergency data were also included on an EEPROM chipcard with a 24 kb capacity. The program is written in FOX-PRO language. A group of 5000 chronically ill in-patients received these cards which contain their health data. For security reasons the contents of the smart card is only accessible by a doctor's PIN coded key card. The personalization of each card was carried out in our health center and the depersonalized alphanumeric data were collected for further statistical evaluation. This information served as a basis for a real need assessment of health care and for the calculation of its cost. Code-combined with an optical card, a completely paperless electronic patient record system has been developed containing all three information carriers in medicine: Texts, Curves and Pictures.

Mild Traumatic Brain Injury Pocket Guide (CONUS)

DTIC Science & Technology

2010-01-01

Cognitive Rehab Driving Following TBI Patient Education Clinical Tools and Resources Report Documentation Page Form ApprovedOMB No. 0704-0188 Public... Rehab Driving Following TBI Patient Education Clinical Tools and Resources 2 3 TBI Basics VA/DoD CPG Management of Headaches Management of Other...Symptoms ICD-9 Coding Cognitive Rehab Driving Following TBI Patient Education Clinical Tools and Resources TBI BASICS 4 5 TBI BASICS dod definition

[Complexity level simulation in the German diagnosis-related groups system: the financial effect of coding of comorbidity diagnostics in urology].

PubMed

Wenke, A; Gaber, A; Hertle, L; Roeder, N; Pühse, G

2012-07-01

Precise and complete coding of diagnoses and procedures is of value for optimizing revenues within the German diagnosis-related groups (G-DRG) system. The implementation of effective structures for coding is cost-intensive. The aim of this study was to prove whether higher costs can be refunded by complete acquisition of comorbidities and complications. Calculations were based on DRG data of the Department of Urology, University Hospital of Münster, Germany, covering all patients treated in 2009. The data were regrouped and subjected to a process of simulation (increase and decrease of patient clinical complexity levels, PCCL) with the help of recently developed software. In urology a strong dependency of quantity and quality of coding of secondary diagnoses on PCCL and subsequent profits was found. Departmental budgetary procedures can be optimized when coding is effective. The new simulation tool can be a valuable aid to improve profits available for distribution. Nevertheless, calculation of time use and financial needs by this procedure are subject to specific departmental terms and conditions. Completeness of coding of (secondary) diagnoses must be the ultimate administrative goal of patient case documentation in urology.

The positive financial impact of using an Intensive Care Information System in a tertiary Intensive Care Unit.

PubMed

Levesque, Eric; Hoti, Emir; de La Serna, Sofia; Habouchi, Houssam; Ichai, Philippe; Saliba, Faouzi; Samuel, Didier; Azoulay, Daniel

2013-03-01

In the French healthcare system, the intensive care budget allocated is directly dependent on the activity level of the center. To evaluate this activity level, it is necessary to code the medical diagnoses and procedures performed on Intensive Care Unit (ICU) patients. The aim of this study was to evaluate the effects of using an Intensive Care Information System (ICIS) on the incidence of coding errors and its impact on the ICU budget allocated. Since 2005, the documentation on and monitoring of every patient admitted to our ICU has been carried out using an ICIS. However, the coding process was performed manually until 2008. This study focused on two periods: the period of manual coding (year 2007) and the period of computerized coding (year 2008) which covered a total of 1403 ICU patients. The time spent on the coding process, the rate of coding errors (defined as patients missed/not coded or wrongly identified as undergoing major procedure/s) and the financial impact were evaluated for these two periods. With computerized coding, the time per admission decreased significantly (from 6.8 ± 2.8 min in 2007 to 3.6 ± 1.9 min in 2008, p<0.001). Similarly, a reduction in coding errors was observed (7.9% vs. 2.2%, p<0.001). This decrease in coding errors resulted in a reduced difference between the potential and real ICU financial supplements obtained in the respective years (€194,139 loss in 2007 vs. a €1628 loss in 2008). Using specific computer programs improves the intensive process of manual coding by shortening the time required as well as reducing errors, which in turn positively impacts the ICU budget allocation. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Importance of Proper Utilization of International Classification of Diseases 10th Revision and Clinical Documentation in Modern Payment Models.

PubMed

Nichols, Joseph C; Osmani, Feroz A; Sayeed, Yousuf

2016-05-01

Health care payment models are changing rapidly, and the measurement of outcomes and costs is increasing. With the implementation of International Classification of Diseases 10th revision (ICD-10) codes, providers now have the ability to introduce a precise array of diagnoses for their patients. More specific diagnostic codes do not eliminate the potential for vague application, as was seen with the utility of ICD-9. Complete, accurate, and consistent data that reflect the risk, severity, and complexity of care are becoming critically important in this new environment. Orthopedic specialty organizations must be actively involved in influencing the definition of value and risk in the patient population. Now is the time to use the ICD-10 diagnostic codes to improve the management of patient conditions in data. Copyright © 2016 Elsevier Inc. All rights reserved.

Open-source framework for documentation of scientific software written on MATLAB-compatible programming languages

NASA Astrophysics Data System (ADS)

Konnik, Mikhail V.; Welsh, James

2012-09-01

Numerical simulators for adaptive optics systems have become an essential tool for the research and development of the future advanced astronomical instruments. However, growing software code of the numerical simulator makes it difficult to continue to support the code itself. The problem of adequate documentation of the astronomical software for adaptive optics simulators may complicate the development since the documentation must contain up-to-date schemes and mathematical descriptions implemented in the software code. Although most modern programming environments like MATLAB or Octave have in-built documentation abilities, they are often insufficient for the description of a typical adaptive optics simulator code. This paper describes a general cross-platform framework for the documentation of scientific software using open-source tools such as LATEX, mercurial, Doxygen, and Perl. Using the Perl script that translates M-files MATLAB comments into C-like, one can use Doxygen to generate and update the documentation for the scientific source code. The documentation generated by this framework contains the current code description with mathematical formulas, images, and bibliographical references. A detailed description of the framework components is presented as well as the guidelines for the framework deployment. Examples of the code documentation for the scripts and functions of a MATLAB-based adaptive optics simulator are provided.

Technical Support Document for Version 3.6.1 of the COMcheck Software

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

Bartlett, Rosemarie; Connell, Linda M.; Gowri, Krishnan

2009-09-29

This technical support document (TSD) is designed to explain the technical basis for the COMcheck software as originally developed based on the ANSI/ASHRAE/IES Standard 90.1-1989 (Standard 90.1-1989). Documentation for other national model codes and standards and specific state energy codes supported in COMcheck has been added to this report as appendices. These appendices are intended to provide technical documentation for features specific to the supported codes and for any changes made for state-specific codes that differ from the standard features that support compliance with the national model codes and standards.

Prevalence of Pulsatile Tinnitus Among Patients With Migraine.

PubMed

Weinreich, Heather M; Carey, John P

2016-03-01

To examine the prevalence of pulsatile tinnitus (PT) among patients with a diagnosis of migraine and to determine if treatment of migraine improves symptoms. Single-institution retrospective patient review. Academic tertiary referral center. Billing data capturing ICD-9 codes 346.xx and 388.3x was used to identify patients with history of migraine and tinnitus. Patients were excluded if the symptom of PT could be attributed to an alternate diagnosis. Data were extracted from the patients' electronic medical records. Therapeutic patients were prescribed a strict migraine diet with or without migraine medication. Subjective improvement in tinnitus as documented in electronic medical records. One thousand two hundred four patients were identified with an ICD-9 code for migraine and of those patients, 12% (n = 145) had an ICD-9 code for tinnitus. After ruling out alternative causes, the prevalence of PT among all patients with migraine was 1.9%. Of migrainers with PT who underwent migraine treatment, 11 out of 16 reported resolution or improvement of their PT. PT can be observed in the context of migraine. Migraine treatment with avoidance of dietary triggers with or without medication can possibly lead to resolution of PT.

Hospital-acquired catheter-associated urinary tract infection: documentation and coding issues may reduce financial impact of Medicare's new payment policy.

PubMed

Meddings, Jennifer; Saint, Sanjay; McMahon, Laurence F

2010-06-01

To evaluate whether hospital-acquired catheter-associated urinary tract infections (CA-UTIs) are accurately documented in discharge records with the use of International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes so that nonpayment is triggered, as mandated by the Centers for Medicare and Medicaid Services (CMS) Hospital-Acquired Conditions Initiative. We conducted a retrospective medical record review of 80 randomly selected adult discharges from May 2006 through September 2007 from the University of Michigan Health System (UMHS) with secondary-diagnosis urinary tract infections (UTIs). One physician-abstractor reviewed each record to categorize UTIs as catheter associated and/or hospital acquired; these results (considered "gold standard") were compared with diagnosis codes assigned by hospital coders. Annual use of the catheter association code (996.64) by UMHS coders was compared with state and US rates by using Healthcare Cost and Utilization Project data. Patient mean age was 58 years; 56 (70%) were women; median length of hospital stay was 6 days; 50 patients (62%) used urinary catheters during hospitalization. Hospital coders had listed 20 secondary-diagnosis UTIs (25%) as hospital acquired, whereas physician-abstractors indicated that 37 (46%) were hospital acquired. Hospital coders had identified no CA-UTIs (code 996.64 was never used), whereas physician-abstractors identified 36 CA-UTIs (45%; 28 hospital acquired and 8 present on admission). Catheter use often was evident only from nursing notes, which, unlike physician notes, cannot be used by coders to assign discharge codes. State and US annual rates of 996.64 coding (approximately 1% of secondary-diagnosis UTIs) were similar to those at UMHS. Hospital coders rarely use the catheter association code needed to identify CA-UTI among secondary-diagnosis UTIs. Coders often listed a UTI as present on admission, although the medical record indicated that it was hospital acquired. Because coding of hospital-acquired CA-UTI seems to be fraught with error, nonpayment according to CMS policy may not reliably occur.

Surviving "Payment by Results": a simple method of improving clinical coding in burn specialised services in the United Kingdom.

PubMed

Wallis, Katy L; Malic, Claudia C; Littlewood, Sonia L; Judkins, Keith; Phipps, Alan R

2009-03-01

Coding inpatient episodes plays an important role in determining the financial remuneration of a clinical service. Insufficient or incomplete data may have very significant consequences on its viability. We created a document that improves the coding process in our Burns Centre. At Yorkshire Regional Burns Centre an inpatient summary sheet was designed to prospectively record and present essential information on a daily basis, for use in the coding process. The level of care was also recorded. A 3-month audit was conducted to assess the efficacy of the new forms. Forty-nine patients were admitted to the Burns Centre with a mean age of 27.6 years and TBSA ranging from 0.5% to 65%. The total stay in the Burns Centre was 758 days, of which 22% were at level B3-B5 and 39% at level B2. The use of the new discharge document identified potential income of about 500,000 GB pound sterling at our local daily tariffs for high dependency and intensive care. The new form is able to ensure a high quality of coding with a possible direct impact on the financial resources accrued for burn care.

[Patient information in urology: current legal situation with particular emphasis on the codification of the contract governing medical treatment in the German Civil Code (BGB)].

PubMed

Fischer, C; Petersilie, F

2014-12-01

The extent and specification of patient information have so far been defined by case law. Henceforth, the rules of patient information are included in a new type of contract, a contract governing medical treatment (Behandlungsvertrag), codified in §§630a-630e of the German Civil Code (BGB). The main conclusions of the case law are now governed by law; however, some new requirements, such as the obligation to inform patients about treatment errors or the stipulation to deliver copies of undersigned documents have been added. This article gives an overview of the codification of patient information, explains how to inform patients, particularly in urology and illustrates where it is still likely that law courts will be concerned with questions of interpretation. Correct patient information is crucial for declarations of informed consent.

Review of medical discharge summaries and medical documentation in a metropolitan hospital: impact on diagnostic-related groups and Weighted Inlier Equivalent Separation.

PubMed

Chin, N; Perera, P; Roberts, A; Nagappan, R

2013-07-01

Accurate and comprehensive clinical documentation is crucial for effective ongoing patient care, follow up and to optimise case mix-based funding. Each Diagnostic Related Group (DRG) is assigned a 'weight', leading to Weighted Inlier Equivalent Separation (WIES), a system many public and private hospitals in Australia subscribe to. To identify the top DRG in a general medical inpatient service, the completeness of medical discharge documentation, commonly missed comorbidities and system-related issues and subsequent impact on DRG and WIES allocation. One hundred and fifty completed discharge summaries were randomly selected from the top 10 medical DRG in our health service. From a detailed review of the clinical documentation, principal diagnoses, associated comorbidities and complications, where appropriate, the DRG and WIES were modified. Seventy-two (48%) of the 150 reviewed admissions resulted in a revision of DRG and WIES equivalent to an increase of AUD 142,000. Respiratory-based DRG generated the largest revision of DRG and WIES, while 'Cellulitis' DRG had the largest relative change. Twenty-seven per cent of summaries reviewed necessitated a change in coding with no subsequent change in DRG allocation or WIES. Acute renal failure, anaemia and electrolyte disturbances were the most commonly underrepresented entities in clinical discharge documentation. Seven patients had their WIES downgraded. Comprehensive documentation of principal diagnosis/diagnoses, comorbidities and their complications is imperative to optimal DRG and WIES allocation. Regular meetings between clinical and coding staff improve the quality and timeliness of medical documentation, ensure adequate communication with general practitioners and lead to appropriate funding. © 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.

Code Verification Capabilities and Assessments in Support of ASC V&V Level 2 Milestone #6035

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

Doebling, Scott William; Budzien, Joanne Louise; Ferguson, Jim Michael

This document provides a summary of the code verification activities supporting the FY17 Level 2 V&V milestone entitled “Deliver a Capability for V&V Assessments of Code Implementations of Physics Models and Numerical Algorithms in Support of Future Predictive Capability Framework Pegposts.” The physics validation activities supporting this milestone are documented separately. The objectives of this portion of the milestone are: 1) Develop software tools to support code verification analysis; 2) Document standard definitions of code verification test problems; and 3) Perform code verification assessments (focusing on error behavior of algorithms). This report and a set of additional standalone documents servemore » as the compilation of results demonstrating accomplishment of these objectives.« less

43 CFR 11.64 - Injury determination phase-testing and sampling methods.

Code of Federal Regulations, 2012 CFR

2012-10-01

.... In developing these objectives, the availability of information from response actions relating to the...), test cases proving the code works, and any alteration of previously documented code made to adapt the... computer code (if any), test cases proving the code works, and any alteration of previously documented code...

43 CFR 11.64 - Injury determination phase-testing and sampling methods.

Code of Federal Regulations, 2014 CFR

2014-10-01

.... In developing these objectives, the availability of information from response actions relating to the...), test cases proving the code works, and any alteration of previously documented code made to adapt the... computer code (if any), test cases proving the code works, and any alteration of previously documented code...

43 CFR 11.64 - Injury determination phase-testing and sampling methods.

Code of Federal Regulations, 2013 CFR

2013-10-01

.... In developing these objectives, the availability of information from response actions relating to the...), test cases proving the code works, and any alteration of previously documented code made to adapt the... computer code (if any), test cases proving the code works, and any alteration of previously documented code...

A Bayesian network coding scheme for annotating biomedical information presented to genetic counseling clients.

PubMed

Green, Nancy

2005-04-01

We developed a Bayesian network coding scheme for annotating biomedical content in layperson-oriented clinical genetics documents. The coding scheme supports the representation of probabilistic and causal relationships among concepts in this domain, at a high enough level of abstraction to capture commonalities among genetic processes and their relationship to health. We are using the coding scheme to annotate a corpus of genetic counseling patient letters as part of the requirements analysis and knowledge acquisition phase of a natural language generation project. This paper describes the coding scheme and presents an evaluation of intercoder reliability for its tag set. In addition to giving examples of use of the coding scheme for analysis of discourse and linguistic features in this genre, we suggest other uses for it in analysis of layperson-oriented text and dialogue in medical communication.

[Epidemiology of Imperfect Osteogenesis: a Rare Disease in the Valencia Region.

PubMed

Gimeno-Martos, Silvia; Pérez-Riera, Carlos; Guardiola-Vilarroig, Sandra; Cavero-Carbonell, Clara

2017-11-28

Osteogenesis imperfecta (OI) is a rare connective tissue and bone disease that results in a bone fragility of varying severity. The objective was to determine and describe the OI in the Valencia Region (VR) during the period 2004 to 2014. From the Rare Diseases Information System of the VR (SIER-CV) patients from 2004 to 2014 with the codes of the International Classification of Diseases for the OI were identified: 756.51 from the 9th Revision-Clinical Modification and Q78.0 from the 10th Revision. The information was validated by reviewing clinical documentation (mainly electronic health records) and a descriptive analysis of the confirmed cases (diagnosis of OI in the clinical documentation) was performed. 162 patients were identified with a code for OI. 145 of the 161 patients with available clinical documentation were confirmed as cases. The prevalence was 0.29 per 10.000 inhabitants. 93.1% were Spanish, 54.5% were women and they were treated in 25 different hospitals in the VR. The type of OI was known in the 26.4% of the cases and type I was the most common (9.7%). 6.2% of the patients died with an average death age of 60.8 years. 44.8% of patients received treatment with bisphosphonates and 10.4% had affected relatives. The real situation of the OI in the VR has been established, which will allow a better planning in the health actions to improve the quality of life of the affected ones and their families.

Effect of discharge instructions on readmission of hospitalised patients with heart failure: do all of the Joint Commission on Accreditation of Healthcare Organizations heart failure core measures reflect better care?

PubMed Central

VanSuch, Monica; Naessens, James M; Stroebel, Robert J; Huddleston, Jeanne M; Williams, Arthur R

2006-01-01

Background Most nationally standardised quality measures use widely accepted evidence‐based processes as their foundation, but the discharge instruction component of the United States standards of Joint Commission on Accreditation of Healthcare Organizations heart failure core measure appears to be based on expert opinion alone. Objective To determine whether documentation of compliance with any or all of the six required discharge instructions is correlated with readmissions to hospital or mortality. Research design A retrospective study at a single tertiary care hospital was conducted on randomly sampled patients hospitalised for heart failure from July 2002 to September 2003. Participants Applying the Joint Commission on Accreditation of Healthcare Organizations criteria, 782 of 1121 patients were found eligible to receive discharge instructions. Eligibility was determined by age, principal diagnosis codes and discharge status codes. Measures The primary outcome measures are time to death and time to readmission for heart failure or readmission for any cause and time to death. Results In all, 68% of patients received all instructions, whereas 6% received no instructions. Patients who received all instructions were significantly less likely to be readmitted for any cause (p = 0.003) and for heart failure (p = 0.035) than those who missed at least one type of instruction. Documentation of discharge instructions is correlated with reduced readmission rates. However, there was no association between documentation of discharge instructions and mortality (p = 0.521). Conclusions Including discharge instructions among other evidence‐based heart failure core measures appears justified. PMID:17142589

The process of implementing a rural VA wound care program for diabetic foot ulcer patients.

PubMed

Reiber, Gayle E; Raugi, Gregory J; Rowberg, Donald

2007-10-01

Delivering and documenting evidence-based treatment to all Department of Veterans Affairs (VA) foot ulcer patients has wide appeal. However, primary and secondary care medical centers where 52% of these patients receive care are at a disadvantage given the frequent absence of trained specialists to manage diabetic foot ulcers. A retrospective review of diabetic foot ulcer patient records and a provider survey were conducted to document the foot ulcer problem and to assess practitioner needs. Results showed of the 125 persons with foot ulcers identified through administrative data, only, 21% of diabetic foot patients were correctly coded. Chronic Care and Microsystem models were used to prepare a tailored intervention in a VA primary care medical center. The site Principal Investigators, a multidisciplinary site wound care team, and study investigators jointly implemented a diabetic foot ulcer program. Intervention components include wound care team education and training, standardized good wound care practices based on strong scientific evidence, and a wound care template embedded in the electronic medical record to facilitate data collection, clinical decision making, patient ordering, and coding. A strategy for delivering offloading pressure devices, regular case management support, and 24/7 emergency assistance also was developed. It took 9 months to implement the model. Patients were enrolled and followed for 1 year. Process and outcome evaluations are on-going.

Software for Better Documentation of Other Software

NASA Technical Reports Server (NTRS)

Pinedo, John

2003-01-01

The Literate Programming Extraction Engine is a Practical Extraction and Reporting Language- (PERL-)based computer program that facilitates and simplifies the implementation of a concept of self-documented literate programming in a fashion tailored to the typical needs of scientists. The advantage for the programmer is that documentation and source code are written side-by-side in the same file, reducing the likelihood that the documentation will be inconsistent with the code and improving the verification that the code performs its intended functions. The advantage for the user is the knowledge that the documentation matches the software because they come from the same file. This program unifies the documentation process for a variety of programming languages, including C, C++, and several versions of FORTRAN. This program can process the documentation in any markup language, and incorporates the LaTeX typesetting software. The program includes sample Makefile scripts for automating both the code-compilation (when appropriate) and documentation-generation processes into a single command-line statement. Also included are macro instructions for the Emacs display-editor software, making it easy for a programmer to toggle between editing in a code or a documentation mode.

Variation in printed handoff documents: Results and recommendations from a multicenter needs assessment.

PubMed

Rosenbluth, Glenn; Bale, James F; Starmer, Amy J; Spector, Nancy D; Srivastava, Rajendu; West, Daniel C; Sectish, Theodore C; Landrigan, Christopher P

2015-08-01

Handoffs of patient care are a leading root cause of medical errors. Standardized techniques exist to minimize miscommunications during verbal handoffs, but studies to guide standardization of printed handoff documents are lacking. To determine whether variability exists in the content of printed handoff documents and to identify key data elements that should be uniformly included in these documents. Pediatric hospitalist services at 9 institutions in the United States and Canada. Sample handoff documents from each institution were reviewed, and structured group interviews were conducted to understand each institution's priorities for written handoffs. An expert panel reviewed all handoff documents and structured group-interview findings, and subsequently made consensus-based recommendations for data elements that were either essential or recommended, including best overall printed handoff practices. Nine sites completed structured group interviews and submitted data. We identified substantial variation in both the structure and content of printed handoff documents. Only 4 of 23 possible data elements (17%) were uniformly present in all sites' handoff documents. The expert panel recommended the following as essential for all printed handoffs: assessment of illness severity, patient summary, action items, situation awareness and contingency plans, allergies, medications, age, weight, date of admission, and patient and hospital service identifiers. Code status and several other elements were also recommended. Wide variation exists in the content of printed handoff documents. Standardizing printed handoff documents has the potential to decrease omissions of key data during patient care transitions, which may decrease the risk of downstream medical errors. © 2015 Society of Hospital Medicine.

Community health center provider ability to identify, treat and account for the social determinants of health: a card study.

PubMed

Lewis, Joy H; Whelihan, Kate; Navarro, Isaac; Boyle, Kimberly R

2016-08-27

The social determinants of health (SDH) are conditions that shape the overall health of an individual on a continuous basis. As momentum for addressing social factors in primary care settings grows, provider ability to identify, treat and assess these factors remains unknown. Community health centers care for over 20-million of America's highest risk populations. This study at three centers evaluates provider ability to identify, treat and code for the SDH. Investigators utilized a pre-study survey and a card study design to obtain evidence from the point of care. The survey assessed providers' perceptions of the SDH and their ability to address them. Then providers filled out one anonymous card per patient on four assigned days over a 4-week period, documenting social factors observed during encounters. The cards allowed providers to indicate if they were able to: provide counseling or other interventions, enter a diagnosis code and enter a billing code for identified factors. The results of the survey indicate providers were familiar with the SDH and were comfortable identifying social factors at the point of care. A total of 747 cards were completed. 1584 factors were identified and 31 % were reported as having a service provided. However, only 1.2 % of factors were associated with a billing code and 6.8 % received a diagnosis code. An obvious discrepancy exists between the number of identifiable social factors, provider ability to address them and documentation with billing and diagnosis codes. This disparity could be related to provider inability to code for social factors and bill for related time and services. Health care organizations should seek to implement procedures to document and monitor social factors and actions taken to address them. Results of this study suggest simple methods of identification may be sufficient. The addition of searchable codes and reimbursements may improve the way social factors are addressed for individuals and populations.

More than skin deep. Ten year follow‐up of delayed cutaneous adverse drug reactions (CADR)

PubMed Central

Ly, Jenny; Trubiano, Jason; Aung, Ar Kar

2016-01-01

Abstract Aims To determine the gaps in practice regarding appropriate ADR documentation and risk communication for patients diagnosed with severe cutaneous adverse drug reactions (CADR). Methods This was a retrospective observational cohort study conducted using hospital coding and databases to identify inpatients diagnosed with CADR from January 2004 to August 2014. Hospital discharge summaries, ADR reports and pharmacy dispensing records were reviewed for ADR documentation. Patients still living in Australia and who did not opt out of being contacted were invited to be surveyed by telephone to determine their understanding of recommendations, re‐exposure rates and long‐term effects. Results Of 85 patients identified, median age was 59 (IQR 44–72) years and 47.1% were male. The most common diagnosis was TENS (49.4%). Ten patients (11.8%) died as inpatients. Of the 81 patients with a drug‐related causality, 47 (58%) had appropriate documentation in all three required medical record platforms. Of the 56 eligible patients, 38 (67.9%) were surveyed; 13% had no information provided upon discharge and 26.3% patients had a mismatch in knowledge of implicated medications. No surveyed patient had a relapse of CADR, but 23.7% had a subsequent unrelated allergic reaction. Thirteen patients (34.2%) reported long‐term effects. Conclusions We found gaps in the accuracy of ADR documentation and communication of risk at discharge, which indicated risks to patient safety. Electronic systems are being developed to improve documentation. Written information about CADR is being provided at discharge to improve patient understanding and knowledge. PMID:27265387

Use of Headings and Classifications by Physicians in Medical Narratives of EHRs

PubMed Central

Häyrinen, K.; Harno, K.; Nykänen, P.

2011-01-01

Objective The purpose of this study was to describe and evaluate patient care documentation by hospital physicians in EHRs and especially the use of national headings and classifications in these documentations Material and Methods The initial material consisted of a random sample of 3,481 medical narratives documented in EHRs during the period 2004-2005 in one department of a Finnish central hospital. The final material comprised a subset of 1,974 medical records with a focus on consultation requests and consultation responses by two specialist groups from 871 patients. This electronic documentation was analyzed using deductive content analyses and descriptive statistics. Results The physicians documented patient care in EHRs principally as narrative text. The medical narratives recorded by specialists were structured with headings in less than half of the patient cases. Consultation responses in general were more often structured with headings than consultation requests. The use of classifications was otherwise insignificant, but diagnoses were documented as ICD 10 codes in over 50% of consultation responses by both medical specialties. Conclusion There is an obvious need to improve the structuring of narrative text with national headings and classifications. According to the findings of this study, reason for care, patient history, health status, follow-up care plan and diagnosis are meaningful headings in physicians’ documentation. The existing list of headings needs to be analyzed within a consistent unified terminology system as a basis for further development. Adhering to headings and classifications in EHR documentation enables patient data to be shared and aggregated. The secondary use of data is expected to improve care management and quality of care. PMID:23616866

Emergency readmissions to paediatric surgery and urology: The impact of inappropriate coding.

PubMed

Peeraully, R; Henderson, K; Davies, B

2016-04-01

Introduction In England, emergency readmissions within 30 days of hospital discharge after an elective admission are not reimbursed if they do not meet Payment by Results (PbR) exclusion criteria. However, coding errors could inappropriately penalise hospitals. We aimed to assess the accuracy of coding for emergency readmissions. Methods Emergency readmissions attributed to paediatric surgery and urology between September 2012 and August 2014 to our tertiary referral centre were retrospectively reviewed. Payment by Results (PbR) coding data were obtained from the hospital's Family Health Directorate. Clinical details were obtained from contemporaneous records. All readmissions were categorised as appropriately coded (postoperative or nonoperative) or inappropriately coded (planned surgical readmission, unrelated surgical admission, unrelated medical admission or coding error). Results Over the 24-month period, 241 patients were coded as 30-day readmissions, with 143 (59%) meeting the PbR exclusion criteria. Of the remaining 98 (41%) patients, 24 (25%) were inappropriately coded as emergency readmissions. These readmissions resulted in 352 extra bed days, of which 117 (33%) were attributable to inappropriately coded cases. Conclusions One-quarter of non-excluded emergency readmissions were inappropriately coded, accounting for one-third of additional bed days. As a stay on a paediatric ward costs up to £500 a day, the potential cost to our institution due to inappropriate readmission coding was over £50,000. Diagnoses and the reason for admission for each care episode should be accurately documented and coded, and readmission data should be reviewed at a senior clinician level.

Turning whine into wine: the fiscal impact of comprehensive documentation and billing for nonoperative pediatric surgical services.

PubMed

Gollin, Gerald; Moores, Donald

2006-06-01

Some pediatric surgeons rarely document nonoperative services, believing that the reimbursement provided for such care is negligible. We evaluated the impact of comprehensive documentation and billing for nonoperative, pediatric surgical care. All bills submitted for inpatient, nonoperative care for 1 year were reviewed. Total receipts for documented admissions, consultations, critical care, and daily care were determined. The Evaluation and Management code billed for each service was recorded, and the total and average payments attributable to each Evaluation and Management code were calculated. Fifty-six percent of services were covered by Medicaid and 26% by a commercial insurer. There were 607 billed admission history and physical exams for which reimbursement totaled 43,493 dollars. Critical care services were provided to 49 patients and yielded 8964 dollars in payments. Six hundred thirty-nine inpatient consultations were performed with a reimbursement of 42,830 dollars. Daily care services were billed 1044 times and produced 71,579 dollars in payments. Overall reimbursement for documented, nonoperative services was 166,866 dollars. This represented 16.2% of total, noncontracted income for the practice. Despite a payer mix heavily weighted toward Medicaid, comprehensive documentation and billing for nonoperative services increased total, noncontracted reimbursement by almost 20% over what it would have been had only operative services been billed. The yield from properly documented, nonoperative care can be substantial.

Code-Switching in Judaeo-Arabic Documents from the Cairo Geniza

ERIC Educational Resources Information Center

Wagner, Esther-Miriam; Connolly, Magdalen

2018-01-01

This paper investigates code-switching and script-switching in medieval documents from the Cairo Geniza, written in Judaeo-Arabic (Arabic in Hebrew script), Hebrew, Arabic and Aramaic. Legal documents regularly show a macaronic style of Judaeo-Arabic, Aramaic and Hebrew, while in letters code-switching from Judaeo-Arabic to Hebrew is tied in with…

Raptor: An Enterprise Knowledge Discovery Engine Version 2.0

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

2011-08-31

The Raptor Version 2.0 computer code uses a set of documents as seed documents to recommend documents of interest from a large, target set of documents. The computer code provides results that show the recommended documents with the highest similarity to the seed documents. Version 2.0 was specifically developed to work with SharePoint 2007 and MS SQL server.

Technical Support Document for Version 3.9.0 of the COMcheck Software

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

Bartlett, Rosemarie; Connell, Linda M.; Gowri, Krishnan

2011-09-01

COMcheck provides an optional way to demonstrate compliance with commercial and high-rise residential building energy codes. Commercial buildings include all use groups except single family and multifamily not over three stories in height. COMcheck was originally based on ANSI/ASHRAE/IES Standard 90.1-1989 (Standard 90.1-1989) requirements and is intended for use with various codes based on Standard 90.1, including the Codification of ASHRAE/IES Standard 90.1-1989 (90.1-1989 Code) (ASHRAE 1989a, 1993b) and ASHRAE/IESNA Standard 90.1-1999 (Standard 90.1-1999). This includes jurisdictions that have adopted the 90.1-1989 Code, Standard 90.1-1989, Standard 90.1-1999, or their own code based on one of these. We view Standard 90.1-1989more » and the 90.1-1989 Code as having equivalent technical content and have used both as source documents in developing COMcheck. This technical support document (TSD) is designed to explain the technical basis for the COMcheck software as originally developed based on the ANSI/ASHRAE/IES Standard 90.1-1989 (Standard 90.1-1989). Documentation for other national model codes and standards and specific state energy codes supported in COMcheck has been added to this report as appendices. These appendices are intended to provide technical documentation for features specific to the supported codes and for any changes made for state-specific codes that differ from the standard features that support compliance with the national model codes and standards. Beginning with COMcheck version 3.8.0, support for 90.1-1989, 90.1-1999, and the 1998 IECC are no longer included, but those sections remain in this document for reference purposes.« less

Technical Support Document for Version 3.9.1 of the COMcheck Software

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

Bartlett, Rosemarie; Connell, Linda M.; Gowri, Krishnan

2012-09-01

COMcheck provides an optional way to demonstrate compliance with commercial and high-rise residential building energy codes. Commercial buildings include all use groups except single family and multifamily not over three stories in height. COMcheck was originally based on ANSI/ASHRAE/IES Standard 90.1-1989 (Standard 90.1-1989) requirements and is intended for use with various codes based on Standard 90.1, including the Codification of ASHRAE/IES Standard 90.1-1989 (90.1-1989 Code) (ASHRAE 1989a, 1993b) and ASHRAE/IESNA Standard 90.1-1999 (Standard 90.1-1999). This includes jurisdictions that have adopted the 90.1-1989 Code, Standard 90.1-1989, Standard 90.1-1999, or their own code based on one of these. We view Standard 90.1-1989more » and the 90.1-1989 Code as having equivalent technical content and have used both as source documents in developing COMcheck. This technical support document (TSD) is designed to explain the technical basis for the COMcheck software as originally developed based on the ANSI/ASHRAE/IES Standard 90.1-1989 (Standard 90.1-1989). Documentation for other national model codes and standards and specific state energy codes supported in COMcheck has been added to this report as appendices. These appendices are intended to provide technical documentation for features specific to the supported codes and for any changes made for state-specific codes that differ from the standard features that support compliance with the national model codes and standards. Beginning with COMcheck version 3.8.0, support for 90.1-1989, 90.1-1999, and the 1998 IECC and version 3.9.0 support for 2000 and 2001 IECC are no longer included, but those sections remain in this document for reference purposes.« less

Exploration of ICD-9-CM Coding of Chronic Disease within the Elixhauser Comorbidity Measure in Patients with Chronic Heart Failure

PubMed Central

Garvin, Jennifer Hornung; Redd, Andrew; Bolton, Dan; Graham, Pauline; Roche, Dominic; Groeneveld, Peter; Leecaster, Molly; Shen, Shuying; Weiner, Mark G.

2013-01-01

Introduction International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes capture comorbidities that can be used to risk adjust nonrandom patient groups. We explored the accuracy of capturing comorbidities associated with one risk adjustment method, the Elixhauser Comorbidity Measure (ECM), in patients with chronic heart failure (CHF) at one Veterans Affairs (VA) medical center. We explored potential reasons for the differences found between the original codes assigned and conditions found through retrospective review. Methods This descriptive, retrospective study used a cohort of patients discharged with a principal diagnosis coded as CHF from one VA medical center in 2003. One admission per patient was used in the study; with multiple admissions, only the first admission was analyzed. We compared the assignment of original codes assigned to conditions found in a retrospective, manual review of the medical record conducted by an investigator with coding expertise as well as by physicians. Members of the team experienced with assigning ICD-9-CM codes and VA coding processes developed themes related to systemic reasons why chronic conditions were not coded in VA records using applied thematic techniques. Results In the 181-patient cohort, 388 comorbid conditions were identified; 305 of these were chronic conditions, originally coded at the time of discharge with an average of 1.7 comorbidities related to the ECM per patient. The review by an investigator with coding expertise revealed a total of 937 comorbidities resulting in 618 chronic comorbid conditions with an average of 3.4 per patient; physician review found 872 total comorbidities with 562 chronic conditions (average 3.1 per patient). The agreement between the original and the retrospective coding review was 88 percent. The kappa statistic for the original and the retrospective coding review was 0.375 with a 95 percent confidence interval (CI) of 0.352 to 0.398. The kappa statistic for the retrospective coding review and physician review was 0.849 (CI, 0.823–0.875). The kappa statistic for the original coding and the physician review was 0.340 (CI, 0.316–0.364). Several systemic factors were identified, including familiarity with inpatient VA and non-VA guidelines, the quality of documentation, and operational requirements to complete the coding process within short time frames and to identify the reasons for movement within a given facility. Conclusion Comorbidities within the ECM representing chronic conditions were significantly underrepresented in the original code assignment. Contributing factors potentially include prioritization of codes related to acute conditions over chronic conditions; coders’ professional training, educational level, and experience; and the limited number of codes allowed in initial coding software. This study highlights the need to evaluate systemic causes of underrepresentation of chronic conditions to improve the accuracy of risk adjustment used for health services research, resource allocation, and performance measurement. PMID:24159270

Bar-code medication administration system for anesthetics: effects on documentation and billing.

PubMed

Nolen, Agatha L; Rodes, W Dyer

2008-04-01

The effects of using a new bar-code medication administration (BCMA) system for anesthetics to automate documentation of drug administration by anesthesiologists were studied. From October 1, 2004, to September 15, 2005, all medications administered to patients undergoing cardiac surgery were documented with a BCMA system at a large acute care facility. Drug claims data for 12 targeted anesthetics in diagnosis-related groups (DRGs) 104-111 were analyzed to determine the quantity of drugs charged and the revenue generated. Those data were compared with claims data for a historical case-control group (October 1, 2003, to September 15, 2004, for the same DRGs) for which medication use was documented manually. From October 1, 2005, to October 1, 2006, anesthesiologists for cardiac surgeries either voluntarily used the automated system or completed anesthesia records manually. A total of 870 cardiac surgery cases for which the BCMA system was used were evaluated. There were 961 cardiac surgery cases in the historical control group. The BCMA system increased the quantity of drugs documented per case by 21.7% and drug revenue captured per case by 18.8%. The time needed by operating-room pharmacy staff to process an anesthesia record for billing decreased by eight minutes per case. After two years, anesthesiologists voluntarily used the new technology on 100% of cardiac surgery patients. Implementation of a BCMA system for anesthetic use in cardiac surgery increased the quantity of drugs charged by 21.7% per case and drug revenue per case by 18.8%. Anesthesiologists continued to use the automated system on a voluntary basis after conclusion of the initial study.

Identifying and acting on potentially inappropriate care? Inadequacy of current hospital coding for this task.

PubMed

Cooper, P David; Smart, David R

2017-06-01

Recent Australian attempts to facilitate disinvestment in healthcare, by identifying instances of 'inappropriate' care from large Government datasets, are subject to significant methodological flaws. Amongst other criticisms has been the fact that the Government datasets utilized for this purpose correlate poorly with datasets collected by relevant professional bodies. Government data derive from official hospital coding, collected retrospectively by clerical personnel, whilst professional body data derive from unit-specific databases, collected contemporaneously with care by clinical personnel. Assessment of accuracy of official hospital coding data for hyperbaric services in a tertiary referral hospital. All official hyperbaric-relevant coding data submitted to the relevant Australian Government agencies by the Royal Hobart Hospital, Tasmania, Australia for financial year 2010-2011 were reviewed and compared against actual hyperbaric unit activity as determined by reference to original source documents. Hospital coding data contained one or more errors in diagnoses and/or procedures in 70% of patients treated with hyperbaric oxygen that year. Multiple discrete error types were identified, including (but not limited to): missing patients; missing treatments; 'additional' treatments; 'additional' patients; incorrect procedure codes and incorrect diagnostic codes. Incidental observations of errors in surgical, anaesthetic and intensive care coding within this cohort suggest that the problems are not restricted to the specialty of hyperbaric medicine alone. Publications from other centres indicate that these problems are not unique to this institution or State. Current Government datasets are irretrievably compromised and not fit for purpose. Attempting to inform the healthcare policy debate by reference to these datasets is inappropriate. Urgent clinical engagement with hospital coding departments is warranted.

Doclet To Synthesize UML

NASA Technical Reports Server (NTRS)

Barry, Matthew R.; Osborne, Richard N.

2005-01-01

The RoseDoclet computer program extends the capability of Java doclet software to automatically synthesize Unified Modeling Language (UML) content from Java language source code. [Doclets are Java-language programs that use the doclet application programming interface (API) to specify the content and format of the output of Javadoc. Javadoc is a program, originally designed to generate API documentation from Java source code, now also useful as an extensible engine for processing Java source code.] RoseDoclet takes advantage of Javadoc comments and tags already in the source code to produce a UML model of that code. RoseDoclet applies the doclet API to create a doclet passed to Javadoc. The Javadoc engine applies the doclet to the source code, emitting the output format specified by the doclet. RoseDoclet emits a Rose model file and populates it with fully documented packages, classes, methods, variables, and class diagrams identified in the source code. The way in which UML models are generated can be controlled by use of new Javadoc comment tags that RoseDoclet provides. The advantage of using RoseDoclet is that Javadoc documentation becomes leveraged for two purposes: documenting the as-built API and keeping the design documentation up to date.

System Design Description for the TMAD Code

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

Finfrock, S.H.

This document serves as the System Design Description (SDD) for the TMAD Code System, which includes the TMAD code and the LIBMAKR code. The SDD provides a detailed description of the theory behind the code, and the implementation of that theory. It is essential for anyone who is attempting to review or modify the code or who otherwise needs to understand the internal workings of the code. In addition, this document includes, in Appendix A, the System Requirements Specification for the TMAD System.

Technical Support Document for Version 3.4.0 of the COMcheck Software

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

Bartlett, Rosemarie; Connell, Linda M.; Gowri, Krishnan

2007-09-14

COMcheck provides an optional way to demonstrate compliance with commercial and high-rise residential building energy codes. Commercial buildings include all use groups except single family and multifamily not over three stories in height. COMcheck was originally based on ANSI/ASHRAE/IES Standard 90.1-1989 (Standard 90.1-1989) requirements and is intended for use with various codes based on Standard 90.1, including the Codification of ASHRAE/IES Standard 90.1-1989 (90.1-1989 Code) (ASHRAE 1989a, 1993b) and ASHRAE/IESNA Standard 90.1-1999 (Standard 90.1-1999). This includes jurisdictions that have adopted the 90.1-1989 Code, Standard 90.1-1989, Standard 90.1-1999, or their own code based on one of these. We view Standard 90.1-1989more » and the 90.1-1989 Code as having equivalent technical content and have used both as source documents in developing COMcheck. This technical support document (TSD) is designed to explain the technical basis for the COMcheck software as originally developed based on the ANSI/ASHRAE/IES Standard 90.1-1989 (Standard 90.1-1989). Documentation for other national model codes and standards and specific state energy codes supported in COMcheck has been added to this report as appendices. These appendices are intended to provide technical documentation for features specific to the supported codes and for any changes made for state-specific codes that differ from the standard features that support compliance with the national model codes and standards.« less

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

PubMed

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

2013-01-01

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

Using Inspections to Improve the Quality of Product Documentation and Code.

ERIC Educational Resources Information Center

Zuchero, John

1995-01-01

Describes how, by adapting software inspections to assess documentation and code, technical writers can collaborate with development personnel, editors, and customers to dramatically improve both the quality of documentation and the very process of inspecting that documentation. Notes that the five steps involved in the inspection process are:…

Emergency readmissions to paediatric surgery and urology: The impact of inappropriate coding

PubMed Central

Peeraully, R; Henderson, K; Davies, B

2016-01-01

Introduction In England, emergency readmissions within 30 days of hospital discharge after an elective admission are not reimbursed if they do not meet Payment by Results (PbR) exclusion criteria. However, coding errors could inappropriately penalise hospitals. We aimed to assess the accuracy of coding for emergency readmissions. Methods Emergency readmissions attributed to paediatric surgery and urology between September 2012 and August 2014 to our tertiary referral centre were retrospectively reviewed. Payment by Results (PbR) coding data were obtained from the hospital’s Family Health Directorate. Clinical details were obtained from contemporaneous records. All readmissions were categorised as appropriately coded (postoperative or nonoperative) or inappropriately coded (planned surgical readmission, unrelated surgical admission, unrelated medical admission or coding error). Results Over the 24-month period, 241 patients were coded as 30-day readmissions, with 143 (59%) meeting the PbR exclusion criteria. Of the remaining 98 (41%) patients, 24 (25%) were inappropriately coded as emergency readmissions. These readmissions resulted in 352 extra bed days, of which 117 (33%) were attributable to inappropriately coded cases. Conclusions One-quarter of non-excluded emergency readmissions were inappropriately coded, accounting for one-third of additional bed days. As a stay on a paediatric ward costs up to £500 a day, the potential cost to our institution due to inappropriate readmission coding was over £50,000. Diagnoses and the reason for admission for each care episode should be accurately documented and coded, and readmission data should be reviewed at a senior clinician level. PMID:26924486

A point prevalence cross-sectional study of healthcare-associated urinary tract infections in six Australian hospitals

PubMed Central

Gardner, Anne; Mitchell, Brett; Beckingham, Wendy; Fasugba, Oyebola

2014-01-01

Objectives Urinary tract infections (UTIs) account for over 30% of healthcare-associated infections. The aim of this study was to determine healthcare-associated UTI (HAUTI) and catheter-associated UTI (CAUTI) point prevalence in six Australian hospitals to inform a national point prevalence process and compare two internationally accepted HAUTI definitions. We also described the level and comprehensiveness of clinical record documentation, microbiology laboratory and coding data at identifying HAUTIs and CAUTIs. Setting Data were collected from three public and three private Australian hospitals over the first 6 months of 2013. Participants A total of 1109 patients were surveyed. Records of patients of all ages, hospitalised on the day of the point prevalence at the study sites, were eligible for inclusion. Outpatients, patients in adult mental health units, patients categorised as maintenance care type (ie, patients waiting to be transferred to a long-term care facility) and those in the emergency department during the duration of the survey were excluded. Outcome measures The primary outcome measures were the HAUTI and CAUTI point prevalence. Results Overall HAUTI and CAUTI prevalence was 1.4% (15/1109) and 0.9% (10/1109), respectively. Staphylococcus aureus and Candida species were the most common pathogens. One-quarter (26.3%) of patients had a urinary catheter and fewer than half had appropriate documentation. Eight of the 15 patients ascertained to have a HAUTI based on clinical records (6 being CAUTI) were coded by the medical records department with an International Classification of Diseases (ICD)-10 code for UTI diagnosis. The Health Protection Agency Surveillance definition had a positive predictive value of 91.67% (CI 64.61 to 98.51) compared against the Centers for Disease Control and Prevention definition. Conclusions These study results provide a foundation for a national Australian point prevalence study and inform the development and implementation of targeted healthcare-associated infection surveillance more broadly. PMID:25079929

Documentation of the GLAS fourth order general circulation model. Volume 2: Scalar code

NASA Technical Reports Server (NTRS)

Kalnay, E.; Balgovind, R.; Chao, W.; Edelmann, D.; Pfaendtner, J.; Takacs, L.; Takano, K.

1983-01-01

Volume 2, of a 3 volume technical memoranda contains a detailed documentation of the GLAS fourth order general circulation model. Volume 2 contains the CYBER 205 scalar and vector codes of the model, list of variables, and cross references. A variable name dictionary for the scalar code, and code listings are outlined.

[Prospective DRG coding : Improvement in cost-effectiveness and documentation quality of in-patient hospital care].

PubMed

Geuss, S; Jungmeister, A; Baumgart, A; Seelos, R; Ockert, S

2018-02-01

In prospective reimbursement schemes a diagnosis-related group (DRG) is assigned to each case according to all coded diagnoses and procedures. This process can be conducted retrospectively after (DC) or prospectively during the hospitalization (PC). The use of PC offers advantages in terms of cost-effectiveness and documentation quality without impairing patient safety. A retrospective analysis including all DRG records and billing data from 2012 to 2015 of a surgical department was carried out. The use of PC was introduced into the vascular surgery unit (VS) in September 2013, while the remaining surgical units (RS) stayed with DC. Analysis focused on differences between VS and RS before and after introduction of PC. Characteristics of cost-effectiveness were earnings (EBIT-DA), length of stay (LOS), the case mix index (CMI) and the productivity in relation to the DRG benchmark (productivity index, PI). The number of recorded diagnoses/procedures (ND/NP) was an indicator for documentation quality. A total of 1703 cases with VS and 27,679 cases with RS were analyzed. After introduction of PC the EBIT-DA per case increased in VS but not in RS (+3342 Swiss francs vs. +84, respectively, p < 0.001). The CMI increased slightly in both groups (+0.10 VS vs. +0.08 RS, p > 0.05) and the LOS was more reduced in VS than in RS (-0.36 days vs. -0.03 days, p > 0.005). The PI increased in VS but decreased in RS (+0.131 vs. -0.032, p < 0.001), ND increased more in VS (+1.29 VS vs. +0.26 RS, p < 0.001) and NP remained stable in both groups. The use of PC helps to significantly improve cost-effectiveness and documentation quality of in-patient hospital care, essentially by optimizing LOS and cost weight in relation to the DRG benchmark, i. e. increasing the PI. The increasing ND indicates an improvement in documentation quality.

Classifying clinical notes with pain assessment using machine learning.

PubMed

Fodeh, Samah Jamal; Finch, Dezon; Bouayad, Lina; Luther, Stephen L; Ling, Han; Kerns, Robert D; Brandt, Cynthia

2017-12-26

Pain is a significant public health problem, affecting millions of people in the USA. Evidence has highlighted that patients with chronic pain often suffer from deficits in pain care quality (PCQ) including pain assessment, treatment, and reassessment. Currently, there is no intelligent and reliable approach to identify PCQ indicators inelectronic health records (EHR). Hereby, we used unstructured text narratives in the EHR to derive pain assessment in clinical notes for patients with chronic pain. Our dataset includes patients with documented pain intensity rating ratings > = 4 and initial musculoskeletal diagnoses (MSD) captured by (ICD-9-CM codes) in fiscal year 2011 and a minimal 1 year of follow-up (follow-up period is 3-yr maximum); with complete data on key demographic variables. A total of 92 patients with 1058 notes was used. First, we manually annotated qualifiers and descriptors of pain assessment using the annotation schema that we previously developed. Second, we developed a reliable classifier for indicators of pain assessment in clinical note. Based on our annotation schema, we found variations in documenting the subclasses of pain assessment. In positive notes, providers mostly documented assessment of pain site (67%) and intensity of pain (57%), followed by persistence (32%). In only 27% of positive notes, did providers document a presumed etiology for the pain complaint or diagnosis. Documentation of patients' reports of factors that aggravate pain was only present in 11% of positive notes. Random forest classifier achieved the best performance labeling clinical notes with pain assessment information, compared to other classifiers; 94, 95, 94, and 94% was observed in terms of accuracy, PPV, F1-score, and AUC, respectively. Despite the wide spectrum of research that utilizes machine learning in many clinical applications, none explored using these methods for pain assessment research. In addition, previous studies using large datasets to detect and analyze characteristics of patients with various types of pain have relied exclusively on billing and coded data as the main source of information. This study, in contrast, harnessed unstructured narrative text data from the EHR to detect pain assessment clinical notes. We developed a Random forest classifier to identify clinical notes with pain assessment information. Compared to other classifiers, ours achieved the best results in most of the reported metrics. Graphical abstract Framework for detecting pain assessment in clinical notes.

Correct coding for laboratory procedures during assisted reproductive technology cycles.

PubMed

2016-04-01

This document provides updated coding information for services related to assisted reproductive technology procedures. This document replaces the 2012 ASRM document of the same name. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Clinical integration of billing for a pediatric nephrology and transplant program.

PubMed

Tietjen, Andrea L; Orsini, Jenoveva; Mulgaonkar, Shamkant; Morgan, Debbie

2003-09-01

To develop and implement a billing process that fully integrates all activities of a pediatric nephrology and transplant program, by facilitating and coordinating data from patients, physicians, hospitals, and third-party billing services to maximize revenues. Financial operations were analyzed via a randomized audit of patient charts that focused on office procedures and revenue collection. Results based on monthly reports documenting revenue received and outstanding, procedures billed, and patient registration accuracy. The combination of improvements in patient registration, chart documentation, new billing sheets with procedure and diagnosis codes, physician in-service education, upgraded charges, and the recredentialing of all practice physicians realized an increase in revenue collections from 18% in 2000 to 89% in 2001. The need to integrate and coordinate information is vital for both billing accuracy and revenue collections. Integration of clinical services and billing procedures has maximized performance, profitability, and accuracy while decreasing administrative time and costs.

FERRET data analysis code

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

Schmittroth, F.

1979-09-01

A documentation of the FERRET data analysis code is given. The code provides a way to combine related measurements and calculations in a consistent evaluation. Basically a very general least-squares code, it is oriented towards problems frequently encountered in nuclear data and reactor physics. A strong emphasis is on the proper treatment of uncertainties and correlations and in providing quantitative uncertainty estimates. Documentation includes a review of the method, structure of the code, input formats, and examples.

Preparing a collection of radiology examinations for distribution and retrieval.

PubMed

Demner-Fushman, Dina; Kohli, Marc D; Rosenman, Marc B; Shooshan, Sonya E; Rodriguez, Laritza; Antani, Sameer; Thoma, George R; McDonald, Clement J

2016-03-01

Clinical documents made available for secondary use play an increasingly important role in discovery of clinical knowledge, development of research methods, and education. An important step in facilitating secondary use of clinical document collections is easy access to descriptions and samples that represent the content of the collections. This paper presents an approach to developing a collection of radiology examinations, including both the images and radiologist narrative reports, and making them publicly available in a searchable database. The authors collected 3996 radiology reports from the Indiana Network for Patient Care and 8121 associated images from the hospitals' picture archiving systems. The images and reports were de-identified automatically and then the automatic de-identification was manually verified. The authors coded the key findings of the reports and empirically assessed the benefits of manual coding on retrieval. The automatic de-identification of the narrative was aggressive and achieved 100% precision at the cost of rendering a few findings uninterpretable. Automatic de-identification of images was not quite as perfect. Images for two of 3996 patients (0.05%) showed protected health information. Manual encoding of findings improved retrieval precision. Stringent de-identification methods can remove all identifiers from text radiology reports. DICOM de-identification of images does not remove all identifying information and needs special attention to images scanned from film. Adding manual coding to the radiologist narrative reports significantly improved relevancy of the retrieved clinical documents. The de-identified Indiana chest X-ray collection is available for searching and downloading from the National Library of Medicine (http://openi.nlm.nih.gov/). Published by Oxford University Press on behalf of the American Medical Informatics Association 2015. This work is written by US Government employees and is in the public domain in the US.

[New patients' rights act--what do we have to consider?].

PubMed

Kranz, J; Wartensleben, H; Steffens, J

2014-05-01

The controversially discussed act of improving the rights of patients entered into force in Germany on 26 February 2013 without any transitional period. The current law of patients "rights brings together patients" rights at one uniform place in the civil code (BGB, "Bürgerlichen Gesetzbuch") and should, therefore, attract the medical stakeholders' interest. The new patients "rights law improves the patients" position concerning both treatment and doctor's liability law and is supposed to strengthen a new "error culture" in health care. Similarly, clinical and daily practice becomes more complex with high levels of bureaucracy and the patient-physician relation shifts in favour of meticulous documentation.

Computer-assisted coding and clinical documentation: first things first.

PubMed

Tully, Melinda; Carmichael, Angela

2012-10-01

Computer-assisted coding tools have the potential to drive improvements in seven areas: Transparency of coding. Productivity (generally by 20 to 25 percent for inpatient claims). Accuracy (by improving specificity of documentation). Cost containment (by reducing overtime expenses, audit fees, and denials). Compliance. Efficiency. Consistency.

[Variations in patient data coding affect hospital standardized mortality ratio (HSMR)].

PubMed

van den Bosch, Wim F; Silberbusch, Joseph; Roozendaal, Klaas J; Wagner, Cordula

2010-01-01

To investigate the impact of coding variations on 'hospital standardized mortality ratio' (HSMR) and to define variation reduction measures. Retrospective, descriptive. We analysed coding variations in HSMR parameters for main diagnosis, urgency of the admission and comorbidity in the national medical registration (LMR) database of admissions in 6 Dutch top clinical hospitals during 2003-2007. More than a quarter of these admission records had been included in the HSMR calculation. Admissions with ICD-9 main diagnosis codes that were excluded from HSMR calculations were investigated for inter-hospital variability and correct exclusion. Variation in coding admission type was signalled by analyzing admission records with diagnoses that had an emergency nature by their title. Variation in the average number of comorbidity diagnoses per admission was determined as an indicator for coding variation. Interviews with coding teams were used to check whether the conclusions of the analysis were correct. Over 165,000 admissions that were excluded from HSMR calculations showed large variability between hospitals. This figure was 40% of all admissions that were included. Of the admissions with a main diagnosis indicating an emergency, 34% to 93% were recorded as an emergency. The average number of comorbidity diagnoses varied between hospitals from 0.9 to 3.0 per admission. Coding of main diagnoses, urgency of admission and comorbidities showed strong inter-hospital variation with a potentially large impact on the HSMR outcomes of the hospitals. Coding variations originated from differences in interpretation of coding rules, differences in coding capacity, quality of patient records and discharge documentation and timely delivery of these.

Transforming to a computerized system for nursing care: organizational success within Magnet idealism.

PubMed

Lindgren, Carolyn L; Elie, Leslie G; Vidal, Elizabeth C; Vasserman, Alex

2010-01-01

In reaching the goal for standardized, quality care, a not-for-profit healthcare system consisting of seven institutional entities is transforming nursing practice guidelines, patient care workflow, and patient documents into electronic, online, real-time modalities for use across departments and all healthcare delivery entities of the system. Organizational structure and a strategic plan were developed for the 2-year Clinical Transformation Project. The Siemens Patient Care Document System was adopted and adapted to the hospitals' documentation and information needs. Two fast-track sessions of more than 100 nurses and representatives from other health disciplines were held to standardize assessments, histories, care protocols, and interdisciplinary plans of care for the top 10 diagnostic regulatory groups. Education needs of the users were addressed. After the first year, a productive, functional system is evidenced. For example, the bar-coded Medication Administration Check System is in full use on the clinical units of one of the hospitals, and the other institutional entities are at substantial stages of implementation of Patient Care Documentation System. The project requires significant allocation of personnel and financial resources for a highly functional informatics system that will transform clinical care. The project exemplifies four of the Magnet ideals and serves as a model for others who may be deciding about launching a similar endeavor.

An audit of inpatient management of community-acquired pneumonia in Oman: a comparison with regional clinical guidelines.

PubMed

Al-Abri, Seif Salem; Al-Maashani, Said; Memish, Ziad A; Beeching, Nick J

2012-06-01

Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide. Herein, we present the findings from an audit of CAP management at a tertiary hospital in Oman. The main objective was to evaluate the quality of care given to patients and compare it with the standards in the Gulf Cooperation Council (GCC) CAP guidelines. A retrospective case study of all patients admitted with CAP from June 2006 to September 2008 examined the adherence to standards for the diagnosis, investigation, and management of CAP, including the documentation of illness severity. The case notes of 342 patients were reviewed. Of these, 170 patients were excluded from the study, and 172 patients met the diagnostic criteria for inclusion. A CURB-65 severity score was documented for only 4 (2.3%) patients, and a smoking history was documented for 56 (32.6%) patients. Although 17 different antibiotic regimens were used, 115 (67%) patients received co-amoxiclav and clarithromycin, which is the standard of care. Additionally, 139 (81%) patients received their first dose of antibiotics within four hours of hospital admission. There was no documentation of offering influenza or pneumococcal vaccine to high risk patients. The clinical coding of CAP diagnosis was poor. There was very poor adherence to the CAP severity assessment and the provision of preventive measures upon hospital discharge. The development and implementation of a local hospital-based integrated care pathway may lead to more successful implementation of the guidelines. Copyright © 2012 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

Medical decision-making during the guardianship process for incapacitated, hospitalized adults: a descriptive cohort study.

PubMed

Bandy, Robin J; Helft, Paul R; Bandy, Robert W; Torke, Alexia M

2010-10-01

It is sometimes necessary for courts to appoint guardians for adult, incapacitated patients. There are few data describing how medical decisions are made for such patients before and during the guardianship process. To describe the process of medical decision-making for incapacitated, hospitalized adults for whom court-appointed guardians are requested. Retrospective, descriptive cohort study. Patients were identified from the legal files of a public, urban hospital. Medical and legal records were reviewed for demographic data, code status, diagnoses, code status orders and invasive procedures and person authorizing the order or procedure, dates of incapacitation and appointment of temporary guardian, reason for guardianship, and documentation of communication with a guardian. A total of 79 patients met inclusion criteria; 68.4% were male and 56.2% African-American. The median age was 65 years. Of the 71 patients with medical records available 89% of patients had a temporary guardianship petitioned because of the need for placement only. Seventeen patients had a new DNR order written during hospitalization, eight of which were ordered by physicians without consultation with a surrogate decision maker. Overall, 32 patients underwent a total of 81 documented invasive procedures, 16 of which were authorized by the patient, 15 by family or friend, and 11 by a guardian; consent was not required for 39 of the procedures because of emergency conditions or because a procedure was medically necessary and no surrogate decision maker was available. Although most of the guardianships were requested for placement purposes, important medical decisions were made while patients were awaiting appointment of a guardian. Hospitalized, incapacitated adults awaiting guardianship may lack a surrogate decision maker when serious decisions must be made about their medical care.

A Verification-Driven Approach to Traceability and Documentation for Auto-Generated Mathematical Software

NASA Technical Reports Server (NTRS)

Denney, Ewen W.; Fischer, Bernd

2009-01-01

Model-based development and automated code generation are increasingly used for production code in safety-critical applications, but since code generators are typically not qualified, the generated code must still be fully tested, reviewed, and certified. This is particularly arduous for mathematical and control engineering software which requires reviewers to trace subtle details of textbook formulas and algorithms to the code, and to match requirements (e.g., physical units or coordinate frames) not represented explicitly in models or code. Both tasks are complicated by the often opaque nature of auto-generated code. We address these problems by developing a verification-driven approach to traceability and documentation. We apply the AUTOCERT verification system to identify and then verify mathematical concepts in the code, based on a mathematical domain theory, and then use these verified traceability links between concepts, code, and verification conditions to construct a natural language report that provides a high-level structured argument explaining why and how the code uses the assumptions and complies with the requirements. We have applied our approach to generate review documents for several sub-systems of NASA s Project Constellation.

Improving and Measuring Inpatient Documentation of Medical Care within the MS-DRG System: Education, Monitoring, and Normalized Case Mix Index

PubMed Central

Rosenbaum, Benjamin P.; Lorenz, Robert R.; Luther, Ralph B.; Knowles-Ward, Lisa; Kelly, Dianne L.; Weil, Robert J.

2014-01-01

Documentation of the care delivered to hospitalized patients is a ubiquitous and important aspect of medical care. The majority of references to documentation and coding are based on the Centers for Medicare and Medicaid Services (CMS) Medicare Severity Diagnosis Related Group (MS-DRG) inpatient prospective payment system (IPPS). We educated the members of a clinical care team in a single department (neurosurgery) at our hospital. We measured subsequent documentation improvements in a simple, meaningful, and reproducible fashion. We created a new metric to measure documentation, termed the “normalized case mix index,” that allows comparison of hospitalizations across multiple unrelated MS-DRG groups. Compared to one year earlier, the traditional case mix index, normalized case mix index, severity of illness, and risk of mortality increased one year after the educational intervention. We encourage other organizations to implement and systematically monitor documentation improvement efforts when attempting to determine the accuracy and quality of documentation achieved. PMID:25214820

Improving and measuring inpatient documentation of medical care within the MS-DRG system: education, monitoring, and normalized case mix index.

PubMed

Rosenbaum, Benjamin P; Lorenz, Robert R; Luther, Ralph B; Knowles-Ward, Lisa; Kelly, Dianne L; Weil, Robert J

2014-01-01

Documentation of the care delivered to hospitalized patients is a ubiquitous and important aspect of medical care. The majority of references to documentation and coding are based on the Centers for Medicare and Medicaid Services (CMS) Medicare Severity Diagnosis Related Group (MS-DRG) inpatient prospective payment system (IPPS). We educated the members of a clinical care team in a single department (neurosurgery) at our hospital. We measured subsequent documentation improvements in a simple, meaningful, and reproducible fashion. We created a new metric to measure documentation, termed the "normalized case mix index," that allows comparison of hospitalizations across multiple unrelated MS-DRG groups. Compared to one year earlier, the traditional case mix index, normalized case mix index, severity of illness, and risk of mortality increased one year after the educational intervention. We encourage other organizations to implement and systematically monitor documentation improvement efforts when attempting to determine the accuracy and quality of documentation achieved.

Aeroacoustic Codes for Rotor Harmonic and BVI Noise. CAMRAD.Mod1/HIRES: Methodology and Users' Manual

NASA Technical Reports Server (NTRS)

Boyd, D. Douglas, Jr.; Brooks, Thomas F.; Burley, Casey L.; Jolly, J. Ralph, Jr.

1998-01-01

This document details the methodology and use of the CAMRAD.Mod1/HIRES codes, which were developed at NASA Langley Research Center for the prediction of helicopter harmonic and Blade-Vortex Interaction (BVI) noise. CANMAD.Mod1 is a substantially modified version of the performance/trim/wake code CANMAD. High resolution blade loading is determined in post-processing by HIRES and an associated indicial aerodynamics code. Extensive capabilities of importance to noise prediction accuracy are documented, including a new multi-core tip vortex roll-up wake model, higher harmonic and individual blade control, tunnel and fuselage correction input, diagnostic blade motion input, and interfaces for acoustic and CFD aerodynamics codes. Modifications and new code capabilities are documented with examples. A users' job preparation guide and listings of variables and namelists are given.

The National Transport Code Collaboration Module Library

NASA Astrophysics Data System (ADS)

Kritz, A. H.; Bateman, G.; Kinsey, J.; Pankin, A.; Onjun, T.; Redd, A.; McCune, D.; Ludescher, C.; Pletzer, A.; Andre, R.; Zakharov, L.; Lodestro, L.; Pearlstein, L. D.; Jong, R.; Houlberg, W.; Strand, P.; Wiley, J.; Valanju, P.; John, H. St.; Waltz, R.; Mandrekas, J.; Mau, T. K.; Carlsson, J.; Braams, B.

2004-12-01

This paper reports on the progress in developing a library of code modules under the auspices of the National Transport Code Collaboration (NTCC). Code modules are high quality, fully documented software packages with a clearly defined interface. The modules provide a variety of functions, such as implementing numerical physics models; performing ancillary functions such as I/O or graphics; or providing tools for dealing with common issues in scientific programming such as portability of Fortran codes. Researchers in the plasma community submit code modules, and a review procedure is followed to insure adherence to programming and documentation standards. The review process is designed to provide added confidence with regard to the use of the modules and to allow users and independent reviews to validate the claims of the modules' authors. All modules include source code; clear instructions for compilation of binaries on a variety of target architectures; and test cases with well-documented input and output. All the NTCC modules and ancillary information, such as current standards and documentation, are available from the NTCC Module Library Website http://w3.pppl.gov/NTCC. The goal of the project is to develop a resource of value to builders of integrated modeling codes and to plasma physics researchers generally. Currently, there are more than 40 modules in the module library.

77 FR 67340 - National Fire Codes: Request for Comments on NFPA's Codes and Standards

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-09

... the process. The Code Revision Process contains four basic steps that are followed for developing new documents as well as revising existing documents. Step 1: Public Input Stage, which results in the First Draft Report (formerly ROP); Step 2: Comment Stage, which results in the Second Draft Report (formerly...

Sensitivity of Claims-Based Algorithms to Ascertain Smoking Status More Than Doubled with Meaningful Use.

PubMed

Huo, Jinhai; Yang, Ming; Tina Shih, Ya-Chen

2018-03-01

The "meaningful use of certified electronic health record" policy requires eligible professionals to record smoking status for more than 50% of all individuals aged 13 years or older in 2011 to 2012. To explore whether the coding to document smoking behavior has increased over time and to assess the accuracy of smoking-related diagnosis and procedure codes in identifying previous and current smokers. We conducted an observational study with 5,423,880 enrollees from the year 2009 to 2014 in the Truven Health Analytics database. Temporal trends of smoking coding, sensitivity, specificity, positive predictive value, and negative predictive value were measured. The rate of coding of smoking behavior improved significantly by the end of the study period. The proportion of patients in the claims data recorded as current smokers increased 2.3-fold and the proportion of patients recorded as previous smokers increased 4-fold during the 6-year period. The sensitivity of each International Classification of Diseases, Ninth Revision, Clinical Modification code was generally less than 10%. The diagnosis code of tobacco use disorder (305.1X) was the most sensitive code (9.3%) for identifying smokers. The specificities of these codes and the Current Procedural Terminology codes were all more than 98%. A large improvement in the coding of current and previous smoking behavior has occurred since the inception of the meaningful use policy. Nevertheless, the use of diagnosis and procedure codes to identify smoking behavior in administrative data is still unreliable. This suggests that quality improvements toward medical coding on smoking behavior are needed to enhance the capability of claims data for smoking-related outcomes research. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

[Establishing a clinical information system for surgical ophthalmology and orthopedics specialties with reference to GSG '93].

PubMed

Dick, B; Basad, E

1996-04-01

As a result of new health care guidelines (Gesundheitsstrukturgesetz) and the federal hospital and nursing ordinance, there has been a large increase in the documentation required for diagnoses (ICD-9) and service ("Operationenschlüssel nach section 301 SGB V" = ICPM), all of which is done in the form of a numeric code. The method of coding diagnoses is supposed to make possible data entry and statistical evaluation of plausibility controls, as well as conspicuous and random testing of economic feasibility. Our data processing system is designed to assist in the planning and organization of clinical activities, while at the same time making documentation in accordance with health care guidelines easier and providing scientific documentation and evaluation. The application MedAccess was developed by clinicians on the basis of a relational client-server database. The application has been in use since June 1992 and has been further developed during operation according to the requirements and wishes of clinic and administrative staff. In cooperation with the Institute for Medical Information Technology, a computer interface with the patient check-in system was created, making possible the importing of patient data. The application is continuously updated according to the current needs of the clinic and administration. The primary functions of MedAccess include managing patient data, planning of in-patient admissions, surgical planning, organization, documentation (surgery book, reports with follow-up treatment records), administration of the tissue bank, clinic communications, clinic work processing, and management of the staff duty roster. Clinical data are entered into a computer and processed on site, and the user is assisted by practical applications which do not require special knowledge of data processing or encoding systems. The data is entered only once, but can be further used for other purposes, such as evaluations or selective transfer, for example, to clinical documents. Through an integrated flow of data, information entered one time remains readily available, while, at the same time, preventing duplicate entries. The integration of hardware and software via a mainframe computer (clinic system WING) has proven to be well-suited for the exchange of data. The use of this thesaurus-supported and graphics-oriented system required no special knowledge of the ICD code and makes documentation much easier to produce. The advantages of computer-supported encoding not only include a savings in time, but also an improvement in the quality of the encoding from which clinical and scientific reports can be derived. The relational client-server, operating in a graphics-supported programming environment, makes it possible for the clinic's doctors to further develop and improve the system. Through the installation and support of a Macintosh network, and training of doctors, medical personnel and clerical staff, cost as well as investment of time have been kept to a minimum in comparison to other LAN servers.

Augmenting advance care planning in poor prognosis cancer with a video decision aid: a preintervention-postintervention study.

PubMed

Volandes, Angelo E; Levin, Tomer T; Slovin, Susan; Carvajal, Richard D; O'Reilly, Eileen M; Keohan, Mary Louise; Theodoulou, Maria; Dickler, Maura; Gerecitano, John F; Morris, Michael; Epstein, Andrew S; Naka-Blackstone, Anastazia; Walker-Corkery, Elizabeth S; Chang, Yuchiao; Noy, Ariela

2012-09-01

The authors tested whether an educational video on the goals of care in advanced cancer (life-prolonging care, basic care, or comfort care) helped patients understand these goals and had an impact on their preferences for resuscitation. A survey of 80 patients with advanced cancer was conducted before and after they viewed an educational video. The outcomes of interest included changes in goals of care preference and knowledge and consistency of preferences with code status. Before viewing the video, 10 patients (13%) preferred life-prolonging care, 24 patients (30%) preferred basic care, 29 patients (36%) preferred comfort care, and 17 patients (21%) were unsure. Preferences did not change after the video, when 9 patients (11%) chose life-prolonging care, 28 patients (35%) chose basic care, 29 patients (36%) chose comfort care, and, 14 patients (18%) were unsure (P = .28). Compared with baseline, after the video presentation, more patients did not want cardiopulmonary resuscitation (CPR) (71% vs 62%; P = .03) or ventilation (80% vs 67%; P = .008). Knowledge about goals of care and likelihood of resuscitation increased after the video (P < .001). Of the patients who did not want CPR or ventilation after the video augmentation, only 4 patients (5%) had a documented do-not-resuscitate order in their medical record (kappa statistic, -0.01; 95% confidence interval, -0.06 to 0.04). Acceptability of the video was high. Patients with advanced cancer did not change care preferences after viewing the video, but fewer wanted CPR or ventilation. Documented code status was inconsistent with patient preferences. Patients were more knowledgeable after the video, reported that the video was acceptable, and said they would recommend it to others. The current results indicated that this type of video may enable patients to visualize "goals of care," enriching patient understanding of worsening health states and better informing decision making. Copyright © 2012 American Cancer Society.

Dynamic modeling of patient and physician eye gaze to understand the effects of electronic health records on doctor-patient communication and attention.

PubMed

Montague, Enid; Asan, Onur

2014-03-01

The aim of this study was to examine eye gaze patterns between patients and physicians while electronic health records were used to support patient care. Eye gaze provides an indication of physician attention to patient, patient/physician interaction, and physician behaviors such as searching for information and documenting information. A field study was conducted where 100 patient visits were observed and video recorded in a primary care clinic. Videos were then coded for gaze behaviors where patients' and physicians' gaze at each other and artifacts such as electronic health records were coded using a pre-established objective coding scheme. Gaze data were then analyzed using lag sequential methods. Results showed that there are several eye gaze patterns significantly dependent to each other. All doctor-initiated gaze patterns were followed by patient gaze patterns. Some patient-initiated gaze patterns were also followed by doctor gaze patterns significantly unlike the findings in previous studies. Health information technology appears to contribute to some of the new significant patterns that have emerged. Differences were also found in gaze patterns related to technology that differ from patterns identified in studies with paper charts. Several sequences related to patient-doctor-technology were also significant. Electronic health records affect the patient-physician eye contact dynamic differently than paper charts. This study identified several patterns of patient-physician interaction with electronic health record systems. Consistent with previous studies, physician initiated gaze is an important driver of the interactions between patient and physician and patient and technology. Published by Elsevier Ireland Ltd.

Documents Pertaining to Resource Conservation and Recovery Act Corrective Action Event Codes

EPA Pesticide Factsheets

Document containing RCRA Corrective Action event codes and definitions, including national requirements, initiating sources, dates, and guidance, from the first facility assessment until the Corrective Action is terminated.

C++ Coding Standards for the AMP Project

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

Evans, Thomas M; Clarno, Kevin T

2009-09-01

This document provides an initial starting point to define the C++ coding standards used by the AMP nuclear fuel performance integrated code project and a part of AMP's software development process. This document draws from the experiences, and documentation [1], of the developers of the Marmot Project at Los Alamos National Laboratory. Much of the software in AMP will be written in C++. The power of C++ can be abused easily, resulting in code that is difficult to understand and maintain. This document gives the practices that should be followed on the AMP project for all new code that ismore » written. The intent is not to be onerous but to ensure that the code can be readily understood by the entire code team and serve as a basis for collectively defining a set of coding standards for use in future development efforts. At the end of the AMP development in fiscal year (FY) 2010, all developers will have experience with the benefits, restrictions, and limitations of the standards described and will collectively define a set of standards for future software development. External libraries that AMP uses do not have to meet these requirements, although we encourage external developers to follow these practices. For any code of which AMP takes ownership, the project will decide on any changes on a case-by-case basis. The practices that we are using in the AMP project have been in use in the Denovo project [2] for several years. The practices build on those given in References [3-5]; the practices given in these references should also be followed. Some of the practices given in this document can also be found in [6].« less

78 FR 77632 - Amendments to Excepted Benefits

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-24

...This document contains proposed rules that would amend the regulations regarding excepted benefits under the Employee Retirement Income Security Act of 1974, the Internal Revenue Code, and the Public Health Service Act. Excepted benefits are generally exempt from the health reform requirements that were added to those laws by the Health Insurance Portability and Accountability Act and the Patient Protection and Affordable Care Act.

Dynamic modeling of patient and physician eye gaze to understand the effects of electronic health records on doctor-patient communication and attention

PubMed Central

Montague, Enid; Asan, Onur

2014-01-01

Objective The aim of this study was to examine eye gaze patterns between patients and physicians while electronic health records were used to support patient care. Background Eye gaze provides an indication of physician attention to patient, patient/physician interaction, and physician behaviors such as searching for information and documenting information. Methods A field study was conducted where 100 patient visits were observed and video recorded in a primary care clinic. Videos were then coded for gaze behaviors where patients’ and physicians’ gaze at each other and artifacts such as electronic health records were coded using a pre-established objective coding scheme. Gaze data were then analyzed using lag sequential methods. Results Results showed that there are several eye gaze patterns significantly dependent to each other. All doctor-initiated gaze patterns were followed by patient gaze patterns. Some patient-initiated gaze patterns were also followed by doctor gaze patterns significantly unlike the findings in previous studies. Health information technology appears to contribute to some of the new significant patterns that have emerged. Differences were also found in gaze patterns related to technology that differ from patterns identified in studies with paper charts. Several sequences related to patient-doctor- technology were also significant. Electronic health records affect the patient-physician eye contact dynamic differently than paper charts. Conclusion This study identified several patterns of patient-physician interaction with electronic health record systems. Consistent with previous studies, physician initiated gaze is an important driver of the interactions between patient and physician and patient and technology. PMID:24380671

Outcomes of In-Hospital Cardiopulmonary Resuscitation Among Patients With Cancer.

PubMed

Zafar, Waleed; Ghafoor, Irum; Jamshed, Arif; Gul, Sabika; Hafeez, Haroon

2017-04-01

To review all episodes where an emergency code was called in a cancer-specialized hospital in Pakistan and to assess survival to discharge among patients who received a cardiopulmonary resuscitation (CPR). We reviewed demographic and clinical data related to all "code blue" calls over 3 years. Multivariate logistic regression analyses were used to test the association of clinical characteristics with the primary outcome of survival to discharge. A total of 646 code blue calls were included in the analysis. The CPR was performed in 388 (60%) of these calls. For every 20 episodes of CPR among patients with cancer of all ages, only 1 resulted in a patient's survival to discharge, even though in 52.2% episodes there was a return of spontaneous circulation. No association was found between the type of rhythm at initiation of CPR and likelihood of survival to discharge. The proportion of patients with advanced cancer surviving to discharge after in-hospital CPR in a low-income country was in line with the reported international experience. Most patients with cancer who received in-hospital CPR did not survive to discharge and did not appear to benefit from resuscitation. Advance directives by patients with cancer limiting aggressive interventions at end of life and proper documentation of these directives will help in provision of care that is humane and consonant with patients' wishes for a dignified death. Patients' early appreciation of the limited benefits of CPR in advanced cancer is likely to help them formulate such advance directives.

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

PubMed

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

2013-01-01

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

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

PubMed

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

2012-10-01

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

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

NONE

This document contains the State Building Energy Codes Status prepared by Pacific Northwest National Laboratory for the U.S. Department of Energy under Contract DE-AC06-76RL01830 and dated September 1996. The U.S. Department of Energy`s Office of Codes and Standards has developed this document to provide an information resource for individuals interested in energy efficiency of buildings and the relevant building energy codes in each state and U.S. territory. This is considered to be an evolving document and will be updated twice a year. In addition, special state updates will be issued as warranted.

General Electromagnetic Model for the Analysis of Complex Systems (GEMACS) Computer Code Documentation (Version 3). Volume 3, Part 4.

DTIC Science & Technology

1983-09-01

6ENFRAL. ELECTROMAGNETIC MODEL FOR THE ANALYSIS OF COMPLEX SYSTEMS **%(GEMA CS) Computer Code Documentation ii( Version 3 ). A the BDM Corporation Dr...ANALYSIS FnlTcnclRpr F COMPLEX SYSTEM (GmCS) February 81 - July 83- I TR CODE DOCUMENTATION (Version 3 ) 6.PROMN N.REPORT NUMBER 5. CONTRACT ORGAT97...the ti and t2 directions on the source patch. 3 . METHOD: The electric field at a segment observation point due to the source patch j is given by 1-- lnA

Structuring and coding in health care records: a qualitative analysis using diabetes as a case study.

PubMed

Robertson, Ann R R; Fernando, Bernard; Morrison, Zoe; Kalra, Dipak; Sheikh, Aziz

2015-03-27

Globally, diabetes mellitus presents a substantial and increasing burden to individuals, health care systems and society. Structuring and coding of information in the electronic health record underpin attempts to improve sharing and searching for information. Digital records for those with long-term conditions are expected to bring direct and secondary uses benefits, and potentially to support patient self-management. We sought to investigate if how and why records for adults with diabetes were structured and coded and to explore a range of UK stakeholders' perceptions of current practice in the National Health Service. We carried out a qualitative, theoretically informed case study of documenting health care information for diabetes in family practice and hospital settings in England, using semi-structured interviews, observations, systems demonstrations and documentary data. We conducted 22 interviews and four on-site observations. With respect to secondary uses - research, audit, public health and service planning - interviewees clearly articulated the benefits of highly structured and coded diabetes data and it was believed that benefits would expand through linkage to other datasets. Direct, more marginal, clinical benefits in terms of managing and monitoring diabetes and perhaps encouraging patient self-management were also reported. We observed marked differences in levels of record structuring and/or coding between family practices, where it was high, and the hospital. We found little evidence that structured and coded data were being exploited to improve information sharing between care settings. Using high levels of data structuring and coding in records for diabetes patients has the potential to be exploited more fully, and lessons might be learned from successful developments elsewhere in the UK. A first step would be for hospitals to attain levels of health information technology infrastructure and systems use commensurate with family practices.

Juggling confidentiality and safety: a qualitative study of how general practice clinicians document domestic violence in families with children.

PubMed

Drinkwater, Jessica; Stanley, Nicky; Szilassy, Eszter; Larkins, Cath; Hester, Marianne; Feder, Gene

2017-06-01

Domestic violence and abuse (DVA) and child safeguarding are interlinked problems, impacting on all family members. Documenting in electronic patient records (EPRs) is an important part of managing these families. Current evidence and guidance, however, treats DVA and child safeguarding separately. This does not reflect the complexity clinicians face when documenting both issues in one family. To explore how and why general practice clinicians document DVA in families with children. A qualitative interview study using vignettes with GPs and practice nurses (PNs) in England. Semi-structured telephone interviews with 54 clinicians (42 GPs and 12 PNs) were conducted across six sites in England. Data were analysed thematically using a coding frame incorporating concepts from the literature and emerging themes. Most clinicians recognised DVA and its impact on child safeguarding, but struggled to work out the best way to document it. They described tensions among the different roles of the EPR: a legal document; providing continuity of care; information sharing to improve safety; and a patient-owned record. This led to strategies to hide information, so that it was only available to other clinicians. Managing DVA in families with children is complex and challenging for general practice clinicians. National integrated guidance is urgently needed regarding how clinicians should manage the competing roles of the EPR, while maintaining safety of the whole family, especially in the context of online EPRs and patient access. © British Journal of General Practice 2017.

Juggling confidentiality and safety: a qualitative study of how general practice clinicians document domestic violence in families with children

PubMed Central

Drinkwater, Jessica; Stanley, Nicky; Szilassy, Eszter; Larkins, Cath; Hester, Marianne; Feder, Gene

2017-01-01

Background Domestic violence and abuse (DVA) and child safeguarding are interlinked problems, impacting on all family members. Documenting in electronic patient records (EPRs) is an important part of managing these families. Current evidence and guidance, however, treats DVA and child safeguarding separately. This does not reflect the complexity clinicians face when documenting both issues in one family. Aim To explore how and why general practice clinicians document DVA in families with children. Design and setting A qualitative interview study using vignettes with GPs and practice nurses (PNs) in England. Method Semi-structured telephone interviews with 54 clinicians (42 GPs and 12 PNs) were conducted across six sites in England. Data were analysed thematically using a coding frame incorporating concepts from the literature and emerging themes. Results Most clinicians recognised DVA and its impact on child safeguarding, but struggled to work out the best way to document it. They described tensions among the different roles of the EPR: a legal document; providing continuity of care; information sharing to improve safety; and a patient-owned record. This led to strategies to hide information, so that it was only available to other clinicians. Conclusion Managing DVA in families with children is complex and challenging for general practice clinicians. National integrated guidance is urgently needed regarding how clinicians should manage the competing roles of the EPR, while maintaining safety of the whole family, especially in the context of online EPRs and patient access. PMID:28137783

[Incidence and Costs of 1:1 Care in Psychiatric Hospitals in Germany - A Descriptive Analysis Based on the VIPP Project Data Set].

PubMed

Nienaber, André; Schulz, Michael; Noelle, Rüdiger; Wiegand, Hauke Felix; Wolff-Menzler, Claus; Häfner, Sibylle; Seemüller, Florian; Godemann, Frank; Löhr, Michael

2016-05-01

1:1 care is applied for patients requiring close psychiatric monitoring and care like patients with acute suicidality. The article describes the frequency of 1:1 care across different diagnoses and age groups in German psychiatric hospitals. The analysis was based on the VIPP Project from the years 2011 and 2012. A total of 47 hospitals with more than 120,000 cases were included. Object of the analysis was the OPS code 9-640.0 1:1 care. The evaluation was performed on case level. Data of 47 hospitals were included. Of the 121,454 cases evaluated in 2011 3.8 % documented a 1:1 care within the meaning of OPS 9-640.0 additional code. Of the 66 245 male cases a 1:1 care was documented in 3.5 % and the 55 207 female cases was 4.1 %. Compared to 2011, the proportion of 1:1 care in 2012 rose to 4.8 %. The results show that 1:1 care is frequently applied in German psychiatric hospitals. The Data of the VIPP project have proven to be a useful tool to gain information on the frequency of cost-intensive interventions in German psychiatric hospitals. Further analyses should create the possibility of evaluation at the level of the individual codes. © Georg Thieme Verlag KG Stuttgart · New York.

Patient Self-Defined Goals: Essentials of Person-Centered Care for Serious Illness.

PubMed

Schellinger, Sandra Ellen; Anderson, Eric Worden; Frazer, Monica Schmitz; Cain, Cindy Lynn

2018-01-01

This research, a descriptive qualitative analysis of self-defined serious illness goals, expands the knowledge of what goals are important beyond the physical-making existing disease-specific guidelines more holistic. Integration of goals of care discussions and documentation is standard for quality palliative care but not consistently executed into general and specialty practice. Over 14 months, lay health-care workers (care guides) provided monthly supportive visits for 160 patients with advanced heart failure, cancer, and dementia expected to die in 2 to 3 years. Care guides explored what was most important to patients and documented their self-defined goals on a medical record flow sheet. Using definitions of an expanded set of whole-person domains adapted from the National Consensus Project (NCP) Clinical Practice Guidelines for Quality Palliative Care, 999 goals and their associated plans were deductively coded and examined. Four themes were identified-medical, nonmedical, multiple, and global. Forty percent of goals were coded into the medical domain; 40% were coded to nonmedical domains-social (9%), ethical (7%), family (6%), financial/legal (5%), psychological (5%), housing (3%), legacy/bereavement (3%), spiritual (1%), and end-of-life care (1%). Sixteen percent of the goals were complex and reflected a mix of medical and nonmedical domains, "multiple" goals. The remaining goals (4%) were too global to attribute to an NCP domain. Self-defined serious illness goals express experiences beyond physical health and extend into all aspects of whole person. It is feasible to elicit and record serious illness goals. This approach to goals can support meaningful person-centered care, decision-making, and planning that accords with individual preferences of late life.

A point prevalence cross-sectional study of healthcare-associated urinary tract infections in six Australian hospitals.

PubMed

Gardner, Anne; Mitchell, Brett; Beckingham, Wendy; Fasugba, Oyebola

2014-07-29

Urinary tract infections (UTIs) account for over 30% of healthcare-associated infections. The aim of this study was to determine healthcare-associated UTI (HAUTI) and catheter-associated UTI (CAUTI) point prevalence in six Australian hospitals to inform a national point prevalence process and compare two internationally accepted HAUTI definitions. We also described the level and comprehensiveness of clinical record documentation, microbiology laboratory and coding data at identifying HAUTIs and CAUTIs. Data were collected from three public and three private Australian hospitals over the first 6 months of 2013. A total of 1109 patients were surveyed. Records of patients of all ages, hospitalised on the day of the point prevalence at the study sites, were eligible for inclusion. Outpatients, patients in adult mental health units, patients categorised as maintenance care type (ie, patients waiting to be transferred to a long-term care facility) and those in the emergency department during the duration of the survey were excluded. The primary outcome measures were the HAUTI and CAUTI point prevalence. Overall HAUTI and CAUTI prevalence was 1.4% (15/1109) and 0.9% (10/1109), respectively. Staphylococcus aureus and Candida species were the most common pathogens. One-quarter (26.3%) of patients had a urinary catheter and fewer than half had appropriate documentation. Eight of the 15 patients ascertained to have a HAUTI based on clinical records (6 being CAUTI) were coded by the medical records department with an International Classification of Diseases (ICD)-10 code for UTI diagnosis. The Health Protection Agency Surveillance definition had a positive predictive value of 91.67% (CI 64.61 to 98.51) compared against the Centers for Disease Control and Prevention definition. These study results provide a foundation for a national Australian point prevalence study and inform the development and implementation of targeted healthcare-associated infection surveillance more broadly. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Amendments to excepted benefits. Final rules.

PubMed

2014-10-01

This document contains final regulations that amend the regulations regarding excepted benefits under the Employee Retirement Income Security Act of 1974, the Internal Revenue Code (the Code), and the Public Health Service Act. Excepted benefits are generally exempt from the health reform requirements that were added to those laws by the Health Insurance Portability and Accountability Act and the Patient Protection and Affordable Care Act. In addition, eligibility for excepted benefits does not preclude an individual from eligibility for a premium tax credit under section 36B of the Code if an individual chooses to enroll in coverage under a Qualified Health Plan through an Affordable Insurance Exchange. These regulations finalize some but not all of the proposed rules with minor modifications; additional guidance on limited wraparound coverage is forthcoming.

A coding single-nucleotide polymorphism in lysine demethylase KDM4A associates with increased sensitivity to mTOR inhibitors.

PubMed

Van Rechem, Capucine; Black, Joshua C; Greninger, Patricia; Zhao, Yang; Donado, Carlos; Burrowes, Paul D; Ladd, Brendon; Christiani, David C; Benes, Cyril H; Whetstine, Johnathan R

2015-03-01

SNPs occur within chromatin-modulating factors; however, little is known about how these variants within the coding sequence affect cancer progression or treatment. Therefore, there is a need to establish their biochemical and/or molecular contribution, their use in subclassifying patients, and their impact on therapeutic response. In this report, we demonstrate that coding SNP-A482 within the lysine tridemethylase gene KDM4A/JMJD2A has different allelic frequencies across ethnic populations, associates with differential outcome in patients with non-small cell lung cancer (NSCLC), and promotes KDM4A protein turnover. Using an unbiased drug screen against 87 preclinical and clinical compounds, we demonstrate that homozygous SNP-A482 cells have increased mTOR inhibitor sensitivity. mTOR inhibitors significantly reduce SNP-A482 protein levels, which parallels the increased drug sensitivity observed with KDM4A depletion. Our data emphasize the importance of using variant status as candidate biomarkers and highlight the importance of studying SNPs in chromatin modifiers to achieve better targeted therapy. This report documents the first coding SNP within a lysine demethylase that associates with worse outcome in patients with NSCLC. We demonstrate that this coding SNP alters the protein turnover and associates with increased mTOR inhibitor sensitivity, which identifies a candidate biomarker for mTOR inhibitor therapy and a therapeutic target for combination therapy. ©2015 American Association for Cancer Research.

Patient care outcomes of a tobacco use registry in an academic family practice.

PubMed

Ripley-Moffitt, Carol; Neutze, Dana; Gwynne, Mark; Goldstein, Adam O

2015-01-01

While the potential benefit of a chronic disease registry for tobacco use is great, outcome reports have not been generated. We examined the effect of implementing a tobacco use registry, including a decision support tool, on treatment outcomes within an academic family medicine clinic. A chart review of 200 patients who smoked and attended the clinic before and after registry implementation assessed the number of patients with clinic notes documenting (1) counseling for tobacco use, (2) recommendations for cessation medication, (3) a set quit date, (4) referrals to the on-site Nicotine Dependence Program (NDP) and/or QuitlineNC, and (5) pneumococcal vaccine. Data from the NDP, QuitlineNC, and clinic billing records before and after implementation compared the number of clinic-generated QuitlineNC fax referrals, new scheduled appointments for the NDP, and visits coded for tobacco counseling reimbursement. Significant increases in documentation occurred across most chart review variables. Significant increases in the number of clinic-generated fax referrals to QuitlineNC (from 27 to 96), initial scheduled appointments for the NDP (from 84 to 148), and coding for tobacco counseling (from 101 to 287) also occurred when compared with total patient visits during the same time periods. Patient attendance at the NDP (52%) and acceptance of QuitlineNC services (31%) remained constant. The tobacco use registry's decision support tool increased evidenced-based tobacco use treatment (referrals, medications, and counseling) for patients at an academic family medicine clinic. This novel tool offers standardized care for all patients who use tobacco, ensuring improved access to effective tobacco use counseling and medication treatments. © Copyright 2015 by the American Board of Family Medicine.

The spectrum of rheumatic in-patient diagnoses at a pediatric hospital in Kenya.

PubMed

Migowa, Angela; Colmegna, Inés; Hitchon, Carol; Were, Eugene; Ng'ang'a, Evelyn; Ngwiri, Thomas; Wachira, John; Bernatsky, Sasha; Scuccimarri, Rosie

2017-01-14

Pediatric rheumatic diseases are chronic illnesses that can cause considerable disease burden to children and their families. There is limited epidemiologic data on these diseases in East Africa. The aim of this study was to assess the spectrum of pediatric rheumatic diagnoses in an in-patient setting and determine the accuracy of ICD-10 codes in identifying these conditions. Medical records from Gertrude's Children's Hospital in Kenya were reviewed for patients diagnosed with "diseases of the musculoskeletal system and connective tissue" as per ICD-10 diagnostic codes assigned at discharge between January and December 2011. Cases were classified as "rheumatic" or "non-rheumatic". Accuracy of the assigned ICD-10 code was ascertained. Death records were reviewed. Longitudinal follow-up of "rheumatic" cases was done by chart review up to March 2014. Twenty six patients were classified as having a "rheumatic" condition accounting for 0.32% of patients admitted. Of these, 11 (42.3%) had an acute inflammatory arthropathy, 6 (23.1%) had septic arthritis, 4 (15.4%) had Kawasaki disease, 2 (7.7%) had pyomyositis, and there was one case each of septic bursitis, rheumatic fever, and a non-specific soft tissue disorder. No cases of juvenile idiopathic arthritis (JIA) were identified. One case of systemic lupus erythematosus was documented by death records. The agreement between the treating physician's discharge diagnosis and medical records ICD-10 code assignment was good (Kappa: 0.769). On follow-up, one child had recurrent knee swelling that was suspicious for JIA. Pediatric rheumatic conditions represented 0.32% of admissions at a pediatric hospital in Kenya. Acute inflammatory arthropathies, septic arthritis and Kawasaki disease were the most frequent in-patient rheumatic diagnoses. Chronic pediatric rheumatic diseases were rare amongst this in-patient population. Despite limitations associated with the use of administrative diagnostic codes, they can be a first step in evaluating the spectrum of pediatric rheumatic conditions in Kenya and other countries in East Africa.

Prevalence and recognition of obesity and its associated comorbidities: cross-sectional analysis of electronic health record data from a large US integrated health system.

PubMed

Pantalone, Kevin M; Hobbs, Todd M; Chagin, Kevin M; Kong, Sheldon X; Wells, Brian J; Kattan, Michael W; Bouchard, Jonathan; Sakurada, Brian; Milinovich, Alex; Weng, Wayne; Bauman, Janine; Misra-Hebert, Anita D; Zimmerman, Robert S; Burguera, Bartolome

2017-11-16

To determine the prevalence of obesity and its related comorbidities among patients being actively managed at a US academic medical centre, and to examine the frequency of a formal diagnosis of obesity, via International Classification of Diseases, Ninth Revision (ICD-9) documentation among patients with body mass index (BMI) ≥30 kg/m 2 . The electronic health record system at Cleveland Clinic was used to create a cross-sectional summary of actively managed patients meeting minimum primary care physician visit frequency requirements. Eligible patients were stratified by BMI categories, based on most recent weight and median of all recorded heights obtained on or before the index date of 1July 2015. Relationships between patient characteristics and BMI categories were tested. A large US integrated health system. A total of 324 199 active patients with a recorded BMI were identified. There were 121 287 (37.4%) patients found to be overweight (BMI ≥25 and <29.9), 75 199 (23.2%) had BMI 30-34.9, 34 152 (10.5%) had BMI 35-39.9 and 25 137 (7.8%) had BMI ≥40. There was a higher prevalence of type 2 diabetes, pre-diabetes, hypertension and cardiovascular disease (P value<0.0001) within higher BMI compared with lower BMI categories. In patients with a BMI >30 (n=134 488), only 48% (64 056) had documentation of an obesity ICD-9 code. In those patients with a BMI >40, only 75% had an obesity ICD-9 code. This cross-sectional summary from a large US integrated health system found that three out of every four patients had overweight or obesity based on BMI. Patients within higher BMI categories had a higher prevalence of comorbidities. Less than half of patients who were identified as having obesity according to BMI received a formal diagnosis via ICD-9 documentation. The disease of obesity is very prevalent yet underdiagnosed in our clinics. The under diagnosing of obesity may serve as an important barrier to treatment initiation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Diagnosing somatisation disorder (P75) in routine general practice using the International Classification of Primary Care.

PubMed

Schaefert, Rainer; Laux, Gunter; Kaufmann, Claudia; Schellberg, Dieter; Bölter, Regine; Szecsenyi, Joachim; Sauer, Nina; Herzog, Wolfgang; Kuehlein, Thomas

2010-09-01

(i) To analyze general practitioners' diagnosis of somatisation disorder (P75) using the International Classification of Primary Care (ICPC)-2-E in routine general practice. (ii) To validate the distinctiveness of the ICD-10 to ICPC-2 conversion rule which maps ICD-10 dissociative/conversion disorder (F44) as well as half of the somatoform categories (F45.0-2) to P75 and codes the other half of these disorders (F45.3-9), including autonomic organ dysfunctions and pain syndromes, as symptom diagnoses plus a psychosocial code in a multiaxial manner. Cross-sectional analysis of routine data from a German research database comprising the electronic patient records of 32 general practitioners from 22 practices. For each P75 patient, control subjects matched for age, gender, and practice were selected from the 2007 yearly contact group (YCG) without a P75 diagnosis using a propensity-score algorithm that resulted in eight controls per P75 patient. Of the 49,423 patients in the YCG, P75 was diagnosed in 0.6% (302) and F45.3-9 in 1.8% (883) of cases; overall, somatisation syndromes were diagnosed in 2.4% of patients. The P75 coding pattern coincided with typical characteristics of severe, persistent medically unexplained symptoms (MUS). F45.3-9 was found to indicate moderate MUS that otherwise showed little clinical difference from P75. Pain syndromes exhibited an unspecific coding pattern. Mild and moderate MUS were predominantly recorded as symptom diagnoses. Psychosocial codes were rarely documented. ICPC-2 P75 was mainly diagnosed in cases of severe MUS. Multiaxial coding appears to be too complicated for routine primary care. Instead of splitting P75 and F45.3-9 diagnoses, it is proposed that the whole MUS spectrum should be conceptualized as a continuum model comprising categorizations of uncomplicated (mild) and complicated (moderate and severe) courses. Psychosocial factors require more attention. Copyright (c) 2010 Elsevier Inc. All rights reserved.

Predictive value of the present-on-admission indicator for hospital-acquired venous thromboembolism.

PubMed

Khanna, Raman R; Kim, Sharon B; Jenkins, Ian; El-Kareh, Robert; Afsarmanesh, Nasim; Amin, Alpesh; Sand, Heather; Auerbach, Andrew; Chia, Catherine Y; Maynard, Gregory; Romano, Patrick S; White, Richard H

2015-04-01

Hospital-acquired venous thromboembolic (HA-VTE) events are an important, preventable cause of morbidity and death, but accurately identifying HA-VTE events requires labor-intensive chart review. Administrative diagnosis codes and their associated "present-on-admission" (POA) indicator might allow automated identification of HA-VTE events, but only if VTE codes are accurately flagged "not present-on-admission" (POA=N). New codes were introduced in 2009 to improve accuracy. We identified all medical patients with at least 1 VTE "other" discharge diagnosis code from 5 academic medical centers over a 24-month period. We then sampled, within each center, patients with VTE codes flagged POA=N or POA=U (insufficient documentation) and POA=Y or POA=W (timing clinically uncertain) and abstracted each chart to clarify VTE timing. All events that were not clearly POA were classified as HA-VTE. We then calculated predictive values of the POA=N/U flags for HA-VTE and the POA=Y/W flags for non-HA-VTE. Among 2070 cases with at least 1 "other" VTE code, we found 339 codes flagged POA=N/U and 1941 flagged POA=Y/W. Among 275 POA=N/U abstracted codes, 75.6% (95% CI, 70.1%-80.6%) were HA-VTE; among 291 POA=Y/W abstracted events, 73.5% (95% CI, 68.0%-78.5%) were non-HA-VTE. Extrapolating from this sample, we estimated that 59% of actual HA-VTE codes were incorrectly flagged POA=Y/W. POA indicator predictive values did not improve after new codes were introduced in 2009. The predictive value of VTE events flagged POA=N/U for HA-VTE was 75%. However, sole reliance on this flag may substantially underestimate the incidence of HA-VTE.

Factors associated with opioid dose increases: a chart review of patients’ first year on long-term opioids

PubMed Central

Bautista, Christopher A.; Iosif, Ana-Maria; Wilsey, Barth L.; Melnikow, Joy A.; Crichlow, Althea; Henry, Stephen G.

2016-01-01

OBJECTIVE To examine encounter-level factors associated with opioid dose increases during patients’ first year on opioid therapy for chronic pain. DESIGN Case-control study analyzing all opioid prescriptions for patients with chronic pain during their first year after opioid initiation. Cases were patients who experienced an overall dose escalation of ≥30 mg morphine equivalents over the 1-year period; controls did not experience overall dose escalation. Main measures were encounter type; opioid dose change; documented prescribing rationale; documentation of guideline-concordant opioid prescribing practices. Two coders reviewed all encounters associated with opioid prescriptions. Analysis of factors associated with dose increases and provider documentation of prescribing rationale was conducted using multiple logistic regression. RESULTS 674 encounters were coded for 66 patients (22 cases, 44 controls). Fifty-three percent of opioid prescriptions were associated with telephone encounters; 13% were associated with email encounters. No prescribing rationale was documented for 43% of all opioid prescriptions and 25% of dose increases. Likelihood of dose increase and documentation of prescribing rationale did not significantly differ for cases versus controls. Compared to face-to-face encounters, dose increases were significantly less likely for telephone (OR 0.18, 95%CI 0.11 – 0.28) and email (OR 0.23, 95%CI 0.12 – 0.47) encounters; documentation of prescribing rationale was significantly more likely for email (OR 5.06, 95%CI 1.87–13.72) and less likely for telephone (OR 0.30, 95%CI 0.18–0.51) encounters. CONCLUSION Most opioid prescriptions were written without face-to-face encounters. One quarter of dose increases contained no documented prescribing rationale. Documented encounter-level factors were not significantly associated with overall opioid dose escalation. PMID:27477581

Help, my rating looks bad! Coding comorbidities in arthroplasty.

PubMed

Galloway, Joseph D; Voss, Frank R

2016-09-01

In medicine today, there is a trend toward increasing transparency. Higher quality and better value are being sought, and one of the methods being used is publicly reported health care outcomes. However, there is a problem that comes from our loss of anonymity. Physicians who are being individually watched have to choose between doing what is best for the patient and doing what would look good when it is publicly reported. Often this might mean choosing not to treat a particularly sick patient who is unlikely to have a good outcome. Adjusting outcomes to account for risk factors should be a way to prevent this effect, but these methods need to be studied more. The current performance measures being released are based on administrative claims data, and to date, much of that information is not properly risk adjusted. To ensure that the increasing transparency reveals an accurate picture, it is critical that the complexity of care provided by surgeons be carefully documented. Therefore, we propose accurate coding of patients' comorbidities during hospitalization for total knee arthroplasty and total hip arthroplasty, and we have included a chart detailing our recommendations of the specific diagnostic codes that are most important.

Crowdsourcing the Measurement of Interstate Conflict

PubMed Central

2016-01-01

Much of the data used to measure conflict is extracted from news reports. This is typically accomplished using either expert coders to quantify the relevant information or machine coders to automatically extract data from documents. Although expert coding is costly, it produces quality data. Machine coding is fast and inexpensive, but the data are noisy. To diminish the severity of this tradeoff, we introduce a method for analyzing news documents that uses crowdsourcing, supplemented with computational approaches. The new method is tested on documents about Militarized Interstate Disputes, and its accuracy ranges between about 68 and 76 percent. This is shown to be a considerable improvement over automated coding, and to cost less and be much faster than expert coding. PMID:27310427

RELAP-7 Theory Manual

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

Berry, Ray Alden; Zou, Ling; Zhao, Haihua

This document summarizes the physical models and mathematical formulations used in the RELAP-7 code. In summary, the MOOSE based RELAP-7 code development is an ongoing effort. The MOOSE framework enables rapid development of the RELAP-7 code. The developmental efforts and results demonstrate that the RELAP-7 project is on a path to success. This theory manual documents the main features implemented into the RELAP-7 code. Because the code is an ongoing development effort, this RELAP-7 Theory Manual will evolve with periodic updates to keep it current with the state of the development, implementation, and model additions/revisions.

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

DOEpatents

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

2014-07-22

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

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

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

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

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

3 CFR - Delegation of Reporting Functions Specified in Section 491 of Title 10, United State Code

Code of Federal Regulations, 2014 CFR

2014-01-01

... 3 The President 1 2014-01-01 2014-01-01 false Delegation of Reporting Functions Specified in Section 491 of Title 10, United State Code Presidential Documents Other Presidential Documents Memorandum of June 19, 2013 Delegation of Reporting Functions Specified in Section 491 of Title 10, United State Code Memorandum for the Secretary of Defense B...

3 CFR - Delegation of Functions and Authority Under Sections 315 and 325 of Title 32, United States Code

Code of Federal Regulations, 2012 CFR

2012-01-01

... 3 The President 1 2012-01-01 2012-01-01 false Delegation of Functions and Authority Under Sections 315 and 325 of Title 32, United States Code Presidential Documents Other Presidential Documents Memorandum of April 14, 2011 Delegation of Functions and Authority Under Sections 315 and 325 of Title 32, United States Code Memorandum for the...

Single-channel voice-response-system program documentation volume I : system description

DOT National Transportation Integrated Search

1977-01-01

This report documents the design and implementation of a Voice Response System (VRS) using Adaptive Differential Pulse Code Modulation (ADPCM) voice coding. Implemented on a Digital Equipment Corporation PDP-11/20,R this VRS system supports a single ...

Sierra/Aria 4.48 Verification Manual.

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

Sierra Thermal Fluid Development Team

Presented in this document is a portion of the tests that exist in the Sierra Thermal/Fluids verification test suite. Each of these tests is run nightly with the Sierra/TF code suite and the results of the test checked under mesh refinement against the correct analytic result. For each of the tests presented in this document the test setup, derivation of the analytic solution, and comparison of the code results to the analytic solution is provided. This document can be used to confirm that a given code capability is verified or referenced as a compilation of example problems.

An Experiment in Scientific Code Semantic Analysis

NASA Technical Reports Server (NTRS)

Stewart, Mark E. M.

1998-01-01

This paper concerns a procedure that analyzes aspects of the meaning or semantics of scientific and engineering code. This procedure involves taking a user's existing code, adding semantic declarations for some primitive variables, and parsing this annotated code using multiple, distributed expert parsers. These semantic parser are designed to recognize formulae in different disciplines including physical and mathematical formulae and geometrical position in a numerical scheme. The parsers will automatically recognize and document some static, semantic concepts and locate some program semantic errors. Results are shown for a subroutine test case and a collection of combustion code routines. This ability to locate some semantic errors and document semantic concepts in scientific and engineering code should reduce the time, risk, and effort of developing and using these codes.

National Survey of Patients’ Bill of Rights Statutes

PubMed Central

Jacob, Dan M.; Hochhauser, Mark; Parker, Ruth M.

2009-01-01

BACKGROUND Despite vigorous national debate between 1999–2001 the federal patients’ bill of rights (PBOR) was not enacted. However, states have enacted legislation and the Joint Commission defined an accreditation standard to present patients with their rights. Because such initiatives can be undermined by overly complex language, we surveyed the readability of hospital PBOR documents as well as texts mandated by state law. METHODS State Web sites and codes were searched to identify PBOR statutes for general patient populations. The rights addressed were compared with the 12 themes presented in the American Hospital Association’s (AHA) PBOR text of 2002. In addition, we obtained PBOR texts from a sample of hospitals in each state. Readability was evaluated using Prose, a software program which reports an average of eight readability formulas. RESULTS Of 23 states with a PBOR statute for the general public, all establish a grievance policy, four protect a private right of action, and one stipulates fines for violations. These laws address an average of 7.4 of the 12 AHA themes. Nine states’ statutes specify PBOR text for distribution to patients. These documents have an average readability of 15th grade (range, 11.6, New York, to 17.0, Minnesota). PBOR documents from 240 US hospitals have an average readability of 14th grade (range, 8.2 to 17.0). CONCLUSIONS While the average U.S. adult reads at an 8th grade reading level, an advanced college reading level is routinely required to read PBOR documents. Patients are not likely to learn about their rights from documents they cannot read. PMID:19189192

Redundancy-Aware Topic Modeling for Patient Record Notes

PubMed Central

Cohen, Raphael; Aviram, Iddo; Elhadad, Michael; Elhadad, Noémie

2014-01-01

The clinical notes in a given patient record contain much redundancy, in large part due to clinicians’ documentation habit of copying from previous notes in the record and pasting into a new note. Previous work has shown that this redundancy has a negative impact on the quality of text mining and topic modeling in particular. In this paper we describe a novel variant of Latent Dirichlet Allocation (LDA) topic modeling, Red-LDA, which takes into account the inherent redundancy of patient records when modeling content of clinical notes. To assess the value of Red-LDA, we experiment with three baselines and our novel redundancy-aware topic modeling method: given a large collection of patient records, (i) apply vanilla LDA to all documents in all input records; (ii) identify and remove all redundancy by chosing a single representative document for each record as input to LDA; (iii) identify and remove all redundant paragraphs in each record, leaving partial, non-redundant documents as input to LDA; and (iv) apply Red-LDA to all documents in all input records. Both quantitative evaluation carried out through log-likelihood on held-out data and topic coherence of produced topics and qualitative assessement of topics carried out by physicians show that Red-LDA produces superior models to all three baseline strategies. This research contributes to the emerging field of understanding the characteristics of the electronic health record and how to account for them in the framework of data mining. The code for the two redundancy-elimination baselines and Red-LDA is made publicly available to the community. PMID:24551060

Redundancy-aware topic modeling for patient record notes.

PubMed

Cohen, Raphael; Aviram, Iddo; Elhadad, Michael; Elhadad, Noémie

2014-01-01

The clinical notes in a given patient record contain much redundancy, in large part due to clinicians' documentation habit of copying from previous notes in the record and pasting into a new note. Previous work has shown that this redundancy has a negative impact on the quality of text mining and topic modeling in particular. In this paper we describe a novel variant of Latent Dirichlet Allocation (LDA) topic modeling, Red-LDA, which takes into account the inherent redundancy of patient records when modeling content of clinical notes. To assess the value of Red-LDA, we experiment with three baselines and our novel redundancy-aware topic modeling method: given a large collection of patient records, (i) apply vanilla LDA to all documents in all input records; (ii) identify and remove all redundancy by chosing a single representative document for each record as input to LDA; (iii) identify and remove all redundant paragraphs in each record, leaving partial, non-redundant documents as input to LDA; and (iv) apply Red-LDA to all documents in all input records. Both quantitative evaluation carried out through log-likelihood on held-out data and topic coherence of produced topics and qualitative assessment of topics carried out by physicians show that Red-LDA produces superior models to all three baseline strategies. This research contributes to the emerging field of understanding the characteristics of the electronic health record and how to account for them in the framework of data mining. The code for the two redundancy-elimination baselines and Red-LDA is made publicly available to the community.

Implementing a bar-coded bedside medication administration system.

PubMed

Yates, Cindy

2007-01-01

Hospitals across the nation are struggling with implementing electronic medication administration and reporting (eMAR) systems as part of patient safety programs. St Luke's Hospital in Chesterfield, Mo, initiated their eMAR initiative in June 2003, initiating program start-up in September 2004. This case study documents how the project was approached, its overall success, and what was learned along the way. Also included is a recent update highlighting the expansion of St Luke's patient safety initiative, adapting eMAR to two specialty units: dialysis and laboratory processes.

Right Brain: The E-lephant in the room: One resident's challenge in transitioning to modern electronic medicine.

PubMed

Strowd, Roy E

2014-09-23

The electronic medical record (EMR) is changing the landscape of medical practice in the modern age. Increasing emphasis on quality metric reporting, data-driven documentation, and timely coding and billing are pressuring institutions across the country to adopt the latest EMR technology. The impact of these systems on the patient-physician relationship is profound. One year following the latest EMR transition, one resident reviews his experience and provides a personal perspective on the impact the EMR on patient-physician communication. © 2014 American Academy of Neurology.

TRIAD IV: Nationwide Survey of Medical Students' Understanding of Living Wills and DNR Orders.

PubMed

Mirarchi, Ferdinando L; Ray, Matthew; Cooney, Timothy

2016-12-01

Living wills are a form of advance directives that help to protect patient autonomy. They are frequently encountered in the conduct of medicine. Because of their impact on care, it is important to understand the adequacy of current medical school training in the preparation of physicians to interpret these directives. Between April and August 2011 of third and fourth year medical students participated in an internet survey involving the interpretation of living wills. The survey presented a standard living will as a "stand-alone," a standard living will with the addition an emergent clinical scenario and then variations of the standard living will that included a code status designation ("DNR," "Full Code," or "Comfort Care"). For each version/ scenario, respondents were asked to assign a code status and choose interventions based on the cases presented. Four hundred twenty-five students from medical schools throughout the country responded. The majority indicated they had received some form of advance directive training and understood the concept of code status and the term "DNR." Based on a stand-alone document, 15% of respondents correctly denoted "full code" as the appropriate code status; adding a clinical scenario yielded negligible improvement. When a code designation was added to the living will, correct code status responses ranged from 68% to 93%, whereas correct treatment decisions ranged from 18% to 78%. Previous training in advance directives had no impact on these results. Our data indicate that the majority of students failed to understand the key elements of a living will; adding a code status designations improved correct responses with the exception of the term DNR. Misunderstanding of advance directives is a nationwide problem and jeopardizes patient safety. Medical School ethics curricula need to be improved to ensure competency with respect to understanding advance directives.

Quality of data regarding diagnoses of spinal disorders in administrative databases. A multicenter study.

PubMed

Faciszewski, T; Broste, S K; Fardon, D

1997-10-01

The purpose of the present study was to evaluate the accuracy of data regarding diagnoses of spinal disorders in administrative databases at eight different institutions. The records of 189 patients who had been managed for a disorder of the lumbar spine were independently reviewed by a physician who assigned the appropriate diagnostic codes according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The age range of the 189 patients was seventeen to eighty-four years. The six major diagnostic categories studied were herniation of a lumbar disc, a previous operation on the lumbar spine, spinal stenosis, cauda equina syndrome, acquired spondylolisthesis, and congenital spondylolisthesis. The diagnostic codes assigned by the physician were compared with the codes that had been assigned during the ordinary course of events by personnel in the medical records department of each of the eight hospitals. The accuracy of coding was also compared among the eight hospitals, and it was found to vary depending on the diagnosis. Although there were both false-negative and false-positive codes at each institution, most errors were related to the low sensitivity of coding for previous spinal operations: only seventeen (28 per cent) of sixty-one such diagnoses were coded correctly. Other errors in coding were less frequent, but their implications for conclusions drawn from the information in administrative databases depend on the frequency of a diagnosis and its importance in an analysis. This study demonstrated that the accuracy of a diagnosis of a spinal disorder recorded in an administrative database varies according to the specific condition being evaluated. It is necessary to document the relative accuracy of specific ICD-9-CM diagnostic codes in order to improve the ability to validate the conclusions derived from investigations based on administrative databases.

Temporal trends in the systemic inflammatory response syndrome, sepsis, and medical coding of sepsis.

PubMed

Thomas, Benjamin S; Jafarzadeh, S Reza; Warren, David K; McCormick, Sandra; Fraser, Victoria J; Marschall, Jonas

2015-11-24

Recent reports using administrative claims data suggest the incidence of community- and hospital-onset sepsis is increasing. Whether this reflects changing epidemiology, more effective diagnostic methods, or changes in physician documentation and medical coding practices is unclear. We performed a temporal-trend study from 2008 to 2012 using administrative claims data and patient-level clinical data of adult patients admitted to Barnes-Jewish Hospital in St. Louis, Missouri. Temporal-trend and annual percent change were estimated using regression models with autoregressive integrated moving average errors. We analyzed 62,261 inpatient admissions during the 5-year study period. 'Any SIRS' (i.e., SIRS on a single calendar day during the hospitalization) and 'multi-day SIRS' (i.e., SIRS on 3 or more calendar days), which both use patient-level data, and medical coding for sepsis (i.e., ICD-9-CM discharge diagnosis codes 995.91, 995.92, or 785.52) were present in 35.3 %, 17.3 %, and 3.3 % of admissions, respectively. The incidence of admissions coded for sepsis increased 9.7 % (95 % CI: 6.1, 13.4) per year, while the patient data-defined events of 'any SIRS' decreased by 1.8 % (95 % CI: -3.2, -0.5) and 'multi-day SIRS' did not change significantly over the study period. Clinically-defined sepsis (defined as SIRS plus bacteremia) and severe sepsis (defined as SIRS plus hypotension and bacteremia) decreased at statistically significant rates of 5.7 % (95 % CI: -9.0, -2.4) and 8.6 % (95 % CI: -4.4, -12.6) annually. All-cause mortality, SIRS mortality, and SIRS and clinically-defined sepsis case fatality did not change significantly during the study period. Sepsis mortality, based on ICD-9-CM codes, however, increased by 8.8 % (95 % CI: 1.9, 16.2) annually. The incidence of sepsis, defined by ICD-9-CM codes, and sepsis mortality increased steadily without a concomitant increase in SIRS or clinically-defined sepsis. Our results highlight the need to develop strategies to integrate clinical patient-level data with administrative data to draw more accurate conclusions about the epidemiology of sepsis.

78 FR 51139 - Notice of Proposed Changes to the National Handbook of Conservation Practices for the Natural...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-20

... (Code 324), Field Border (Code 386), Filter Strip (Code 393), Land Smoothing (Code 466), Livestock... the implementation requirement document to the specifications and plans. Filter Strip (Code 393)--The...

RADTRAD: A simplified model for RADionuclide Transport and Removal And Dose estimation

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

Humphreys, S.L.; Miller, L.A.; Monroe, D.K.

1998-04-01

This report documents the RADTRAD computer code developed for the U.S. Nuclear Regulatory Commission (NRC) Office of Nuclear Reactor Regulation (NRR) to estimate transport and removal of radionuclides and dose at selected receptors. The document includes a users` guide to the code, a description of the technical basis for the code, the quality assurance and code acceptance testing documentation, and a programmers` guide. The RADTRAD code can be used to estimate the containment release using either the NRC TID-14844 or NUREG-1465 source terms and assumptions, or a user-specified table. In addition, the code can account for a reduction in themore » quantity of radioactive material due to containment sprays, natural deposition, filters, and other natural and engineered safety features. The RADTRAD code uses a combination of tables and/or numerical models of source term reduction phenomena to determine the time-dependent dose at user-specified locations for a given accident scenario. The code system also provides the inventory, decay chain, and dose conversion factor tables needed for the dose calculation. The RADTRAD code can be used to assess occupational radiation exposures, typically in the control room; to estimate site boundary doses; and to estimate dose attenuation due to modification of a facility or accident sequence.« less

ICAM (Conceptual Design for Computer-Integrated Manufacturing. Volume 2. Part 6. Task B - Establishment of the Factory of the Future Conceptual Framework Conceptual Framework Document, (MMR)

DTIC Science & Technology

1984-06-29

effort that requires hard copy documentation. As a result, there are generally numerous delays in providing current quality information. In the FoF...process have had fixed controls or were based on " hard -coded" information. A template, for example, is hard -coded information defining the shape of a...represents soft-coded control information. (Although manual handling of punch tapes still possess some of the limitations of " hard -coded" controls

Automatic Certification of Kalman Filters for Reliable Code Generation

NASA Technical Reports Server (NTRS)

Denney, Ewen; Fischer, Bernd; Schumann, Johann; Richardson, Julian

2005-01-01

AUTOFILTER is a tool for automatically deriving Kalman filter code from high-level declarative specifications of state estimation problems. It can generate code with a range of algorithmic characteristics and for several target platforms. The tool has been designed with reliability of the generated code in mind and is able to automatically certify that the code it generates is free from various error classes. Since documentation is an important part of software assurance, AUTOFILTER can also automatically generate various human-readable documents, containing both design and safety related information. We discuss how these features address software assurance standards such as DO-178B.

What is competent communication behaviour of patients in physician consultations? - Chronically-ill patients answer in focus groups.

PubMed

Schmidt, Erika; Schöpf, Andrea C; Farin, Erik

2017-09-01

Many desirable outcomes depend on good patient-physician communication. Patient-based perspectives of what constitutes competent communication behavior with physicians are needed for patient-oriented health care. Therefore it was our main aim to identify competent patient communication skills from the patient's perspective. We also wanted to reveal any differences in opinion among various groups (chronic ischemic heart disease, chronic low back pain, breast cancer). This study examined nine guideline-supported focus groups in rehabilitation centers. The criterion for study inclusion was any one of the three diagnoses. Enrolled in the study were N = 49 patients (32 women) aged M = 60.1 (SD = 12.8). The interview recordings were transcribed and subjected to content analysis. We documented 396 commentaries in these interviews that were allocated to 82 different codes; these in turn resulted in the formation of 12 main topics. Examples are: posing questions, being an active and participatory patient, being aware of emotions and communicating them. This study represents stage two ('documentation of patient and clinician views') in the seven-stage model of communication research. Findings reveal that chronically-ill patients name behaviours that contribute to successful discussion with a physician. These enable us to develop communication trainings and design-measuring tools used for patient-based communication skills.

Differentiation of ileostomy from colostomy procedures: assessing the accuracy of current procedural terminology codes and the utility of natural language processing.

PubMed

Vo, Elaine; Davila, Jessica A; Hou, Jason; Hodge, Krystle; Li, Linda T; Suliburk, James W; Kao, Lillian S; Berger, David H; Liang, Mike K

2013-08-01

Large databases provide a wealth of information for researchers, but identifying patient cohorts often relies on the use of current procedural terminology (CPT) codes. In particular, studies of stoma surgery have been limited by the accuracy of CPT codes in identifying and differentiating ileostomy procedures from colostomy procedures. It is important to make this distinction because the prevalence of complications associated with stoma formation and reversal differ dramatically between types of stoma. Natural language processing (NLP) is a process that allows text-based searching. The Automated Retrieval Console is an NLP-based software that allows investigators to design and perform NLP-assisted document classification. In this study, we evaluated the role of CPT codes and NLP in differentiating ileostomy from colostomy procedures. Using CPT codes, we conducted a retrospective study that identified all patients undergoing a stoma-related procedure at a single institution between January 2005 and December 2011. All operative reports during this time were reviewed manually to abstract the following variables: formation or reversal and ileostomy or colostomy. Sensitivity and specificity for validation of the CPT codes against the mastery surgery schedule were calculated. Operative reports were evaluated by use of NLP to differentiate ileostomy- from colostomy-related procedures. Sensitivity and specificity for identifying patients with ileostomy or colostomy procedures were calculated for CPT codes and NLP for the entire cohort. CPT codes performed well in identifying stoma procedures (sensitivity 87.4%, specificity 97.5%). A total of 664 stoma procedures were identified by CPT codes between 2005 and 2011. The CPT codes were adequate in identifying stoma formation (sensitivity 97.7%, specificity 72.4%) and stoma reversal (sensitivity 74.1%, specificity 98.7%), but they were inadequate in identifying ileostomy (sensitivity 35.0%, specificity 88.1%) and colostomy (75.2% and 80.9%). NLP performed with greater sensitivity, specificity, and accuracy than CPT codes in identifying stoma procedures and stoma types. Major differences where NLP outperformed CPT included identifying ileostomy (specificity 95.8%, sensitivity 88.3%, and accuracy 91.5%) and colostomy (97.6%, 90.5%, and 92.8%, respectively). CPT codes can identify effectively patients who have had stoma procedures and are adequate in distinguishing between formation and reversal; however, CPT codes cannot differentiate ileostomy from colostomy. NLP can be used to differentiate between ileostomy- and colostomy-related procedures. The role of NLP in conjunction with electronic medical records in data retrieval warrants further investigation. Published by Mosby, Inc.

Comparison of handheld computer-assisted and conventional paper chart documentation of medical records. A randomized, controlled trial.

PubMed

Stengel, Dirk; Bauwens, Kai; Walter, Martin; Köpfer, Thilo; Ekkernkamp, Axel

2004-03-01

Daily documentation and maintenance of medical record quality is a crucial issue in orthopaedic surgery. The purpose of the present study was to determine whether the introduction of a handheld computer could improve both the quantitative and qualitative aspects of medical records. A series of consecutive patients who were admitted for the first time to a thirty-six-bed orthopaedic ward of an academic teaching hospital for a planned operation or any other treatment of an acute injury or chronic condition were randomized to daily documentation of their clinical charts on a handheld computer or on conventional paper forms. The electronic documentation consisted of a specially designed software package on a handheld computer for bedside use with structured decision trees for examination, obtaining a history, and coding. In the control arm, chart notes were compiled on standard paper forms and were subsequently entered into the hospital's information system. The number of documented ICD (International Classification of Diseases) diagnoses was the primary end point for sample size calculations. All patient charts were reread by an expert panel consisting of two surgeons and the surgical quality assurance manager. These experts assigned quality ratings to the different documentation systems by scrutinizing the extent and accuracy of the patient histories and the physical findings as assessed by daily chart notes. Eighty patients were randomized to one of the two documentation arms, and seventy-eight (forty-seven men and thirty-one women) of them were eligible for final analysis. Documentation with the handheld computer increased the median number of diagnoses per patients from four to nine (p < 0.0001), but it produced some overcoding for false or redundant items. Documentation quality ratings improved significantly with the introduction of the handheld device (p < 0.01) with respect to the correct assessment of a patient's progress and translation into ICD diagnoses. Various learning curve effects were observed with different operators. Study physicians assigned slightly better practicability ratings to the handheld device. The preliminary data from this study suggest that handheld computers may improve the quality of hospital charts in orthopaedic surgery. Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.

The Proteus Navier-Stokes code

NASA Technical Reports Server (NTRS)

Towne, Charles E.; Bui, Trong T.; Cavicchi, Richard H.; Conley, Julianne M.; Molls, Frank B.; Schwab, John R.

1992-01-01

An effort is currently underway at NASA Lewis to develop two- and three-dimensional Navier-Stokes codes, called Proteus, for aerospace propulsion applications. The emphasis in the development of Proteus is not algorithm development or research on numerical methods, but rather the development of the code itself. The objective is to develop codes that are user-oriented, easily-modified, and well-documented. Well-proven, state-of-the-art solution algorithms are being used. Code readability, documentation (both internal and external), and validation are being emphasized. This paper is a status report on the Proteus development effort. The analysis and solution procedure are described briefly, and the various features in the code are summarized. The results from some of the validation cases that have been run are presented for both the two- and three-dimensional codes.

Proximity to Industrial Food Animal Production and Asthma Exacerbations in Pennsylvania, 2005-2012.

PubMed

Rasmussen, Sara G; Casey, Joan A; Bandeen-Roche, Karen; Schwartz, Brian S

2017-03-31

The research on industrial food animal production (IFAP) and asthma exacerbations in the United States has relied on small sample sizes and/or self-reported outcomes. We assessed associations of proximity to large-scale and densely stocked swine and dairy/veal IFAP with three types of asthma exacerbations: hospitalizations, emergency encounters, and oral corticosteroid (OCS) medication orders from Geisinger Clinic in Pennsylvania. We used a diagnosis code ( International Classification of Diseases, 9th Revision, Clinical Modification code 493.x) and medication orders from electronic health records to identify these exacerbations among asthma patients ( n = 35,269) from 2005-2012. We compared residential proximity to swine or dairy/veal IFAP (dichotomized as <3 miles (4.8 km) or ≥3 miles) among asthma patients with and without exacerbations and estimated odds ratios using multilevel logistic regression. In adjusted models, proximity to IFAP was associated (odds ratio (95% confidence interval)) with OCS orders (1.11 (1.04-1.19)) and hospitalizations (1.29 (1.15-1.46)), but not emergency encounters (1.12 (0.91-1.37)). This study contributes to growing evidence that IFAP may impact health, in this case clinically-documented asthma exacerbations. No prior study has evaluated the association of IFAP and clinically-documented asthma exacerbations in the United States.

Determining Multiple Sclerosis Phenotype from Electronic Medical Records.

PubMed

Nelson, Richard E; Butler, Jorie; LaFleur, Joanne; Knippenberg, Kristin; C Kamauu, Aaron W; DuVall, Scott L

2016-12-01

Multiple sclerosis (MS), a central nervous system disease in which nerve signals are disrupted by scarring and demyelination, is classified into phenotypes depending on the patterns of cognitive or physical impairment progression: relapsing-remitting MS (RRMS), primary-progressive MS (PPMS), secondary-progressive MS (SPMS), or progressive-relapsing MS (PRMS). The phenotype is important in managing the disease and determining appropriate treatment. The ICD-9-CM code 340.0 is uninformative about MS phenotype, which increases the difficulty of studying the effects of phenotype on disease. To identify MS phenotype using natural language processing (NLP) techniques on progress notes and other clinical text in the electronic medical record (EMR). Patients with at least 2 ICD-9-CM codes for MS (340.0) from 1999 through 2010 were identified from nationwide EMR data in the Department of Veterans Affairs. Clinical experts were interviewed for possible keywords and phrases denoting MS phenotype in order to develop a data dictionary for NLP. For each patient, NLP was used to search EMR clinical notes, since the first MS diagnosis date for these keywords and phrases. Presence of phenotype-related keywords and phrases were analyzed in context to remove mentions that were negated (e.g., "not relapsing-remitting") or unrelated to MS (e.g., "RR" meaning "respiratory rate"). One thousand mentions of MS phenotype were validated, and all records of 150 patients were reviewed for missed mentions. There were 7,756 MS patients identified by ICD-9-CM code 340.0. MS phenotype was identified for 2,854 (36.8%) patients, with 1,836 (64.3%) of those having just 1 phenotype mentioned in their EMR clinical notes: 1,118 (39.2%) RRMS, 325 (11.4%) PPMS, 374 (13.1%) SPMS, and 19 (0.7%) PRMS. A total of 747 patients (26.2%) had 2 phenotypes, the most common being 459 patients (16.1%) with RRMS and SPMS. A total of 213 patients (7.5%) had 3 phenotypes, and 58 patients (2.0%) had 4 phenotypes mentioned in their EMR clinical notes. Positive predictive value of phenotype identification was 93.8% with sensitivity of 94.0%. Phenotype was documented for slightly more than one third of MS patients, an important but disappointing finding that sets a limit on studying the effects of phenotype on MS in general. However, for cases where the phenotype was documented, NLP accurately identified the phenotypes. Having multiple phenotypes documented is consistent with disease progression. The most common misidentification was because of ambiguity while clinicians were trying to determine phenotype. This study brings attention to the need for care providers to document MS phenotype more consistently and provides a solution for capturing phenotype from clinical text. This study was funded by Anolinx and F. Hoffman-La Roche. Nelson serves as a consultant for Anolinx. Kamauu is owner of Anolinx, which has received multiple research grants from pharmaceutical and biotechnology companies. LaFleur has received a Novartis grant for ongoing work. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the U.S. government. Study concept and design were contributed by Butler, LaFleur, Kamauu, DuVall, and Nelson. DuVall collected the data, and interpretation was performed by Nelson, DuVall, and Kamauu, along with Butler, LaFleur, and Knippenberg. The manuscript was written primarily by Nelson, along with Knippenberg and assisted by the other authors, and revised by Knippenberg, Nelson, and DuVall, along with the other authors.

How to Link to Official Documents from the Government Publishing Office (GPO)

EPA Pesticide Factsheets

The most consistent way to present up-to-date content from the Federal Register, US Code, Code of Federal Regulations (CFR), and so on is to link to the official version of the document on the GPO's Federal Digital System (FDSys) website.

Code of ethics for the national pharmaceutical system: Codifying and compilation

PubMed Central

Salari, Pooneh; Namazi, Hamidreza; Abdollahi, Mohammad; Khansari, Fatemeh; Nikfar, Shekoufeh; Larijani, Bagher; Araminia, Behin

2013-01-01

Pharmacists as one of health-care providers face ethical issues in terms of pharmaceutical care, relationship with patients and cooperation with the health-care team. Other than pharmacy, there are pharmaceutical companies in various fields of manufacturing, importing or distributing that have their own ethical issues. Therefore, pharmacy practice is vulnerable to ethical challenges and needs special code of conducts. On feeling the need, based on a shared project between experts of the ethics from relevant research centers, all the needs were fully recognized and then specified code of conduct for each was written. The code of conduct was subject to comments of all experts involved in the pharmaceutical sector and thus criticized in several meetings. The prepared code of conduct is comprised of professional code of ethics for pharmacists, ethics guideline for pharmaceutical manufacturers, ethics guideline for pharmaceutical importers, ethics guideline for pharmaceutical distributors, and ethics guideline for policy makers. The document was compiled based on the principles of bioethics and professionalism. The compiling the code of ethics for the national pharmaceutical system is the first step in implementing ethics in pharmacy practice and further attempts into teaching the professionalism and the ethical code as the necessary and complementary effort are highly recommended. PMID:24174954

The frequency of adverse drug reaction related admissions according to method of detection, admission urgency and medical department specialty

PubMed Central

Brvar, Miran; Fokter, Nina; Bunc, Matjaz; Mozina, Martin

2009-01-01

Background Adverse Drug Reactions (ADRs) have been regarded as a major public health problem since they represent a sizable percentage of admissions. Unfortunately, there is a wide variation of ADR related admissions among different studies. The aim of this study was to evaluate the frequency of ADR related admissions and its dependency on reporting and method of detection, urgency of admissions and included medical departments reflecting department/hospital type within one study. Methods The study team of internal medicine specialists retrospectively reviewed 520 randomly selected medical records (3%) of patients treated in the medical departments of the primary city and tertiary referral governmental hospital for certain ADRs causing admissions regarding WHO causality criteria. All medical records were checked for whether the treating physicians recognised and documented ADRs causing admissions. The hospital information system was checked to ensure ADR related diagnoses were properly coded and the database of a national spontaneous reporting system was searched for patients with ADRs included in this study. Results The established frequency of admissions due to certain ADRs recognised by the study team and documented in medical records by the treating physicians was the same and represented 5.8% of all patients (30/520). The frequency of ADR causing admissions detected by employing a computer-assisted approach using an ICD-10 coding system was 0.2% (1/520), and no patient admitted due to ADRs was reported to the national reporting system (0/520). The recognized frequency of ADR related admissions also depends on the department's specialty (p = 0.001) and acceptance of urgently admitted patients (p = 0.001). Patients admitted due to ADRs were significantly older compared to patients without ADRs (p = 0.025). Gastrointestinal bleeding due to NSAID, acetylsalicylic acid and warfarin was the most common ADR that resulted in admission and represented 40% of all certain ADRs (12/30) according to WHO causality criteria. Conclusion ADRs cause 5.8% of admissions in medical departments in the primary city and tertiary referral hospital. The physicians recognise certain ADR related admissions according to WHO causality criteria and note them in medical records, but they rarely code and report ADRs. The established frequency of ADR related admissions depends on the detection method, department specialty and frequency of urgently admitted patients. PMID:19409112

Volume I: fluidized-bed code documentation, for the period February 28, 1983-March 18, 1983

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

Piperopoulou, H.; Finson, M.; Bloomfield, D.

1983-03-01

This documentation supersedes the previous documentation of the Fluidized-Bed Gasifier code. Volume I documents a simulation program of a Fluidized-Bed Gasifier (FBG), and Volume II documents a systems model of the FBG. The FBG simulation program is an updated version of the PSI/FLUBED code which is capable of modeling slugging beds and variable bed diameter. In its present form the code is set up to model a Westinghouse commercial scale gasifier. The fluidized bed gasifier model combines the classical bubbling bed description for the transport and mixing processes with PSI-generated models for coal chemistry. At the distributor plate, the bubblemore » composition is that of the inlet gas and the initial bubble size is set by the details of the distributor plate. Bubbles grow by coalescence as they rise. The bubble composition and temperature change with height due to transport to and from the cloud as well as homogeneous reactions within the bubble. The cloud composition also varies with height due to cloud/bubble exchange, cloud/emulsion, exchange, and heterogeneous coal char reactions. The emulsion phase is considered to be well mixed.« less

Challenges to nurses' efforts of retrieving, documenting, and communicating patient care information.

PubMed

Keenan, Gail; Yakel, Elizabeth; Dunn Lopez, Karen; Tschannen, Dana; Ford, Yvonne B

2013-01-01

To examine information flow, a vital component of a patient's care and outcomes, in a sample of multiple hospital nursing units to uncover potential sources of error and opportunities for systematic improvement. This was a qualitative study of a sample of eight medical-surgical nursing units from four diverse hospitals in one US state. We conducted direct work observations of nursing staff's communication patterns for entire shifts (8 or 12 h) for a total of 200 h and gathered related documentation artifacts for analyses. Data were coded using qualitative content analysis procedures and then synthesized and organized thematically to characterize current practices. Three major themes emerged from the analyses, which represent serious vulnerabilities in the flow of patient care information during nurse hand-offs and to the entire interdisciplinary team across time and settings. The three themes are: (1) variation in nurse documentation and communication; (2) the absence of a centralized care overview in the patient's electronic health record, ie, easily accessible by the entire care team; and (3) rarity of interdisciplinary communication. The care information flow vulnerabilities are a catalyst for multiple types of serious and undetectable clinical errors. We have two major recommendations to address the gaps: (1) to standardize the format, content, and words used to document core information, such as the plan of care, and make this easily accessible to all team members; (2) to conduct extensive usability testing to ensure that tools in the electronic health record help the disconnected interdisciplinary team members to maintain a shared understanding of the patient's plan.

Challenges to nurses' efforts of retrieving, documenting, and communicating patient care information

PubMed Central

Yakel, Elizabeth; Dunn Lopez, Karen; Tschannen, Dana; Ford, Yvonne B

2013-01-01

Objective To examine information flow, a vital component of a patient's care and outcomes, in a sample of multiple hospital nursing units to uncover potential sources of error and opportunities for systematic improvement. Design This was a qualitative study of a sample of eight medical–surgical nursing units from four diverse hospitals in one US state. We conducted direct work observations of nursing staff's communication patterns for entire shifts (8 or 12 h) for a total of 200 h and gathered related documentation artifacts for analyses. Data were coded using qualitative content analysis procedures and then synthesized and organized thematically to characterize current practices. Results Three major themes emerged from the analyses, which represent serious vulnerabilities in the flow of patient care information during nurse hand-offs and to the entire interdisciplinary team across time and settings. The three themes are: (1) variation in nurse documentation and communication; (2) the absence of a centralized care overview in the patient's electronic health record, ie, easily accessible by the entire care team; and (3) rarity of interdisciplinary communication. Conclusion The care information flow vulnerabilities are a catalyst for multiple types of serious and undetectable clinical errors. We have two major recommendations to address the gaps: (1) to standardize the format, content, and words used to document core information, such as the plan of care, and make this easily accessible to all team members; (2) to conduct extensive usability testing to ensure that tools in the electronic health record help the disconnected interdisciplinary team members to maintain a shared understanding of the patient's plan. PMID:22822042

NMC code advice on digital communications.

PubMed

Moorley, Calvin; Watson, Roger

Nurses and midwives are increasingly using social media as a professional tool. This is reflected in the Nursing and Midwifery Council's (NMC) new professional code, which says nurses must use social media and other communication responsibly, respecting the right to privacy of others at all times. A growing body of literature documents the positive influence social media, when used appropriately, can have on nurses' practice and the care they deliver to patients. However, nurses need more guidance and training to ensure online professionalism and appropriate behaviour online. Requiring nurses and midwives to complete an online continuous professional development course on social networking at the point of revalidation could keep them up to date and promote online professionalism.

Informatics can identify systemic sclerosis (SSc) patients at risk for scleroderma renal crisis.

PubMed

Redd, Doug; Frech, Tracy M; Murtaugh, Maureen A; Rhiannon, Julia; Zeng, Qing T

2014-10-01

Electronic medical records (EMR) provide an ideal opportunity for the detection, diagnosis, and management of systemic sclerosis (SSc) patients within the Veterans Health Administration (VHA). The objective of this project was to use informatics to identify potential SSc patients in the VHA that were on prednisone, in order to inform an outreach project to prevent scleroderma renal crisis (SRC). The electronic medical data for this study came from Veterans Informatics and Computing Infrastructure (VINCI). For natural language processing (NLP) analysis, a set of retrieval criteria was developed for documents expected to have a high correlation to SSc. The two annotators reviewed the ratings to assemble a single adjudicated set of ratings, from which a support vector machine (SVM) based document classifier was trained. Any patient having at least one document positively classified for SSc was considered positive for SSc and the use of prednisone≥10mg in the clinical document was reviewed to determine whether it was an active medication on the prescription list. In the VHA, there were 4272 patients that have a diagnosis of SSc determined by the presence of an ICD-9 code. From these patients, 1118 patients (21%) had the use of prednisone≥10mg. Of these patients, 26 had a concurrent diagnosis of hypertension, thus these patients should not be on prednisone. By the use of natural language processing (NLP) an additional 16,522 patients were identified as possible SSc, highlighting that cases of SSc in the VHA may exist that are unidentified by ICD-9. A 10-fold cross validation of the classifier resulted in a precision (positive predictive value) of 0.814, recall (sensitivity) of 0.973, and f-measure of 0.873. Our study demonstrated that current clinical practice in the VHA includes the potentially dangerous use of prednisone for veterans with SSc. This present study also suggests there may be many undetected cases of SSc and NLP can successfully identify these patients. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Library Systems Act and Rules for Administering the Library Systems Act.

ERIC Educational Resources Information Center

Texas State Library, Austin. Library Development Div.

This document contains the Texas Library Systems Act and rules for administering the Library Systems Act. Specifically, it includes the following documents: Texas Library Systems Act; Summary of Codes;Texas Administrative Code: Service Complaints and Protest Procedure; Criteria For Texas Library System Membership; and Certification Requirements…

Validity of ICD-9-CM codes for breast, lung and colorectal cancers in three Italian administrative healthcare databases: a diagnostic accuracy study protocol.

PubMed

Abraha, Iosief; Serraino, Diego; Giovannini, Gianni; Stracci, Fabrizio; Casucci, Paola; Alessandrini, Giuliana; Bidoli, Ettore; Chiari, Rita; Cirocchi, Roberto; De Giorgi, Marcello; Franchini, David; Vitale, Maria Francesca; Fusco, Mario; Montedori, Alessandro

2016-03-25

Administrative healthcare databases are useful tools to study healthcare outcomes and to monitor the health status of a population. Patients with cancer can be identified through disease-specific codes, prescriptions and physician claims, but prior validation is required to achieve an accurate case definition. The objective of this protocol is to assess the accuracy of International Classification of Diseases Ninth Revision-Clinical Modification (ICD-9-CM) codes for breast, lung and colorectal cancers in identifying patients diagnosed with the relative disease in three Italian administrative databases. Data from the administrative databases of Umbria Region (910,000 residents), Local Health Unit 3 of Napoli (1,170,000 residents) and Friuli--Venezia Giulia Region (1,227,000 residents) will be considered. In each administrative database, patients with the first occurrence of diagnosis of breast, lung or colorectal cancer between 2012 and 2014 will be identified using the following groups of ICD-9-CM codes in primary position: (1) 233.0 and (2) 174.x for breast cancer; (3) 162.x for lung cancer; (4) 153.x for colon cancer and (5) 154.0-154.1 and 154.8 for rectal cancer. Only incident cases will be considered, that is, excluding cases that have the same diagnosis in the 5 years (2007-2011) before the period of interest. A random sample of cases and non-cases will be selected from each administrative database and the corresponding medical charts will be assessed for validation by pairs of trained, independent reviewers. Case ascertainment within the medical charts will be based on (1) the presence of a primary nodular lesion in the breast, lung or colon-rectum, documented with imaging or endoscopy and (2) a cytological or histological documentation of cancer from a primary or metastatic site. Sensitivity and specificity with 95% CIs will be calculated. Study results will be disseminated widely through peer-reviewed publications and presentations at national and international conferences. 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/

Code Status Reconciliation to Improve Identification and Documentation of Code Status in Electronic Health Records.

PubMed

Jain, Viral G; Greco, Peter J; Kaelber, David C

2017-03-08

Code status (CS) of a patient (part of their end-of-life wishes) can be critical information in healthcare delivery, which can change over time, especially at transitions of care. Although electronic health record (EHR) tools exist for medication reconciliation across transitions of care, much less attention is given to CS, and standard EHR tools have not been implemented for CS reconciliation (CSR). Lack of CSR creates significant potential patient safety and quality of life issues. To study the tools, workflow, and impact of clinical decision support (CDS) for CSR. We established rules for CS implementation in our EHR. At admission, a CS is required as part of a patient's admission order set. Using standard CDS tools in our EHR, we built an interruptive alert for CSR at discharge if a patient did not have the same inpatient (current) CS at discharge as that prior to admission CS. Of 80,587 admissions over a four year period (2 years prior to and post CSR implementation), CS discordance was seen in 3.5% of encounters which had full code status prior to admission, but Do Not Resuscitate (DNR) CS at discharge. In addition, 1.4% of the encounters had a different variant of the DNR CS at discharge when compared with CS prior to admission. On pre-post CSR implementation analysis, DNR CS per 1000 admissions per month increased significantly among patients discharged and in patients being admitted (mean ± SD: 85.36 ± 13.69 to 399.85 ± 182.86, p<0.001; and 1.99 ± 1.37 vs 16.70 ± 4.51, p<0.001, respectively). EHR enabled CSR is effective and represents a significant informatics opportunity to help honor patients' end-of-life wishes. CSR represents one example of non-medication reconciliation at transitions of care that should be considered in all EHRs to improve care quality and patient safety.

Using a public hospital funding model to strengthen a case for improved nutritional care in a cancer setting.

PubMed

Boltong, Anna G; Loeliger, Jenelle M; Steer, Belinda L

2013-06-01

This study aimed to measure the prevalence of malnutrition risk and assessed malnutrition in patients admitted to a cancer-specific public hospital, and to model the potential hospital funding opportunity associated with implementing routine malnutrition screening. A point-prevalence audit of malnutrition risk and diagnosable malnutrition was conducted. A retrospective audit of hospital funding associated with documented cases of malnutrition was conducted. Audit results were used to estimate annual malnutrition prevalence, associated casemix-based reimbursement potential and the clinical support resources required to adequately identify and treat malnutrition. Sixty-four percent of inpatients were at risk of malnutrition. Of these, 90% were assessed as malnourished. Twelve percent of malnourished patients produced a positive change in the diagnosis-related group (DRG) and increased allocated financial reimbursement. Identifying and diagnosing all cases of malnutrition could contribute an additional AU$413644 reimbursement funding annually. Early identification of malnutrition may expedite appropriate nutritional management and improve patient outcomes in addition to contributing to casemix-based reimbursement funding for health services. A successful business case for additional clinical resources to improve nutritional care was aided by demonstrating the link between malnutrition screening, hospital reimbursements and improved nutritional care. What is known about the topic? It is known that between 20 and 50% of hospital patients are malnourished and oncology patients are 1.7 times more likely to be malnourished than are other hospitalised patients. Despite the existence of practice guidelines for malnutrition screening of at-risk oncology patients, these are not routinely implemented. Identification of malnutrition in hospitalised patients is linked to casemix funding via DRG. Casemix reimbursement for malnutrition can be enhanced if: (1) malnutrition risk is identified; (2) malnutrition is diagnosed; (3) the word 'malnutrition' and an associated action plan is documented in the medical record; and (4) malnutrition is recognised and recorded by the clinical coder. Amendments to the ICD-10-AM in 2008 allowing malnutrition to be recognised as a complication for coding when it is documented by a dietitian in the medical history has hospital reimbursement implications for dietetic practice. Reimbursement potential for malnutrition has been calculated in public hospitals in Australia with varying results. What does this paper add? This paper reports the components of a successful business case made to enhance resources for identification and treatment of malnutrition on the basis of improved treatment as well as enhanced reimbursement potential resulting from changes to the ICD-10-AM. The present study adds to the body of literature showing that malnutrition coding contributes to casemix funding in Australian public hospitals, as well as internationally, and highlights the previously unreported opportunity for a cancer-specific health service. This work demonstrated that reassignment of a DRG based on a diagnosis of malnutrition altered the overall casemix funding value for 12% of audited patients. This compares with the findings of other authors who demonstrated hypothetical DRG changes and financial reallocation. What are the implications for practitioners? This paper highlights that practitioner-centred strategies are needed to enhance malnutrition identification, diagnosis, documentation and coding to maximise casemix reimbursement and better treat malnutrition in hospitals. Strategies include education of the dietetics, medical and health-information workforce. This manuscript provides a description of the conduct of quality-improvement activities that may support successful business cases for increased dietetic resources in future.

TFaNS Tone Fan Noise Design/Prediction System. Volume 1; System Description, CUP3D Technical Documentation and Manual for Code Developers

NASA Technical Reports Server (NTRS)

Topol, David A.

1999-01-01

TFaNS is the Tone Fan Noise Design/Prediction System developed by Pratt & Whitney under contract to NASA Lewis (presently NASA Glenn). The purpose of this system is to predict tone noise emanating from a fan stage including the effects of reflection and transmission by the rotor and stator and by the duct inlet and nozzle. These effects have been added to an existing annular duct/isolated stator noise prediction capability. TFaNS consists of: The codes that compute the acoustic properties (reflection and transmission coefficients) of the various elements and write them to files. Cup3D: Fan Noise Coupling Code that reads these files, solves the coupling problem, and outputs the desired noise predictions. AWAKEN: CFD/Measured Wake Postprocessor which reformats CFD wake predictions and/or measured wake data so it can be used by the system. This volume of the report provides technical background for TFaNS including the organization of the system and CUP3D technical documentation. This document also provides information for code developers who must write Acoustic Property Files in the CUP3D format. This report is divided into three volumes: Volume I: System Description, CUP3D Technical Documentation, and Manual for Code Developers; Volume II: User's Manual, TFaNS Vers. 1.4; Volume III: Evaluation of System Codes.

The diagnosis related groups enhanced electronic medical record.

PubMed

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

2003-07-01

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

The Nuremberg Code-A critique.

PubMed

Ghooi, Ravindra B

2011-04-01

The Nuremberg Code drafted at the end of the Doctor's trial in Nuremberg 1947 has been hailed as a landmark document in medical and research ethics. Close examination of this code reveals that it was based on the Guidelines for Human Experimentation of 1931. The resemblance between these documents is uncanny. It is unfortunate that the authors of the Nuremberg Code passed it off as their original work. There is evidence that the defendants at the trial did request that their actions be judged on the basis of the 1931 Guidelines, in force in Germany. The prosecutors, however, ignored the request and tried the defendants for crimes against humanity, and the judges included the Nuremberg Code as a part of the judgment. Six of ten principles in Nuremberg Code are derived from the 1931 Guidelines, and two of four newly inserted principles are open to misinterpretation. There is little doubt that the Code was prepared after studying the Guidelines, but no reference was made to the Guidelines, for reasons that are not known. Using the Guidelines as a base document without giving due credit is plagiarism; as per our understanding of ethics today, this would be considered unethical. The Nuremberg Code has fallen by the wayside; since unlike the Declaration of Helsinki, it is not regularly reviewed and updated. The regular updating of some ethics codes is evidence of the evolving nature of human ethics.

Gender Differences in CDC Guideline Compliance for STIs in Emergency Departments.

PubMed

Kane, Bryan G; Guillaume, Alexander W D; Evans, Elizabeth M; Goyke, Terrence E; Eygnor, Jessica K; Semler, Lauren; Dusza, Stephen W; Greenberg, Marna Rayl

2017-04-01

Sexually transmitted infections (STIs) are a common reason for emergency department (ED) visits. The objective of this study was to determine if there were gender differences in adherence to Centers for Disease Control and Prevention (CDC) STI diagnosis and treatment guidelines, as documented by emergency providers. We performed a retrospective chart review to identify patients treated for urethritis, cervicitis, and pelvic inflammatory disease (PID) in the EDs of three hospitals in a Pennsylvania network during a calendar year. Cases were reviewed to assess for compliance with CDC guidelines. We used descriptive statistics to assess the distributions of study variables by patient sex. In the analysis we used Student's t-tests, chi-square tests, and logistic regression. Statistical significance was set at p ≤ 0.05. We identified 286 patient records. Of these, we excluded 39 for the following reasons: incorrect disease coding; the patient was admitted and treated as an inpatient for his/her disease; or the patient left the ED after refusing care. Of the 247 participants, 159 (64.4%) were female. Females were significantly younger (26.6 years, SD=8.0) than males (31.2, SD=11.5%), (95% confidence interval [CI] [2.0- 7.0], p=0.0003). All of the males (n=88) in the cohort presented with urethritis; 25.8% of females presented with cervicitis, and 74.2% with PID. Physician compliance for the five CDC criteria ranged from 68.8% for patient history to 93.5% for patient diagnostic testing, including urine pregnancy and gonorrhea/chlamydia cultures. We observed significant differences by patient sex. Fifty-four percent of the charts had symptoms recorded for female patients that were consistent with CDC characteristics for diagnostic criteria compared to over 95% for males, OR=16.9; 95% CI [5.9-48.4], p<0.001. Similar results were observed for patient discharge instructions, with physicians completely documenting delivery of discharge instructions to 51.6% of females compared to 97.7% of complete documentation in males, OR=42.3; 95% CI [10.0-178.6] p<0.001). We observed no significant sex differences in physician documentation for physical exam or for therapeutic antibiotic treatment. This retrospective study found patient gender differences in how emergency providers complied with documenting with regard to the 2010 CDC guidelines for the diagnosis and treatment of urethritis, cervicitis, and PID. Specifically medical records of men were more likely to have complete documentation of symptoms recorded (95% CI 5.9-48.4) and to have discharge instruction documentation (95% CI 10.0-178.6) than records of women.

Ischaemic stroke management at Al-Shifa Hospital in the Gaza Strip: a clinical audit.

PubMed

Abukaresh, Amir; Al-Abadlah, Rami; Böttcher, Bettina; El-Essi, Khamis

2018-02-21

In the 2014 Palestinian annual health report, cerebrovascular accident was ranked as the third leading cause of death in the occupied Palestinian territory. Cerebrovascular accident is also one the most common causes of disability worldwide. Good management decreases mortality and morbidity. The aim of this study was to assess the current management of patients with ischaemic stroke at the Al-Shifa Hospital and to compare this with international guidelines. For this clinical audit, we used simple random sampling to select files of patients admitted with the diagnosis of ischaemic stroke to the Al-Shifa Hospital. Data collection sheets were completed, and clinical practice was compared with the 2013 American Stroke Association guidelines. Between January and June, 2016, 254 patients were admitted with ischaemic stroke, haemorrhagic stroke, or transient ischaemic attack. We selected 55 patient files. The International Classification of Diseases coding for cerebral infarction in patient files was relatively good, with 92% of files correctly coded. However, we found a substantial weakness in the documentation of duration, progression of symptoms (documented in 20% of files only), and physiotherapy assessment. Most essential acute investigations were done on time (for all [100%] patients needing blood count, renal function tests, and CT scan and for 42 [76%] patients needing ECG). However, thrombolytic drugs were not used because they were not available. Long-term antiplatelet therapy was provided properly to 51 (92%) patients discharged from hospital. However, the initial doses of antiplatelet therapy were generally lower than the international recommendations. Findings also showed a marked inconformity of blood pressure management, especially with respect to the treatment decision and the choice of antihypertensive drug. No local guidelines exist. Furthermore, the lack of availability of thrombolysis medication and the poor deviation in blood pressure management show a lack of evidence-based practice. These findings point to the urgent need for the development of local, evidence-based guidelines. None. Copyright © 2018 Elsevier Ltd. All rights reserved.

"First-person view" of pathogen transmission and hand hygiene - use of a new head-mounted video capture and coding tool.

PubMed

Clack, Lauren; Scotoni, Manuela; Wolfensberger, Aline; Sax, Hugo

2017-01-01

Healthcare workers' hands are the foremost means of pathogen transmission in healthcare, but detailed hand trajectories have been insufficiently researched so far. We developed and applied a new method to systematically document hand-to-surface exposures (HSE) to delineate true hand transmission pathways in real-life healthcare settings. A head-mounted camera and commercial coding software were used to capture ten active care episodes by eight nurses and two physicians and code HSE type and duration using a hierarchical coding scheme. We identified HSE sequences of particular relevance to infectious risks for patients based on the WHO 'Five Moments for Hand Hygiene'. The study took place in a trauma intensive care unit in a 900-bed university hospital in Switzerland. Overall, the ten videos totaled 296.5 min and featured eight nurses and two physicians. A total of 4222 HSE were identified (1 HSE every 4.2 s), which concerned bare (79%) and gloved (21%) hands. The HSE inside the patient zone ( n  = 1775; 42%) included mobile objects (33%), immobile surfaces (5%), and patient intact skin (4%), while HSE outside the patient zone ( n  = 1953; 46%) included HCW's own body (10%), mobile objects (28%), and immobile surfaces (8%). A further 494 (12%) events involved patient critical sites. Sequential analysis revealed 291 HSE transitions from outside to inside patient zone, i.e. "colonization events", and 217 from any surface to critical sites, i.e. "infection events". Hand hygiene occurred 97 times, 14 (5% adherence) times at colonization events and three (1% adherence) times at infection events. On average, hand rubbing lasted 13 ± 9 s. The abundance of HSE underscores the central role of hands in the spread of potential pathogens while hand hygiene occurred rarely at potential colonization and infection events. Our approach produced a valid video and coding instrument for in-depth analysis of hand trajectories during active patient care that may help to design more efficient prevention schemes.

An Integrative Model of Patient-Centeredness – A Systematic Review and Concept Analysis

PubMed Central

Scholl, Isabelle; Zill, Jördis M.; Härter, Martin; Dirmaier, Jörg

2014-01-01

Background Existing models of patient-centeredness reveal a lack of conceptual clarity. This results in a heterogeneous use of the term, unclear measurement dimensions, inconsistent results regarding the effectiveness of patient-centered interventions, and finally in difficulties in implementing patient-centered care. The aim of this systematic review was to identify the different dimensions of patient-centeredness described in the literature and to propose an integrative model of patient-centeredness based on these results. Methods Protocol driven search in five databases, combined with a comprehensive secondary search strategy. All articles that include a definition of patient-centeredness were eligible for inclusion in the review and subject to subsequent content analysis. Two researchers independently first screened titles and abstracts, then assessed full texts for eligibility. In each article the given definition of patient-centeredness was coded independently by two researchers. We discussed codes within the research team and condensed them into an integrative model of patient-centeredness. Results 4707 records were identified through primary and secondary search, of which 706 were retained after screening of titles and abstracts. 417 articles (59%) contained a definition of patient-centeredness and were coded. 15 dimensions of patient-centeredness were identified: essential characteristics of clinician, clinician-patient relationship, clinician-patient communication, patient as unique person, biopsychosocial perspective, patient information, patient involvement in care, involvement of family and friends, patient empowerment, physical support, emotional support, integration of medical and non-medical care, teamwork and teambuilding, access to care, coordination and continuity of care. In the resulting integrative model the dimensions were mapped onto different levels of care. Conclusions The proposed integrative model of patient-centeredness allows different stakeholders to speak the same language. It provides a foundation for creating better measures and interventions. It can also be used to inform the development of clinical guidance documents and health policy directives, and through this support the shift towards patient-centered health care. PMID:25229640

Validation of two case definitions to identify pressure ulcers using hospital administrative data

PubMed Central

Ho, Chester; Jiang, Jason; Eastwood, Cathy A; Wong, Holly; Weaver, Brittany; Quan, Hude

2017-01-01

Objective Pressure ulcer development is a quality of care indicator, as pressure ulcers are potentially preventable. Yet pressure ulcer is a leading cause of morbidity, discomfort and additional healthcare costs for inpatients. Methods are lacking for accurate surveillance of pressure ulcer in hospitals to track occurrences and evaluate care improvement strategies. The main study aim was to validate hospital discharge abstract database (DAD) in recording pressure ulcers against nursing consult reports, and to calculate prevalence of pressure ulcers in Alberta, Canada in DAD. We hypothesised that a more inclusive case definition for pressure ulcers would enhance validity of cases identified in administrative data for research and quality improvement purposes. Setting A cohort of patients with pressure ulcers were identified from enterostomal (ET) nursing consult documents at a large university hospital in 2011. Participants There were 1217 patients with pressure ulcers in ET nursing documentation that were linked to a corresponding record in DAD to validate DAD for correct and accurate identification of pressure ulcer occurrence, using two case definitions for pressure ulcer. Results Using pressure ulcer definition 1 (7 codes), prevalence was 1.4%, and using definition 2 (29 codes), prevalence was 4.2% after adjusting for misclassifications. The results were lower than expected. Definition 1 sensitivity was 27.7% and specificity was 98.8%, while definition 2 sensitivity was 32.8% and specificity was 95.9%. Pressure ulcer in both DAD and ET consultation increased with age, number of comorbidities and length of stay. Conclusion DAD underestimate pressure ulcer prevalence. Since various codes are used to record pressure ulcers in DAD, the case definition with more codes captures more pressure ulcer cases, and may be useful for monitoring facility trends. However, low sensitivity suggests that this data source may not be accurate for determining overall prevalence, and should be cautiously compared with other prevalence studies. PMID:28851785

SCALE: A modular code system for performing standardized computer analyses for licensing evaluation. Functional modules F1--F8 -- Volume 2, Part 1, Revision 4

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

Greene, N.M.; Petrie, L.M.; Westfall, R.M.

SCALE--a modular code system for Standardized Computer Analyses Licensing Evaluation--has been developed by Oak Ridge National Laboratory at the request of the US Nuclear Regulatory Commission. The SCALE system utilizes well-established computer codes and methods within standard analysis sequences that (1) allow an input format designed for the occasional user and/or novice, (2) automate the data processing and coupling between modules, and (3) provide accurate and reliable results. System development has been directed at problem-dependent cross-section processing and analysis of criticality safety, shielding, heat transfer, and depletion/decay problems. Since the initial release of SCALE in 1980, the code system hasmore » been heavily used for evaluation of nuclear fuel facility and package designs. This revision documents Version 4.2 of the system. The manual is divided into three volumes: Volume 1--for the control module documentation; Volume 2--for functional module documentation; and Volume 3--for documentation of the data libraries and subroutine libraries.« less

A Strategy for Reusing the Data of Electronic Medical Record Systems for Clinical Research.

PubMed

Matsumura, Yasushi; Hattori, Atsushi; Manabe, Shiro; Tsuda, Tsutomu; Takeda, Toshihiro; Okada, Katsuki; Murata, Taizo; Mihara, Naoki

2016-01-01

There is a great need to reuse data stored in electronic medical records (EMR) databases for clinical research. We previously reported the development of a system in which progress notes and case report forms (CRFs) were simultaneously recorded using a template in the EMR in order to exclude redundant data entry. To make the data collection process more efficient, we are developing a system in which the data originally stored in the EMR database can be populated within a frame in a template. We developed interface plugin modules that retrieve data from the databases of other EMR applications. A universal keyword written in a template master is converted to a local code using a data conversion table, then the objective data is retrieved from the corresponding database. The template element data, which are entered by a template, are stored in the template element database. To retrieve the data entered by other templates, the objective data is designated by the template element code with the template code, or by the concept code if it is written for the element. When the application systems in the EMR generate documents, they also generate a PDF file and a corresponding document profile XML, which includes important data, and send them to the document archive server and the data sharing saver, respectively. In the data sharing server, the data are represented by an item with an item code with a document class code and its value. By linking a concept code to an item identifier, an objective data can be retrieved by designating a concept code. We employed a flexible strategy in which a unique identifier for a hospital is initially attached to all of the data that the hospital generates. The identifier is secondarily linked with concept codes. The data that are not linked with a concept code can also be retrieved using the unique identifier of the hospital. This strategy makes it possible to reuse any of a hospital's data.

A concise evaluation and management curriculum for physicians in training improved billing at an outpatient academic rheumatology clinic.

PubMed

Hirsh, Joel M; Collier, David H; Boyle, Dennis J; Gardner, Edward M

2010-04-01

To study whether providing house staff with a brief lecture and handout about proper documentation could improve billing at an academic rheumatology clinic. The authors created an educational sheet about documentation and billing after a review of the common documentation omissions responsible for down coding (Appendix, Supplemental Digital Content 1, available at: http://links.lww.com/RHU/A8). Beginning in November of 2006, the house staff were provided with this sheet and a brief lecture regarding how outpatient evaluation and management levels of service are coded. The results of clinic billing from January 1, 2006 to October 31, 2006 and November 1, 2006 to August 31, 2007 were obtained from the physician billing office. The authors compared the average level of service, by appointment type, in the prepost comparison periods using the student t test. There was a significant improvement in the level of service billed for new visits (P < 0.001), consults (P < 0.001), and return visits (P < 0.001) after November 1, 2006. The percentage of patients evaluated for the first time who were billed as consults improved from 15% to 78% (P < 0.001 by chi2). These changes resulted in $34,342 of additional billing during the postintervention period. A simple strategy for educating the house staff about proper documentation of the history, physical examination, and clinical decision making resulted in a significant improvement in an academic rheumatology division's outpatient billing.

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

Yoo, Jun Soo; Choi, Yong Joon

The RELAP-7 code verification and validation activities are ongoing under the code assessment plan proposed in the previous document (INL-EXT-16-40015). Among the list of V&V test problems in the ‘RELAP-7 code V&V RTM (Requirements Traceability Matrix)’, the RELAP-7 7-equation model has been tested with additional demonstration problems and the results of these tests are reported in this document. In this report, we describe the testing process, the test cases that were conducted, and the results of the evaluation.

The SIFT hardware/software systems. Volume 2: Software listings

NASA Technical Reports Server (NTRS)

Palumbo, Daniel L.

1985-01-01

This document contains software listings of the SIFT operating system and application software. The software is coded for the most part in a variant of the Pascal language, Pascal*. Pascal* is a cross-compiler running on the VAX and Eclipse computers. The output of Pascal* is BDX-390 assembler code. When necessary, modules are written directly in BDX-390 assembler code. The listings in this document supplement the description of the SIFT system found in Volume 1 of this report, A Detailed Description.

Documentation of the GLAS fourth order general calculation model. Volume 3: Vectorized code for the Cyber 205

NASA Technical Reports Server (NTRS)

Kalnay, E.; Balgovind, R.; Chao, W.; Edelmann, D.; Pfaendtner, J.; Takacs, L.; Takano, K.

1983-01-01

Volume 3 of a 3-volume technical memoranda which contains documentation of the GLAS fourth order genera circulation model is presented. The volume contains the CYBER 205 scalar and vector codes of the model, list of variables, and cross references. A dictionary of FORTRAN variables used in the Scalar Version, and listings of the FORTRAN Code compiled with the C-option, are included. Cross reference maps of local variables are included for each subroutine.

Lean coding machine. Facilities target productivity and job satisfaction with coding automation.

PubMed

Rollins, Genna

2010-07-01

Facilities are turning to coding automation to help manage the volume of electronic documentation, streamlining workflow, boosting productivity, and increasing job satisfaction. As EHR adoption increases, computer-assisted coding may become a necessity, not an option.

76 FR 11191 - Hazardous Materials: Adoption of ASME Code Section XII and the National Board Inspection Code

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-01

... parts of the National Board Inspection Code at http://www.nationalboard.org . DATES: The comment period... edition of the National Board Inspection Code for public review at www.nationalboard.org . Both documents...

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

PubMed

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

2010-10-01

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

An empirical evaluation of supervised learning approaches in assigning diagnosis codes to electronic medical records

PubMed Central

Kavuluru, Ramakanth; Rios, Anthony; Lu, Yuan

2015-01-01

Background Diagnosis codes are assigned to medical records in healthcare facilities by trained coders by reviewing all physician authored documents associated with a patient's visit. This is a necessary and complex task involving coders adhering to coding guidelines and coding all assignable codes. With the popularity of electronic medical records (EMRs), computational approaches to code assignment have been proposed in the recent years. However, most efforts have focused on single and often short clinical narratives, while realistic scenarios warrant full EMR level analysis for code assignment. Objective We evaluate supervised learning approaches to automatically assign international classification of diseases (ninth revision) - clinical modification (ICD-9-CM) codes to EMRs by experimenting with a large realistic EMR dataset. The overall goal is to identify methods that offer superior performance in this task when considering such datasets. Methods We use a dataset of 71,463 EMRs corresponding to in-patient visits with discharge date falling in a two year period (2011–2012) from the University of Kentucky (UKY) Medical Center. We curate a smaller subset of this dataset and also use a third gold standard dataset of radiology reports. We conduct experiments using different problem transformation approaches with feature and data selection components and employing suitable label calibration and ranking methods with novel features involving code co-occurrence frequencies and latent code associations. Results Over all codes with at least 50 training examples we obtain a micro F-score of 0.48. On the set of codes that occur at least in 1% of the two year dataset, we achieve a micro F-score of 0.54. For the smaller radiology report dataset, the classifier chaining approach yields best results. For the smaller subset of the UKY dataset, feature selection, data selection, and label calibration offer best performance. Conclusions We show that datasets at different scale (size of the EMRs, number of distinct codes) and with different characteristics warrant different learning approaches. For shorter narratives pertaining to a particular medical subdomain (e.g., radiology, pathology), classifier chaining is ideal given the codes are highly related with each other. For realistic in-patient full EMRs, feature and data selection methods offer high performance for smaller datasets. However, for large EMR datasets, we observe that the binary relevance approach with learning-to-rank based code reranking offers the best performance. Regardless of the training dataset size, for general EMRs, label calibration to select the optimal number of labels is an indispensable final step. PMID:26054428

An empirical evaluation of supervised learning approaches in assigning diagnosis codes to electronic medical records.

PubMed

Kavuluru, Ramakanth; Rios, Anthony; Lu, Yuan

2015-10-01

Diagnosis codes are assigned to medical records in healthcare facilities by trained coders by reviewing all physician authored documents associated with a patient's visit. This is a necessary and complex task involving coders adhering to coding guidelines and coding all assignable codes. With the popularity of electronic medical records (EMRs), computational approaches to code assignment have been proposed in the recent years. However, most efforts have focused on single and often short clinical narratives, while realistic scenarios warrant full EMR level analysis for code assignment. We evaluate supervised learning approaches to automatically assign international classification of diseases (ninth revision) - clinical modification (ICD-9-CM) codes to EMRs by experimenting with a large realistic EMR dataset. The overall goal is to identify methods that offer superior performance in this task when considering such datasets. We use a dataset of 71,463 EMRs corresponding to in-patient visits with discharge date falling in a two year period (2011-2012) from the University of Kentucky (UKY) Medical Center. We curate a smaller subset of this dataset and also use a third gold standard dataset of radiology reports. We conduct experiments using different problem transformation approaches with feature and data selection components and employing suitable label calibration and ranking methods with novel features involving code co-occurrence frequencies and latent code associations. Over all codes with at least 50 training examples we obtain a micro F-score of 0.48. On the set of codes that occur at least in 1% of the two year dataset, we achieve a micro F-score of 0.54. For the smaller radiology report dataset, the classifier chaining approach yields best results. For the smaller subset of the UKY dataset, feature selection, data selection, and label calibration offer best performance. We show that datasets at different scale (size of the EMRs, number of distinct codes) and with different characteristics warrant different learning approaches. For shorter narratives pertaining to a particular medical subdomain (e.g., radiology, pathology), classifier chaining is ideal given the codes are highly related with each other. For realistic in-patient full EMRs, feature and data selection methods offer high performance for smaller datasets. However, for large EMR datasets, we observe that the binary relevance approach with learning-to-rank based code reranking offers the best performance. Regardless of the training dataset size, for general EMRs, label calibration to select the optimal number of labels is an indispensable final step. Copyright © 2015 Elsevier B.V. All rights reserved.

A nurse-facilitated depression screening program in an Army primary care clinic: an evidence-based project.

PubMed

Yackel, Edward E; McKennan, Madelyn S; Fox-Deise, Adrianna

2010-01-01

Depression, sometimes with suicidal manifestations, is a medical condition commonly seen in primary care clinics. Routine screening for depression and suicidal ideation is recommended of all adult patients in the primary care setting because it offers depressed patients a greater chance of recovery and response to treatment, yet such screening often is overlooked or omitted. The purpose of this study was to develop, to implement, and to test the efficacy of a systematic depression screening process to increase the identification of depression in family members of active duty soldiers older than 18 years at a military family practice clinic located on an Army infantry post in the Pacific. The Iowa Model of Evidence-Based Practice to Promote Quality Care was used to develop a practice guideline incorporating a decision algorithm for nurses to screen for depression. A pilot project to institute this change in practice was conducted, and outcomes were measured. Before implementation, approximately 100 patients were diagnosed with depression in each of the 3 months preceding the practice change. Approximately 130 patients a month were assigned a 311.0 Code 3 months after the practice change, and 140 patients per month received screenings and were assigned the correct International Classification of Diseases, Ninth Revision Code 311.0 at 1 year. The improved screening and coding for depression and suicidality added approximately 3 minutes to the patient screening process. The education of staff in the process of screening for depression and correct coding coupled with monitoring and staff feedback improved compliance with the identification and the documentation of patients with depression. Nurses were more likely than primary care providers to agree strongly that screening for depression enhances quality of care. Data gathered during this project support the integration of military and civilian nurse-facilitated screening for depression in the military primary care setting. The decision algorithm should be adapted and tested in other primary care environments.

A Semantic Analysis Method for Scientific and Engineering Code

NASA Technical Reports Server (NTRS)

Stewart, Mark E. M.

1998-01-01

This paper develops a procedure to statically analyze aspects of the meaning or semantics of scientific and engineering code. The analysis involves adding semantic declarations to a user's code and parsing this semantic knowledge with the original code using multiple expert parsers. These semantic parsers are designed to recognize formulae in different disciplines including physical and mathematical formulae and geometrical position in a numerical scheme. In practice, a user would submit code with semantic declarations of primitive variables to the analysis procedure, and its semantic parsers would automatically recognize and document some static, semantic concepts and locate some program semantic errors. A prototype implementation of this analysis procedure is demonstrated. Further, the relationship between the fundamental algebraic manipulations of equations and the parsing of expressions is explained. This ability to locate some semantic errors and document semantic concepts in scientific and engineering code should reduce the time, risk, and effort of developing and using these codes.

A proto-code of ethics and conduct for European nurse directors.

PubMed

Stievano, Alessandro; De Marinis, Maria Grazia; Kelly, Denise; Filkins, Jacqueline; Meyenburg-Altwarg, Iris; Petrangeli, Mauro; Tschudin, Verena

2012-03-01

The proto-code of ethics and conduct for European nurse directors was developed as a strategic and dynamic document for nurse managers in Europe. It invites critical dialogue, reflective thinking about different situations, and the development of specific codes of ethics and conduct by nursing associations in different countries. The term proto-code is used for this document so that specifically country-orientated or organization-based and practical codes can be developed from it to guide professionals in more particular or situation-explicit reflection and values. The proto-code of ethics and conduct for European nurse directors was designed and developed by the European Nurse Directors Association's (ENDA) advisory team. This article gives short explanations of the code' s preamble and two main parts: Nurse directors' ethical basis, and Principles of professional practice, which is divided into six specific points: competence, care, safety, staff, life-long learning and multi-sectorial working.

Trauma registry record linkage: methodological approach to benefit from complementary data using the example of the German Pelvic Injury Register and the TraumaRegister DGU®

PubMed Central

2013-01-01

Background In Germany, hospitals can deliver data from patients with pelvic fractures selectively or twofold to two different trauma registries, i.e. the German Pelvic Injury Register (PIR) and the TraumaRegister DGU® (TR). Both registers are anonymous and differ in composition and content. We describe the methodological approach of linking these registries and reidentifying twofold documented patients. The aim of the approach is to create an intersection set that benefit from complementary data of each registry, respectively. Furthermore, the concordance of data entry of some clinical variables entered in both registries was evaluated. Methods PIR (4,323 patients) and TR (34,134 patients) data from 2004-2009 were linked together by using a specific match code including code of the trauma department, dates of admission and discharge, patient’s age, and sex. Data entry concordance was evaluated using haemoglobin and blood pressure levels at emergency department arrival, Injury Severity Score (ISS), and mortality. Results Altogether, 420 patients were identified as documented in both data sets. Linkage rates for the intersection set were 15.7% for PIR and 44.4% for TR. Initial fluid management for different Tile/OTA types of pelvic ring fractures and the patient’s posttraumatic course, including intensive care unit data, were now available for the PIR population. TR is benefiting from clinical use of the Tile/OTA classification and from correlation with the distinct entity “complex pelvic injury.” Data entry verification showed high concordance for the ISS and mortality, whereas initial haemoglobin and blood pressure data showed significant differences, reflecting inconsistency at the data entry level. Conclusions Individually, the PIR and the TR reflect a valid source for documenting injured patients, although the data reflect the emphasis of the particular registry. Linking the two registries enabled new insights into care of multiple-trauma patients with pelvic fractures even when linkage rates were poor. Future considerations and development of the registries should be done in close bilateral consultation with the aim of benefiting from complementary data and improving data concordance. It is also conceivable to integrate individual modules, e.g. a pelvic fracture module, into the TR likewise a modular system in the future. PMID:23496832

CASL Verification and Validation Plan

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

Mousseau, Vincent Andrew; Dinh, Nam

2016-06-30

This report documents the Consortium for Advanced Simulation of LWRs (CASL) verification and validation plan. The document builds upon input from CASL subject matter experts, most notably the CASL Challenge Problem Product Integrators, CASL Focus Area leaders, and CASL code development and assessment teams. This document will be a living document that will track progress on CASL to do verification and validation for both the CASL codes (including MPACT, CTF, BISON, MAMBA) and for the CASL challenge problems (CIPS, PCI, DNB). The CASL codes and the CASL challenge problems are at differing levels of maturity with respect to validation andmore » verification. The gap analysis will summarize additional work that needs to be done. Additional VVUQ work will be done as resources permit. This report is prepared for the Department of Energy’s (DOE’s) CASL program in support of milestone CASL.P13.02.« less

Integrated information systems for electronic chemotherapy medication administration.

PubMed

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

2011-07-01

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

Metrics for Electronic-Nursing-Record-Based Narratives: cross-sectional analysis.

PubMed

Kim, Kidong; Jeong, Suyeon; Lee, Kyogu; Park, Hyeoun-Ae; Min, Yul Ha; Lee, Joo Yun; Kim, Yekyung; Yoo, Sooyoung; Doh, Gippeum; Ahn, Soyeon

2016-11-30

We aimed to determine the characteristics of quantitative metrics for nursing narratives documented in electronic nursing records and their association with hospital admission traits and diagnoses in a large data set not limited to specific patient events or hypotheses. We collected 135,406,873 electronic, structured coded nursing narratives from 231,494 hospital admissions of patients discharged between 2008 and 2012 at a tertiary teaching institution that routinely uses an electronic health records system. The standardized number of nursing narratives (i.e., the total number of nursing narratives divided by the length of the hospital stay) was suggested to integrate the frequency and quantity of nursing documentation. The standardized number of nursing narratives was higher for patients aged ≥ 70 years (median = 30.2 narratives/day, interquartile range [IQR] = 24.0-39.4 narratives/day), long (≥ 8 days) hospital stays (median = 34.6 narratives/day, IQR = 27.2-43.5 narratives/day), and hospital deaths (median = 59.1 narratives/day, IQR = 47.0-74.8 narratives/day). The standardized number of narratives was higher in "pregnancy, childbirth, and puerperium" (median = 46.5, IQR = 39.0-54.7) and "diseases of the circulatory system" admissions (median = 35.7, IQR = 29.0-43.4). Diverse hospital admissions can be consistently described with nursing-document-derived metrics for similar hospital admissions and diagnoses. Some areas of hospital admissions may have consistently increasing volumes of nursing documentation across years. Usability of electronic nursing document metrics for evaluating healthcare requires multiple aspects of hospital admissions to be considered.

Metrics for Electronic-Nursing-Record-Based Narratives: Cross-sectional Analysis

PubMed Central

Kim, Kidong; Jeong, Suyeon; Lee, Kyogu; Park, Hyeoun-Ae; Min, Yul Ha; Lee, Joo Yun; Kim, Yekyung; Yoo, Sooyoung; Doh, Gippeum

2016-01-01

Summary Objectives We aimed to determine the characteristics of quantitative metrics for nursing narratives documented in electronic nursing records and their association with hospital admission traits and diagnoses in a large data set not limited to specific patient events or hypotheses. Methods We collected 135,406,873 electronic, structured coded nursing narratives from 231,494 hospital admissions of patients discharged between 2008 and 2012 at a tertiary teaching institution that routinely uses an electronic health records system. The standardized number of nursing narratives (i.e., the total number of nursing narratives divided by the length of the hospital stay) was suggested to integrate the frequency and quantity of nursing documentation. Results The standardized number of nursing narratives was higher for patients aged 70 years (median = 30.2 narratives/day, interquartile range [IQR] = 24.0–39.4 narratives/day), long (8 days) hospital stays (median = 34.6 narratives/day, IQR = 27.2–43.5 narratives/day), and hospital deaths (median = 59.1 narratives/day, IQR = 47.0–74.8 narratives/day). The standardized number of narratives was higher in “pregnancy, childbirth, and puerperium” (median = 46.5, IQR = 39.0–54.7) and “diseases of the circulatory system” admissions (median = 35.7, IQR = 29.0–43.4). Conclusions Diverse hospital admissions can be consistently described with nursing-document-derived metrics for similar hospital admissions and diagnoses. Some areas of hospital admissions may have consistently increasing volumes of nursing documentation across years. Usability of electronic nursing document metrics for evaluating healthcare requires multiple aspects of hospital admissions to be considered. PMID:27901174

FORTRAN Automated Code Evaluation System (faces) system documentation, version 2, mod 0. [error detection codes/user manuals (computer programs)

NASA Technical Reports Server (NTRS)

1975-01-01

A system is presented which processes FORTRAN based software systems to surface potential problems before they become execution malfunctions. The system complements the diagnostic capabilities of compilers, loaders, and execution monitors rather than duplicating these functions. Also, it emphasizes frequent sources of FORTRAN problems which require inordinate manual effort to identify. The principle value of the system is extracting small sections of unusual code from the bulk of normal sequences. Code structures likely to cause immediate or future problems are brought to the user's attention. These messages stimulate timely corrective action of solid errors and promote identification of 'tricky' code. Corrective action may require recoding or simply extending software documentation to explain the unusual technique.

A simple approach to improve recording of concerns about childmaltreatment in primary care records: developing a quality improvement intervention

PubMed Central

Woodman, Jenny; Allister, Janice; Rafi, Imran; de Lusignan, Simon; Belsey, Jonathan; Petersen, Irene; Gilbert, Ruth

2012-01-01

Background Information is lacking on how concerns about child maltreatment are recorded in primary care records. Aim To determine how the recording of child maltreatment concerns can be improved. Design and setting Development of a quality improvement intervention involving: clinical audit, a descriptive survey, telephone interviews, a workshop, database analyses, and consensus development in UK general practice. Method Descriptive analyses and incidence estimates were carried out based on 11 study practices and 442 practices in The Health Improvement Network (THIN). Telephone interviews, a workshop, and a consensus development meeting were conducted with lead GPs from 11 study practices. Results The rate of children with at least one maltreatment-related code was 8.4/1000 child years (11 study practices, 2009–2010), and 8.0/1000 child years (THIN, 2009–2010). Of 25 patients with known maltreatment, six had no maltreatment-related codes recorded, but all had relevant free text, scanned documents, or codes. When stating their reasons for undercoding maltreatment concerns, GPs cited damage to the patient relationship, uncertainty about which codes to use, and having concerns about recording information on other family members in the child’s records. Consensus recommendations are to record the code ‘child is cause for concern’ as a red flag whenever maltreatment is considered, and to use a list of codes arranged around four clinical concepts, with an option for a templated short data entry form. Conclusion GPs under-record maltreatment-related concerns in children’s electronic medical records. As failure to use codes makes it impossible to search or audit these cases, an approach designed to be simple and feasible to implement in UK general practice was recommended. PMID:22781996

User Instructions for the Systems Assessment Capability, Rev. 1, Computer Codes Volume 3: Utility Codes

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

Eslinger, Paul W.; Aaberg, Rosanne L.; Lopresti, Charles A.

2004-09-14

This document contains detailed user instructions for a suite of utility codes developed for Rev. 1 of the Systems Assessment Capability. The suite of computer codes for Rev. 1 of Systems Assessment Capability performs many functions.

The Nuremberg Code–A critique

PubMed Central

Ghooi, Ravindra B.

2011-01-01

The Nuremberg Code drafted at the end of the Doctor’s trial in Nuremberg 1947 has been hailed as a landmark document in medical and research ethics. Close examination of this code reveals that it was based on the Guidelines for Human Experimentation of 1931. The resemblance between these documents is uncanny. It is unfortunate that the authors of the Nuremberg Code passed it off as their original work. There is evidence that the defendants at the trial did request that their actions be judged on the basis of the 1931 Guidelines, in force in Germany. The prosecutors, however, ignored the request and tried the defendants for crimes against humanity, and the judges included the Nuremberg Code as a part of the judgment. Six of ten principles in Nuremberg Code are derived from the 1931 Guidelines, and two of four newly inserted principles are open to misinterpretation. There is little doubt that the Code was prepared after studying the Guidelines, but no reference was made to the Guidelines, for reasons that are not known. Using the Guidelines as a base document without giving due credit is plagiarism; as per our understanding of ethics today, this would be considered unethical. The Nuremberg Code has fallen by the wayside; since unlike the Declaration of Helsinki, it is not regularly reviewed and updated. The regular updating of some ethics codes is evidence of the evolving nature of human ethics. PMID:21731859

Patient safety incidents in hospice care: observations from interdisciplinary case conferences.

PubMed

Oliver, Debra Parker; Demiris, George; Wittenberg-Lyles, Elaine; Gage, Ashley; Dewsnap-Dreisinger, Mariah L; Luetkemeyer, Jamie

2013-12-01

In the home hospice environment, issues arise every day presenting challenges to the safety, care, and quality of the dying experience. The literature pertaining to the safety challenges in this environment is limited. The study explored two research questions; 1) What types of patient safety incidents occur in the home hospice setting? 2) How many of these incidents are recognized by the hospice staff and/or the patient or caregiver as a patient safety incident? Video-recordings of hospice interdisciplinary team case conferences were reviewed and coded for patient safety incidents. Patient safety incidents were defined as any event or circumstance that could have resulted or did result in unnecessary harm to the patient or caregiver, or that could have resulted or did result in a negative impact on the quality of the dying experience for the patient. Codes for categories of patient safety incidents were based on the International Classification for Patient Safety. The setting for the study included two rural hospice programs in one Midwestern state in the United States. One hospice team had two separately functioning teams, the second hospice had three teams. 54 video-recordings were reviewed and coded. Patient safety incidents were identified that involved issues in clinical process, medications, falls, family or caregiving, procedural problems, documentation, psychosocial issues, administrative challenges and accidents. This study distinguishes categories of patient safety events that occur in home hospice care. Although the scope and definition of potential patient safety incidents in hospice is unique, the events observed in this study are similar to those observed with in other settings. This study identifies an operating definition and a potential classification for further research on patient safety incidents in hospice. Further research and consensus building of the definition of patient safety incidents and patient safety incidents in this setting is recommended.

GSE, data management system programmers/User' manual

NASA Technical Reports Server (NTRS)

Schlagheck, R. A.; Dolerhie, B. D., Jr.; Ghiglieri, F. J.

1974-01-01

The GSE data management system is a computerized program which provides for a central storage source for key data associated with the mechanical ground support equipment (MGSE). Eight major sort modes can be requested by the user. Attributes that are printed automatically with each sort include the GSE end item number, description, class code, functional code, fluid media, use location, design responsibility, weight, cost, quantity, dimensions, and applicable documents. Multiple subsorts are available for the class code, functional code, fluid media, use location, design responsibility, and applicable document categories. These sorts and how to use them are described. The program and GSE data bank may be easily updated and expanded.

Functional Equivalence Acceptance Testing of FUN3D for Entry Descent and Landing Applications

NASA Technical Reports Server (NTRS)

Gnoffo, Peter A.; Wood, William A.; Kleb, William L.; Alter, Stephen J.; Glass, Christopher E.; Padilla, Jose F.; Hammond, Dana P.; White, Jeffery A.

2013-01-01

The functional equivalence of the unstructured grid code FUN3D to the the structured grid code LAURA (Langley Aerothermodynamic Upwind Relaxation Algorithm) is documented for applications of interest to the Entry, Descent, and Landing (EDL) community. Examples from an existing suite of regression tests are used to demonstrate the functional equivalence, encompassing various thermochemical models and vehicle configurations. Algorithm modifications required for the node-based unstructured grid code (FUN3D) to reproduce functionality of the cell-centered structured code (LAURA) are also documented. Challenges associated with computation on tetrahedral grids versus computation on structured-grid derived hexahedral systems are discussed.

Analysis of cytopenia in geriatric inpatients.

PubMed

Röhrig, G; Becker, I; Pappas, K; Polidori, M C; Schulz, R J

2018-02-01

Peripheral blood dyscrasias in older patients are repeatedly seen in geriatric clinical practice; however, there is substantial lack of data about the epidemiology, possible causes and treatment options in this patient group. Proton pump inhibitors (PPI) are extensively used in older patients and associated with leukopenia. The primary objective of this study was the assessment of encoded cytopenia prevalence in a geriatric patient cohort and the secondary objective was the assessment of putative causes and the analysis of PPI administration in patients with cytopenia. Retrospective evaluation of patients admitted to the geriatric department of a German urban hospital between 2010 and 2012. Electronic patient data were screened for encoded diagnosis of cytopenia according to the International Classification of Diseases (ICD) 10. Inclusion criteria were ICD code D69.0-9 and/or D70.0-7, age ≥60 years and exclusion criteria were no ICD code D69.0-9 and/or D70.0-7 and age <60 years. Out of 9328 screened inpatients 54 patients remained for analysis. Study parameters included hemoglobin (Hb), red blood cell count (RBC), leucocytes, platelets, mean cell volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW), presence of leukopenia (<4000/µl), presence of thrombocytopenia (<140,000/µl) and presence of anemia according to the World Health Organization (WHO). Substitution of blood products, medication with PPI and potential causes for dyscrasias were evaluated based on electronic patient records. The mean age was 78.3 ± 6.5 years (27 females, 27 males), anemia was seen in 78%, leukopenia was encoded in13% and thrombocytopenia in 44.4%. In most of the patients no substitution of blood products was documented. In most of the patients (20.4%) cytopenia was attributed to either heparin-induced thrombocytopenia (HIT) or hemato-oncologic (20.4%) diseases, followed by drug association in 18.5%. In 70.8% of the study patients PPIs were administered but the indication for PPI administration remained unclear in 20.4%. The results encourage accurate assessment of blood dyscrasias and appropriate documentation as well as indication check for PPI treatment in geriatric inpatients.

Identification of Long Bone Fractures in Radiology Reports Using Natural Language Processing to support Healthcare Quality Improvement.

PubMed

Grundmeier, Robert W; Masino, Aaron J; Casper, T Charles; Dean, Jonathan M; Bell, Jamie; Enriquez, Rene; Deakyne, Sara; Chamberlain, James M; Alpern, Elizabeth R

2016-11-09

Important information to support healthcare quality improvement is often recorded in free text documents such as radiology reports. Natural language processing (NLP) methods may help extract this information, but these methods have rarely been applied outside the research laboratories where they were developed. To implement and validate NLP tools to identify long bone fractures for pediatric emergency medicine quality improvement. Using freely available statistical software packages, we implemented NLP methods to identify long bone fractures from radiology reports. A sample of 1,000 radiology reports was used to construct three candidate classification models. A test set of 500 reports was used to validate the model performance. Blinded manual review of radiology reports by two independent physicians provided the reference standard. Each radiology report was segmented and word stem and bigram features were constructed. Common English "stop words" and rare features were excluded. We used 10-fold cross-validation to select optimal configuration parameters for each model. Accuracy, recall, precision and the F1 score were calculated. The final model was compared to the use of diagnosis codes for the identification of patients with long bone fractures. There were 329 unique word stems and 344 bigrams in the training documents. A support vector machine classifier with Gaussian kernel performed best on the test set with accuracy=0.958, recall=0.969, precision=0.940, and F1 score=0.954. Optimal parameters for this model were cost=4 and gamma=0.005. The three classification models that we tested all performed better than diagnosis codes in terms of accuracy, precision, and F1 score (diagnosis code accuracy=0.932, recall=0.960, precision=0.896, and F1 score=0.927). NLP methods using a corpus of 1,000 training documents accurately identified acute long bone fractures from radiology reports. Strategic use of straightforward NLP methods, implemented with freely available software, offers quality improvement teams new opportunities to extract information from narrative documents.

77 FR 72913 - Defining Larger Participants of the Consumer Debt Collection Market; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-07

...;to and codified in the Code of Federal Regulations, which is published #0;under 50 titles pursuant to 44 U.S.C. 1510. #0; #0;The Code of Federal Regulations is sold by the Superintendent of Documents. #0... collection. The final rule contained four typographical errors, which this document corrects. Three of these...

FDA Procedures for Standardization and Certification of Retail Food Inspection/Training Officers, 2000.

ERIC Educational Resources Information Center

Food and Drug Administration (DHHS/PHS), Rockville, MD.

This document provides information, standards, and behavioral objectives for standardization and certification of retail food inspection personnel in the Food and Drug Administration (FDA). The procedures described in the document are based on the FDA Food Code, updated to reflect current Food Code provisions and to include a more refined focus on…

The FORTRAN static source code analyzer program (SAP) user's guide, revision 1

NASA Technical Reports Server (NTRS)

Decker, W.; Taylor, W.; Eslinger, S.

1982-01-01

The FORTRAN Static Source Code Analyzer Program (SAP) User's Guide (Revision 1) is presented. SAP is a software tool designed to assist Software Engineering Laboratory (SEL) personnel in conducting studies of FORTRAN programs. SAP scans FORTRAN source code and produces reports that present statistics and measures of statements and structures that make up a module. This document is a revision of the previous SAP user's guide, Computer Sciences Corporation document CSC/TM-78/6045. SAP Revision 1 is the result of program modifications to provide several new reports, additional complexity analysis, and recognition of all statements described in the FORTRAN 77 standard. This document provides instructions for operating SAP and contains information useful in interpreting SAP output.

The importance of documenting code, and how you might make yourself do it

NASA Astrophysics Data System (ADS)

Tollerud, Erik Jon; Astropy Project

2016-01-01

Your science code is awesome. It reduces data, performs some statistical analysis, or models a physical process better than anyone has done before. You wisely decide that it is worth sharing with your student/advisor, research collaboration, or the whole world. But when you send it out, no one seems willing to use it. Why? Most of the time, it's your documentation. You wrote the code for yourself, so you know what every function, procedure, or class is supposed to do. Unfortunately, your users (sometimes including you 6 months later) do not. In this talk, I will describe some of the tools, both technical and psychological, to make that documentation happen (particularly for the Python ecosystem).

The European Glaucoma Society Glaucocard project: improved digital documentation of medical data for glaucoma patients based on standardized structured international datasets.

PubMed

Schargus, Marc; Grehn, Franz; Glaucocard Workgroup

2008-12-01

To evaluate existing international IT-based ophthalmological medical data projects, and to define a glaucoma data set based on existing international standards of medical and ophthalmological documentation. To develop the technical environment for easy data mining and data exchange in different countries in Europe. Existing clinical and IT-based projects for documentation of medical data in general medicine and ophthalmology were analyzed to create new data sets for medical documentation in glaucoma patients. Different types of data transfer methods were evaluated to find the best method of data exchange between ophthalmologists in different European countries. Data sets from existing IT projects showed a wide variability in specifications, use of codes, terms and graphical data (perimetry, optic nerve analysis etc.) in glaucoma patients. New standardized digital datasets for glaucoma patients were defined, based on existing standards, which can be used by general ophthalmologists for follow-up examinations and for glaucoma specialists to perform teleconsultation, also across country borders. Datasets are available in different languages. Different types of data exchange methods using secure medical data transfer by internet, USB stick and smartcard were tested for different countries with regard to legal acceptance, practicability and technical realization (e.g. compatibility with EMR systems). By creating new standardized glaucoma specific cross-national datasets, it is now possible to develop an electronic glaucoma patient record system for data storage and transfer based on internet, smartcard or USB stick. The digital data can be used for referrals and for teleconsultation of glaucoma specialists in order to optimize glaucoma treatment. This should lead to an increase of quality in glaucoma care, and prevent expenses in health care costs by unnecessary repeated examinations.

Lost in translation: Focused documentation improvement benefits trauma surgeons.

PubMed

Fox, Nicole; Swierczynski, Patricia; Willcutt, Rebecca; Elberfeld, Adrienne; Mazzarelli, Anthony J

2016-09-01

There is a translational gap between physicians who document in the medical record and coders, who ultimately determine which codes are submitted. This gap exists because physicians are never formally educated about documentation strategies despite the fact that the quality of physician documentation directly affects revenue, outcomes and public profiling. We evaluated the effect of a formal model of focused documentation improvement (FDI) on the trauma/critical care division. We hypothesized that FDI would improve physician documentation, resulting in revenue recovery and a shift in the case mix index (CMI) to more accurately reflect the clinical complexity of trauma patients. FDI is defined as targeted physician education followed by concurrent inpatient chart review for documentation improvement opportunities by a clinical documentation specialist (CDS). All trauma surgeons (n=9) at our Level 1 trauma center first completed three hours of mandatory training on documentation improvement. A CDS was subsequently assigned to the trauma service. They reviewed the charts of Medicare patients (n=776) from January-December 2014 to identify opportunities for documentation improvement, participated in ICU rounds and provided ongoing education. Requests to clarify documentation (queries) were posted in the electronic medical record (EMR) and physicians were required to respond within 48h. Data was collected on physician response rate, CMI and revenue recovery. 411 of 776 (57%) charts were reviewed. Opportunities for FDI were identified in 177 (43%) cases. The physician response rate to queries was 100%. The CMI for reviewed cases increased (1.80 (SD 0.15) vs. 2.11 (SD 0.19); p<0.001) after FDI. Overall revenue recovery was $1,132,581 with an average of $154,092 in revenue recovery/clinical full time equivalent. The total cost for administration of FDI was $353,265 resulting in a 220% return on investment (ROI). FDI is an effective strategy to engage physicians in documentation improvement. It provides an infrastructure to assist physicians and yields a significant ROI. Copyright © 2016 Elsevier Ltd. All rights reserved.

Surgical management of failed endoscopic treatment of pancreatic disease.

PubMed

Evans, Kimberly A; Clark, Colby W; Vogel, Stephen B; Behrns, Kevin E

2008-11-01

Endoscopic therapy of acute and chronic pancreatitis has decreased the need for operative intervention. However, a significant proportion of patients treated endoscopically require definitive surgical management for persistent symptoms. Our aim was to determine which patients are likely to fail with endoscopic therapy, and to assess the clinical outcome of surgical management. Patients were identified using ICD-9 codes for pancreatic disease as well as CPT codes for endoscopic therapy followed by surgery. Patients with documented acute or chronic pancreatitis treated endoscopically prior to surgical therapy were included (N = 88). The majority of patients (65%) exhibited chronic pancreatitis due to alcohol abuse. Common indicators for surgery were: persistent symptoms, anatomy not amenable to endoscopic treatment and unresolved common bile duct or pancreatic duct strictures. Surgical salvage procedures included internal drainage of a pseudocyst or an obstructed pancreatic duct (46%), debridement of peripancreatic fluid collections (25%), and pancreatic resection (31%). Death occurred in 3% of patients. The most common complications were hemorrhage (16%), wound infection (13%), and pulmonary complications (11%). Chronic pancreatitis with persistent symptoms is the most common reason for pancreatic surgery following endoscopic therapy. Surgical salvage therapy can largely be accomplished by drainage procedures, but pancreatic resection is common. These complex procedures can be performed with acceptable mortality but also with significant risk for morbidity.

Critical care in the surgical global period.

PubMed

Painter, Julie R

2013-03-01

This article explores the rules and regulations from Current Procedural Terminology (CPT) code set and US Medicare and Medicaid Services (Medicare) regarding multiple physicians reporting critical care services during the global period. The article takes into account the critical care definitions, regulations, documentation requirements, and services each provider can report to Medicare. A clinical scenario based on literature supporting the types of complications and care that might typically be included in the post-operative period for a patient who is surgically treated for a type A aortic dissection was analyzed. It was determined that multiple physicians may provide critical care services to a single patient during the global period. The physician who performed the primary procedure cannot report critical care separately unless documentation supporting use of modifier 25 (significant, separately identifiable services) or 24 (unrelated services) supports that critical care is unrelated to the global period. Other physicians may report critical care services separately if specific criteria are met. To report critical care services to Medicare, the patient's condition must meet the Medicare definition of critical care and the physicians should generally represent different specialties providing different aspects of care to the critically ill or injured patient as defined by Medicare. There should be no overlap in time of services provided by each physician. Each physician's documentation should clearly support medical necessity with the diagnosis demonstrating the critical nature of the patients' illness, the total time spent providing critical care, the critical care service provided, and other contributing factors.

Enhanced Verification Test Suite for Physics Simulation Codes

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

Kamm, J R; Brock, J S; Brandon, S T

2008-10-10

This document discusses problems with which to augment, in quantity and in quality, the existing tri-laboratory suite of verification problems used by Los Alamos National Laboratory (LANL), Lawrence Livermore National Laboratory (LLNL), and Sandia National Laboratories (SNL). The purpose of verification analysis is demonstrate whether the numerical results of the discretization algorithms in physics and engineering simulation codes provide correct solutions of the corresponding continuum equations. The key points of this document are: (1) Verification deals with mathematical correctness of the numerical algorithms in a code, while validation deals with physical correctness of a simulation in a regime of interest.more » This document is about verification. (2) The current seven-problem Tri-Laboratory Verification Test Suite, which has been used for approximately five years at the DOE WP laboratories, is limited. (3) Both the methodology for and technology used in verification analysis have evolved and been improved since the original test suite was proposed. (4) The proposed test problems are in three basic areas: (a) Hydrodynamics; (b) Transport processes; and (c) Dynamic strength-of-materials. (5) For several of the proposed problems we provide a 'strong sense verification benchmark', consisting of (i) a clear mathematical statement of the problem with sufficient information to run a computer simulation, (ii) an explanation of how the code result and benchmark solution are to be evaluated, and (iii) a description of the acceptance criterion for simulation code results. (6) It is proposed that the set of verification test problems with which any particular code be evaluated include some of the problems described in this document. Analysis of the proposed verification test problems constitutes part of a necessary--but not sufficient--step that builds confidence in physics and engineering simulation codes. More complicated test cases, including physics models of greater sophistication or other physics regimes (e.g., energetic material response, magneto-hydrodynamics), would represent a scientifically desirable complement to the fundamental test cases discussed in this report. The authors believe that this document can be used to enhance the verification analyses undertaken at the DOE WP Laboratories and, thus, to improve the quality, credibility, and usefulness of the simulation codes that are analyzed with these problems.« less

Guidelines for development structured FORTRAN programs

NASA Technical Reports Server (NTRS)

Earnest, B. M.

1984-01-01

Computer programming and coding standards were compiled to serve as guidelines for the uniform writing of FORTRAN 77 programs at NASA Langley. Software development philosophy, documentation, general coding conventions, and specific FORTRAN coding constraints are discussed.

Inventory of Safety-related Codes and Standards for Energy Storage Systems with some Experiences related to Approval and Acceptance

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

Conover, David R.

The purpose of this document is to identify laws, rules, model codes, codes, standards, regulations, specifications (CSR) related to safety that could apply to stationary energy storage systems (ESS) and experiences to date securing approval of ESS in relation to CSR. This information is intended to assist in securing approval of ESS under current CSR and to identification of new CRS or revisions to existing CRS and necessary supporting research and documentation that can foster the deployment of safe ESS.

Accuracy of Canadian health administrative databases in identifying patients with rheumatoid arthritis: a validation study using the medical records of rheumatologists.

PubMed

Widdifield, Jessica; Bernatsky, Sasha; Paterson, J Michael; Tu, Karen; Ng, Ryan; Thorne, J Carter; Pope, Janet E; Bombardier, Claire

2013-10-01

Health administrative data can be a valuable tool for disease surveillance and research. Few studies have rigorously evaluated the accuracy of administrative databases for identifying rheumatoid arthritis (RA) patients. Our aim was to validate administrative data algorithms to identify RA patients in Ontario, Canada. We performed a retrospective review of a random sample of 450 patients from 18 rheumatology clinics. Using rheumatologist-reported diagnosis as the reference standard, we tested and validated different combinations of physician billing, hospitalization, and pharmacy data. One hundred forty-nine rheumatology patients were classified as having RA and 301 were classified as not having RA based on our reference standard definition (study RA prevalence 33%). Overall, algorithms that included physician billings had excellent sensitivity (range 94-100%). Specificity and positive predictive value (PPV) were modest to excellent and increased when algorithms included multiple physician claims or specialist claims. The addition of RA medications did not significantly improve algorithm performance. The algorithm of "(1 hospitalization RA code ever) OR (3 physician RA diagnosis codes [claims] with ≥1 by a specialist in a 2-year period)" had a sensitivity of 97%, specificity of 85%, PPV of 76%, and negative predictive value of 98%. Most RA patients (84%) had an RA diagnosis code present in the administrative data within ±1 year of a rheumatologist's documented diagnosis date. We demonstrated that administrative data can be used to identify RA patients with a high degree of accuracy. RA diagnosis date and disease duration are fairly well estimated from administrative data in jurisdictions of universal health care insurance. Copyright © 2013 by the American College of Rheumatology.

Audio Taping Simulated Patient Encounters in Community Pharmacy to Enhance the Reliability of Assessments

PubMed Central

Werner, Joel Benjamin

2008-01-01

Objectives To assess whether audio taping simulated patient interactions can improve the reliability of manually documented data and result in more accurate assessments. Methods Over a 3-month period, 1340 simulated patient visits were made to community pharmacies. Following the encounters, data gathered by the simulated patient were relayed to a coordinator who completed a rating form. Data recorded on the forms were later compared to an audiotape of the interaction. Corrections were tallied and reasons for making them were coded. Results Approximately 10% of cases required corrections, resulting in a 10%-20% modification in the pharmacy's total score. The difference between postcorrection and precorrection scores was significant. Conclusions Audio taping simulated patient visits enhances data integrity. Most corrections were required because of the simulated patients' poor recall abilities. PMID:19325956

Do third-party plans really pay for CVS care?

PubMed

Soden, Richard

2002-04-01

Until specific CPT and ICD-9 codes are created and approved for CVS, and until there is uniform agreement that CVS is a true medical anomaly (or not), each practitioner will have to decide on how to bill for the signs and symptoms of Computer Vision Syndrome. If the practitioner chooses to view CVS as a medical problem, then the same guidelines and rules for all other patients should be followed with appropriate documentation using CPT and ICD-9 coding. If the practitioner chooses to consider CVS solely as an optical problem, this is a "noncovered" service and the patient or any applicable optical plan will be responsible for payment. One final note: each practitioner who tests for CVS will also have to determine if there is a separate fee for CVS testing. If the practitioner considers CVS to be a medical problem, it may be applicable to include testing for Computer Vision Syndrome as an incidental test to the medical office visit. If the practitioner chooses to consider CVS to be purely an optical problem, it may be appropriate to add an appropriate charge to the noncovered examination. Whatever the decision is, there must be consistency from patient to patient.

Lexical analysis of the Code of Medical Ethics of the Federal Council of Medicine.

PubMed

Andrade, Edson de Oliveira; Andrade, Edson de Oliveira

2016-04-01

The Code of Medical Ethics (CME) of the Federal Council of Medicine is the legal document that exposes the moral discourse of Brazilian physicians to society and the profession. It is a set of propositions based on which doctors say they are committed to values of conduct aimed at fair and proper professional practice. To verify through lexical analysis of the CME corpus if the goals presented in the arguments of the resolution that established the code are properly addressed in these regulations. This is a quantitative and qualitative study of descriptive nature, aiming at a lexical analysis of the CME. The lexical analysis was performed using a method of Top-Down Hierarchical Classification of vocabulary, as described by Reinert in 1987, assuming that words used in similar contexts are associated with a single lexical world. In addition to the analysis of results, an improved representation of the charts related with Factorial and Similitude Analyses was made. Six clusters were extracted, leading to the identification of three major branches: health care, professional practice and research. These branches revolve around the figures of physician and patient. The similitude analysis revealed a complementarity status between these two figures. The lexical analysis showed that the purposes contained in the resolution that established the CME were adequately represented in the document body.

Evaluation of Factors Influencing Accuracy of Principal Procedure Coding Based on ICD-9-CM: An Iranian Study

PubMed Central

Farzandipour, Mehrdad; Sheikhtaheri, Abbas

2009-01-01

To evaluate the accuracy of procedural coding and the factors that influence it, 246 records were randomly selected from four teaching hospitals in Kashan, Iran. “Recodes” were assigned blindly and then compared to the original codes. Furthermore, the coders' professional behaviors were carefully observed during the coding process. Coding errors were classified as major or minor. The relations between coding accuracy and possible effective factors were analyzed by χ2 or Fisher exact tests as well as the odds ratio (OR) and the 95 percent confidence interval for the OR. The results showed that using a tabular index for rechecking codes reduces errors (83 percent vs. 72 percent accuracy). Further, more thorough documentation by the clinician positively affected coding accuracy, though this relation was not significant. Readability of records decreased errors overall (p = .003), including major ones (p = .012). Moreover, records with no abbreviations had fewer major errors (p = .021). In conclusion, not using abbreviations, ensuring more readable documentation, and paying more attention to available information increased coding accuracy and the quality of procedure databases. PMID:19471647

Semantic enrichment of medical forms - semi-automated coding of ODM-elements via web services.

PubMed

Breil, Bernhard; Watermann, Andreas; Haas, Peter; Dziuballe, Philipp; Dugas, Martin

2012-01-01

Semantic interoperability is an unsolved problem which occurs while working with medical forms from different information systems or institutions. Standards like ODM or CDA assure structural homogenization but in order to compare elements from different data models it is necessary to use semantic concepts and codes on an item level of those structures. We developed and implemented a web-based tool which enables a domain expert to perform semi-automated coding of ODM-files. For each item it is possible to inquire web services which result in unique concept codes without leaving the context of the document. Although it was not feasible to perform a totally automated coding we have implemented a dialog based method to perform an efficient coding of all data elements in the context of the whole document. The proportion of codable items was comparable to results from previous studies.

Additional extensions to the NASCAP computer code, volume 1

NASA Technical Reports Server (NTRS)

Mandell, M. J.; Katz, I.; Stannard, P. R.

1981-01-01

Extensions and revisions to a computer code that comprehensively analyzes problems of spacecraft charging (NASCAP) are documented. Using a fully three dimensional approach, it can accurately predict spacecraft potentials under a variety of conditions. Among the extensions are a multiple electron/ion gun test tank capability, and the ability to model anisotropic and time dependent space environments. Also documented are a greatly extended MATCHG program and the preliminary version of NASCAP/LEO. The interactive MATCHG code was developed into an extremely powerful tool for the study of material-environment interactions. The NASCAP/LEO, a three dimensional code to study current collection under conditions of high voltages and short Debye lengths, was distributed for preliminary testing.

Supervised Extraction of Diagnosis Codes from EMRs: Role of Feature Selection, Data Selection, and Probabilistic Thresholding.

PubMed

Rios, Anthony; Kavuluru, Ramakanth

2013-09-01

Extracting diagnosis codes from medical records is a complex task carried out by trained coders by reading all the documents associated with a patient's visit. With the popularity of electronic medical records (EMRs), computational approaches to code extraction have been proposed in the recent years. Machine learning approaches to multi-label text classification provide an important methodology in this task given each EMR can be associated with multiple codes. In this paper, we study the the role of feature selection, training data selection, and probabilistic threshold optimization in improving different multi-label classification approaches. We conduct experiments based on two different datasets: a recent gold standard dataset used for this task and a second larger and more complex EMR dataset we curated from the University of Kentucky Medical Center. While conventional approaches achieve results comparable to the state-of-the-art on the gold standard dataset, on our complex in-house dataset, we show that feature selection, training data selection, and probabilistic thresholding provide significant gains in performance.

A Summary of Important Documents in the Field of Research Ethics

PubMed Central

Fischer, Bernard A

2006-01-01

Today's researchers are obligated to conduct their studies ethically. However, it often seems a daunting task to become familiar with the important ethical codes required to do so. The purpose of this article is to examine the content of those ethical documents most relevant to the biomedical researcher. Documents examined include the Nuremberg Code, the Declaration of Helsinki, Henry Beecher's landmark paper, the Belmont Report, the U.S. Common Rule, the Guideline for Good Clinical Practice, and the National Bioethics Advisory Commission's report on research protections for the mentally ill. PMID:16192409

Use, Assessment, and Improvement of the Loci-CHEM CFD Code for Simulation of Combustion in a Single Element GO2/GH2 Injector and Chamber

NASA Technical Reports Server (NTRS)

Westra, Douglas G.; Lin, Jeff; West, Jeff; Tucker, Kevin

2006-01-01

This document is a viewgraph presentation of a paper that documents a continuing effort at Marshall Space Flight Center (MSFC) to use, assess, and continually improve CFD codes to the point of material utility in the design of rocket engine combustion devices. This paper describes how the code is presently being used to simulate combustion in a single element combustion chamber with shear coaxial injectors using gaseous oxygen and gaseous hydrogen propellants. The ultimate purpose of the efforts documented is to assess and further improve the Loci-CHEM code and the implementation of it. Single element shear coaxial injectors were tested as part of the Staged Combustion Injector Technology (SCIT) program, where detailed chamber wall heat fluxes were measured. Data was taken over a range of chamber pressures for propellants injected at both ambient and elevated temperatures. Several test cases are simulated as part of the effort to demonstrate use of the Loci-CHEM CFD code and to enable us to make improvements in the code as needed. The simulations presented also include a grid independence study on hybrid grids. Several two-equation eddy viscosity low Reynolds number turbulence models are also evaluated as part of the study. All calculations are presented with a comparison to the experimental data. Weaknesses of the code relative to test data are discussed and continuing efforts to improve the code are presented.

CTF Theory Manual

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

Avramova, Maria N.; Salko, Robert K.

Coolant-Boiling in Rod Arrays|Two Fluids (COBRA-TF) is a thermal/ hydraulic (T/H) simulation code designed for light water reactor (LWR) vessel analysis. It uses a two-fluid, three-field (i.e. fluid film, fluid drops, and vapor) modeling approach. Both sub-channel and 3D Cartesian forms of 9 conservation equations are available for LWR modeling. The code was originally developed by Pacific Northwest Laboratory in 1980 and had been used and modified by several institutions over the last few decades. COBRA-TF also found use at the Pennsylvania State University (PSU) by the Reactor Dynamics and Fuel Management Group (RDFMG) and has been improved, updated, andmore » subsequently re-branded as CTF. As part of the improvement process, it was necessary to generate sufficient documentation for the open-source code which had lacked such material upon being adopted by RDFMG. This document serves mainly as a theory manual for CTF, detailing the many two-phase heat transfer, drag, and important accident scenario models contained in the code as well as the numerical solution process utilized. Coding of the models is also discussed, all with consideration for updates that have been made when transitioning from COBRA-TF to CTF. Further documentation outside of this manual is also available at RDFMG which focus on code input deck generation and source code global variable and module listings.« less

Care of Patients at the End of Life: Advance Care Planning.

PubMed

Ackermann, Richard J

2016-08-01

Advance directives are legal documents that give instructions about how to provide care when patients develop life-threatening illnesses and can no longer communicate their wishes. Two types of documents are widely used-a living will and a durable power of attorney for health care. Most states also authorize physician orders for life-sustaining treatment. Physicians should encourage patients, particularly those with severe chronic or terminal conditions, to prepare advance directives. Medicare now reimburses billing codes for advance care consultations. Directions regarding cardiopulmonary resuscitation and artificial ventilation often are included in advance care plans, and use of artificial nutrition and hydration (ANH) also should be addressed, particularly for patients with advanced dementia. Evidence shows that in such patients, ANH does not prolong survival, increase comfort, or improve quality of life. Given the lack of benefit, physicians should recommend against use of ANH for patients with dementia. Finally, physicians should encourage use of hospice services by patients whose life expectancy is 6 months or less. Although Medicare and most other health care insurers cover hospice care, and despite evidence that patient and family satisfaction increase when hospice services are used, many patients do not use these services. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

Constitutive relations in TRAC-P1A

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

Rohatgi, U.S.; Saha, P.

1980-08-01

The purpose of this document is to describe the basic thermal-hydraulic models and correlations that are in the TRAC-P1A code, as released in March 1979. It is divided into two parts, A and B. Part A describes the models in the three-dimensional vessel module of TRAC, whereas Part B focuses on the loop components that are treated by one-dimensional formulations. The report follows the format of the questions prepared by the Analysis Development Branch of USNRC and the questionnaire has been attached to this document for completeness. Concerted efforts have been made in understanding the present models in TRAC-P1A bymore » going through the FORTRAN listing of the code. Some discrepancies between the code and the TRAC-P1A manual have been found. These are pointed out in this document. Efforts have also been made to check the TRAC references for the range of applicability of the models and correlations used in the code. 26 refs., 5 figs., 1 tab.« less

Development of a simple binary response questionnaire to identify airflow obstruction in a smoking population in Argentina.

PubMed

Bergna, Miguel A; García, Gabriel R; Alchapar, Ramon; Altieri, Hector; Casas, Juan C Figueroa; Larrateguy, Luis; Nannini, Luis J; Pascansky, Daniel; Grabre, Pedro; Zabert, Gustavo; Miravitlles, Marc

2015-06-01

The CODE questionnaire (COPD detection questionnaire), a simple, binary response scale (yes/no), screening questionnaire, was developed for the identification of patients with chronic obstructive pulmonary disease (COPD). We conducted a survey of 468 subjects with a smoking history in 10 public hospitals in Argentina. Patients with a previous diagnosis of COPD, asthma and other respiratory illness were excluded. Items that measured conceptual domains in terms of characteristics of symptoms, smoking history and demographics data were considered. 96 (20.5%) subjects had a diagnosis of COPD according to the 2010 Global Initiative for Chronic Obstructive Lung Disease strategy document. The variables selected for the final questionnaire were based on univariate and multivariate analyses and clinical criteria. Finally, we selected the presence or absence of six variables (age ≥50 years, smoking history ≥30 pack-years, male sex, chronic cough, chronic phlegm and dyspnoea). Of patients without any of these six variables (0 points), none had COPD. The ability of the CODE questionnaire to discriminate between subjects with and without COPD was good (the area under the receiver operating characteristic curve was 0.75). Higher scores were associated with a greater probability of COPD. The CODE questionnaire is a brief, accurate questionnaire that can identify smoking individuals likely to have COPD. Copyright ©ERS 2015.

Developing VISO: Vaccine Information Statement Ontology for patient education.

PubMed

Amith, Muhammad; Gong, Yang; Cunningham, Rachel; Boom, Julie; Tao, Cui

2015-01-01

To construct a comprehensive vaccine information ontology that can support personal health information applications using patient-consumer lexicon, and lead to outcomes that can improve patient education. The authors composed the Vaccine Information Statement Ontology (VISO) using the web ontology language (OWL). We started with 6 Vaccine Information Statement (VIS) documents collected from the Centers for Disease Control and Prevention (CDC) website. Important and relevant selections from the documents were recorded, and knowledge triples were derived. Based on the collection of knowledge triples, the meta-level formalization of the vaccine information domain was developed. Relevant instances and their relationships were created to represent vaccine domain knowledge. The initial iteration of the VISO was realized, based on the 6 Vaccine Information Statements and coded into OWL2 with Protégé. The ontology consisted of 132 concepts (classes and subclasses) with 33 types of relationships between the concepts. The total number of instances from classes totaled at 460, along with 429 knowledge triples in total. Semiotic-based metric scoring was applied to evaluate quality of the ontology.

Improving identification and management of partner violence: examining the process of academic detailing: a qualitative study

PubMed Central

2011-01-01

Background Many physicians do not routinely inquire about intimate partner violence. Purpose This qualitative study explores the process of academic detailing as an intervention to change physician behavior with regard to intimate partner violence (IPV) identification and documentation. Method A non-physician academic detailer provided a seven-session modular curriculum over a two-and-a-half month period. The detailer noted written details of each training session. Audiotapes of training sessions and semi-structured exit interviews with each physician were recorded and transcribed. Transcriptions were qualitatively and thematically coded and analyzed using Atlas ti®. Results All three study physicians reported increased clarity with regard to the scope of their responsibility to their patients experiencing IPV. They also reported increased levels of comfort in the effective identification and appropriate documentation of IPV and the provision of ongoing support to the patient, including referrals to specialized community services. Conclusion Academic detailing, if presented by a supportive and knowledgeable academic detailer, shows promise to improve physician attitudes and practices with regards to patients in violent relationships. PMID:21679450

Residential Demand Module - NEMS Documentation

EIA Publications

2017-01-01

Model Documentation - Documents the objectives, analytical approach, and development of the National Energy Modeling System (NEMS) Residential Sector Demand Module. The report catalogues and describes the model assumptions, computational methodology, parameter estimation techniques, and FORTRAN source code.

Informatics can identify systemic sclerosis (SSc) patients at risk for scleroderma renal crisis

PubMed Central

Redd, Doug; Frech, Tracy M.; Murtaugh, Maureen A.; Rhiannon, Julia; Zeng, Qing T.

2016-01-01

Background Electronic medical records (EMR) provide an ideal opportunity for the detection, diagnosis, and management of systemic sclerosis (SSc) patients within the Veterans Health Administration (VHA). The objective of this project was to use informatics to identify potential SSc patients in the VHA that were on prednisone, in order to inform an outreach project to prevent scleroderma renal crisis (SRC). Methods The electronic medical data for this study came from Veterans Informatics and Computing Infrastructure (VINCI). For natural language processing (NLP) analysis, a set of retrieval criteria was developed for documents expected to have a high correlation to SSc. The two annotators reviewed the ratings to assemble a single adjudicated set of ratings, from which a support vector machine (SVM) based document classifier was trained. Any patient having at least one document positively classified for SSc was considered positive for SSc and the use of prednisone ≥ 10 mg in the clinical document was reviewed to determine whether it was an active medication on the prescription list. Results In the VHA, there were 4,272 patients that have a diagnosis of SSc determined by the presence of an ICD-9 code. From these patients, 1,118 patients (21%) had the use of prednisone ≥_10 mg. Of these patients, 26 had a concurrent diagnosis of hypertension, thus these patients should not be on prednisone. By the use of natural language processing (NLP) an additional 16,522 patients were identified as possible SSc, highlighting that cases of SSc in the VHA may exist that are unidentified by ICD-9. A 10-fold cross validation of the classifier resulted in a precision (positive predictive value) of 0.814, recall (sensitivity) of 0.973, and f-measure of 0.873. Conclusions Our study demonstrated that current clinical practice in the VHA includes the potentially dangerous use of prednisone for veterans with SSc. This present study also suggests there may be many undetected cases of SSc and NLP can successfully identify these patients. PMID:25168254

Tablet-based cardiac arrest documentation: a pilot study.

PubMed

Peace, Jack M; Yuen, Trevor C; Borak, Meredith H; Edelson, Dana P

2014-02-01

Conventional paper-based resuscitation transcripts are notoriously inaccurate, often lacking the precision that is necessary for recording a fast-paced resuscitation. The aim of this study was to evaluate whether a tablet computer-based application could improve upon conventional practices for resuscitation documentation. Nurses used either the conventional paper code sheet or a tablet application during simulated resuscitation events. Recorded events were compared to a gold standard record generated from video recordings of the simulations and a CPR-sensing defibrillator/monitor. Events compared included defibrillations, medication deliveries, and other interventions. During the study period, 199 unique interventions were observed in the gold standard record. Of these, 102 occurred during simulations recorded by the tablet application, 78 by the paper code sheet, and 19 during scenarios captured simultaneously by both documentation methods These occurred over 18 simulated resuscitation scenarios, in which 9 nurses participated. The tablet application had a mean sensitivity of 88.0% for all interventions, compared to 67.9% for the paper code sheet (P=0.001). The median time discrepancy was 3s for the tablet, and 77s for the paper code sheet when compared to the gold standard (P<0.001). Similar to prior studies, we found that conventional paper-based documentation practices are inaccurate, often misreporting intervention delivery times or missing their delivery entirely. However, our study also demonstrated that a tablet-based documentation method may represent a means to substantially improve resuscitation documentation quality, which could have implications for resuscitation quality improvement and research. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Computer software documentation

NASA Technical Reports Server (NTRS)

Comella, P. A.

1973-01-01

A tutorial in the documentation of computer software is presented. It presents a methodology for achieving an adequate level of documentation as a natural outgrowth of the total programming effort commencing with the initial problem statement and definition and terminating with the final verification of code. It discusses the content of adequate documentation, the necessity for such documentation and the problems impeding achievement of adequate documentation.

A Peer Helpers Code of Behavior.

ERIC Educational Resources Information Center

de Rosenroll, David A.

This document presents a guide for developing a peer helpers code of behavior. The first section discusses issues relevant to the trainers. These issues include whether to give a model directly to the group or whether to engender "ownership" of the code by the group; timing of introduction of the code; and addressing the issue of…

Roanoke College Student Conduct Code 1990-91.

ERIC Educational Resources Information Center

Roanoke Coll., VA.

This Roanoke College (Virginia) 1990-91 conduct code manual is intended for distribution to students. A reproduction of the Academic Integrity and Student Conduct Code Form which all students must sign leads off the document. A section detailing the student conduct code explains the delegation of authority within the institution and describes the…

Integrated Information Systems for Electronic Chemotherapy Medication Administration

PubMed Central

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

2011-01-01

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

Developing patient-centered teams: The role of sharing stories about patients and patient care.

PubMed

Bennett, Ariana H; Hassinger, Jane A; Martin, Lisa A; Harris, Lisa H; Gold, Marji

2015-09-01

Research indicates that health care teams are good for staff, patients, and organizations. The characteristics that make teams effective include shared objectives, mutual respect, clarity of roles, communication, trust, and collaboration. We were interested in examining how teams develop these positive characteristics. This paper explores the role of sharing stories about patients in developing patient-centered teams. Data for this paper came from 1 primary care clinic as part of a larger Providers Share Workshop study conducted by the University of Michigan. Each workshop included 5 facilitated group sessions in which staff met to talk about their work. This paper analyzes qualitative data from the workshops. Through an iterative process, research team members identified major themes, developed a coding scheme, and coded transcripts for qualitative data analysis. One of the most powerful ways group members connected was through sharing stories about their patients. Sharing clinical cases and stories helped participants bond around their shared mission of patient-centered care, build supportive relationships, enhance compassion for patients, communicate and resolve conflict, better understand workflows and job roles, develop trust, and increase morale. These attributes highlighted by participants correspond to those documented in the literature as important elements of teambuilding and key indicators of team effectiveness. The sharing of stories about patients seems to be a promising tool for positive team development in a primary care clinical setting and should be investigated further. (c) 2015 APA, all rights reserved).

Flowgen: Flowchart-based documentation for C + + codes

NASA Astrophysics Data System (ADS)

Kosower, David A.; Lopez-Villarejo, J. J.

2015-11-01

We present the Flowgen tool, which generates flowcharts from annotated C + + source code. The tool generates a set of interconnected high-level UML activity diagrams, one for each function or method in the C + + sources. It provides a simple and visual overview of complex implementations of numerical algorithms. Flowgen is complementary to the widely-used Doxygen documentation tool. The ultimate aim is to render complex C + + computer codes accessible, and to enhance collaboration between programmers and algorithm or science specialists. We describe the tool and a proof-of-concept application to the VINCIA plug-in for simulating collisions at CERN's Large Hadron Collider.

Harmonizing clinical terminologies: driving interoperability in healthcare.

PubMed

Hamm, Russell A; Knoop, Sarah E; Schwarz, Peter; Block, Aaron D; Davis, Warren L

2007-01-01

Internationally, there are countless initiatives to build National Healthcare Information Networks (NHIN) that electronically interconnect healthcare organizations by enhancing and integrating current information technology (IT) capabilities. The realization of such NHINs will enable the simple and immediate exchange of appropriate and vital clinical data among participating organizations. In order for institutions to accurately and automatically exchange information, the electronic clinical documents must make use of established clinical codes, such as those of SNOMED-CT, LOINC and ICD-9 CM. However, there does not exist one universally accepted coding scheme that encapsulates all pertinent clinical information for the purposes of patient care, clinical research and population heatlh reporting. In this paper, we propose a combination of methods and standards that target the harmonization of clinical terminologies and encourage sustainable, interoperable infrastructure for healthcare.

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

PubMed

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

2014-01-01

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

Addressing medical coding and billing part II: a strategy for achieving compliance. A risk management approach for reducing coding and billing errors.

PubMed Central

Adams, Diane L.; Norman, Helen; Burroughs, Valentine J.

2002-01-01

Medical practice today, more than ever before, places greater demands on physicians to see more patients, provide more complex medical services and adhere to stricter regulatory rules, leaving little time for coding and billing. Yet, the need to adequately document medical records, appropriately apply billing codes and accurately charge insurers for medical services is essential to the medical practice's financial condition. Many physicians rely on office staff and billing companies to process their medical bills without ever reviewing the bills before they are submitted for payment. Some physicians may not be receiving the payment they deserve when they do not sufficiently oversee the medical practice's coding and billing patterns. This article emphasizes the importance of monitoring and auditing medical record documentation and coding application as a strategy for achieving compliance and reducing billing errors. When medical bills are submitted with missing and incorrect information, they may result in unpaid claims and loss of revenue to physicians. Addressing Medical Audits, Part I--A Strategy for Achieving Compliance--CMS, JCAHO, NCQA, published January 2002 in the Journal of the National Medical Association, stressed the importance of preparing the medical practice for audits. The article highlighted steps the medical practice can take to prepare for audits and presented examples of guidelines used by regulatory agencies to conduct both medical and financial audits. The Medicare Integrity Program was cited as an example of guidelines used by regulators to identify coding errors during an audit and deny payment to providers when improper billing occurs. For each denied claim, payments owed to the medical practice are are also denied. Health care is, no doubt, a costly endeavor for health care providers, consumers and insurers. The potential risk to physicians for improper billing may include loss of revenue, fraud investigations, financial sanction, disciplinary action and exclusion from participation in government programs. Part II of this article recommends an approach for assessing potential risk, preventing improper billing, and improving financial management of the medical practice. Images p432-a PMID:12078924

Development and progress of Ireland's biobank network: Ethical, legal, and social implications (ELSI), standardized documentation, sample and data release, and international perspective.

PubMed

Mee, Blanaid; Gaffney, Eoin; Glynn, Sharon A; Donatello, Simona; Carroll, Paul; Connolly, Elizabeth; Garrigle, Sarah Mc; Boyle, Terry; Flannery, Delia; Sullivan, Francis J; McCormick, Paul; Griffin, Mairead; Muldoon, Cian; Fay, Joanna; O'Grady, Tony; Kay, Elaine; Eustace, Joe; Burke, Louise; Sheikh, Asim A; Finn, Stephen; Flavin, Richard; Giles, Francis J

2013-02-01

Biobank Ireland Trust (BIT) was established in 2004 to promote and develop an Irish biobank network to benefit patients, researchers, industry, and the economy. The network commenced in 2008 with two hospital biobanks and currently consists of biobanks in the four main cancer hospitals in Ireland. The St. James's Hospital (SJH) Biobank coordinates the network. Procedures, based on ISBER and NCI guidelines, are standardized across the network. Policies and documents-Patient Consent Policy, Patient Information Sheet, Biobank Consent Form, Sample and Data Access Policy (SAP), and Sample Application Form have been agreed upon (after robust discussion) for use in each hospital. An optimum sequence for document preparation and submission for review is outlined. Once consensus is reached among the participating biobanks, the SJH biobank liaises with the Research and Ethics Committees, the Office of the Data Protection Commissioner, The National Cancer Registry (NCR), patient advocate groups, researchers, and other stakeholders. The NCR provides de-identified data from its database for researchers via unique biobank codes. ELSI issues discussed include the introduction of prospective consent across the network and the return of significant research results to patients. Only 4 of 363 patients opted to be re-contacted and re-consented on each occasion that their samples are included in a new project. It was decided, after multidisciplinary discussion, that results will not be returned to patients. The SAP is modeled on those of several international networks. Biobank Ireland is affiliated with international biobanking groups-Marble Arch International Working Group, ISBER, and ESBB. The Irish government continues to deliberate on how to fund and implement biobanking nationally. Meanwhile BIT uses every opportunity to promote awareness of the benefits of biobanking in events and in the media.

Benchmarking of neutron production of heavy-ion transport codes

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

Remec, I.; Ronningen, R. M.; Heilbronn, L.

Document available in abstract form only, full text of document follows: Accurate prediction of radiation fields generated by heavy ion interactions is important in medical applications, space missions, and in design and operation of rare isotope research facilities. In recent years, several well-established computer codes in widespread use for particle and radiation transport calculations have been equipped with the capability to simulate heavy ion transport and interactions. To assess and validate these capabilities, we performed simulations of a series of benchmark-quality heavy ion experiments with the computer codes FLUKA, MARS15, MCNPX, and PHITS. We focus on the comparisons of secondarymore » neutron production. Results are encouraging; however, further improvements in models and codes and additional benchmarking are required. (authors)« less

Automated Detection of Privacy Sensitive Conditions in C-CDAs: Security Labeling Services at the Department of Veterans Affairs

PubMed Central

Bouhaddou, Omar; Davis, Mike; Donahue, Margaret; Mallia, Anthony; Griffin, Stephania; Teal, Jennifer; Nebeker, Jonathan

2016-01-01

Care coordination across healthcare organizations depends upon health information exchange. Various policies and laws govern permissible exchange, particularly when the information includes privacy sensitive conditions. The Department of Veterans Affairs (VA) privacy policy has required either blanket consent or manual sensitivity review prior to exchanging any health information. The VA experience has been an expensive, administratively demanding burden on staffand Veterans alike, particularly for patients without privacy sensitive conditions. Until recently, automatic sensitivity determination has not been feasible. This paper proposes a policy-driven algorithmic approach (Security Labeling Service or SLS) to health information exchange that automatically detects the presence or absence of specific privacy sensitive conditions and then, to only require a Veteran signed consent for release when actually present. The SLS was applied successfully to a sample of real patient Consolidated-Clinical Document Architecture(C-CDA) documents. The SLS identified standard terminology codes by both parsing structured entries and analyzing textual information using Natural Language Processing (NLP). PMID:28269828

Automated Detection of Privacy Sensitive Conditions in C-CDAs: Security Labeling Services at the Department of Veterans Affairs.

PubMed

Bouhaddou, Omar; Davis, Mike; Donahue, Margaret; Mallia, Anthony; Griffin, Stephania; Teal, Jennifer; Nebeker, Jonathan

2016-01-01

Care coordination across healthcare organizations depends upon health information exchange. Various policies and laws govern permissible exchange, particularly when the information includes privacy sensitive conditions. The Department of Veterans Affairs (VA) privacy policy has required either blanket consent or manual sensitivity review prior to exchanging any health information. The VA experience has been an expensive, administratively demanding burden on staffand Veterans alike, particularly for patients without privacy sensitive conditions. Until recently, automatic sensitivity determination has not been feasible. This paper proposes a policy-driven algorithmic approach (Security Labeling Service or SLS) to health information exchange that automatically detects the presence or absence of specific privacy sensitive conditions and then, to only require a Veteran signed consent for release when actually present. The SLS was applied successfully to a sample of real patient Consolidated-Clinical Document Architecture(C-CDA) documents. The SLS identified standard terminology codes by both parsing structured entries and analyzing textual information using Natural Language Processing (NLP).

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

PubMed Central

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

2008-01-01

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

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

PubMed

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

2008-01-01

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

Resident compliance with the american academy of ophthalmology preferred practice pattern guidelines for primary open-angle glaucoma.

PubMed

Ong, Sally S; Sanka, Krishna; Mettu, Priyatham S; Brosnan, Thomas M; Stinnett, Sandra S; Lee, Paul P; Challa, Pratap

2013-12-01

To examine resident adherence to preferred practice pattern (PPP) guidelines set up by the American Academy of Ophthalmology for follow-up care of primary open-angle glaucoma (POAG) patients. Retrospective chart review. One hundred three charts were selected for analysis from all patients with an International Classification of Diseases, Ninth Revision, code of open-angle glaucoma or its related entities who underwent a follow-up evaluation between July 2, 2003, and December 15, 2004, at the resident ophthalmology clinic in the Durham Veteran Affairs Medical Center. Follow-up visits of POAG patients were evaluated for documentation of 19 elements in accordance to PPP guidelines. Compliance rates for the 19 elements of PPP guidelines first were averaged in all charts, and then were averaged per resident and were compared among 8 residents between their first and second years of residency. The overall mean compliance rate for all 19 elements was 82.6% for all charts (n = 103), 78.8% for first-year residents, and 81.7% for second-year residents. The increase from first to second year of residency was not significant (P>0.05). Documentation rates were high (>90%) for 14 elements, including all components of the physical examination and follow-up as well as most components of the examination history and management plan. Residents documented adjusting target intraocular pressure downward, local or systemic problems with medications, and impact of visual function on daily living approximately 50% to 80% of the time. Documentation rates for components of patient education were the lowest, between 5% and 16% in all charts. Residents' compliance with PPP guidelines for a POAG follow-up visit was very high for most elements, but documentation rates for components of patient education were poor. Adherence rates to PPP guidelines can be used as a tool to evaluate and improve resident performance during training. However, further studies are needed to establish the advantages of using PPP guidelines for resident education and to determine if such assessments can lead to improved patient care. Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Using simulation to isolate physician variation in intensive care unit admission decision making for critically ill elders with end-stage cancer: a pilot feasibility study.

PubMed

Barnato, Amber E; Hsu, Heather E; Bryce, Cindy L; Lave, Judith R; Emlet, Lillian L; Angus, Derek C; Arnold, Robert M

2008-12-01

To determine the feasibility of high-fidelity simulation for studying variation in intensive care unit admission decision making for critically ill elders with end-stage cancer. Mixed qualitative and quantitative analysis of physician subjects participating in a simulation scenario using hospital set, actors, medical chart, and vital signs tracings. The simulation depicted a 78-yr-old man with metastatic gastric cancer, life-threatening hypoxia most likely attributable to cancer progression, and stable preferences to avoid intensive care unit admission and intubation. Two independent raters assessed the simulations and subjects completed a postsimulation web-based survey and debriefing interview. Peter M. Winter Institute for Simulation Education and Research at the University of Pittsburgh. Twenty-seven hospital-based attending physicians, including 6 emergency physicians, 13 hospitalists, and 8 intensivists. Outcomes included qualitative report of clinical verisimilitude during the debriefing interview, survey-reported diagnosis and prognosis, and observed treatment decisions. Independent variables included physician demographics, risk attitude, and reactions to uncertainty. All (100%) reported that the case and simulation were highly realistic, and their diagnostic and prognostic assessments were consistent with our intent. Eight physicians (29.6%) admitted the patient to the intensive care unit. Among the eight physicians who admitted the patient to the intensive care unit, three (37%) initiated palliation, two (25%) documented the patient's code status (do not intubate/do not resuscitate), and one intubated the patient. Among the 19 physicians who did not admit the patient to the intensive care unit, 13 (68%) initiated palliation and 5 (42%) documented code status. Intensivists and emergency physicians (p = 0.048) were more likely to admit the patient to the intensive care unit. Years since medical school graduation were inversely associated with the initiation of palliative care (p = 0.043). Simulation can reproduce the decision context of intensive care unit triage for a critically ill patient with terminal illness. When faced with an identical patient, hospital-based physicians from the same institution vary significantly in their treatment decisions.

MILSTAMP TACs: Military Standard Transportation and Movement Procedures Transportation Account Codes. Volume 2

DTIC Science & Technology

1987-02-15

this chapter. NO - If shipment is not second des - tination transportation , obtain fund cite per yes response for question 2 above. 4. For Direct Support...return . . . . . . . . .0 . . . . . . . a. . .. A820 (8) LOGAIR/QUICKTRANS. Transportation Account Codes de - signed herein are applicable to the...oo~• na~- Transportation Tis Document Contains Tasotto Missing Page/s That Are Unavailable In The And Original Document Movement sdocument has boon

Communication tools for end-of-life decision-making in the intensive care unit: a systematic review and meta-analysis.

PubMed

Oczkowski, Simon J W; Chung, Han-Oh; Hanvey, Louise; Mbuagbaw, Lawrence; You, John J

2016-04-09

For many patients admitted to the intensive care unit (ICU), preferences for end-of-life care are unknown, and clinicians and substitute decision-makers are required to make decisions about the goals of care on their behalf. We conducted a systematic review to determine the effect of structured communication tools for end-of-life decision-making, compared to usual care, upon the number of documented goals of care discussions, documented code status, and decisions to withdraw life-sustaining treatments, in adult patients admitted to the ICU. We searched multiple databases including MEDLINE, Embase, CINAHL, ERIC, and Cochrane from database inception until July 2014. Two reviewers independently screened articles, assessed eligibility, verified data extraction, and assessed risk of bias using the tool described by the Cochrane Collaboration and the Newcastle Ottawa Scale. Pooled estimates of effect (relative risk, standardized mean difference, or mean difference), were calculated where sufficient data existed. GRADE was used to evaluate the overall quality of evidence for each outcome. We screened 5785 abstracts and reviewed the full text of 424 articles, finding 168 eligible articles, including 19 studies in the ICU setting. The use of communication tools increased documentation of goals-of-care discussions (RR 3.47, 95% CI 1.55, 7.75, p = 0.020, very low-quality evidence), but did not have an effect on code status documentation (RR 1.03, 95% CI 0.96, 1.10, p = 0.540, low-quality evidence) or decisions to withdraw or withhold life-sustaining treatments (RR 0.98, 95% CI 0.89, 1.08, p = 0.70, low-quality evidence). The use of such tools was associated with a decrease in multiple measures of health care resource utilization, including duration of mechanical ventilation (MD -1.9 days, 95% CI -3.26, -0.54, p = 0.006, very low-quality evidence), length of ICU stay (MD -1.11 days, 95% CI -2.18, -0.03, p = 0.04, very low-quality evidence), and health care costs (SMD -0.32, 95% CI -0.5, -0.15, p < 0.001, very low-quality evidence). Structured communication tools may improve documentation of EOL decision making and may result in lower resource use. The supporting evidence is low to very low in quality. Further high-quality randomized studies of simple communication interventions are needed to determine whether structured, rather than ad hoc, approaches to end-of-life decision-making improve patient-level, family-level, and system-level outcomes. PROSPERO CRD42014012913.

7 CFR Exhibit E to Subpart A of... - Voluntary National Model Building Codes

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 12 2013-01-01 2013-01-01 false Voluntary National Model Building Codes E Exhibit E... National Model Building Codes The following documents address the health and safety aspects of buildings and related structures and are voluntary national model building codes as defined in § 1924.4(h)(2) of...

7 CFR Exhibit E to Subpart A of... - Voluntary National Model Building Codes

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 12 2014-01-01 2013-01-01 true Voluntary National Model Building Codes E Exhibit E to... Model Building Codes The following documents address the health and safety aspects of buildings and related structures and are voluntary national model building codes as defined in § 1924.4(h)(2) of this...

7 CFR Exhibit E to Subpart A of... - Voluntary National Model Building Codes

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 12 2012-01-01 2012-01-01 false Voluntary National Model Building Codes E Exhibit E... National Model Building Codes The following documents address the health and safety aspects of buildings and related structures and are voluntary national model building codes as defined in § 1924.4(h)(2) of...

Using health-system-wide data to understand hepatitis B virus prophylaxis and reactivation outcomes in patients receiving rituximab.

PubMed

Schmajuk, Gabriela; Tonner, Chris; Trupin, Laura; Li, Jing; Sarkar, Urmimala; Ludwig, Dana; Shiboski, Stephen; Sirota, Marina; Dudley, R Adams; Murray, Sara; Yazdany, Jinoos

2017-03-01

Hepatitis B virus (HBV) reactivation in the setting of rituximab use is a potentially fatal but preventable safety event. The rate of HBV screening and proportion of patients at risk who receive antiviral prophylaxis in patients initiating rituximab is unknown.We analyzed electronic health record (EHR) data from 2 health systems, a university center and a safety net health system, including diagnosis grouper codes, problem lists, medications, laboratory results, procedures codes, clinical encounter notes, and scanned documents. We identified all patients who received rituximab between 6/1/2012 and 1/1/2016. We calculated the proportion of rituximab users with inadequate screening for HBV according to the Centers for Disease Control guidelines for detecting latent HBV infection before their first rituximab infusion during the study period. We also assessed the proportion of patients with positive hepatitis B screening tests who were prescribed antiviral prophylaxis. Finally, we characterized safety failures and adverse events.We included 926 patients from the university and 132 patients from the safety net health system. Sixty-one percent of patients from the university had adequate screening for HBV compared with 90% from the safety net. Among patients at risk for reactivation based on results of HBV testing, 66% and 92% received antiviral prophylaxis at the university and safety net, respectively.We found wide variations in hepatitis B screening practices among patients receiving rituximab, resulting in unnecessary risks to patients. Interventions should be developed to improve patient safety procedures in this high-risk patient population.

Nevada Administrative Code for Special Education Programs.

ERIC Educational Resources Information Center

Nevada State Dept. of Education, Carson City. Special Education Branch.

This document presents excerpts from Chapter 388 of the Nevada Administrative Code, which concerns definitions, eligibility, and programs for students who are disabled or gifted/talented. The first section gathers together 36 relevant definitions from the Code for such concepts as "adaptive behavior,""autism,""gifted and…

Recent Updates to the MELCOR 1.8.2 Code for ITER Applications

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

Merrill, Brad J

This report documents recent changes made to the MELCOR 1.8.2 computer code for application to the International Thermonuclear Experimental Reactor (ITER), as required by ITER Task Agreement ITA 81-18. There are four areas of change documented by this report. The first area is the addition to this code of a model for transporting HTO. The second area is the updating of the material oxidation correlations to match those specified in the ITER Safety Analysis Data List (SADL). The third area replaces a modification to an aerosol tranpsort subroutine that specified the nominal aerosol density internally with one that now allowsmore » the user to specify this density through user input. The fourth area corrected an error that existed in an air condensation subroutine of previous versions of this modified MELCOR code. The appendices of this report contain FORTRAN listings of the coding for these modifications.« less

Los Alamos and Lawrence Livermore National Laboratories Code-to-Code Comparison of Inter Lab Test Problem 1 for Asteroid Impact Hazard Mitigation

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

Weaver, Robert P.; Miller, Paul; Howley, Kirsten

The NNSA Laboratories have entered into an interagency collaboration with the National Aeronautics and Space Administration (NASA) to explore strategies for prevention of Earth impacts by asteroids. Assessment of such strategies relies upon use of sophisticated multi-physics simulation codes. This document describes the task of verifying and cross-validating, between Lawrence Livermore National Laboratory (LLNL) and Los Alamos National Laboratory (LANL), modeling capabilities and methods to be employed as part of the NNSA-NASA collaboration. The approach has been to develop a set of test problems and then to compare and contrast results obtained by use of a suite of codes, includingmore » MCNP, RAGE, Mercury, Ares, and Spheral. This document provides a short description of the codes, an overview of the idealized test problems, and discussion of the results for deflection by kinetic impactors and stand-off nuclear explosions.« less

The First AO Classification System for Fractures of the Craniomaxillofacial Skeleton: Rationale, Methodological Background, Developmental Process, and Objectives

PubMed Central

Audigé, Laurent; Cornelius, Carl-Peter; Ieva, Antonio Di; Prein, Joachim

2014-01-01

Validated trauma classification systems are the sole means to provide the basis for reliable documentation and evaluation of patient care, which will open the gateway to evidence-based procedures and healthcare in the coming years. With the support of AO Investigation and Documentation, a classification group was established to develop and evaluate a comprehensive classification system for craniomaxillofacial (CMF) fractures. Blueprints for fracture classification in the major constituents of the human skull were drafted and then evaluated by a multispecialty group of experienced CMF surgeons and a radiologist in a structured process during iterative agreement sessions. At each session, surgeons independently classified the radiological imaging of up to 150 consecutive cases with CMF fractures. During subsequent review meetings, all discrepancies in the classification outcome were critically appraised for clarification and improvement until consensus was reached. The resulting CMF classification system is structured in a hierarchical fashion with three levels of increasing complexity. The most elementary level 1 simply distinguishes four fracture locations within the skull: mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code 94). Levels 2 and 3 focus on further defining the fracture locations and for fracture morphology, achieving an almost individual mapping of the fracture pattern. This introductory article describes the rationale for the comprehensive AO CMF classification system, discusses the methodological framework, and provides insight into the experiences and interactions during the evaluation process within the core groups. The details of this system in terms of anatomy and levels are presented in a series of focused tutorials illustrated with case examples in this special issue of the Journal. PMID:25489387

The First AO Classification System for Fractures of the Craniomaxillofacial Skeleton: Rationale, Methodological Background, Developmental Process, and Objectives.

PubMed

Audigé, Laurent; Cornelius, Carl-Peter; Di Ieva, Antonio; Prein, Joachim

2014-12-01

Validated trauma classification systems are the sole means to provide the basis for reliable documentation and evaluation of patient care, which will open the gateway to evidence-based procedures and healthcare in the coming years. With the support of AO Investigation and Documentation, a classification group was established to develop and evaluate a comprehensive classification system for craniomaxillofacial (CMF) fractures. Blueprints for fracture classification in the major constituents of the human skull were drafted and then evaluated by a multispecialty group of experienced CMF surgeons and a radiologist in a structured process during iterative agreement sessions. At each session, surgeons independently classified the radiological imaging of up to 150 consecutive cases with CMF fractures. During subsequent review meetings, all discrepancies in the classification outcome were critically appraised for clarification and improvement until consensus was reached. The resulting CMF classification system is structured in a hierarchical fashion with three levels of increasing complexity. The most elementary level 1 simply distinguishes four fracture locations within the skull: mandible (code 91), midface (code 92), skull base (code 93), and cranial vault (code 94). Levels 2 and 3 focus on further defining the fracture locations and for fracture morphology, achieving an almost individual mapping of the fracture pattern. This introductory article describes the rationale for the comprehensive AO CMF classification system, discusses the methodological framework, and provides insight into the experiences and interactions during the evaluation process within the core groups. The details of this system in terms of anatomy and levels are presented in a series of focused tutorials illustrated with case examples in this special issue of the Journal.

75 FR 28594 - Ready-to-Learn Television Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-21

... Federal Register. Free Internet access to the official edition of the Federal Register and the Code of... Access to This Document: You can view this document, as well as all other documents of this Department published in the Federal Register, in text or Adobe Portable Document Format (PDF) on the Internet at the...

Rotor Wake/Stator Interaction Noise Prediction Code Technical Documentation and User's Manual

NASA Technical Reports Server (NTRS)

Topol, David A.; Mathews, Douglas C.

2010-01-01

This report documents the improvements and enhancements made by Pratt & Whitney to two NASA programs which together will calculate noise from a rotor wake/stator interaction. The code is a combination of subroutines from two NASA programs with many new features added by Pratt & Whitney. To do a calculation V072 first uses a semi-empirical wake prediction to calculate the rotor wake characteristics at the stator leading edge. Results from the wake model are then automatically input into a rotor wake/stator interaction analytical noise prediction routine which calculates inlet aft sound power levels for the blade-passage-frequency tones and their harmonics, along with the complex radial mode amplitudes. The code allows for a noise calculation to be performed for a compressor rotor wake/stator interaction, a fan wake/FEGV interaction, or a fan wake/core stator interaction. This report is split into two parts, the first part discusses the technical documentation of the program as improved by Pratt & Whitney. The second part is a user's manual which describes how input files are created and how the code is run.

What are the trends and demographics in sports-related pediatric spinal cord injuries?

PubMed

Nadarajah, Vidushan; Jauregui, Julio J; Perfetti, Dean; Shasti, Mark; Koh, Eugene Y; Henn, Ralph Frank

2018-02-01

Pediatric spinal cord injury (PSCI) is a devastating injury that can cause significant long-term consequences. The purpose of this study is to calculate and report the prevalence of PSCI, identify risk factors for sports-related PSCI, and evaluate associated factors. The data sets of the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) from 2000-2012 were analyzed using ICD-9-CM external cause of injury codes to identify the mechanism of injury contributing to PSCI hospitalization. We then extracted demographic data on each admission including age, gender, race, and year of admission. We further stratified the data by sports-related cases of injury. Multivariate logistic regression analyses were used to identify independent risk factors. Of our study population, 0.8% had a documented diagnosis of spinal cord injury (SCI). The most common documented external cause of injury code was motor vehicle accidents, representing roughly half of all cases in patients 0-9 years-old (p = 0.001). PSCI due to sports as an external cause of injury was more prevalent in patients 10-17 years old, and was especially prevalent in the 10-13 year-old age category in which sports-related PSCI reached a high of 25.6%. Risk factors for traumatic PSCI after a sports-related external cause included being of older age, male, and white. The prevalence of SCI increased with age. Given the popularity of youth sports in the United States, parents and sports officials should be aware of the increased risk of sports-related PSCI among patients 10-17 years old. Level III, retrospective cohort study.

Risk of hypoglycaemia in type 2 diabetes patients under different insulin regimens: a primary care database analysis.

PubMed

Kostev, Karel; Dippel, Franz W; Rathmann, Wolfgang

2015-01-01

To compare rates and predictors of documented hypoglycaemia in type 2 diabetes patients treated with either basal insulin supported oral therapy (BOT), conventional therapy (CT) or supplementary insulin therapy (SIT) in primary care. Data from 10,842 anonymous patients (mean age ± SD: 54 ± 8 yrs) on BOT, 2,407 subjects (56 ± 7 yrs) on CT, and 7,480 patients (52 ± 10 yrs) using SIT from 1,198 primary care practices were retrospectively analyzed (Disease Analyzer, Germany: 01/2005-07/2013). Stepwise logistic regression (≥1 documented hypoglycaemia: ICD code) was used to evaluate risk factors of hypoglycemia. The unadjusted rates (95% CI) per 100 patient-years of documented hypoglycaemia were 1.01 (0.80-1.20) (BOT), 1.68 (1.10-2.30) (CT), and 1.61 (1.30-1.90) (SIT), respectively. The odds of having ≥1 hypoglycemia was increased for CT (OR; 95% CI: 1.71; 1.13-2.58) and SIT (1.55; 1.15-2.08) (reference: BOT). Previous hypoglycemia (OR: 11.24; 6.71-18.85), duration of insulin treatment (days) (1.06; 1.05-1.07), history of transient ischemic attack (TIA)/stroke (1.91; 1.04-3.50), and former salicylate prescriptions (1.44; 1.06-1.98) also showed an increased odds of having hypoglycemia. Higher age was associated with a slightly lower odds ratio (per year: 0.98; 0.97-0.99). Insulin naïve type 2 diabetes patients in primary care, initiated with CT and SIT have an increased risk of hypoglycaemia compared to BOT, which is in line with previous randomized controlled trials. As hypoglycaemic events are associated with an increased mortality risk, this real-world finding is of clinical relevance.

Using multiple sources of data for surveillance of postoperative venous thromboembolism among surgical patients treated in Department of Veterans Affairs hospitals, 2005-2010.

PubMed

Nelson, Richard E; Grosse, Scott D; Waitzman, Norman J; Lin, Junji; DuVall, Scott L; Patterson, Olga; Tsai, James; Reyes, Nimia

2015-04-01

There are limitations to using administrative data to identify postoperative venous thromboembolism (VTE). We used a novel approach to quantify postoperative VTE events among Department of Veterans Affairs (VA) surgical patients during 2005-2010. We used VA administrative data to exclude patients with VTE during 12 months prior to surgery. We identified probable postoperative VTE events within 30 and 90 days post-surgery in three settings: 1) pre-discharge inpatient, using a VTE diagnosis code and a pharmacy record for anticoagulation; 2) post-discharge inpatient, using a VTE diagnosis code followed by a pharmacy record for anticoagulation within 7 days; and 3) outpatient, using a VTE diagnosis code and either anticoagulation or a therapeutic procedure code with natural language processing (NLP) to confirm acute VTE in clinical notes. Among 468,515 surgeries without prior VTE, probable VTEs were documented within 30 and 90 days in 3,931 (0.8%) and 5,904 (1.3%), respectively. Of probable VTEs within 30 or 90 days post-surgery, 47.8% and 62.9%, respectively, were diagnosed post-discharge. Among post-discharge VTE diagnoses, 86% resulted in a VA hospital readmission. Fewer than 25% of outpatient records with both VTE diagnoses and anticoagulation prescriptions were confirmed by NLP as acute VTE events. More than half of postoperative VTE events were diagnosed post-discharge; analyses of surgical discharge records are inadequate to identify postoperative VTE. The NLP results demonstrate that the combination of VTE diagnoses and anticoagulation prescriptions in outpatient administrative records cannot be used to validly identify postoperative VTE events. Copyright © 2015. Published by Elsevier Ltd.

Using multiple sources of data for surveillance of postoperative venous thromboembolism among surgical patients treated in Department of Veterans Affairs hospitals, 2005–2010

PubMed Central

Nelson, Richard E.; Grosse, Scott D.; Waitzman, Norman J.; Lin, Junji; DuVall, Scott L.; Patterson, Olga; Tsai, James; Reyes, Nimia

2015-01-01

Background There are limitations to using administrative data to identify postoperative venous thromboembolism (VTE). We used a novel approach to quantify postoperative VTE events among Department of Veterans Affairs (VA) surgical patients during 2005–2010. Methods We used VA administrative data to exclude patients with VTE during 12 months prior to surgery. We identified probable postoperative VTE events within 30 and 90 days post-surgery in three settings: 1) pre-discharge inpatient, using a VTE diagnosis code and a pharmacy record for anticoagulation; 2) post-discharge inpatient, using a VTE diagnosis code followed by a pharmacy record for anticoagulation within 7 days; and 3) outpatient, using a VTE diagnosis code and either anticoagulation or a therapeutic procedure code with natural language processing (NLP) to confirm acute VTE in clinical notes. Results Among 468,515 surgeries without prior VTE, probable VTEs were documented within 30 and 90 days in 3,931 (0.8%) and 5,904 (1.3%), respectively. Of probable VTEs within 30 or 90 days post-surgery, 47.8% and 62.9%, respectively, were diagnosed post-discharge. Among post-discharge VTE diagnoses, 86% resulted in a VA hospital readmission. Fewer than 25% of outpatient records with both VTE diagnoses and anticoagulation prescriptions were confirmed by NLP as acute VTE events. Conclusion More than half of postoperative VTE events were diagnosed post-discharge; analyses of surgical discharge records are inadequate to identify postoperative VTE. The NLP results demonstrate that the combination of VTE diagnoses and anticoagulation prescriptions in outpatient administrative records cannot be used to validly identify postoperative VTE events. PMID:25666908

7 CFR Exhibit E to Subpart A of... - Voluntary National Model Building Codes

Code of Federal Regulations, 2011 CFR

2011-01-01

... National Model Building Codes The following documents address the health and safety aspects of buildings... International, Inc., 4051 West Flossmoor Road, Country Club Hills, Illinois 60477. 2 Southern Building Code Congress International, Inc., 900 Montclair Road, Birmingham, Alabama 35213-1206. 3 International...

California Library Laws. 1977.

ERIC Educational Resources Information Center

Silver, Cy H.

This document contains selections from the California Administrative Code, Education Code, Government Code, and others relating to public libraries, county law libraries and the State Library. The first section presents legal developments in California from 1974 to 1976 which are of interest to librarians. Laws and regulations are presented under…

Metal Matrix Laminate Tailoring (MMLT) code: User's manual

NASA Technical Reports Server (NTRS)

Murthy, P. L. N.; Morel, M. R.; Saravanos, D. A.

1993-01-01

The User's Manual for the Metal Matrix Laminate Tailoring (MMLT) program is presented. The code is capable of tailoring the fabrication process, constituent characteristics, and laminate parameters (individually or concurrently) for a wide variety of metal matrix composite (MMC) materials, to improve the performance and identify trends or behavior of MMC's under different thermo-mechanical loading conditions. This document is meant to serve as a guide in the use of the MMLT code. Detailed explanations of the composite mechanics and tailoring analysis are beyond the scope of this document, and may be found in the references. MMLT was developed by the Structural Mechanics Branch at NASA Lewis Research Center (LeRC).

Population-based drug-related anaphylaxis in children and adolescents captured by South Carolina Emergency Room Hospital Discharge Database (SCERHDD) (2000-2002).

PubMed

West, Suzanne L; D'Aloisio, Aimee A; Ringel-Kulka, Tamar; Waller, Anna E; Clayton Bordley, W

2007-12-01

Anaphylaxis is a life-threatening condition; drug-related anaphylaxis represents approximately 10% of all cases. We assessed the utility of a statewide emergency department (ED) database for identifying drug-related anaphylaxis in children by developing and validating an algorithm composed of ICD-9-CM codes. There were 1 314,760 visits to South Carolina (SC) emergency departments (EDs) for patients <19 years in 2000-2002. We used ICD-9-CM disease or external cause of injury codes (E-codes) that suggested drug-related anaphylaxis or a severe drug-related allergic reaction. We found 50 cases classifiable as probable or possible drug-related anaphylaxis and 13 as drug-related allergic reactions. We used clinical evaluation by two pediatricians as the 'alloyed gold standard'1 for estimating sensitivity, specificity, and positive predictive value (PPV) of our algorithm. ED-treated drug-related anaphylaxis in the SC pediatric population was 1.56/100,000 person-years based on the algorithm and 0.50/100,000 person-years based on clinical evaluation. Assuming the disease codes we used identified all potential anaphylaxis cases in the database, the sensitivity was 1.00 (95%CI: 0.79, 1.00), specificity was 0.28 (95%CI: 0.16, 0.43), and the PPV was 0.32 (0.20, 0.47) for the algorithm. Sensitivity analyses improved the measurement properties of the algorithm. E-codes were invaluable for developing an anaphylaxis algorithm although the frequently used code of E947.9 was often incorrectly applied. We believe that our algorithm may have over-ascertained drug-related anaphylaxis patients seen in an ED, but the clinical evaluation may have under-represented this diagnosis due to limited information on the offending agent in the abstracted ED records. Post-marketing drug surveillance using ED records may be viable if clinicians were to document drug-related anaphylaxis in the charts so that billing codes could be assigned properly. Copyright 2007 John Wiley & Sons, Ltd.

A multidisciplinary approach to vascular surgery procedure coding improves coding accuracy, work relative value unit assignment, and reimbursement.

PubMed

Aiello, Francesco A; Judelson, Dejah R; Messina, Louis M; Indes, Jeffrey; FitzGerald, Gordon; Doucet, Danielle R; Simons, Jessica P; Schanzer, Andres

2016-08-01

Vascular surgery procedural reimbursement depends on accurate procedural coding and documentation. Despite the critical importance of correct coding, there has been a paucity of research focused on the effect of direct physician involvement. We hypothesize that direct physician involvement in procedural coding will lead to improved coding accuracy, increased work relative value unit (wRVU) assignment, and increased physician reimbursement. This prospective observational cohort study evaluated procedural coding accuracy of fistulograms at an academic medical institution (January-June 2014). All fistulograms were coded by institutional coders (traditional coding) and by a single vascular surgeon whose codes were verified by two institution coders (multidisciplinary coding). The coding methods were compared, and differences were translated into revenue and wRVUs using the Medicare Physician Fee Schedule. Comparison between traditional and multidisciplinary coding was performed for three discrete study periods: baseline (period 1), after a coding education session for physicians and coders (period 2), and after a coding education session with implementation of an operative dictation template (period 3). The accuracy of surgeon operative dictations during each study period was also assessed. An external validation at a second academic institution was performed during period 1 to assess and compare coding accuracy. During period 1, traditional coding resulted in a 4.4% (P = .004) loss in reimbursement and a 5.4% (P = .01) loss in wRVUs compared with multidisciplinary coding. During period 2, no significant difference was found between traditional and multidisciplinary coding in reimbursement (1.3% loss; P = .24) or wRVUs (1.8% loss; P = .20). During period 3, traditional coding yielded a higher overall reimbursement (1.3% gain; P = .26) than multidisciplinary coding. This increase, however, was due to errors by institution coders, with six inappropriately used codes resulting in a higher overall reimbursement that was subsequently corrected. Assessment of physician documentation showed improvement, with decreased documentation errors at each period (11% vs 3.1% vs 0.6%; P = .02). Overall, between period 1 and period 3, multidisciplinary coding resulted in a significant increase in additional reimbursement ($17.63 per procedure; P = .004) and wRVUs (0.50 per procedure; P = .01). External validation at a second academic institution was performed to assess coding accuracy during period 1. Similar to institution 1, traditional coding revealed an 11% loss in reimbursement ($13,178 vs $14,630; P = .007) and a 12% loss in wRVU (293 vs 329; P = .01) compared with multidisciplinary coding. Physician involvement in the coding of endovascular procedures leads to improved procedural coding accuracy, increased wRVU assignments, and increased physician reimbursement. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Performance Measures of Diagnostic Codes for Detecting Opioid Overdose in the Emergency Department.

PubMed

Rowe, Christopher; Vittinghoff, Eric; Santos, Glenn-Milo; Behar, Emily; Turner, Caitlin; Coffin, Phillip O

2017-04-01

Opioid overdose mortality has tripled in the United States since 2000 and opioids are responsible for more than half of all drug overdose deaths, which reached an all-time high in 2014. Opioid overdoses resulting in death, however, represent only a small fraction of all opioid overdose events and efforts to improve surveillance of this public health problem should include tracking nonfatal overdose events. International Classification of Disease (ICD) diagnosis codes, increasingly used for the surveillance of nonfatal drug overdose events, have not been rigorously assessed for validity in capturing overdose events. The present study aimed to validate the use of ICD, 9th revision, Clinical Modification (ICD-9-CM) codes in identifying opioid overdose events in the emergency department (ED) by examining multiple performance measures, including sensitivity and specificity. Data on ED visits from January 1, 2012, to December 31, 2014, including clinical determination of whether the visit constituted an opioid overdose event, were abstracted from electronic medical records for patients prescribed long-term opioids for pain from any of six safety net primary care clinics in San Francisco, California. Combinations of ICD-9-CM codes were validated in the detection of overdose events as determined by medical chart review. Both sensitivity and specificity of different combinations of ICD-9-CM codes were calculated. Unadjusted logistic regression models with robust standard errors and accounting for clustering by patient were used to explore whether overdose ED visits with certain characteristics were more or less likely to be assigned an opioid poisoning ICD-9-CM code by the documenting physician. Forty-four (1.4%) of 3,203 ED visits among 804 patients were determined to be opioid overdose events. Opioid-poisoning ICD-9-CM codes (E850.2-E850.2, 965.00-965.09) identified overdose ED visits with a sensitivity of 25.0% (95% confidence interval [CI] = 13.6% to 37.8%) and specificity of 99.9% (95% CI = 99.8% to 100.0%). Expanding the ICD-9-CM codes to include both nonspecified and general (i.e., without a decimal modifier) drug poisoning and drug abuse codes identified overdose ED visits with a sensitivity of 56.8% (95% CI = 43.6%-72.7%) and specificity of 96.2% (95% CI = 94.8%-97.2%). Additional ICD-9-CM codes not explicitly relevant to opioid overdose were necessary to further enhance sensitivity. Among the 44 overdose ED visits, neither naloxone administration during the visit, whether the patient responded to the naloxone, nor the specific opioids involved were associated with the assignment of an opioid poisoning ICD-9-CM code (p ≥ 0.05). Tracking opioid overdose ED visits by diagnostic coding is fairly specific but insensitive, and coding was not influenced by administration of naloxone or the specific opioids involved. The reason for the high rate of missed cases is uncertain, although these results suggest that a more clearly defined case definition for overdose may be necessary to ensure effective opioid overdose surveillance. Changes in coding practices under ICD-10 might help to address these deficiencies. © 2016 by the Society for Academic Emergency Medicine.

Downtown Waterfront Form-Based Code Workshop

EPA Pesticide Factsheets

This document is a description of a Smart Growth Implementation Assistance for Coastal Communities project in Marquette, Michigan, to develop a form-based code that would attract and support vibrant development.

Sexual Abuse of the Mentally Retarded Patient: Medical and Legal Analysis for the Primary Care Physician

PubMed Central

Morano, Jamie P.

2001-01-01

The primary care physician has a vital role in documenting and preventing sexual abuse among the mentally retarded populations in our community. Since the current national trend is to integrate citizens with mental retardation into the community away from institutionalized care, it is essential that all physicians have a basic understanding of the unique medical and legal ramifications of their clinical diagnoses. As the legal arena is currently revising laws concerning rights of sexual consent among the mentally retarded, it is essential that determinations of mental competency follow national standards in order to delineate clearly any instance of sexual abuse. Clinical documentation of sexual abuse and sexually transmitted disease is an important part of a routine examination since many such individuals are indeed sexually active. Legal codes adjudicating sexual abuse cases of the mentally retarded often offer scant protection and vague terminology. Thus, medical documentation and physician competency rulings form a solid foundation for future work toward legal recourse for the abused. PMID:15014610

CBP Toolbox Version 3.0 “Beta Testing” Performance Evaluation

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

Smith, III, F. G.

2016-07-29

One function of the Cementitious Barriers Partnership (CBP) is to assess available models of cement degradation and to assemble suitable models into a “Toolbox” that would be made available to members of the partnership, as well as the DOE Complex. To this end, SRNL and Vanderbilt University collaborated to develop an interface using the GoldSim software to the STADIUM @ code developed by SIMCO Technologies, Inc. and LeachXS/ORCHESTRA developed by Energy research Centre of the Netherlands (ECN). Release of Version 3.0 of the CBP Toolbox is planned in the near future. As a part of this release, an increased levelmore » of quality assurance for the partner codes and the GoldSim interface has been developed. This report documents results from evaluation testing of the ability of CBP Toolbox 3.0 to perform simulations of concrete degradation applicable to performance assessment of waste disposal facilities. Simulations of the behavior of Savannah River Saltstone Vault 2 and Vault 1/4 concrete subject to sulfate attack and carbonation over a 500- to 1000-year time period were run using a new and upgraded version of the STADIUM @ code and the version of LeachXS/ORCHESTRA released in Version 2.0 of the CBP Toolbox. Running both codes allowed comparison of results from two models which take very different approaches to simulating cement degradation. In addition, simulations of chloride attack on the two concretes were made using the STADIUM @ code. The evaluation sought to demonstrate that: 1) the codes are capable of running extended realistic simulations in a reasonable amount of time; 2) the codes produce “reasonable” results; the code developers have provided validation test results as part of their code QA documentation; and 3) the two codes produce results that are consistent with one another. Results of the evaluation testing showed that the three criteria listed above were met by the CBP partner codes. Therefore, it is concluded that the codes can be used to support performance assessment. This conclusion takes into account the QA documentation produced for the partner codes and for the CBP Toolbox.« less

Identification of Long Bone Fractures in Radiology Reports Using Natural Language Processing to Support Healthcare Quality Improvement

PubMed Central

Masino, Aaron J.; Casper, T. Charles; Dean, Jonathan M.; Bell, Jamie; Enriquez, Rene; Deakyne, Sara; Chamberlain, James M.; Alpern, Elizabeth R.

2016-01-01

Summary Background Important information to support healthcare quality improvement is often recorded in free text documents such as radiology reports. Natural language processing (NLP) methods may help extract this information, but these methods have rarely been applied outside the research laboratories where they were developed. Objective To implement and validate NLP tools to identify long bone fractures for pediatric emergency medicine quality improvement. Methods Using freely available statistical software packages, we implemented NLP methods to identify long bone fractures from radiology reports. A sample of 1,000 radiology reports was used to construct three candidate classification models. A test set of 500 reports was used to validate the model performance. Blinded manual review of radiology reports by two independent physicians provided the reference standard. Each radiology report was segmented and word stem and bigram features were constructed. Common English “stop words” and rare features were excluded. We used 10-fold cross-validation to select optimal configuration parameters for each model. Accuracy, recall, precision and the F1 score were calculated. The final model was compared to the use of diagnosis codes for the identification of patients with long bone fractures. Results There were 329 unique word stems and 344 bigrams in the training documents. A support vector machine classifier with Gaussian kernel performed best on the test set with accuracy=0.958, recall=0.969, precision=0.940, and F1 score=0.954. Optimal parameters for this model were cost=4 and gamma=0.005. The three classification models that we tested all performed better than diagnosis codes in terms of accuracy, precision, and F1 score (diagnosis code accuracy=0.932, recall=0.960, precision=0.896, and F1 score=0.927). Conclusions NLP methods using a corpus of 1,000 training documents accurately identified acute long bone fractures from radiology reports. Strategic use of straightforward NLP methods, implemented with freely available software, offers quality improvement teams new opportunities to extract information from narrative documents. PMID:27826610

Seamless recording of glucometer measurements among older experienced diabetic patients - A study of perception and usability.

PubMed

Rasche, Peter; Mertens, Alexander; Miron-Shatz, Talya; Berzon, Corinne; Schlick, Christopher M; Jahn, Michael; Becker, Stefan

2018-01-01

Self-measurement and documentation of blood-glucose are critical elements of diabetes management, particularly in regimes including insulin. In this study, we analyze the usability of iBG-STAR, the first blood glucose meter connectable to a smartphone. This technology records glucometer measurements, removing the burden of documentation from diabetic patients. This study assesses the potential for implementation of iBG-STAR in routine care. Twelve long-term diabetic patients (4 males; median age of 66.5 years) were enrolled in the study. N = 4/12 reported diabetic polyneuropathy. Reported subjective mental workload for all tasks related to iBG-STAR was on average lower than 12 points, corresponding to the verbal code 'nearly no effort needed'. A "Post Study System Usability Questionnaire", evaluated the glucometer at an average value of 2.06 (SD = 1.02) on a 7-Likert-scale (1 = 'I fully agree' to 7 = 'I completely disagree') for usability. These results represent a positive user-experience. Patients with polyneuropathy may experience physical difficulties in completing the tasks, thereby affecting usability. Technologically savvy patients (n = 6) with a positive outlook on diabetes assessed the product as a suitable tool for themselves and would recommend to other diabetic patients. The main barrier to regular use was treating physicians' inability to retrieve digitally recorded data. This barrier was due to a shortcoming in interoperability of mobile devices and medical information systems.

Outpatient evaluation, recognition, and initial management of pediatric overweight and obesity in U.S. military medical treatment facilities.

PubMed

Dickey, Wayne; Arday, David R; Kelly, Joseph; Carnahan, Col David

2017-02-01

As childhood obesity is a concern in many communities, this study investigated outpatient evaluation and initial management of overweight and obese pediatric patients in U.S. military medical treatment facilities (MTFs). Samples of 579 overweight and 341 obese patients (as determined by body mass index [BMI]) aged 3-17 years were drawn from MTFs. All available FY2011 outpatient records were searched for documentation of BMI assessment, overweight/obesity diagnosis, and counseling. Administrative data for these patients were merged to assess coded diagnostic and counseling rates and receipt of recommended laboratory screenings. Generic BMI documentation was high, but BMI percentile assessments were found among fewer than half the patients. Diagnostic recording or recognition totaled 10.9% of overweight and 32.0% of obese. Counseling rates were higher, with 46.4% and 61.0% of overweight and obese patients, respectively, receiving weight related counseling. Among patients 10 years of age or older, rates of recommended lab screenings for diabetes, liver abnormality, and dyslipidemia were not greater than 33%. BMI percentile recording was strongly associated with diagnostic recording, and diagnostic recording was strongly associated with counseling. Improvements to electronic health records or implementation of local procedures to facilitate better diagnostic recording would likely improve adherence to clinical practice guidelines. ©2016 American Association of Nurse Practitioners.

Analyzing communication skills of Pediatric Postgraduate Residents in Clinical Encounter by using video recordings

PubMed Central

Bari, Attia; Khan, Rehan Ahmed; Jabeen, Uzma; Rathore, Ahsan Waheed

2017-01-01

Objective: To analyze communication skills of pediatric postgraduate residents in clinical encounter by using video recordings. Methods: This qualitative exploratory research was conducted through video recording at The Children’s Hospital Lahore, Pakistan. Residents who had attended the mandatory communication skills workshop offered by CPSP were included. The video recording of clinical encounter was done by a trained audiovisual person while the resident was interacting with the patient in the clinical encounter. Data was analyzed by thematic analysis. Results: Initially on open coding 36 codes emerged and then through axial and selective coding these were condensed to 17 subthemes. Out of these four main themes emerged: (1) Courteous and polite attitude, (2) Marginal nonverbal communication skills, (3) Power game/Ignoring child participation and (4) Patient as medical object/Instrumental behaviour. All residents treated the patient as a medical object to reach a right diagnosis and ignored them as a human being. There was dominant role of doctors and marginal nonverbal communication skills were displayed by the residents in the form of lack of social touch, and appropriate eye contact due to documenting notes. A brief non-medical interaction for rapport building at the beginning of interaction was missing and there was lack of child involvement. Conclusion: Paediatric postgraduate residents were polite while communicating with parents and child but lacking in good nonverbal communication skills. Communication pattern in our study was mostly one-way showing doctor’s instrumental behaviour and ignoring the child participation. PMID:29492050

A Comprehensive Approach to Convert a Radiology Department From Coding Based on International Classification of Diseases, Ninth Revision, to Coding Based on International Classification of Diseases, Tenth Revision.

PubMed

McBee, Morgan P; Laor, Tal; Pryor, Rebecca M; Smith, Rachel; Hardin, Judy; Ulland, Lisa; May, Sally; Zhang, Bin; Towbin, Alexander J

2018-02-01

The purpose of this study was to adapt our radiology reports to provide the documentation required for specific International Classification of Diseases, tenth rev (ICD-10) diagnosis coding. Baseline data were analyzed to identify the reports with the greatest number of unspecified ICD-10 codes assigned by computer-assisted coding software. A two-part quality improvement initiative was subsequently implemented. The first component involved improving clinical histories by utilizing technologists to obtain information directly from the patients or caregivers, which was then imported into the radiologist's report within the speech recognition software. The second component involved standardization of report terminology and creation of four different structured report templates to determine which yielded the fewest reports with an unspecified ICD-10 code assigned by an automated coding engine. In all, 12,077 reports were included in the baseline analysis. Of these, 5,151 (43%) had an unspecified ICD-10 code. The majority of deficient reports were for radiographs (n = 3,197; 62%). Inadequacies included insufficient clinical history provided and lack of detailed fracture descriptions. Therefore, the focus was standardizing terminology and testing different structured reports for radiographs obtained for fractures. At baseline, 58% of radiography reports contained a complete clinical history with improvement to >95% 8 months later. The total number of reports that contained an unspecified ICD-10 code improved from 43% at baseline to 27% at completion of this study (P < .0001). The number of radiology studies with a specific ICD-10 code can be improved through quality improvement methodology, specifically through the use of technologist-acquired clinical histories and structured reporting. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

[Research ethics committees: a necessary good].

PubMed

Riera, Alejandra V

2013-12-01

The Nuremberg Code, issued as the result of the deliberations of the Nuremberg Trials, which judged the atrocities carried out during Nazi Germany (1933-1945), was the first universal document that defined research ethics principles for human experimentation. This code served as the basis for the subsequent ethical codes and principles used today by the Research Ethics Committees. The Research Ethics Committee is a multidisciplinary body whose primary role is to protect the rights and welfare of research subjects through the review of research protocols, ensuring compliance with internationally and locally accepted ethical guidelines. Worldwide, there have been important improvements in order to promote and regulate bioethics in medical research. In Venezuela, several national organizations have been constituted with the aim of promoting the establishment of ethics committees; however, there has not been a significant progress in the quantity or quality of the functioning of Research Ethics Committees in the country. It is imperative for each research institution to establish and work to improve their ethics committee to ensure the quality of the clinical research conducted, making it adherent to ethical codes, and safeguarding the integrity and credibility of the investigators and the research institutions, and more importantly, the patient's rights.

7 CFR Exhibit E to Subpart A of... - Voluntary National Model Building Codes

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false Voluntary National Model Building Codes E Exhibit E... HOUSING SERVICE, RURAL BUSINESS-COOPERATIVE SERVICE, RURAL UTILITIES SERVICE, AND FARM SERVICE AGENCY... National Model Building Codes The following documents address the health and safety aspects of buildings...

78 FR 35143 - 1,3-Propanediol; Exemptions From the Requirement of a Tolerance

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-12

... rabbits. Dermal sensitization studies on guinea pigs showed that 1,3-propanediol is not a sensitizer. In a... whether this document applies to them. Potentially affected entities may include: Crop production (NAICS code 111). Animal production (NAICS code 112). Food manufacturing (NAICS code 311). Pesticide...

Poster - 28: Shielding of X-ray Rooms in Ontario in the Absence of Best Practice

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

Frimeth, Jeff; Richer, Jeff; Nesbitt, James

This poster will be strictly based on the Healing Arts Radiation Protection (HARP) Act, Regulation 543 under this Act (X-ray Safety Code), and personal communication the presenting author has had. In Ontario, the process of approval of an X-ray machine installation by the Director of the X-ray Inspection Service (XRIS) follows a certain protocol. Initially, the applicant submits a series of forms, including recommended shielding amounts, in order to satisfy the law. This documentation is then transferred to a third-party vendor (i.e. a professional engineer – P.Eng.) outsourced by the Ministry of Health and Long-term Care (MOHLTC). The P.Eng. thenmore » evaluates the submitted documentation for appropriate fulfillment of the HARP Act and Reg. 543 requirements. If the P.Eng.’s evaluation of the documentation is to their satisfaction, the XRIS is then notified. Finally, the Director will then issue a letter of approval to install the equipment at the facility. The methodology required to be used by the P.Eng. in order to determine the required amounts of protective barriers, and recommended to be used by the applicant, is contained within Safety Code 20A. However, Safety Code 35 has replaced the obsolete Safety Code 20A document and employs best practices in shielding design. This talk will focus further on specific intentions and limitations of Safety Code 20A. Furthermore, this talk will discuss the definition of the “practice of professional engineering” in Ontario. COMP members who are involved in shielding design are strongly encouraged to attend.« less

Automated Classification of Pathology Reports.

PubMed

Oleynik, Michel; Finger, Marcelo; Patrão, Diogo F C

2015-01-01

This work develops an automated classifier of pathology reports which infers the topography and the morphology classes of a tumor using codes from the International Classification of Diseases for Oncology (ICD-O). Data from 94,980 patients of the A.C. Camargo Cancer Center was used for training and validation of Naive Bayes classifiers, evaluated by the F1-score. Measures greater than 74% in the topographic group and 61% in the morphologic group are reported. Our work provides a successful baseline for future research for the classification of medical documents written in Portuguese and in other domains.

[Computer-assisted management of depots for blood products in health establishments].

PubMed

Carré, J

2008-11-01

To manage the filing of blood components at the hospital of the city of Bayeux, the laboratory uses Cursus, a dedicated software for haemovigilance. Benefits for using this software at different steps of the blood bank management are: simplification, security and harmonization of practices during receipt and issurance of blood components, securing recordings with the use of bar codes for patient identification and blood components listing, implementation of a computerized tracking system for transfusion, traceability, limitation of written documents and availability of statistics on the management of the depot.

Minimum essential coverage and other rules regarding the shared responsibility payment for individuals. Final regulations.

PubMed

2014-11-26

This document contains final regulations relating to the requirement to maintain minimum essential coverage enacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended by the TRICARE Affirmation Act and Public Law 111-173 (collectively, the Affordable Care Act). These final regulations provide individual taxpayers with guidance under section 5000A of the Internal Revenue Code on the requirement to maintain minimum essential coverage and rules governing certain types of exemptions from that requirement.

Reconciliation of international administrative coding systems for comparison of colorectal surgery outcome.

PubMed

Munasinghe, A; Chang, D; Mamidanna, R; Middleton, S; Joy, M; Penninckx, F; Darzi, A; Livingston, E; Faiz, O

2014-07-01

Significant variation in colorectal surgery outcomes exists between different countries. Better understanding of the sources of variable outcomes using administrative data requires alignment of differing clinical coding systems. We aimed to map similar diagnoses and procedures across administrative coding systems used in different countries. Administrative data were collected in a central database as part of the Global Comparators (GC) Project. In order to unify these data, a systematic translation of diagnostic and procedural codes was undertaken. Codes for colorectal diagnoses, resections, operative complications and reoperative interventions were mapped across the respective national healthcare administrative coding systems. Discharge data from January 2006 to June 2011 for patients who had undergone colorectal surgical resections were analysed to generate risk-adjusted models for mortality, length of stay, readmissions and reoperations. In all, 52 544 case records were collated from 31 institutions in five countries. Mapping of all the coding systems was achieved so that diagnosis and procedures from the participant countries could be compared. Using the aligned coding systems to develop risk-adjusted models, the 30-day mortality rate for colorectal surgery was 3.95% (95% CI 0.86-7.54), the 30-day readmission rate was 11.05% (5.67-17.61), the 28-day reoperation rate was 6.13% (3.68-9.66) and the mean length of stay was 14 (7.65-46.76) days. The linkage of international hospital administrative data that we developed enabled comparison of documented surgical outcomes between countries. This methodology may facilitate international benchmarking. Colorectal Disease © 2014 The Association of Coloproctology of Great Britain and Ireland.

Color-coded perfusion analysis of CEUS for pre-interventional diagnosis of microvascularisation in cases of vascular malformations.

PubMed

Teusch, V I; Wohlgemuth, W A; Piehler, A P; Jung, E M

2014-01-01

Aim of our pilot study was the application of a contrast-enhanced color-coded ultrasound perfusion analysis in patients with vascular malformations to quantify microcirculatory alterations. 28 patients (16 female, 12 male, mean age 24.9 years) with high flow (n = 6) or slow-flow (n = 22) malformations were analyzed before intervention. An experienced examiner performed a color-coded Doppler sonography (CCDS) and a Power Doppler as well as a contrast-enhanced ultrasound after intravenous bolus injection of 1 - 2.4 ml of a second-generation ultrasound contrast medium (SonoVue®, Bracco, Milan). The contrast-enhanced examination was documented as a cine sequence over 60 s. The quantitative analysis based on color-coded contrast-enhanced ultrasound (CEUS) images included percentage peak enhancement (%peak), time to peak (TTP), area under the curve (AUC), and mean transit time (MTT). No side effects occurred after intravenous contrast injection. The mean %peak in arteriovenous malformations was almost twice as high as in slow-flow-malformations. The area under the curve was 4 times higher in arteriovenous malformations compared to the mean value of other malformations. The mean transit time was 1.4 times higher in high-flow-malformations compared to slow-flow-malformations. There was no difference regarding the time to peak between the different malformation types. The comparison between all vascular malformation and surrounding tissue showed statistically significant differences for all analyzed data (%peak, TTP, AUC, MTT; p < 0.01). High-flow and slow-flow vascular malformations had statistically significant differences in %peak (p < 0.01), AUC analysis (p < 0.01), and MTT (p < 0.05). Color-coded perfusion analysis of CEUS seems to be a promising technique for the dynamic assessment of microvasculature in vascular malformations.

Quality of narrative operative reports in pancreatic surgery

PubMed Central

Wiebe, Meagan E.; Sandhu, Lakhbir; Takata, Julie L.; Kennedy, Erin D.; Baxter, Nancy N.; Gagliardi, Anna R.; Urbach, David R.; Wei, Alice C.

2013-01-01

Background Quality in health care can be evaluated using quality indicators (QIs). Elements contained in the surgical operative report are potential sources for QI data, but little is known about the completeness of the narrative operative report (NR). We evaluated the completeness of the NR for patients undergoing a pancreaticoduodenectomy. Methods We reviewed NRs for patients undergoing a pancreaticoduodenectomy over a 1-year period. We extracted 79 variables related to patient and narrator characteristics, process of care measures, surgical technique and oncology-related outcomes by document analysis. Data were coded and evaluated for completeness. Results We analyzed 74 NRs. The median number of variables reported was 43.5 (range 13–54). Variables related to surgical technique were most complete. Process of care and oncology-related variables were often omitted. Completeness of the NR was associated with longer operative duration. Conclusion The NRs were often incomplete and of poor quality. Important elements, including process of care and oncology-related data, were frequently missing. Thus, the NR is an inadequate data source for QI. Development and use of alternative reporting methods, including standardized synoptic operative reports, should be encouraged to improve documentation of care and serve as a measure of quality of surgical care. PMID:24067527

Quality of narrative operative reports in pancreatic surgery.

PubMed

Wiebe, Meagan E; Sandhu, Lakhbir; Takata, Julie L; Kennedy, Erin D; Baxter, Nancy N; Gagliardi, Anna R; Urbach, David R; Wei, Alice C

2013-10-01

Quality in health care can be evaluated using quality indicators (QIs). Elements contained in the surgical operative report are potential sources for QI data, but little is known about the completeness of the narrative operative report (NR). We evaluated the completeness of the NR for patients undergoing a pancreaticoduodenectomy. We reviewed NRs for patients undergoing a pancreaticoduodenectomy over a 1-year period. We extracted 79 variables related to patient and narrator characteristics, process of care measures, surgical technique and oncology-related outcomes by document analysis. Data were coded and evaluated for completeness. We analyzed 74 NRs. The median number of variables reported was 43.5 (range 13-54). Variables related to surgical technique were most complete. Process of care and oncology-related variables were often omitted. Completeness of the NR was associated with longer operative duration. The NRs were often incomplete and of poor quality. Important elements, including process of care and oncology-related data, were frequently missing. Thus, the NR is an inadequate data source for QI. Development and use of alternative reporting methods, including standardized synoptic operative reports, should be encouraged to improve documentation of care and serve as a measure of quality of surgical care.

A multidisciplinary three-phase approach to improve the clinical utility of patient safety indicators.

PubMed

Najjar, Peter; Kachalia, Allen; Sutherland, Tori; Beloff, Jennifer; David-Kasdan, Jo Ann; Bates, David W; Urman, Richard D

2015-01-01

The AHRQ Patient Safety Indicators (PSIs) are used for calculation of risk-adjusted postoperative rates for adverse events. The payers and quality consortiums are increasingly requiring public reporting of hospital performance on these metrics. We discuss processes designed to improve the accuracy and clinical utility of PSI reporting in practice. The study was conducted at a 793-bed tertiary care academic medical center where PSI processes have been aggressively implemented to track patient safety events at discharge. A three-phased approach to improving administrative data quality was implemented. The initiative consisted of clinical review of all PSIs, documentation improvement, and provider outreach including active querying for patient safety events. This multidisciplinary effort to develop a streamlined process for PSI calculation reduced the reporting of miscoded PSIs and increased the clinical utility of PSI monitoring. Over 4 quarters, 4 of 41 (10%) PSI-11 and 9 of 138 (7%) PSI-15 errors were identified on review of clinical documentation and appropriate adjustments were made. A multidisciplinary, phased approach leveraging existing billing infrastructure for robust metric coding, ongoing clinical review, and frontline provider outreach is a novel and effective way to reduce the reporting of false-positive outcomes and improve the clinical utility of PSIs.

Computer Description of Black Hawk Helicopter

DTIC Science & Technology

1979-06-01

Model Combinatorial Geometry Models Black Hawk Helicopter Helicopter GIFT Computer Code Geometric Description of Targets 20. ABSTRACT...description was made using the technique of combinatorial geometry (COM-GEOM) and will be used as input to the GIFT computer code which generates Tliic...rnHp The data used bv the COVART comtmter code was eenerated bv the Geometric Information for Targets ( GIFT )Z computer code. This report documents

Federal Logistics Information Systems. FLIS Procedures Manual. Document Identifier Code Input/Output Formats (Variable Length). Volume 9.

DTIC Science & Technology

1997-04-01

DATA COLLABORATORS 0001N B NQ 8380 NUMBER OF DATA RECEIVERS 0001N B NQ 2533 AUTHORIZED ITEM IDENTIFICATION DATA COLLABORATOR CODE 0002 ,X B 03 18 TD...01 NC 8268 DATA ELEMENT TERMINATOR CODE 000iX VT 9505 TYPE OF SCREENING CODE 0001A 01 NC 8268 DATA ELEMENT TERMINATOR CODE 000iX VT 4690 OUTPUT DATA... 9505 TYPE OF SCREENING CODE 0001A 2 89 2910 REFERENCE NUMBER CATEGORY CODE (RNCC) 0001X 2 89 4780 REFERENCE NUMBER VARIATION CODE (RNVC) 0001 N 2 89

Electronic Document Delivery: OCLC's Prototype System.

ERIC Educational Resources Information Center

Hickey, Thomas B.; Calabrese, Andrew M.

1986-01-01

Describes development of system for retrieval of documents from magnetic storage that uses stored font definition codes to control an inexpensive laser printer in the production of copies that closely resemble original document. Trends in information equipment and printing industries that will govern future application of this technology are…

39 CFR 3007.2 - Scope.

Code of Federal Regulations, 2010 CFR

2010-07-01

... information, documents, and things in its possession or control, or any information, documents, and things... under title 39 of the U.S. Code. Information, documents, and things the Postal Service may be required to provide, include, but are not limited to, paper hard copy and electronically stored data and...

Computer Code for Transportation Network Design and Analysis

DOT National Transportation Integrated Search

1977-01-01

This document describes the results of research into the application of the mathematical programming technique of decomposition to practical transportation network problems. A computer code called Catnap (for Control Analysis Transportation Network A...

Documentation of a numerical code for the simulation of variable density ground-water flow in three dimensions

USGS Publications Warehouse

Kuiper, L.K.

1985-01-01

A numerical code is documented for the simulation of variable density time dependent groundwater flow in three dimensions. The groundwater density, although variable with distance, is assumed to be constant in time. The Integrated Finite Difference grid elements in the code follow the geologic strata in the modeled area. If appropriate, the determination of hydraulic head in confining beds can be deleted to decrease computation time. The strongly implicit procedure (SIP), successive over-relaxation (SOR), and eight different preconditioned conjugate gradient (PCG) methods are used to solve the approximating equations. The use of the computer program that performs the calculations in the numerical code is emphasized. Detailed instructions are given for using the computer program, including input data formats. An example simulation and the Fortran listing of the program are included. (USGS)

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

Watson, C.R.

The SNODOG Glossary is used by the DOE-supported life-span beagle studies to describe medical observations in a standardized format. It is an adaptation of the human medical glossary, SNOMED, which lists 107,165 terms. Each of the five laboratories, Argonne National Laboratory, the Inhalation Toxicology Research Institute, the Pacific Northwest Laboratory, the University of California at Davis, and the University of Utah, has selected an appropriate subset from the published SNOMED glossary and added beagle and research-specific terms. The National Radiobiology Archives is the coordinator of these enhancements, and periodically distributes SNODOG to the respective laboratories. Information donated by Colorado Statemore » University and Oak Ridge National Laboratory has been related to SNODOG and is available in a standardized format. This document is designed for the database manager and the scientist who will be managing or coding medical observations. It is also designed for the scientist analyzing coded information. The document includes: an overview of the NRA and the SNODOG glossary, a discussion of hardware requirements, a review of the SNODOG code structure and printed lists of the 4,770 terms which have been used at least once. Instructions for obtaining electronic copies of the glossary and for nominating additional terms are provided. This document describes the origins and structure of the SNODOG codes, explains code usage at each participating institution, and presents a usage frequency tabulation of the terms for neoplasia. A diskette or magnetic tape containing 15,641 SNODOG codes and translations is available on request.« less

SNODOG Glossary: Part 1, Introduction

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

Watson, C.R.

The SNODOG Glossary is used by the DOE-supported life-span beagle studies to describe medical observations in a standardized format. It is an adaptation of the human medical glossary, SNOMED, which lists 107,165 terms. Each of the five laboratories, Argonne National Laboratory, the Inhalation Toxicology Research Institute, the Pacific Northwest Laboratory, the University of California at Davis, and the University of Utah, has selected an appropriate subset from the published SNOMED glossary and added beagle and research-specific terms. The National Radiobiology Archives is the coordinator of these enhancements, and periodically distributes SNODOG to the respective laboratories. Information donated by Colorado Statemore » University and Oak Ridge National Laboratory has been related to SNODOG and is available in a standardized format. This document is designed for the database manager and the scientist who will be managing or coding medical observations. It is also designed for the scientist analyzing coded information. The document includes: an overview of the NRA and the SNODOG glossary, a discussion of hardware requirements, a review of the SNODOG code structure and printed lists of the 4,770 terms which have been used at least once. Instructions for obtaining electronic copies of the glossary and for nominating additional terms are provided. This document describes the origins and structure of the SNODOG codes, explains code usage at each participating institution, and presents a usage frequency tabulation of the terms for neoplasia. A diskette or magnetic tape containing 15,641 SNODOG codes and translations is available on request.« less

STAR-CCM+ Verification and Validation Plan

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

Pointer, William David

2016-09-30

The commercial Computational Fluid Dynamics (CFD) code STAR-CCM+ provides general purpose finite volume method solutions for fluid dynamics and energy transport. This document defines plans for verification and validation (V&V) of the base code and models implemented within the code by the Consortium for Advanced Simulation of Light water reactors (CASL). The software quality assurance activities described herein are port of the overall software life cycle defined in the CASL Software Quality Assurance (SQA) Plan [Sieger, 2015]. STAR-CCM+ serves as the principal foundation for development of an advanced predictive multi-phase boiling simulation capability within CASL. The CASL Thermal Hydraulics Methodsmore » (THM) team develops advanced closure models required to describe the subgrid-resolution behavior of secondary fluids or fluid phases in multiphase boiling flows within the Eulerian-Eulerian framework of the code. These include wall heat partitioning models that describe the formation of vapor on the surface and the forces the define bubble/droplet dynamic motion. The CASL models are implemented as user coding or field functions within the general framework of the code. This report defines procedures and requirements for V&V of the multi-phase CFD capability developed by CASL THM. Results of V&V evaluations will be documented in a separate STAR-CCM+ V&V assessment report. This report is expected to be a living document and will be updated as additional validation cases are identified and adopted as part of the CASL THM V&V suite.« less

Industrial Demand Module - NEMS Documentation

EIA Publications

2014-01-01

Documents the objectives, analytical approach, and development of the National Energy Modeling System (NEMS) Industrial Demand Module. The report catalogues and describes model assumptions, computational methodology, parameter estimation techniques, and model source code.

Some Practical Universal Noiseless Coding Techniques

NASA Technical Reports Server (NTRS)

Rice, Robert F.

1994-01-01

Report discusses noiseless data-compression-coding algorithms, performance characteristics and practical consideration in implementation of algorithms in coding modules composed of very-large-scale integrated circuits. Report also has value as tutorial document on data-compression-coding concepts. Coding techniques and concepts in question "universal" in sense that, in principle, applicable to streams of data from variety of sources. However, discussion oriented toward compression of high-rate data generated by spaceborne sensors for lower-rate transmission back to earth.

JSC document index

NASA Technical Reports Server (NTRS)

1988-01-01

The Johnson Space Center (JSC) document index is intended to provide a single source listing of all published JSC-numbered documents their authors, and the designated offices of prime responsibility (OPR's) by mail code at the time of publication. The index contains documents which have been received and processed by the JSC Technical Library as of January 13, 1988. Other JSC-numbered documents which are controlled but not available through the JSC Library are also listed.

SIERRA Code Coupling Module: Arpeggio User Manual Version 4.44

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

Subia, Samuel R.; Overfelt, James R.; Baur, David G.

2017-04-01

The SNL Sierra Mechanics code suite is designed to enable simulation of complex multiphysics scenarios. The code suite is composed of several specialized applications which can operate either in standalone mode or coupled with each other. Arpeggio is a supported utility that enables loose coupling of the various Sierra Mechanics applications by providing access to Framework services that facilitate the coupling. More importantly Arpeggio orchestrates the execution of applications that participate in the coupling. This document describes the various components of Arpeggio and their operability. The intent of the document is to provide a fast path for analysts interested inmore » coupled applications via simple examples of its usage.« less

A method for modeling co-occurrence propensity of clinical codes with application to ICD-10-PCS auto-coding.

PubMed

Subotin, Michael; Davis, Anthony R

2016-09-01

Natural language processing methods for medical auto-coding, or automatic generation of medical billing codes from electronic health records, generally assign each code independently of the others. They may thus assign codes for closely related procedures or diagnoses to the same document, even when they do not tend to occur together in practice, simply because the right choice can be difficult to infer from the clinical narrative. We propose a method that injects awareness of the propensities for code co-occurrence into this process. First, a model is trained to estimate the conditional probability that one code is assigned by a human coder, given than another code is known to have been assigned to the same document. Then, at runtime, an iterative algorithm is used to apply this model to the output of an existing statistical auto-coder to modify the confidence scores of the codes. We tested this method in combination with a primary auto-coder for International Statistical Classification of Diseases-10 procedure codes, achieving a 12% relative improvement in F-score over the primary auto-coder baseline. The proposed method can be used, with appropriate features, in combination with any auto-coder that generates codes with different levels of confidence. The promising results obtained for International Statistical Classification of Diseases-10 procedure codes suggest that the proposed method may have wider applications in auto-coding. © 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.

[Descriptive Analysis of Health Economics of Intensive Home Care of Ventilated Patients].

PubMed

Lehmann, Yvonne; Ostermann, Julia; Reinhold, Thomas; Ewers, Michael

2018-05-14

Long-term ventilated patients in Germany receive intensive care mainly in the patients' home or in assisted-living facilities. There is a lack of knowledge about the nature and extent of resource use and costs associated with care of this small, heterogeneous but overall growing patient group. A sub-study in the context of a research project SHAPE analyzed costs of 29 patients descriptively from a social perspective. Direct and indirect costs of intensive home care over a period of three months were recorded and analyzed retrospectively. Standardized recorded written self-reports from patients and relatives as well as information from the interviewing of nursing staff and from nursing documentation were the basis for this analysis. There was an average total cost of intensive home care for three months per patient of 61194 € (95% CI 53 884-68 504) including hospital stays. The main costs were directly linked to outpatient medical and nursing care provided according to the Code of Social Law V and XI. Services provided by nursing home care service according to § 37(2) Code of Social Law V (65%) were the largest cost item. Approximately 13% of the total costs were attributable to indirect costs. Intensive home care for ventilated patients is resource-intensive and cost-intensive and has received little attention also from a health economics perspective. Valid information and transparency about the cost structures are required for an effective and economic design and management of the long-term care of this patient group. © Georg Thieme Verlag KG Stuttgart · New York.

77 FR 43103 - Policy on the 2009 Revision of the International Maritime Organization Code for the Construction...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-23

... Offshore Drilling Units AGENCY: Coast Guard, DHS. ACTION: Notice of availability. SUMMARY: The Coast Guard...), Code for the Construction and Equipment of Mobile Offshore Drilling Units, 2009 (2009 MODU Code). CG...: Background and Purpose Foreign documented MODUs engaged in any offshore activity associated with the...

26 CFR 1.6042-3 - Dividends subject to reporting.

Code of Federal Regulations, 2012 CFR

2012-04-01

... documentation of foreign status and definition of U.S. payor and non-U.S. payor) shall apply. The provisions of... the Internal Revenue Code (Code). (iv) Distributions or payments from sources outside the United States (as determined under the provisions of part I, subchapter N, chapter 1 of the Code and the...

Standardized Definitions for Code Verification Test Problems

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

Doebling, Scott William

This document contains standardized definitions for several commonly used code verification test problems. These definitions are intended to contain sufficient information to set up the test problem in a computational physics code. These definitions are intended to be used in conjunction with exact solutions to these problems generated using Exact- Pack, www.github.com/lanl/exactpack.

xRage Equation of State

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

Grove, John W.

2016-08-16

The xRage code supports a variety of hydrodynamic equation of state (EOS) models. In practice these are generally accessed in the executing code via a pressure-temperature based table look up. This document will describe the various models supported by these codes and provide details on the algorithms used to evaluate the equation of state.

Shock Spectrum Calculation from Acceleration Time Histories

DTIC Science & Technology

1980-09-01

CLASSIFICATIONe OF THIS PAGE (Uh-e DOg ~ 9--t)____________________ REPORT DOCUMENTATION PAGE BEFORE COMPLETING FORM I. REPRT NU9911ACCUIISIO6 NO .3ASCCSPICHT’S...SCE. Oakland CA NAVSCOLCECOFF C35 Port Hueneme. CA,. CO, Code C44A Porn Hueneme. CA NAVSEASYSCOM Code 05M13 (Newhouse) Wash DC; Code 6212, Wash DC

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

Singleton, Jr., Robert; Israel, Daniel M.; Doebling, Scott William

For code verification, one compares the code output against known exact solutions. There are many standard test problems used in this capacity, such as the Noh and Sedov problems. ExactPack is a utility that integrates many of these exact solution codes into a common API (application program interface), and can be used as a stand-alone code or as a python package. ExactPack consists of python driver scripts that access a library of exact solutions written in Fortran or Python. The spatial profiles of the relevant physical quantities, such as the density, fluid velocity, sound speed, or internal energy, are returnedmore » at a time specified by the user. The solution profiles can be viewed and examined by a command line interface or a graphical user interface, and a number of analysis tools and unit tests are also provided. We have documented the physics of each problem in the solution library, and provided complete documentation on how to extend the library to include additional exact solutions. ExactPack’s code architecture makes it easy to extend the solution-code library to include additional exact solutions in a robust, reliable, and maintainable manner.« less

W-026, Waste Receiving and Processing Facility data management system validation and verification report

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

Palmer, M.E.

1997-12-05

This V and V Report includes analysis of two revisions of the DMS [data management system] System Requirements Specification (SRS) and the Preliminary System Design Document (PSDD); the source code for the DMS Communication Module (DMSCOM) messages; the source code for selected DMS Screens, and the code for the BWAS Simulator. BDM Federal analysts used a series of matrices to: compare the requirements in the System Requirements Specification (SRS) to the specifications found in the System Design Document (SDD), to ensure the design supports the business functions, compare the discreet parts of the SDD with each other, to ensure thatmore » the design is consistent and cohesive, compare the source code of the DMS Communication Module with the specifications, to ensure that the resultant messages will support the design, compare the source code of selected screens to the specifications to ensure that resultant system screens will support the design, compare the source code of the BWAS simulator with the requirements to interface with DMS messages and data transfers relating to the BWAS operations.« less

Validation of an administrative claims-based diagnostic code for pneumonia in a US-based commercially insured COPD population

PubMed Central

Kern, David M; Davis, Jill; Williams, Setareh A; Tunceli, Ozgur; Wu, Bingcao; Hollis, Sally; Strange, Charlie; Trudo, Frank

2015-01-01

Objective To estimate the accuracy of claims-based pneumonia diagnoses in COPD patients using clinical information in medical records as the reference standard. Methods Selecting from a repository containing members’ data from 14 regional United States health plans, this validation study identified pneumonia diagnoses within a group of patients initiating treatment for COPD between March 1, 2009 and March 31, 2012. Patients with ≥1 claim for pneumonia (International Classification of Diseases Version 9-CM code 480.xx–486.xx) were identified during the 12 months following treatment initiation. A subset of 800 patients was randomly selected to abstract medical record data (paper based and electronic) for a target sample of 400 patients, to estimate validity within 5% margin of error. Positive predictive value (PPV) was calculated for the claims diagnosis of pneumonia relative to the reference standard, defined as a documented diagnosis in the medical record. Results A total of 388 records were reviewed; 311 included a documented pneumonia diagnosis, indicating 80.2% (95% confidence interval [CI]: 75.8% to 84.0%) of claims-identified pneumonia diagnoses were validated by the medical charts. Claims-based diagnoses in inpatient or emergency departments (n=185) had greater PPV versus outpatient settings (n=203), 87.6% (95% CI: 81.9%–92.0%) versus 73.4% (95% CI: 66.8%–79.3%), respectively. Claims-diagnoses verified with paper-based charts had similar PPV as the overall study sample, 80.2% (95% CI: 71.1%–87.5%), and higher PPV than those linked to electronic medical records, 73.3% (95% CI: 65.5%–80.2%). Combined paper-based and electronic records had a higher PPV, 87.6% (95% CI: 80.9%–92.6%). Conclusion Administrative claims data indicating a diagnosis of pneumonia in COPD patients are supported by medical records. The accuracy of a medical record diagnosis of pneumonia remains unknown. With increased use of claims data in medical research, COPD researchers can study pneumonia with confidence that claims data are a valid tool when studying the safety of COPD therapies that could potentially lead to increased pneumonia susceptibility or severity. PMID:26229461

Validation of an administrative claims-based diagnostic code for pneumonia in a US-based commercially insured COPD population.

PubMed

Kern, David M; Davis, Jill; Williams, Setareh A; Tunceli, Ozgur; Wu, Bingcao; Hollis, Sally; Strange, Charlie; Trudo, Frank

2015-01-01

To estimate the accuracy of claims-based pneumonia diagnoses in COPD patients using clinical information in medical records as the reference standard. Selecting from a repository containing members' data from 14 regional United States health plans, this validation study identified pneumonia diagnoses within a group of patients initiating treatment for COPD between March 1, 2009 and March 31, 2012. Patients with ≥1 claim for pneumonia (International Classification of Diseases Version 9-CM code 480.xx-486.xx) were identified during the 12 months following treatment initiation. A subset of 800 patients was randomly selected to abstract medical record data (paper based and electronic) for a target sample of 400 patients, to estimate validity within 5% margin of error. Positive predictive value (PPV) was calculated for the claims diagnosis of pneumonia relative to the reference standard, defined as a documented diagnosis in the medical record. A total of 388 records were reviewed; 311 included a documented pneumonia diagnosis, indicating 80.2% (95% confidence interval [CI]: 75.8% to 84.0%) of claims-identified pneumonia diagnoses were validated by the medical charts. Claims-based diagnoses in inpatient or emergency departments (n=185) had greater PPV versus outpatient settings (n=203), 87.6% (95% CI: 81.9%-92.0%) versus 73.4% (95% CI: 66.8%-79.3%), respectively. Claims-diagnoses verified with paper-based charts had similar PPV as the overall study sample, 80.2% (95% CI: 71.1%-87.5%), and higher PPV than those linked to electronic medical records, 73.3% (95% CI: 65.5%-80.2%). Combined paper-based and electronic records had a higher PPV, 87.6% (95% CI: 80.9%-92.6%). Administrative claims data indicating a diagnosis of pneumonia in COPD patients are supported by medical records. The accuracy of a medical record diagnosis of pneumonia remains unknown. With increased use of claims data in medical research, COPD researchers can study pneumonia with confidence that claims data are a valid tool when studying the safety of COPD therapies that could potentially lead to increased pneumonia susceptibility or severity.

Agency-wide Quality System Documents

EPA Pesticide Factsheets

Quality specifications for EPA organizations as defined by EPA Directives are internal policy documents that apply only to EPA organizations. The Code of Federal Regulations defines specifications for extramural agreements with non-EPA organizations.

Development of Learning Management in Moral Ethics and Code of Ethics of the Teaching Profession Course

NASA Astrophysics Data System (ADS)

Boonsong, S.; Siharak, S.; Srikanok, V.

2018-02-01

The purposes of this research were to develop the learning management, which was prepared for the enhancement of students’ Moral Ethics and Code of Ethics in Rajamangala University of Technology Thanyaburi (RMUTT). The contextual study and the ideas for learning management development was conducted by the document study, focus group method and content analysis from the document about moral ethics and code of ethics of the teaching profession concerning Graduate Diploma for Teaching Profession Program. The main tools of this research were the summarize papers and analyse papers. The results of development showed the learning management for the development of moral ethics and code of ethics of the teaching profession for Graduate Diploma for Teaching Profession students could promote desired moral ethics and code of ethics of the teaching profession character by the integrated learning techniques which consisted of Service Learning, Contract System, Value Clarification, Role Playing, and Concept Mapping. The learning management was presented in 3 steps.

ForTrilinos Design Document

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

Young, Mitchell T.; Johnson, Seth R.; Prokopenko, Andrey V.

With the development of a Fortran Interface to Trilinos, ForTrilinos, modelers using modern Fortran will beable to provide their codes the capability to use solvers and other capabilities on exascale machines via astraightforward infrastructure that accesses Trilinos. This document outlines what Fortrilinos does andexplains briefly how it works. We show it provides a general access to packages via an entry point and usesan xml file from fortran code. With the first release, ForTrilinos will enable Teuchos to take xml parameterlists from Fortran code and set up data structures. It will provide access to linear solvers and eigensolvers.Several examples are providedmore » to illustrate the capabilities in practice. We explain what the user shouldhave already with their code and what Trilinos provides and returns to the Fortran code. We provideinformation about the build process for ForTrilinos, with a practical example. In future releases, nonlinearsolvers, time iteration, advanced preconditioning techniques, and inversion of control (IoC), to enablecallbacks to Fortran routines, will be available.« less

The Influence of Race/Ethnicity and Socioeconomic Status on End-of-Life Care in the ICU

PubMed Central

Muni, Sarah; Engelberg, Ruth A.; Treece, Patsy D.; Dotolo, Danae

2011-01-01

Background: There is conflicting evidence about the influence of race/ethnicity on the use of intensive care at the end of life, and little is known about the influence of socioeconomic status. Methods: We examined patients who died in the ICU in 15 hospitals. Race/ethnicity was assessed as white and nonwhite. Socioeconomic status included patient education, health insurance, and income by zip code. To explore differences in end-of-life care, we examined the use of (1) advance directives, (2) life-sustaining therapies, (3) symptom management, (4) communication, and (5) support services. Results: Medical charts were abstracted for 3,138/3,400 patients of whom 2,479 (79%) were white and 659 (21%) were nonwhite (or Hispanic). In logistic regressions adjusted for patient demographics, socioeconomic factors, and site, nonwhite patients were less likely to have living wills (OR, 0.41; 95% CI, 0.32-0.54) and more likely to die with full support (OR, 1.59; 95% CI, 1.30-1.94). In documentation of family conferences, nonwhite patients were more likely to have documentation that prognosis was discussed (OR, 1.47; 95% CI, 1.21-1.77) and that physicians recommended withdrawal of life support (OR, 1.57; 95% CI, 1.11-2.21). Nonwhite patients also were more likely to have discord documented among family members or with clinicians (OR, 1.49; 95% CI, 1.04-2.15). Socioeconomic status did not modify these associations and was not a consistent predictor of end-of-life care. Conclusions: We found numerous racial/ethnic differences in end-of-life care in the ICU that were not influenced by socioeconomic status. These differences could be due to treatment preferences, disparities, or both. Improving ICU end-of-life care for all patients and families will require a better understanding of these issues. Trial registry: ClinicalTrials.gov; No.: NCT00685893; URL: www.clinicaltrials.gov PMID:21292758

Comparison of not for resuscitation (NFR) forms across five Victorian health services.

PubMed

Levinson, M; Mills, A; Hutchinson, A M; Heriot, G; Stephenson, G; Gellie, A

2014-07-01

Within Australian hospitals, cardiac and respiratory arrests result in a resuscitation attempt unless the patient is documented as not for resuscitation. To examine the consistency of policies and documentation for withholding in-hospital resuscitation across health services. An observational, qualitative review of hospital policy and documentation was conducted in June 2013 in three public and two private sector hospitals in metropolitan Melbourne. Not for resuscitation (NFR) forms were evaluated for physical characteristics, content, authorisation and decision-making. Hospital policies were coded for alerts, definition of futility and burden of treatment and management of discussions and dissent. There was a lack of standardisation, with each site using its own unique NFR form and accompanying site-specific policies. Differences were found in who could authorise the decision, what was included on the form, the role of patients and families, and how discussions were managed and dissent resolved. Futility and burden of treatment were not defined independently. These inconsistencies across sites contribute to a lack of clarity regarding the decision to withhold resuscitation, and have implications for staff employed across multiple hospitals. NFR forms should be reviewed and standardised so as to be clear, uniform and consistent with the legislative framework. We propose a two-stage process of documentation. Stage 1 facilitates discussion of patient-specific goals of care and consideration of limitations of treatment. Stage 2 serves to communicate a NFR order. Decisions to withhold resuscitation are inherently complex but could be aided by separating the decision-making process from the communication of the decision, resulting in improved end-of-life care. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

Quality of care in patients with atrial fibrillation in primary care: a cross-sectional study comparing clinical and claims data.

PubMed

Preuss, Rebekka; Chenot, Jean-François; Angelow, Aniela

2016-01-01

Objectives: Atrial fibrillation (AF) is a common cardiac arrhythmia with increased risk of thromboembolic stroke. Oral anticoagulation (OAC) reduces stroke risk by up to 68%. The aim of our study was to evaluate quality of care in patients with AF in a primary health care setting with a focus on physician guideline adherence for OAC prescription and heart rate- and rhythm management. In a second step we aimed to compare OAC rates based on primary care data with rates based on claims data. Methods: We included all GP practices in the region Vorpommern-Greifswald, Germany, which were willing to participate (N=29/182, response rate 16%). Claims data was derived from the regional association of statutory health insurance physicians. Patients with a documented AF diagnosis (ICD-10-GM-Code ICD I48.-) from 07/2011-06/2012 were identified using electronic medical records (EMR) and claims data. Stroke and bleeding risk were calculated using the CHA 2 DS 2 -VASc and HAS-BLED scores. We calculated crude treatment rates for OAC, rate and rhythm control medications and adjusted OAC treatment rates based on practice and claims data. Adjusted rates were calculated including the CHA 2 DS 2 -VASc and HAS-BLED scores and individual factors affecting guideline based treatment. Results: We identified 927 patients based on EMR and 1,247 patients based on claims data. The crude total OAC treatment rate was 69% based on EMR and 61% based on claims data. The adjusted OAC treatment rates were 90% for patients based on EMR and 63% based on claims data. 82% of the AF patients received a treatment for rate control and 12% a treatment for rhythm control. The most common reasons for non-prescription of OAC were an increased risk of falling, dementia and increased bleeding risk. Conclusion: Our results suggest that a high rate of AF patients receive a drug therapy according to guidelines. There is a large difference between crude and adjusted OAC treatment rates. This is due to individual contraindications and comorbidities which cannot be documented using ICD coding. Therefore, quality indicators based on crude EMR data or claims data would lead to a systematic underestimation of the quality of care. A possible overtreatment of low-risk patients cannot be ruled out.

International Natural Gas Model 2011, Model Documentation Report

EIA Publications

2013-01-01

This report documents the objectives, analytical approach and development of the International Natural Gas Model (INGM). It also catalogues and describes critical assumptions, computational methodology, parameter estimation techniques, and model source code.

A Three-Phase Decision Model of Computer-Aided Coding for the Iranian Classification of Health Interventions (IRCHI).

PubMed

Azadmanjir, Zahra; Safdari, Reza; Ghazisaeedi, Marjan; Mokhtaran, Mehrshad; Kameli, Mohammad Esmail

2017-06-01

Accurate coded data in the healthcare are critical. Computer-Assisted Coding (CAC) is an effective tool to improve clinical coding in particular when a new classification will be developed and implemented. But determine the appropriate method for development need to consider the specifications of existing CAC systems, requirements for each type, our infrastructure and also, the classification scheme. The aim of the study was the development of a decision model for determining accurate code of each medical intervention in Iranian Classification of Health Interventions (IRCHI) that can be implemented as a suitable CAC system. first, a sample of existing CAC systems was reviewed. Then feasibility of each one of CAC types was examined with regard to their prerequisites for their implementation. The next step, proper model was proposed according to the structure of the classification scheme and was implemented as an interactive system. There is a significant relationship between the level of assistance of a CAC system and integration of it with electronic medical documents. Implementation of fully automated CAC systems is impossible due to immature development of electronic medical record and problems in using language for medical documenting. So, a model was proposed to develop semi-automated CAC system based on hierarchical relationships between entities in the classification scheme and also the logic of decision making to specify the characters of code step by step through a web-based interactive user interface for CAC. It was composed of three phases to select Target, Action and Means respectively for an intervention. The proposed model was suitable the current status of clinical documentation and coding in Iran and also, the structure of new classification scheme. Our results show it was practical. However, the model needs to be evaluated in the next stage of the research.

About the necessity to manage events coded with MedDRA prior to statistical analysis: proposal of a strategy with application to a randomized clinical trial, ANRS 099 ALIZE.

PubMed

Journot, Valérie; Tabuteau, Sophie; Collin, Fidéline; Molina, Jean-Michel; Chene, Geneviève; Rancinan, Corinne

2008-03-01

Since 2003, the Medical Dictionary for Regulatory Activities (MedDRA) is the regulatory standard for safety report in clinical trials in the European Community. Yet, we found no published example of a practical experience for a scientifically oriented statistical analysis of events coded with MedDRA. We took advantage of a randomized trial in HIV-infected patients with MedDRA-coded events to explain the difficulties encountered during the events analysis and the strategy developed to report events consistently with trial-specific objectives. MedDRA has a rich hierarchical structure, which allows the grouping of coded terms into 5 levels, the highest being "System Organ Class" (SOC). Each coded term may be related to several SOCs, among which one primary SOC is defined. We developed a new general 5-step strategy to select a SOC as trial primary SOC, consistently with trial-specific objectives for this analysis. We applied it to the ANRS 099 ALIZE trial, where all events were coded with MedDRA version 3.0. We compared the MedDRA and the ALIZE primary SOCs. In the ANRS 099 ALIZE trial, 355 patients were recruited, and 3,722 events were reported and documented, among which 35% had multiple SOCs (2 to 4). We applied the proposed 5-step strategy. Altogether, 23% of MedDRA primary SOCs were modified, mainly from MedDRA primary SOCs "Investigations" (69%) and "Ear and labyrinth disorders" (6%), for the ALIZE primary SOCs "Hepatobiliary disorders" (35%), "Musculoskeletal and connective tissue disorders" (21%), and "Gastrointestinal disorders" (15%). MedDRA largely enhanced in size and complexity with versioning and the development of Standardized MedDRA Queries. Yet, statisticians should not systematically rely on primary SOCs proposed by MedDRA to report events. A simple general 5-step strategy to re-classify events consistently with the trial-specific objectives might be useful in HIV trials as well as in other fields.

Coding for urologic office procedures.

PubMed

Dowling, Robert A; Painter, Mark

2013-11-01

This article summarizes current best practices for documenting, coding, and billing common office-based urologic procedures. Topics covered include general principles, basic and advanced urologic coding, creation of medical records that support compliant coding practices, bundled codes and unbundling, global periods, modifiers for procedure codes, when to bill for evaluation and management services during the same visit, coding for supplies, and laboratory and radiology procedures pertinent to urology practice. Detailed information is included for the most common urology office procedures, and suggested resources and references are provided. This information is of value to physicians, office managers, and their coding staff. Copyright © 2013 Elsevier Inc. All rights reserved.

78 FR 13338 - Exposure Modeling Public Meeting; Notice of Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-27

... code 22 Professional, Scientific and Technical NAICS code 54 B. How can I get copies of this document... dates and abstract requests are announced through the ``empmlist'' forum on the LYRIS list server at...

Programming (Tips) for Physicists & Engineers

ScienceCinema

Ozcan, Erkcan

2018-02-19

Programming for today's physicists and engineers. Work environment: today's astroparticle, accelerator experiments and information industry rely on large collaborations. Need more than ever: code sharing/resuse, code building--framework integration, documentation and good visualization, working remotely, not reinventing the wheel.

Programming (Tips) for Physicists & Engineers

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

Ozcan, Erkcan

2010-07-13

Programming for today's physicists and engineers. Work environment: today's astroparticle, accelerator experiments and information industry rely on large collaborations. Need more than ever: code sharing/resuse, code building--framework integration, documentation and good visualization, working remotely, not reinventing the wheel.

Faunus: An object oriented framework for molecular simulation

PubMed Central

Lund, Mikael; Trulsson, Martin; Persson, Björn

2008-01-01

Background We present a C++ class library for Monte Carlo simulation of molecular systems, including proteins in solution. The design is generic and highly modular, enabling multiple developers to easily implement additional features. The statistical mechanical methods are documented by extensive use of code comments that – subsequently – are collected to automatically build a web-based manual. Results We show how an object oriented design can be used to create an intuitively appealing coding framework for molecular simulation. This is exemplified in a minimalistic C++ program that can calculate protein protonation states. We further discuss performance issues related to high level coding abstraction. Conclusion C++ and the Standard Template Library (STL) provide a high-performance platform for generic molecular modeling. Automatic generation of code documentation from inline comments has proven particularly useful in that no separate manual needs to be maintained. PMID:18241331

Terminology Services: Standard Terminologies to Control Health Vocabulary.

PubMed

González Bernaldo de Quirós, Fernán; Otero, Carlos; Luna, Daniel

2018-04-22

Healthcare Information Systems should capture clinical data in a structured and preferably coded format. This is crucial for data exchange between health information systems, epidemiological analysis, quality and research, clinical decision support systems, administrative functions, among others. Structured data entry is an obstacle for the usability of electronic health record (EHR) applications and their acceptance by physicians who prefer to document patient EHRs using "free text". Natural language allows for rich expressiveness but at the same time is ambiguous; it has great dependence on context and uses jargon and acronyms. Although much progress has been made in knowledge and natural language processing techniques, the result is not yet satisfactory enough for the use of free text in all dimensions of clinical documentation. In order to address the trade-off between capturing data with free text and at the same time coding data for computer processing, numerous terminological systems for the systematic recording of clinical data have been developed. The purpose of terminology services consists of representing facts that happen in the real world through database management in order to allow for semantic interoperability and computerized applications. These systems interrelate concepts of a particular domain and provide references to related terms with standards codes. In this way, standard terminologies allow the creation of a controlled medical vocabulary, making terminology services a fundamental component for health data management in the healthcare environment. The Hospital Italiano de Buenos Aires has been working in the development of its own terminology server. This work describes its experience in the field. Georg Thieme Verlag KG Stuttgart.

Revisiting Principles of Ethical Practice Using a Case Study Framework

ERIC Educational Resources Information Center

Combes, Bertina H.; Peak, Pamela W.; Barrio, Brenda L.; Lindo, Endia J.; Hovey, Katrina A.; Lim, Okyoung; Peterson-Ahmad, Maria; Dorel, Theresa G.; Goran, Lisa

2016-01-01

A code of ethics serves as a compass, guiding professionals as they perform the roles associated with their profession. These codes are evidence to the public that professionals are concerned about the services they provide and the individuals to whom they are provided. Codes of ethics should be living documents, changing focus as the fields they…

NAEYC Code of Ethical Conduct. Revised = Codigo de Conducta Etica. Revisada

ERIC Educational Resources Information Center

National Association of Elementary School Principals (NAESP), 2005

2005-01-01

This document presents a code of ethics for early childhood educators that offers guidelines for responsible behavior and sets forth a common basis for resolving ethical dilemmas encountered in early education. It represents the English and Spanish versions of the revised code. Its contents were approved by the NAEYC Governing Board in April 2005…

75 FR 33992 - Interest and Penalty Suspension Provisions Under Section 6404(g) of the Internal Revenue Code

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-16

... Interest and Penalty Suspension Provisions Under Section 6404(g) of the Internal Revenue Code AGENCY.... SUMMARY: This document contains final regulations under section 6404(g)(2)(E) of the Internal Revenue Code... Procedure and Administration Regulations (26 CFR part 301) by adding rules under section 6404(g) relating to...

44 CFR 71.4 - Documentation.

Code of Federal Regulations, 2012 CFR

2012-10-01

... evidence that the structure was not in compliance with the building code at the time it was built; and (2... evidence that the structure was not in compliance with the building code at the time it was built; and (2... structure and found no evidence that the structure was not in compliance with the building code at the time...

44 CFR 71.4 - Documentation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... evidence that the structure was not in compliance with the building code at the time it was built; and (2... evidence that the structure was not in compliance with the building code at the time it was built; and (2... structure and found no evidence that the structure was not in compliance with the building code at the time...

44 CFR 71.4 - Documentation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... evidence that the structure was not in compliance with the building code at the time it was built; and (2... evidence that the structure was not in compliance with the building code at the time it was built; and (2... structure and found no evidence that the structure was not in compliance with the building code at the time...

44 CFR 71.4 - Documentation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... evidence that the structure was not in compliance with the building code at the time it was built; and (2... evidence that the structure was not in compliance with the building code at the time it was built; and (2... structure and found no evidence that the structure was not in compliance with the building code at the time...

44 CFR 71.4 - Documentation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... evidence that the structure was not in compliance with the building code at the time it was built; and (2... evidence that the structure was not in compliance with the building code at the time it was built; and (2... structure and found no evidence that the structure was not in compliance with the building code at the time...

Review and verification of CARE 3 mathematical model and code

NASA Technical Reports Server (NTRS)

Rose, D. M.; Altschul, R. E.; Manke, J. W.; Nelson, D. L.

1983-01-01

The CARE-III mathematical model and code verification performed by Boeing Computer Services were documented. The mathematical model was verified for permanent and intermittent faults. The transient fault model was not addressed. The code verification was performed on CARE-III, Version 3. A CARE III Version 4, which corrects deficiencies identified in Version 3, is being developed.

Comprehensive modeling of critical health care activities, costs, and data needs within the context of addiction rehabilitiation

NASA Astrophysics Data System (ADS)

Hoffman, Kenneth J.; Keithley, Hudson

1994-12-01

There are few systems which aggregate standardized pertinent clinical observations of discrete patient problems and resolutions. The systematic information supplied by clinicians is generally provided to justify reimbursement from insurers. Insurers, by their nature, and expert in modeling health care costs by diagnosis, procedures, and population risk groups. Medically, they rely on clinician generated diagnostic and coded procedure information. Clinicians will document a patient's status at a discrete point in time through narrative. Clinical notes do not support aggregate and systematic analysis of outcome. A methodology exists and has been used by the US Army Drug and Alcohol Program to model the clinical activities, associated costs, and data requirements of an outpatient clinic. This has broad applicability for a comprehensive health care system to which patient costs and data requirements can be established.

Addison's disease with polyglandular autoimmunity carries a more than 2·5-fold risk for adrenal crises: German Health insurance data 2010-2013.

PubMed

Meyer, Gesine; Badenhoop, Klaus; Linder, Roland

2016-09-01

Adrenal crises are potentially life-threatening complications in patients with adrenal insufficiency (AI). Our objective was to investigate the frequency of adrenal crises in different forms of AI. The Statutory Health Insurance (SHI) database of the Techniker Krankenkasse - covering more than 12% of the German population - was analysed for diagnostic codes from 1 January 2010 to 31 December 2013. By analysis of routine data from a large healthcare provider. Diagnoses of AI were recorded and classified in primary AI, secondary AI and autoimmune polyglandular syndrome (APS). The ICD-code E27·2 (AC) was retrieved in all cohorts. We found a prevalence of 222/million for secondary and 126/million for primary AI. AC was documented with a frequency of 4·8/100 patient years. Crises were significantly more frequent in patients with primary (7·6/100 patient years) compared to those with secondary AI (3·2/100 patient years; P < 0·0001). Prevalence of crises was higher in individuals with APS (10·9/100 patient years) and highest in patients with primary AI and type 1 diabetes (12·5/100 patient years). Applying a SHI database comprising more than 9 million individuals, we identified robust data about the risk of AC in different groups of patients with AI. Our data confirm and extend the clinical observation that patients with APS are at highest risk for AC. Approximately 1 of 8 patients with primary AI and type 1 diabetes suffers from an AC each year. Specific targeting of efforts aiming at the prevention of AC is necessary. © 2016 John Wiley & Sons Ltd.

Patterns of task and network actions performed by navigators to facilitate cancer care.

PubMed

Clark, Jack A; Parker, Victoria A; Battaglia, Tracy A; Freund, Karen M

2014-01-01

Patient navigation is a widely implemented intervention to facilitate access to care and reduce disparities in cancer care, but the activities of navigators are not well characterized. The aim of this study is to describe what patient navigators actually do and explore patterns of activity that clarify the roles they perform in facilitating cancer care. We conducted field observations of nine patient navigation programs operating in diverse health settings of the national patient navigation research program, including 34 patient navigators, each observed an average of four times. Trained observers used a structured observation protocol to code as they recorded navigator actions and write qualitative field notes capturing all activities in 15-minute intervals during observations ranging from 2 to 7 hours; yielding a total of 133 observations. Rates of coded activity were analyzed using numerical cluster analysis of identified patterns, informed by qualitative analysis of field notes. Six distinct patterns of navigator activity were identified, which differed most relative to how much time navigators spent directly interacting with patients and how much time they spent dealing with medical records and documentation tasks. Navigator actions reveal a complex set of roles in which navigators both provide the direct help to patients denoted by their title and also carry out a variety of actions that function to keep the health system operating smoothly. Working to navigate patients through complex health services entails working to repair the persistent challenges of health services that can render them inhospitable to patients. The organizations that deploy navigators might learn from navigators' efforts and explore alternative approaches, structures, or systems of care in addressing both the barriers patients face and the complex solutions navigators create in helping patients.

Human Rights Texts: Converting Human Rights Primary Source Documents into Data.

PubMed

Fariss, Christopher J; Linder, Fridolin J; Jones, Zachary M; Crabtree, Charles D; Biek, Megan A; Ross, Ana-Sophia M; Kaur, Taranamol; Tsai, Michael

2015-01-01

We introduce and make publicly available a large corpus of digitized primary source human rights documents which are published annually by monitoring agencies that include Amnesty International, Human Rights Watch, the Lawyers Committee for Human Rights, and the United States Department of State. In addition to the digitized text, we also make available and describe document-term matrices, which are datasets that systematically organize the word counts from each unique document by each unique term within the corpus of human rights documents. To contextualize the importance of this corpus, we describe the development of coding procedures in the human rights community and several existing categorical indicators that have been created by human coding of the human rights documents contained in the corpus. We then discuss how the new human rights corpus and the existing human rights datasets can be used with a variety of statistical analyses and machine learning algorithms to help scholars understand how human rights practices and reporting have evolved over time. We close with a discussion of our plans for dataset maintenance, updating, and availability.

Human Rights Texts: Converting Human Rights Primary Source Documents into Data

PubMed Central

Fariss, Christopher J.; Linder, Fridolin J.; Jones, Zachary M.; Crabtree, Charles D.; Biek, Megan A.; Ross, Ana-Sophia M.; Kaur, Taranamol; Tsai, Michael

2015-01-01

We introduce and make publicly available a large corpus of digitized primary source human rights documents which are published annually by monitoring agencies that include Amnesty International, Human Rights Watch, the Lawyers Committee for Human Rights, and the United States Department of State. In addition to the digitized text, we also make available and describe document-term matrices, which are datasets that systematically organize the word counts from each unique document by each unique term within the corpus of human rights documents. To contextualize the importance of this corpus, we describe the development of coding procedures in the human rights community and several existing categorical indicators that have been created by human coding of the human rights documents contained in the corpus. We then discuss how the new human rights corpus and the existing human rights datasets can be used with a variety of statistical analyses and machine learning algorithms to help scholars understand how human rights practices and reporting have evolved over time. We close with a discussion of our plans for dataset maintenance, updating, and availability. PMID:26418817

Oil and gas field code master list, 1993

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

Not Available

This document contains data collected through October 1993 and provides standardized field name spellings and codes for all identified oil and/or gas fields in the United States. Other Federal and State government agencies, as well as industry, use the EIA Oil and Gas Field Code Master List as the standard for field identification. A machine-readable version of the Oil and Gas Field Code Master List is available from the National Technical Information Service.

Taking advantage of continuity of care documents to populate a research repository.

PubMed

Klann, Jeffrey G; Mendis, Michael; Phillips, Lori C; Goodson, Alyssa P; Rocha, Beatriz H; Goldberg, Howard S; Wattanasin, Nich; Murphy, Shawn N

2015-03-01

Clinical data warehouses have accelerated clinical research, but even with available open source tools, there is a high barrier to entry due to the complexity of normalizing and importing data. The Office of the National Coordinator for Health Information Technology's Meaningful Use Incentive Program now requires that electronic health record systems produce standardized consolidated clinical document architecture (C-CDA) documents. Here, we leverage this data source to create a low volume standards based import pipeline for the Informatics for Integrating Biology and the Bedside (i2b2) clinical research platform. We validate this approach by creating a small repository at Partners Healthcare automatically from C-CDA documents. We designed an i2b2 extension to import C-CDAs into i2b2. It is extensible to other sites with variances in C-CDA format without requiring custom code. We also designed new ontology structures for querying the imported data. We implemented our methodology at Partners Healthcare, where we developed an adapter to retrieve C-CDAs from Enterprise Services. Our current implementation supports demographics, encounters, problems, and medications. We imported approximately 17 000 clinical observations on 145 patients into i2b2 in about 24 min. We were able to perform i2b2 cohort finding queries and view patient information through SMART apps on the imported data. This low volume import approach can serve small practices with local access to C-CDAs and will allow patient registries to import patient supplied C-CDAs. These components will soon be available open source on the i2b2 wiki. Our approach will lower barriers to entry in implementing i2b2 where informatics expertise or data access are limited. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Infornut® Process; improves accessibility to diagnosis and nutritional support for the malnourished hospitalized patient; impact on management indicators; two-year assessment.

PubMed

Villalobos Gámez, Juan Luis; González Pérez, Cristina; García-Almeida, José Manuel; Martínez Reina, Alfonso; Del Río Mata, José; Márquez Fernández, Efrén; Rioja Vázquez, Rosalía; Barranco Pérez, Joaquín; Enguix Armada, Alfredo; Rodríguez García, Luis Miguel; Bernal Losada, Olga; Osorio Fernández, Diego; Mínguez Mañanes, Alfredo; Lara Ramos, Carlos; Dani, Laila; Vallejo Báez, Antonio; Martínez Martín, Jesús; Fernández Ovies, José Manuel; Tinahones Madueño, Francisco Javier; Fernández-Crehuet Navajas, Joaquín

2014-06-01

The high prevalence of disease-related hospital malnutrition justifies the need for screening tools and early detection in patients at risk for malnutrition, followed by an assessment targeted towards diagnosis and treatment. At the same time there is clear undercoding of malnutrition diagnoses and the procedures to correct it Objectives: To describe the INFORNUT program/ process and its development as an information system. To quantify performance in its different phases. To cite other tools used as a coding source. To calculate the coding rates for malnutrition diagnoses and related procedures. To show the relationship to Mean Stay, Mortality Rate and Urgent Readmission; as well as to quantify its impact on the hospital Complexity Index and its effect on the justification of Hospitalization Costs. The INFORNUT® process is based on an automated screening program of systematic detection and early identification of malnourished patients on hospital admission, as well as their assessment, diagnoses, documentation and reporting. Of total readmissions with stays longer than three days incurred in 2008 and 2010, we recorded patients who underwent analytical screening with an alert for a medium or high risk of malnutrition, as well as the subgroup of patients in whom we were able to administer the complete INFORNUT® process, generating a report for each. Other documentary coding sources are cited. From the Minimum Basic Data Set, codes defined in the SEDOMSENPE consensus were analyzed. The data were processed with the Alcor-DRG program. Rates in ‰ of discharges for 2009 and 2010 of diagnoses of malnutrition, procedure and procedures-related diagnoses were calculated. These rates were compared with the mean rates in Andalusia. The contribution of these codes to the Complexity Index was estimated and, from the cost accounting data, the fraction of the hospitalization cost seen as justified by this activity was estimated. RESULTS are summarized for both study years. With respect to process performance, more than 3,600 patients per year (30% of admissions with a stay > 3 days) underwent analytical screening. Half of these patients were at medium or high risk and a nutritional assessment using INFORNUT® was completed for 55% of them, generating approximately 1,000 reports/year. Our coding rates exceeded the mean rates in Andalusia, being 3.5 times higher for diagnoses (35‰); 2.5 times higher for procedures (50‰) and five times the rate of procedurerelated diagnoses in the same patient (25‰). The Mean Stay of patients coded with malnutrition at discharge was 31.7 days, compared to 9.5 for the overall hospital stay. The Mortality Rate for the same patients (21.8%) was almost five times higher than the mean and Urgent Readmissions (5.5%) were 1.9 times higher. The impact of this coding on the hospital Complexity Index was four hundredths (from 2.08 to 2.12 in 2009 and 2.15 to 2.19 in 2010). This translates into a hospitalization cost justification of 2,000,000; five to six times the cost of artificial nutrition. The process facilitated access to the diagnosis of malnutrition and to understanding the risk of developing it, as well as to the prescription of procedures and/or supplements to correct it. The interdisciplinary team coordination, the participatory process and the tools used improved coding rates to give results far above the Andalusian mean. These results help to upwardly adjust the hospital Complexity Index or Case Mix-, as well as to explain hospitalization costs. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Evaluation of the Present-on-Admission Indicator among Hospitalized Fee-for-Service Medicare Patients with a Pressure Ulcer Diagnosis: Coding Patterns and Impact on Hospital-Acquired Pressure Ulcer Rates.

PubMed

Squitieri, Lee; Waxman, Daniel A; Mangione, Carol M; Saliba, Debra; Ko, Clifford Y; Needleman, Jack; Ganz, David A

2018-01-25

To evaluate national present-on-admission (POA) reporting for hospital-acquired pressure ulcers (HAPUs) and examine the impact of quality measure exclusion criteria on HAPU rates. Medicare inpatient, outpatient, and nursing facility data as well as independent provider claims (2010-2011). Retrospective cross-sectional study. We evaluated acute inpatient hospital admissions among Medicare fee-for-service (FFS) beneficiaries in 2011. Admissions were categorized as follows: (1) no pressure ulcer diagnosis, (2) new pressure ulcer diagnosis, and (3) previously documented pressure ulcer diagnosis. HAPU rates were calculated by varying patient exclusion criteria. Among admissions with a pressure ulcer diagnosis, we observed a large discrepancy in the proportion of admissions with a HAPU based on hospital-reported POA data (5.2 percent) and the proportion with a new pressure ulcer diagnosis based on patient history in billing claims (49.7 percent). Applying quality measure exclusion criteria resulted in removal of 91.2 percent of admissions with a pressure injury diagnosis from HAPU rate calculations. As payers and health care organizations expand the use of quality measures, it is important to consider how the measures are implemented, coding revisions to improve measure validity, and the impact of patient exclusion criteria on provider performance evaluation. © Health Research and Educational Trust.

The collection and utilisation of patient ethnicity data in general practices and hospitals in the United Kingdom: a qualitative case study.

PubMed

Morrison, Zoe; Fernando, Bernard; Kalra, Dipak; Cresswell, Kathrin; Robertson, Ann; Sheikh, Aziz

2014-01-01

Although the collection of patient ethnicity data is a requirement of publicly funded healthcare providers in the UK, recording of ethnicity is sub-optimal for reasons that remain poorly understood. We sought to understand enablers and barriers to the collection and utilisation of ethnicity data within electronic health records, how these practices have developed and what benefit this information provides to different stakeholder groups. We undertook an in-depth, qualitative case study drawing on interviews and documents obtained from participants working as academics, managers and administrators within the UK. Information regarding patient ethnicity was collected and coded as administrative patient data, and/or in narrative form within clinical records. We identified disparities in the classification of ethnicity, approaches to coding and levels of completeness due to differing local, regional and national policies and processes. Most participants could not identify any clinical value of ethnicity information and many did not know if and when data were shared between services or used to support quality of care and research. Findings highlighted substantial variations in data classification, and practical challenges in data collection and usage that undermine the integrity of data collected. Future work needs to focus on explaining the uses of these data to frontline clinicians, identifying resources that can support busy professionals to collect standardised data and then, once collected, maximising the utility of these data.

Evaluating a Dental Diagnostic Terminology in an Electronic Health Record

PubMed Central

White, Joel M.; Kalenderian, Elsbeth; Stark, Paul C.; Ramoni, Rachel L.; Vaderhobli, Ram; Walji, Muhammad F.

2011-01-01

Standardized treatment procedure codes and terms are routinely used in dentistry. Utilization of a diagnostic terminology is common in medicine, but there is not a satisfactory or commonly standardized dental diagnostic terminology available at this time. Recent advances in dental informatics have provided an opportunity for inclusion of diagnostic codes and terms as part of treatment planning and documentation in the patient treatment history. This article reports the results of the use of a diagnostic coding system in a large dental school’s predoctoral clinical practice. A list of diagnostic codes and terms, called Z codes, was developed by dental faculty members. The diagnostic codes and terms were implemented into an electronic health record (EHR) for use in a predoctoral dental clinic. The utilization of diagnostic terms was quantified. The validity of Z code entry was evaluated by comparing the diagnostic term entered to the procedure performed, where valid diagnosis-procedure associations were determined by consensus among three calibrated academically based dentists. A total of 115,004 dental procedures were entered into the EHR during the year sampled. Of those, 43,053 were excluded from this analysis because they represent diagnosis or other procedures unrelated to treatments. Among the 71,951 treatment procedures, 27,973 had diagnoses assigned to them with an overall utilization of 38.9 percent. Of the 147 available Z codes, ninety-three were used (63.3 percent). There were 335 unique procedures provided and 2,127 procedure/diagnosis pairs captured in the EHR. Overall, 76.7 percent of the diagnoses entered were valid. We conclude that dental diagnostic terminology can be incorporated within an electronic health record and utilized in an academic clinical environment. Challenges remain in the development of terms and implementation and ease of use that, if resolved, would improve the utilization. PMID:21546594

Communications and Information: Compendium of Communications and Information Terminology

DTIC Science & Technology

2002-02-01

Basic Access Module BASIC— Beginners All-Purpose Symbolic Instruction Code BBP—Baseband Processor BBS—Bulletin Board Service (System) BBTC—Broadband...media, formats and labels, programming language, computer documentation, flowcharts and terminology, character codes, data communications and input

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

Aleman, S.E.

This report documents a finite element code designed to model subsurface flow and contaminant transport, named FACT. FACT is a transient three-dimensional, finite element code designed to simulate isothermal groundwater flow, moisture movement, and solute transport in variably saturated and fully saturated subsurface porous media.

The effects of EMR deployment on doctors' work practices: a qualitative study in the emergency department of a teaching hospital.

PubMed

Park, Sun Young; Lee, So Young; Chen, Yunan

2012-03-01

The goal of this study was to examine the effects of medical notes (MD) in an electronic medical records (EMR) system on doctors' work practices at an Emergency Department (ED). We conducted a six-month qualitative study, including in situ field observations and semi-structured interviews, in an ED affiliated with a large teaching hospital during the time periods of before, after, and during the paper-to-electronic transition of the rollout of an EMR system. Data were analyzed using open coding method and various visual representations of workflow diagrams. The use of the EMR in the ED resulted in both direct and indirect effects on ED doctors' work practices. It directly influenced the ED doctors' documentation process: (i) increasing documentation time four to five fold, which in turn significantly increased the number of incomplete charts, (ii) obscuring the distinction between residents' charting inputs and those of attendings, shifting more documentation responsibilities to the residents, and (iii) leading to the use of paper notes as documentation aids to transfer information from the patient bedside to the charting room. EMR use also had indirect consequences: it increased the cognitive burden of doctors, since they had to remember multiple patients' data; it aggravated doctors' multi-tasking due to flexibility in the system use allowing more interruptions; and it caused ED doctors' work to become largely stationary in the charting room, which further contributed to reducing doctors' time with patients and their interaction with nurses. We suggest three guidelines for designing future EMR systems to be used in teaching hospitals. First, the design of documentation tools in EMR needs to take into account what we called "note-intensive tasks" to support the collaborative nature of medical work. Second, it should clearly define roles and responsibilities. Lastly, the system should provide a balance between flexibility and interruption to better manage the complex nature of medical work and to facilitate necessary interactions among ED staff and patients in the work environment. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Emergency care provision at the 2009 Special Olympics Great Britain.

PubMed

Williamson, Timothy; Wheeler, Patrick; Stephens, Catherine; Ferguson, Mike

2013-05-01

The Special Olympics Great Britain (SOLGB) summer games 2009 were held in Leicester between 25 and 31 July. They involved 2413 athletes that were engaged in 21 different sports across 19 different locations. The onsite healthcare was provided by a specialist medical team. The hospital services available were at the local emergency department (ED) and the co-located urgent care centre (UCC). To assess the on-site provision required to support a large multisport event for people with learning disabilities and to ascertain the impact on the local hospital services. On-site consultations were documented on SOLGB medical record forms. Referrals to the local ED and UCC were identified from the SOLGB medical notes or from the ED/UCC attendance codes, as a specific code was applied to all patients related to the games. 581 on-site consultations were documented at SOLGB 2009, of which 95% of these were for athletes. 477 treatments were completed in total, of which 444 were undertaken on-site (93%). 20 people attended the ED; there were no documented attendances at the UCC. 17 of the 20 attendances at the ED were athletes competing. Allocation of the healthcare team was appropriate, with the exception of one sport, where a doctor was moved from a nearby event to consult on 13 occasions. Attendances to the local ED and UCC were minimal. Therefore, the model of on-site medical care that was used, which led to minimal impact on NHS resources, will support the arrangements of medical requirements at future SOLGB games.

Seizure Correlates with Prolonged Hospital Stay, Increased Costs, and Increased Mortality in Nontraumatic Subdural Hematoma.

PubMed

Joseph, Jacob R; Smith, Brandon W; Williamson, Craig A; Park, Paul

2016-08-01

Nontraumatic subdural hematoma (NTSDH) is a common neurosurgical disease process, with mortality reported as high as 13%. Seizure has a known association with NTSDH, although patient outcomes have not previously been well studied in this population. The purpose of this study was to examine the relationship between in-hospital seizure and inpatient outcomes in NTSDH. Using the University HealthSystem Consortium (UHC) database, we performed a retrospective cohort study of adults with a principal diagnosis of NTSDH (International Classification of Diseases, Ninth Revision code 43.21) between 2011 and 2015. Patients with in-hospital seizure (International Classification of Diseases, Ninth Revision codes 34500-34591, 78033, 78039) were compared with those without. Patients with a history of seizure before arrival were excluded. Patient demographics, hospital length of stay (LOS), intensive care unit stay, in-hospital mortality, and direct costs were recorded. A total 16,928 patients with NTSDH were identified. Mean age was 69.2 years, and 64.7% were male. In-hospital seizure was documented in 744 (4.40%) patients. Hospital LOS was 17.64 days in patients with seizure and 6.26 days in those without (P < 0.0001). Mean intensive care unit stay increased from 3.36 days without seizure to 9.36 days with seizure. In-hospital mortality was 9.19% in patients without seizure and 16.13% in those with seizure (P < 0.0001). Direct costs were $12,781 in patients without seizure and $38,110 in those with seizure (P < 0.0001). Seizure in patients with NTSDH correlates with significantly increased total LOS and increased mortality. Direct costs are similarly increased. Further studies accounting for effects of illness severity are necessary to validate these results. Copyright © 2016 Elsevier Inc. All rights reserved.

Certifying Auto-Generated Flight Code

NASA Technical Reports Server (NTRS)

Denney, Ewen

2008-01-01

Model-based design and automated code generation are being used increasingly at NASA. Many NASA projects now use MathWorks Simulink and Real-Time Workshop for at least some of their modeling and code development. However, there are substantial obstacles to more widespread adoption of code generators in safety-critical domains. Since code generators are typically not qualified, there is no guarantee that their output is correct, and consequently the generated code still needs to be fully tested and certified. Moreover, the regeneration of code can require complete recertification, which offsets many of the advantages of using a generator. Indeed, manual review of autocode can be more challenging than for hand-written code. Since the direct V&V of code generators is too laborious and complicated due to their complex (and often proprietary) nature, we have developed a generator plug-in to support the certification of the auto-generated code. Specifically, the AutoCert tool supports certification by formally verifying that the generated code is free of different safety violations, by constructing an independently verifiable certificate, and by explaining its analysis in a textual form suitable for code reviews. The generated documentation also contains substantial tracing information, allowing users to trace between model, code, documentation, and V&V artifacts. This enables missions to obtain assurance about the safety and reliability of the code without excessive manual V&V effort and, as a consequence, eases the acceptance of code generators in safety-critical contexts. The generation of explicit certificates and textual reports is particularly well-suited to supporting independent V&V. The primary contribution of this approach is the combination of human-friendly documentation with formal analysis. The key technical idea is to exploit the idiomatic nature of auto-generated code in order to automatically infer logical annotations. The annotation inference algorithm itself is generic, and parametrized with respect to a library of coding patterns that depend on the safety policies and the code generator. The patterns characterize the notions of definitions and uses that are specific to the given safety property. For example, for initialization safety, definitions correspond to variable initializations while uses are statements which read a variable, whereas for array bounds safety, definitions are the array declarations, while uses are statements which access an array variable. The inferred annotations are thus highly dependent on the actual program and the properties being proven. The annotations, themselves, need not be trusted, but are crucial to obtain the automatic formal verification of the safety properties without requiring access to the internals of the code generator. The approach has been applied to both in-house and commercial code generators, but is independent of the particular generator used. It is currently being adapted to flight code generated using MathWorks Real-Time Workshop, an automatic code generator that translates from Simulink/Stateflow models into embedded C code.

Standardized development of computer software. Part 2: Standards

NASA Technical Reports Server (NTRS)

Tausworthe, R. C.

1978-01-01

This monograph contains standards for software development and engineering. The book sets forth rules for design, specification, coding, testing, documentation, and quality assurance audits of software; it also contains detailed outlines for the documentation to be produced.

EA Shuttle Document Retention Effort

NASA Technical Reports Server (NTRS)

Wagner, Howard A.

2010-01-01

This slide presentation reviews the effort of code EA at Johnson Space Center (JSC) to identify and acquire databases and documents from the space shuttle program that are adjudged important for retention after the retirement of the space shuttle.

World Energy Projection System Plus Model Documentation: Coal Module

EIA Publications

2011-01-01

This report documents the objectives, analytical approach and development of the World Energy Projection System Plus (WEPS ) Coal Model. It also catalogues and describes critical assumptions, computational methodology, parameter estimation techniques, and model source code.

World Energy Projection System Plus Model Documentation: Transportation Module

EIA Publications

2017-01-01

This report documents the objectives, analytical approach and development of the World Energy Projection System Plus (WEPS ) International Transportation model. It also catalogues and describes critical assumptions, computational methodology, parameter estimation techniques, and model source code.

World Energy Projection System Plus Model Documentation: Residential Module

EIA Publications

2016-01-01

This report documents the objectives, analytical approach and development of the World Energy Projection System Plus (WEPS ) Residential Model. It also catalogues and describes critical assumptions, computational methodology, parameter estimation techniques, and model source code.

World Energy Projection System Plus Model Documentation: Refinery Module

EIA Publications

2016-01-01

This report documents the objectives, analytical approach and development of the World Energy Projection System Plus (WEPS ) Refinery Model. It also catalogues and describes critical assumptions, computational methodology, parameter estimation techniques, and model source code.

World Energy Projection System Plus Model Documentation: Main Module

EIA Publications

2016-01-01

This report documents the objectives, analytical approach and development of the World Energy Projection System Plus (WEPS ) Main Model. It also catalogues and describes critical assumptions, computational methodology, parameter estimation techniques, and model source code.

Transportation Sector Module - NEMS Documentation

EIA Publications

2017-01-01

Documents the objectives, analytical approach and development of the National Energy Modeling System (NEMS) Transportation Model (TRAN). The report catalogues and describes the model assumptions, computational methodology, parameter estimation techniques, model source code, and forecast results generated by the model.

World Energy Projection System Plus Model Documentation: Electricity Module

EIA Publications

2017-01-01

This report documents the objectives, analytical approach and development of the World Energy Projection System Plus (WEPS ) World Electricity Model. It also catalogues and describes critical assumptions, computational methodology, parameter estimation techniques, and model source code.

77 FR 12202 - Public Inspection of Material Relating to Tax-Exempt Organizations

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-29

...This document contains final regulations pertaining to the public inspection of material relating to tax-exempt organizations and final regulations pertaining to the public inspection of written determinations and background file documents. These regulations are necessary to clarify rules relating to information and materials made available by the IRS for public inspection under the Internal Revenue Code (Code). The final regulations affect certain organizations exempt from Federal income tax, organizations that were exempt but are no longer exempt from Federal income tax, and organizations that were denied tax-exempt status.

Shared responsibility payment for not maintaining minimum essential coverage. Final regulations.

PubMed

2013-08-30

This document contains final regulations on the requirement to maintain minimum essential coverage enacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended by the TRICARE Affirmation Act and Public Law 111-173. These final regulations provide guidance to individual taxpayers on the liability under section 5000A of the Internal Revenue Code for the shared responsibility payment for not maintaining minimum essential coverage and largely finalize the rules in the notice of proposed rulemaking published in the Federal Register on February 1, 2013.

OHD/HL - SHEF: code

Science.gov Websites

specification How to install the software How to use the software Download the source code (using .gz). Standard Exchange Format (SHEF) is a documented set of rules for coding of data in a form for both visual and information to describe the data. Current SHEF specification How to install the software How to use the

36 CFR 1234.20 - What rules apply if there is a conflict between NARA standards and other regulatory standards...

Code of Federal Regulations, 2014 CFR

2014-07-01

... regional building codes, the following rules of precedence apply: (1) Between differing levels of fire... cannot be reconciled with a requirement of this part, the local or regional code applies. (b) If any of... require documentation of the mandatory nature of the conflicting code and the inability to reconcile that...

36 CFR 1234.20 - What rules apply if there is a conflict between NARA standards and other regulatory standards...

Code of Federal Regulations, 2012 CFR

2012-07-01

... regional building codes, the following rules of precedence apply: (1) Between differing levels of fire... cannot be reconciled with a requirement of this part, the local or regional code applies. (b) If any of... require documentation of the mandatory nature of the conflicting code and the inability to reconcile that...

36 CFR 1234.20 - What rules apply if there is a conflict between NARA standards and other regulatory standards...

Code of Federal Regulations, 2011 CFR

2011-07-01

... regional building codes, the following rules of precedence apply: (1) Between differing levels of fire... cannot be reconciled with a requirement of this part, the local or regional code applies. (b) If any of... require documentation of the mandatory nature of the conflicting code and the inability to reconcile that...

36 CFR § 1234.20 - What rules apply if there is a conflict between NARA standards and other regulatory standards...

Code of Federal Regulations, 2013 CFR

2013-07-01

... regional building codes, the following rules of precedence apply: (1) Between differing levels of fire... cannot be reconciled with a requirement of this part, the local or regional code applies. (b) If any of... require documentation of the mandatory nature of the conflicting code and the inability to reconcile that...

Innovation and Standardization in School Building: A Proposal for the National Code in Italy.

ERIC Educational Resources Information Center

Ridolfi, Giuseppe

This document discusses the University of Florence's experience and concepts as it developed the research to define a proposal for designing a new national school building code. Section 1 examines the current school building code and the Italian Reform Process in Education between 1960 and 2000. Section 2 details and explains the new school…

DYNA3D Code Practices and Developments

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

Lin, L.; Zywicz, E.; Raboin, P.

2000-04-21

DYNA3D is an explicit, finite element code developed to solve high rate dynamic simulations for problems of interest to the engineering mechanics community. The DYNA3D code has been under continuous development since 1976[1] by the Methods Development Group in the Mechanical Engineering Department of Lawrence Livermore National Laboratory. The pace of code development activities has substantially increased in the past five years, growing from one to between four and six code developers. This has necessitated the use of software tools such as CVS (Concurrent Versions System) to help manage multiple version updates. While on-line documentation with an Adobe PDF manualmore » helps to communicate software developments, periodically a summary document describing recent changes and improvements in DYNA3D software is needed. The first part of this report describes issues surrounding software versions and source control. The remainder of this report details the major capability improvements since the last publicly released version of DYNA3D in 1996. Not included here are the many hundreds of bug corrections and minor enhancements, nor the development in DYNA3D between the manual release in 1993[2] and the public code release in 1996.« less

New Paradigms for Patient-Centered Outcomes Research in Electronic Medical Records: An Example of Detecting Urinary Incontinence Following Prostatectomy.

PubMed

Hernandez-Boussard, Tina; Tamang, Suzanne; Blayney, Douglas; Brooks, Jim; Shah, Nigam

2016-01-01

National initiatives to develop quality metrics emphasize the need to include patient-centered outcomes. Patient-centered outcomes are complex, require documentation of patient communications, and have not been routinely collected by healthcare providers. The widespread implementation of electronic medical records (EHR) offers opportunities to assess patient-centered outcomes within the routine healthcare delivery system. The objective of this study was to test the feasibility and accuracy of identifying patient centered outcomes within the EHR. Data from patients with localized prostate cancer undergoing prostatectomy were used to develop and test algorithms to accurately identify patient-centered outcomes in post-operative EHRs - we used urinary incontinence as the use case. Standard data mining techniques were used to extract and annotate free text and structured data to assess urinary incontinence recorded within the EHRs. A total 5,349 prostate cancer patients were identified in our EHR-system between 1998-2013. Among these EHRs, 30.3% had a text mention of urinary incontinence within 90 days post-operative compared to less than 1.0% with a structured data field for urinary incontinence (i.e. ICD-9 code). Our workflow had good precision and recall for urinary incontinence (positive predictive value: 0.73 and sensitivity: 0.84). Our data indicate that important patient-centered outcomes, such as urinary incontinence, are being captured in EHRs as free text and highlight the long-standing importance of accurate clinician documentation. Standard data mining algorithms can accurately and efficiently identify these outcomes in existing EHRs; the complete assessment of these outcomes is essential to move practice into the patient-centered realm of healthcare.

Automated encoding of clinical documents based on natural language processing.

PubMed

Friedman, Carol; Shagina, Lyudmila; Lussier, Yves; Hripcsak, George

2004-01-01

The aim of this study was to develop a method based on natural language processing (NLP) that automatically maps an entire clinical document to codes with modifiers and to quantitatively evaluate the method. An existing NLP system, MedLEE, was adapted to automatically generate codes. The method involves matching of structured output generated by MedLEE consisting of findings and modifiers to obtain the most specific code. Recall and precision applied to Unified Medical Language System (UMLS) coding were evaluated in two separate studies. Recall was measured using a test set of 150 randomly selected sentences, which were processed using MedLEE. Results were compared with a reference standard determined manually by seven experts. Precision was measured using a second test set of 150 randomly selected sentences from which UMLS codes were automatically generated by the method and then validated by experts. Recall of the system for UMLS coding of all terms was .77 (95% CI.72-.81), and for coding terms that had corresponding UMLS codes recall was .83 (.79-.87). Recall of the system for extracting all terms was .84 (.81-.88). Recall of the experts ranged from .69 to .91 for extracting terms. The precision of the system was .89 (.87-.91), and precision of the experts ranged from .61 to .91. Extraction of relevant clinical information and UMLS coding were accomplished using a method based on NLP. The method appeared to be comparable to or better than six experts. The advantage of the method is that it maps text to codes along with other related information, rendering the coded output suitable for effective retrieval.

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.

ANOPP programming and documentation standards document

NASA Technical Reports Server (NTRS)

1976-01-01

Standards defining the requirements for preparing software for the Aircraft Noise Prediction Program (ANOPP) were given. It is the intent of these standards to provide definition, design, coding, and documentation criteria for the achievement of a unity among ANOPP products. These standards apply to all of ANOPP's standard software system. The standards encompass philosophy as well as techniques and conventions.

49 CFR 383.153 - Information on the CLP and CDL documents and applications.

Code of Federal Regulations, 2011 CFR

2011-10-01

... materials endorsements; (vi) S for school bus; and (vii) At the discretion of the State, additional codes... on the front or back of the CDL document. (10) The restriction(s) placed on the driver from operating... front or back of the CDL document. (b) Commercial Learner's Permit. (1) A CLP must not contain a...

49 CFR 383.153 - Information on the CLP and CDL documents and applications.

Code of Federal Regulations, 2012 CFR

2012-10-01

... materials endorsements; (vi) S for school bus; and (vii) At the discretion of the State, additional codes... on the front or back of the CDL document. (10) The restriction(s) placed on the driver from operating... front or back of the CDL document. (b) Commercial Learner's Permit. (1) A CLP must not contain a...

The Nature of the Arguments for Creationism, Intelligent Design, and Evolution

ERIC Educational Resources Information Center

Barnes, Ralph M.; Church, Rebecca A.; Draznin-Nagy, Samuel

2017-01-01

Seventy-two Internet documents promoting creationism, intelligent design (I.D.), or evolution were selected for analysis. The primary goal of each of the 72 documents was to present arguments for creationism, I.D., or evolution. We first identified all arguments in these documents. Each argument was then coded in terms of both argument type…

Methodology, status, and plans for development and assessment of the RELAP5 code

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

Johnson, G.W.; Riemke, R.A.

1997-07-01

RELAP/MOD3 is a computer code used for the simulation of transients and accidents in light-water nuclear power plants. The objective of the program to develop and maintain RELAP5 was and is to provide the U.S. Nuclear Regulatory Commission with an independent tool for assessing reactor safety. This paper describes code requirements, models, solution scheme, language and structure, user interface validation, and documentation. The paper also describes the current and near term development program and provides an assessment of the code`s strengths and limitations.

World Energy Projection System Plus Model Documentation: Greenhouse Gases Module

EIA Publications

2011-01-01

This report documents the objectives, analytical approach and development of the World Energy Projection System Plus (WEPS ) Greenhouse Gases Model. It also catalogues and describes critical assumptions, computational methodology, parameter estimation techniques, and model source code.

World Energy Projection System Plus Model Documentation: Natural Gas Module

EIA Publications

2011-01-01

This report documents the objectives, analytical approach and development of the World Energy Projection System Plus (WEPS ) Natural Gas Model. It also catalogues and describes critical assumptions, computational methodology, parameter estimation techniques, and model source code.

World Energy Projection System Plus Model Documentation: District Heat Module

EIA Publications

2017-01-01

This report documents the objectives, analytical approach and development of the World Energy Projection System Plus (WEPS ) District Heat Model. It also catalogues and describes critical assumptions, computational methodology, parameter estimation techniques, and model source code.

World Energy Projection System Plus Model Documentation: Industrial Module

EIA Publications

2016-01-01

This report documents the objectives, analytical approach and development of the World Energy Projection System Plus (WEPS ) World Industrial Model (WIM). It also catalogues and describes critical assumptions, computational methodology, parameter estimation techniques, and model source code.

Language and Program for Documenting Software Design

NASA Technical Reports Server (NTRS)

Kleine, H.; Zepko, T. M.

1986-01-01

Software Design and Documentation Language (SDDL) provides effective communication medium to support design and documentation of complex software applications. SDDL supports communication among all members of software design team and provides for production of informative documentation on design effort. Use of SDDL-generated document to analyze design makes it possible to eliminate many errors not detected until coding and testing attempted. SDDL processor program translates designer's creative thinking into effective document for communication. Processor performs as many automatic functions as possible, freeing designer's energy for creative effort. SDDL processor program written in PASCAL.

Splitting of 2-Digit SIC Codes at 3M's Chemolite Plant

EPA Pesticide Factsheets

This document may be of assistance in applying the New Source Review (NSR) air permitting regulations including the Prevention of Significant Deterioration (PSD) requirements. This document is part of the NSR Policy and Guidance Database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

[Assessment of Coding in German Diagnosis Related Groups System in Otorhinolaryngology].

PubMed

Ellies, Maik; Anders, Berit; Seger, Wolfgang

2018-05-14

Prospective analysis of assessment reports in otorhinolaryngology for the period 01-03-2011 to 31-03-2017 by the Health Advisory Boards in Lower Saxony and Bremen, Germany in relation to coding in the G-DRG-System. The assessment reports were documented using a standardized database system developed on the basis of the electronic data exchange (DTA) by the Health Advisory Board in Lower Saxony. In addition, the documentation of the assessment reports according to the G-DRG system was used for assessment. Furthermore, the assessment of a case was evaluated once again on the basis of the present assessment documents and presented as an example in detail. During the period from 01-03-2011 to 31-03-2017, a total of 27,424 cases of inpatient assessments of DRGs according to the G-DRG system were collected in the field of otorhinolaryngology. In 7,259 cases, the DRG was changed, and in 20,175 cases, the suspicion of a DRG-relevant coding error was not justified in the review; thus, a DRG change rate of 26% of the assessments was identified over the time period investigated. There were different kinds of coding errors. In order to improve the coding quality in otorhinolaryngology, in addition to the special consideration of the presented "hit list" by the otorhinolaryngology departments, there should be more intensive cooperation between hospitals and the Health Advisory Boards of the federal states. © Georg Thieme Verlag KG Stuttgart · New York.

Tobacco document research reporting

PubMed Central

Carter, S

2005-01-01

Design: Interpretive analysis of published research. Sample: 173 papers indexed in Medline between 1995 and 2004 that cited tobacco industry documents. Analysis: Information about year published, journal and author, and a set of codes relating to methods reporting, were managed in N*Vivo. This coding formed the basis of an interpretation of tobacco document research reporting. Results: Two types of papers were identified. The first used tobacco documents as the primary data source (A-papers). The second was dedicated to another purpose but cited a small number of documents (B-papers). In B-papers documents were used either to provide a specific example or to support an expansive contention. A-papers contained information about purpose, sources, searching, analysis, and limitations that differed by author and journal and over time. A-papers had no clear methodological context, but used words from three major traditions—interpretive research, positivist research, and history—to describe analysis. Interpretation: A descriptive mainstream form of tobacco document reporting is proposed, initially typical but decreasing, and a continuum of positioning of the researcher, from conduit to constructor. Reporting practices, particularly from experienced researchers, appeared to evolve towards researcher as constructor, with later papers showing more complex purposes, diverse sources, and detail of searching and analysis. Tobacco document research could learn from existing research traditions: a model for planning and evaluating tobacco document research is presented. PMID:16319359

Decree No. 1900 of 24 August 1989 authorizing civil divorce before a notary for reasons provided in Section 8 of Article 154 of the Civil Code.

PubMed

1989-01-01

This Colombian Decree authorizes civil divorce to take place before a notary by means of public document when the spouses are in mutual agreement; the ground for the divorce is separation, either decreed by a court or formalized before a notary; and the separation has lasted more than 2 years. Such a divorce produces the same legal effects as a divorce decreed by a court. The document is to set forth the duties of both spouses with respect to the provisions of sentence 3 of Article 166 of the Civil Code. If there are minors, the document must receive the approval of the municipal or district representative. Decree No. 2275 of 7 October 1989 (Diario Oficial, 7 October 1989, pp. 75-76) amends this Decree to provide that the judgment of the municipal or district representative must be made within 10 days after the document is received. Sentence 3 of Article 166 of the Civil Code requires that spouses who are separating by mutual consent send to a judge their agreement with respect to the care and support of children, which the judge may reject if necessary in the interests of the children.

Wavelet domain textual coding of Ottoman script images

NASA Astrophysics Data System (ADS)

Gerek, Oemer N.; Cetin, Enis A.; Tewfik, Ahmed H.

1996-02-01

Image coding using wavelet transform, DCT, and similar transform techniques is well established. On the other hand, these coding methods neither take into account the special characteristics of the images in a database nor are they suitable for fast database search. In this paper, the digital archiving of Ottoman printings is considered. Ottoman documents are printed in Arabic letters. Witten et al. describes a scheme based on finding the characters in binary document images and encoding the positions of the repeated characters This method efficiently compresses document images and is suitable for database research, but it cannot be applied to Ottoman or Arabic documents as the concept of character is different in Ottoman or Arabic. Typically, one has to deal with compound structures consisting of a group of letters. Therefore, the matching criterion will be according to those compound structures. Furthermore, the text images are gray tone or color images for Ottoman scripts for the reasons that are described in the paper. In our method the compound structure matching is carried out in wavelet domain which reduces the search space and increases the compression ratio. In addition to the wavelet transformation which corresponds to the linear subband decomposition, we also used nonlinear subband decomposition. The filters in the nonlinear subband decomposition have the property of preserving edges in the low resolution subband image.

Resurrecting Legacy Code Using Ontosoft Knowledge-Sharing and Digital Object Management to Revitalize and Reproduce Software for Groundwater Management Research

NASA Astrophysics Data System (ADS)

Kwon, N.; Gentle, J.; Pierce, S. A.

2015-12-01

Software code developed for research is often used for a relatively short period of time before it is abandoned, lost, or becomes outdated. This unintentional abandonment of code is a valid problem in the 21st century scientific process, hindering widespread reusability and increasing the effort needed to develop research software. Potentially important assets, these legacy codes may be resurrected and documented digitally for long-term reuse, often with modest effort. Furthermore, the revived code may be openly accessible in a public repository for researchers to reuse or improve. For this study, the research team has begun to revive the codebase for Groundwater Decision Support System (GWDSS), originally developed for participatory decision making to aid urban planning and groundwater management, though it may serve multiple use cases beyond those originally envisioned. GWDSS was designed as a java-based wrapper with loosely federated commercial and open source components. If successfully revitalized, GWDSS will be useful for both practical applications as a teaching tool and case study for groundwater management, as well as informing theoretical research. Using the knowledge-sharing approaches documented by the NSF-funded Ontosoft project, digital documentation of GWDSS is underway, from conception to development, deployment, characterization, integration, composition, and dissemination through open source communities and geosciences modeling frameworks. Information assets, documentation, and examples are shared using open platforms for data sharing and assigned digital object identifiers. Two instances of GWDSS version 3.0 are being created: 1) a virtual machine instance for the original case study to serve as a live demonstration of the decision support tool, assuring the original version is usable, and 2) an open version of the codebase, executable installation files, and developer guide available via an open repository, assuring the source for the application is accessible with version control and potential for new branch developments. Finally, metadata about the software has been completed within the OntoSoft portal to provide descriptive curation, make GWDSS searchable, and complete documentation of the scientific software lifecycle.

Content validity--establishing and reporting the evidence in newly developed patient-reported outcomes (PRO) instruments for medical product evaluation: ISPOR PRO good research practices task force report: part 1--eliciting concepts for a new PRO instrument.

PubMed

Patrick, Donald L; Burke, Laurie B; Gwaltney, Chad J; Leidy, Nancy Kline; Martin, Mona L; Molsen, Elizabeth; Ring, Lena

2011-12-01

The importance of content validity in developing patient reported outcomes (PRO) instruments is stressed by both the US Food and Drug Administration and the European Medicines Agency. Content validity is the extent to which an instrument measures the important aspects of concepts that developers or users purport it to assess. A PRO instrument measures the concepts most significant and relevant to a patient's condition and its treatment. For PRO instruments, items and domains as reflected in the scores of an instrument should be important to the target population and comprehensive with respect to patient concerns. Documentation of target population input in item generation, as well as evaluation of patient understanding through cognitive interviewing, can provide the evidence for content validity. Developing content for, and assessing respondent understanding of, newly developed PRO instruments for medical product evaluation will be discussed in this two-part ISPOR PRO Good Research Practices Task Force Report. Topics include the methods for generating items, documenting item development, coding of qualitative data from item generation, cognitive interviewing, and tracking item development through the various stages of research and preparing this tracking for submission to regulatory agencies. Part 1 covers elicitation of key concepts using qualitative focus groups and/or interviews to inform content and structure of a new PRO instrument. Part 2 covers the instrument development process, the assessment of patient understanding of the draft instrument using cognitive interviews and steps for instrument revision. The two parts are meant to be read together. They are intended to offer suggestions for good practices in planning, executing, and documenting qualitative studies that are used to support the content validity of PRO instruments to be used in medical product evaluation. Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Static Verification for Code Contracts

NASA Astrophysics Data System (ADS)

Fähndrich, Manuel

The Code Contracts project [3] at Microsoft Research enables programmers on the .NET platform to author specifications in existing languages such as C# and VisualBasic. To take advantage of these specifications, we provide tools for documentation generation, runtime contract checking, and static contract verification.

Reporting Codes and Fuel Pathways for the EPA Moderated Transaction System (EMTS)

EPA Pesticide Factsheets

Users should reference this document for a complete list of all reporting codes and all possible fuel pathways for Renewable Fuel Standard (RFS) and Fuels Averaging, Banking and Trading (ABT) users of the EPA Moderated Transaction System (EMTS).

78 FR 37923 - Delegation of Reporting Functions Specified in Section 491 of Title 10, United State Code

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-24

...--Delegation of Reporting Functions Specified in Section 491 of Title 10, United States Code Notice of June 20..., June 24, 2013 / Presidential Documents#0;#0; #0; #0;Title 3-- #0;The President [[Page 37923

78 FR 37921 - Delegation of Reporting Functions Specified in Section 491 of Title 10, United State Code

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-24

...--Delegation of Reporting Functions Specified in Section 491 of Title 10, United States Code Notice of June 20..., June 24, 2013 / Presidential Documents#0;#0; #0; #0;Title 3-- #0;The President [[Page 37923

Validation of ICD-9-CM coding algorithm for improved identification of hypoglycemia visits.

PubMed

Ginde, Adit A; Blanc, Phillip G; Lieberman, Rebecca M; Camargo, Carlos A

2008-04-01

Accurate identification of hypoglycemia cases by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes will help to describe epidemiology, monitor trends, and propose interventions for this important complication in patients with diabetes. Prior hypoglycemia studies utilized incomplete search strategies and may be methodologically flawed. We sought to validate a new ICD-9-CM coding algorithm for accurate identification of hypoglycemia visits. This was a multicenter, retrospective cohort study using a structured medical record review at three academic emergency departments from July 1, 2005 to June 30, 2006. We prospectively derived a coding algorithm to identify hypoglycemia visits using ICD-9-CM codes (250.3, 250.8, 251.0, 251.1, 251.2, 270.3, 775.0, 775.6, and 962.3). We confirmed hypoglycemia cases by chart review identified by candidate ICD-9-CM codes during the study period. The case definition for hypoglycemia was documented blood glucose 3.9 mmol/l or emergency physician charted diagnosis of hypoglycemia. We evaluated individual components and calculated the positive predictive value. We reviewed 636 charts identified by the candidate ICD-9-CM codes and confirmed 436 (64%) cases of hypoglycemia by chart review. Diabetes with other specified manifestations (250.8), often excluded in prior hypoglycemia analyses, identified 83% of hypoglycemia visits, and unspecified hypoglycemia (251.2) identified 13% of hypoglycemia visits. The absence of any predetermined co-diagnosis codes improved the positive predictive value of code 250.8 from 62% to 92%, while excluding only 10 (2%) true hypoglycemia visits. Although prior analyses included only the first-listed ICD-9 code, more than one-quarter of identified hypoglycemia visits were outside this primary diagnosis field. Overall, the proposed algorithm had 89% positive predictive value (95% confidence interval, 86-92) for detecting hypoglycemia visits. The proposed algorithm improves on prior strategies to identify hypoglycemia visits in administrative data sets and will enhance the ability to study the epidemiology and design interventions for this important complication of diabetes care.

An Introduction to Thermodynamic Performance Analysis of Aircraft Gas Turbine Engine Cycles Using the Numerical Propulsion System Simulation Code

NASA Technical Reports Server (NTRS)

Jones, Scott M.

2007-01-01

This document is intended as an introduction to the analysis of gas turbine engine cycles using the Numerical Propulsion System Simulation (NPSS) code. It is assumed that the analyst has a firm understanding of fluid flow, gas dynamics, thermodynamics, and turbomachinery theory. The purpose of this paper is to provide for the novice the information necessary to begin cycle analysis using NPSS. This paper and the annotated example serve as a starting point and by no means cover the entire range of information and experience necessary for engine performance simulation. NPSS syntax is presented but for a more detailed explanation of the code the user is referred to the NPSS User Guide and Reference document (ref. 1).

Missed surgical intensive care unit billing: potential financial impact of 24/7 faculty presence.

PubMed

Hendershot, Kimberly M; Bollins, John P; Armen, Scott B; Thomas, Yalaunda M; Steinberg, Steven M; Cook, Charles H

2009-07-01

To efficiently capture evaluation and management (E&M) and procedural billing in our surgical intensive care unit (SICU), we have developed an electronic billing system that links to the electronic medical record (EMR). In this system, only notes electronically signed and coded by an attending generate billing charges. We hypothesized that capture of missed billing during nighttime and weekends might be sufficient to subsidize 24/7 in-house attending coverage. A retrospective chart EMR review was performed of the EMRs for all SICU patients during a 2-month period. Note type, date, time, attending signature, and coding were analyzed. Notes without attending signature, diagnosis, or current procedural terminology (CPT) code were considered incomplete and identified as "missed billing." Four hundred and forty-three patients had 465 admissions generating 2,896 notes. Overall, 76% of notes were signed and coded by an attending and billed. Incomplete (not billed) notes represented an overall missed billing opportunity of $159,138 for the 2-month time period (approximately $954,000 annually). Unbilled E&M encounters during weekdays totaled $54,758, whereas unbilled E&M and procedures from weeknights and weekends totaled $88,408 ($44,566 and $43,842, respectively). Missed billing after-hours thus represents approximately $530K annually, extrapolating to approximately $220K in collections from our payer mix. Surprisingly, missed E&M and procedural billing during weekdays totaled $70,730 (approximately $425K billing, approximately $170K collections annually), and typically represented patients seen, but transferred from the SICU before attending documentation was completed. Capture of nighttime and weekend ICU collections alone may be insufficient to add faculty or incentivize in-house coverage, but could certainly complement other in-house derived revenues to such ends. In addition, missed daytime billing in busy modern ICUs can be substantial, and use of an EMR to identify missed billing opportunities can help create solutions to recover these revenues.

Practical guide to bar coding for patient medication safety.

PubMed

Neuenschwander, Mark; Cohen, Michael R; Vaida, Allen J; Patchett, Jeffrey A; Kelly, Jamie; Trohimovich, Barbara

2003-04-15

Bar coding for the medication administration step of the drug-use process is discussed. FDA will propose a rule in 2003 that would require bar-code labels on all human drugs and biologicals. Even with an FDA mandate, manufacturer procrastination and possible shifts in product availability are likely to slow progress. Such delays should not preclude health systems from adopting bar-code-enabled point-of-care (BPOC) systems to achieve gains in patient safety. Bar-code technology is a replacement for traditional keyboard data entry. The elements of bar coding are content, which determines the meaning; data format, which refers to the embedded data and symbology, which describes the "font" in which the machine-readable code is written. For a BPOC system to deliver an acceptable level of patient protection, the hospital must first establish reliable processes for a patient identification band, caregiver badge, and medication bar coding. Medications can have either drug-specific or patient-specific bar codes. Both varieties result in the desired code that supports patient's five rights of drug administration. When medications are not available from the manufacturer in immediate-container bar-coded packaging, other means of applying the bar code must be devised, including the use of repackaging equipment, overwrapping, manual bar coding, and outsourcing. Virtually all medications should be bar coded, the bar code on the label should be easily readable, and appropriate policies, procedures, and checks should be in place. Bar coding has the potential to be not only cost-effective but to produce a return on investment. By bar coding patient identification tags, caregiver badges, and immediate-container medications, health systems can substantially increase patient safety during medication administration.

Compliance Verification Paths for Residential and Commercial Energy Codes

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

Conover, David R.; Makela, Eric J.; Fannin, Jerica D.

2011-10-10

This report looks at different ways to verify energy code compliance and to ensure that the energy efficiency goals of an adopted document are achieved. Conformity assessment is the body of work that ensures compliance, including activities that can ensure residential and commercial buildings satisfy energy codes and standards. This report identifies and discusses conformity-assessment activities and provides guidance for conducting assessments.

CFL3D User's Manual (Version 5.0)

NASA Technical Reports Server (NTRS)

Krist, Sherrie L.; Biedron, Robert T.; Rumsey, Christopher L.

1998-01-01

This document is the User's Manual for the CFL3D computer code, a thin-layer Reynolds-averaged Navier-Stokes flow solver for structured multiple-zone grids. Descriptions of the code's input parameters, non-dimensionalizations, file formats, boundary conditions, and equations are included. Sample 2-D and 3-D test cases are also described, and many helpful hints for using the code are provided.

The Contract Management Body of Knowledge: A Comparison of Contracting Competencies

DTIC Science & Technology

2013-12-01

SME subject matter expert SOW statement of work TINA Truth in Negotiations Act UCC uniform commercial code WBS work breakdown structure xv...documents whose terms and condition are legally enforceable. Sources of law and guidance covered include the uniform commercial code ( UCC ), Federal...contracting including the uniform commercial code ( UCC ), Federal Acquisition Regulation (FAR), as well as various other laws pertaining to both

NSWC Library of Mathematics Subroutines

DTIC Science & Technology

1993-01-01

standards concerning in-line documentation and the style of code cannot be imposed. In generel, all supportive subreutines not intended for direct use are...proprietary or otherwise restricted codes have been permitted ;’ the library. Only general purpose mathematical subroutines for use by the entire NSWCDD...where the source codes are frequently of prime importance), and for general use in applications. Since expertise is so widely scattered, reliable

Memory T-Cell-Mediated Immune Responses Specific to an Alternative Core Protein in Hepatitis C Virus Infection

PubMed Central

Bain, Christine; Parroche, Peggy; Lavergne, Jean Pierre; Duverger, Blandine; Vieux, Claude; Dubois, Valérie; Komurian-Pradel, Florence; Trépo, Christian; Gebuhrer, Lucette; Paranhos-Baccala, Glaucia; Penin, François; Inchauspé, Geneviève

2004-01-01

In vitro studies have described the synthesis of an alternative reading frame form of the hepatitis C virus (HCV) core protein that was named F protein or ARFP (alternative reading frame protein) and includes a domain coded by the +1 open reading frame of the RNA core coding region. The expression of this protein in HCV-infected patients remains controversial. We have analyzed peripheral blood from 47 chronically or previously HCV-infected patients for the presence of T lymphocytes and antibodies specific to the ARFP. Anti-ARFP antibodies were detected in 41.6% of the patients infected with various HCV genotypes. Using a specific ARFP 99-amino-acid polypeptide as well as four ARFP predicted class I-restricted 9-mer peptides, we show that 20% of the patients display specific lymphocytes capable of producing gamma interferon, interleukin-10, or both cytokines. Patients harboring three different viral genotypes (1a, 1b, and 3) carried T lymphocytes reactive to genotype 1b-derived peptides. In longitudinal analysis of patients receiving therapy, both core and ARFP-specific T-cell- and B-cell-mediated responses were documented. The magnitude and kinetics of the HCV antigen-specific responses differed and were not linked with viremia or therapy outcome. These observations provide strong and new arguments in favor of the synthesis, during natural HCV infection, of an ARFP derived from the core sequence. Moreover, the present data provide the first demonstration of the presence of T-cell-mediated immune responses directed to this novel HCV antigen. PMID:15367612

Population-based Testing and Treatment Characteristics for Chronic Myelogenous Leukemia

PubMed Central

Styles, Timothy; Wu, Manxia; Wilson, Reda; Babcock, Frances; Butterworth, David; West, Dee W.; Richardson, Lisa C.

2017-01-01

Introduction National and International Hematology/Oncology Practice Guidelines recommend testing for the BCR-ABL mutation for definitive diagnosis of chronic myeloid leukemia (CML) to allow for appropriate treatment with a Tyrosine Kinase Inhibitor (TKI). The purpose of our study was to describe population-based testing and treatment practice characteristics for patients diagnosed with CML. Methods We analyzed cases of CML using 2011 data from 10 state registries which are part of the Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries. We describe completeness of testing for the BCR-ABL gene and availability of outpatient treatment with TKIs and associated characteristics. Results A total of 685 cases of CML were identified; 55% (374) had a documented BCR-ABL gene test with 96% (360) of these being positive for the BCR-ABL gene and the remaining 4% (14) either testing negative or had a missing result. Registries were able to identify the use of TKIs in 54% (369) of patients, though only 43% (296) had a corresponding BCR-ABL gene test documented. One state registry reported a significantly lower percentage of patients being tested for the BCR-ABL gene (25%) and receiving TKI treatment (21%). Limiting analysis to CML case reports from the remaining nine CER registries, 78% (305) patients had a documented BCR-ABL gene test and 79% (308) had documented treatment with a TKI. Receipt of testing or treatment for these nine states did not vary by sex, race, ethnicity, census tract poverty level, census tract urbanization, or insurance status; BCR-ABL testing varied by state of residence and BCR-ABL testing and TKI therapy occurred less often with increasing age (OR: 0.97, 95%CI: 0.95–0.99; OR: 0.97, 95%CI: 0.96–0.99 respectively). Conclusions Collection of detailed CML data vary significantly by states. A majority of the case patients had appropriate testing for the BCR-ABL gene and treatment with tyrosine kinase inhibitors. However, BCR-ABL testing and TKI treatment decreased with increasing age. Further research is needed to understand CML coding, testing, and treatment disparities. PMID:28121314

A Process and Programming Design to Develop Virtual Patients for Medical Education

PubMed Central

McGee, James B.; Wu, Martha

1999-01-01

Changes in the financing and delivery of healthcare in our nation's teaching hospitals have diminished the variety and quality of a medical student's clinical training. The Virtual Patient Project is a series of computer-based, multimedia, clinical simulations, designed to fill this gap. After the development of a successful prototype and obtaining funding for a series of 16 cases, a method to write and produce many virtual patients was created. Case authors now meet with our production team to write and edit a movie-like script. This script is converted into a design document which specifies the clinical aspects, teaching points, media production, and interactivity of each case. The program's code was modularized, using object-oriented techniques, to allow for the variations in cases and for team programming. All of the clinical and teaching content is stored in a database, that allows for faster and easier editing by many persons simultaneously.

The Nuremberg Code: its history and implications.

PubMed

Kious, B M

2001-01-01

The Nuremberg Code is a foundational document in the ethics of medical research and human experimentation; the principle its authors espoused in 1946 have provided the framework for modern codes that address the same issues, and have received little challenge and only slight modification in decades since. By analyzing the Code's tragic genesis and its normative implications, it is possible to understand some of the essence of modern experimental ethics, as well as certain outstanding controversies that still plague medical science.

A supersonic three-dimensional code for flow over blunt bodies: Program documentation and test cases

NASA Technical Reports Server (NTRS)

Chaussee, D. S.; Mcmillan, O. J.

1980-01-01

The use of a computer code for the calculation of steady, supersonic, three dimensional, inviscid flow over blunt bodies is illustrated. Input and output are given and explained for two cases: a pointed code of 20 deg half angle at 15 deg angle of attack in a free stream with M sub infinite = 7, and a cone-ogive-cylinder at 10 deg angle of attack with M sub infinite = 2.86. A source listing of the computer code is provided.

A Concept for Run-Time Support of the Chapel Language

NASA Technical Reports Server (NTRS)

James, Mark

2006-01-01

A document presents a concept for run-time implementation of other concepts embodied in the Chapel programming language. (Now undergoing development, Chapel is intended to become a standard language for parallel computing that would surpass older such languages in both computational performance in the efficiency with which pre-existing code can be reused and new code written.) The aforementioned other concepts are those of distributions, domains, allocations, and access, as defined in a separate document called "A Semantic Framework for Domains and Distributions in Chapel" and linked to a language specification defined in another separate document called "Chapel Specification 0.3." The concept presented in the instant report is recognition that a data domain that was invented for Chapel offers a novel approach to distributing and processing data in a massively parallel environment. The concept is offered as a starting point for development of working descriptions of functions and data structures that would be necessary to implement interfaces to a compiler for transforming the aforementioned other concepts from their representations in Chapel source code to their run-time implementations.

Disclosure of terminal illness to patients and families: diversity of governing codes in 14 Islamic countries.

PubMed

Abdulhameed, Hunida E; Hammami, Muhammad M; Mohamed, Elbushra A Hameed

2011-08-01

The consistency of codes governing disclosure of terminal illness to patients and families in Islamic countries has not been studied until now. To review available codes on disclosure of terminal illness in Islamic countries. DATA SOURCE AND EXTRACTION: Data were extracted through searches on Google and PubMed. Codes related to disclosure of terminal illness to patients or families were abstracted, and then classified independently by the three authors. Codes for 14 Islamic countries were located. Five codes were silent regarding informing the patient, seven allowed concealment, one mandated disclosure and one prohibited disclosure. Five codes were silent regarding informing the family, four allowed disclosure and five mandated/recommended disclosure. The Islamic Organization for Medical Sciences code was silent on both issues. Codes regarding disclosure of terminal illness to patients and families differed markedly among Islamic countries. They were silent in one-third of the codes, and tended to favour a paternalistic/utilitarian, family-centred approach over an autonomous, patient-centred approach.

Seismology software: state of the practice

NASA Astrophysics Data System (ADS)

Smith, W. Spencer; Zeng, Zheng; Carette, Jacques

2018-05-01

We analyzed the state of practice for software development in the seismology domain by comparing 30 software packages on four aspects: product, implementation, design, and process. We found room for improvement in most seismology software packages. The principal areas of concern include a lack of adequate requirements and design specification documents, a lack of test data to assess reliability, a lack of examples to get new users started, and a lack of technological tools to assist with managing the development process. To assist going forward, we provide recommendations for a document-driven development process that includes a problem statement, development plan, requirement specification, verification and validation (V&V) plan, design specification, code, V&V report, and a user manual. We also provide advice on tool use, including issue tracking, version control, code documentation, and testing tools.

Seismology software: state of the practice

NASA Astrophysics Data System (ADS)

Smith, W. Spencer; Zeng, Zheng; Carette, Jacques

2018-02-01

We analyzed the state of practice for software development in the seismology domain by comparing 30 software packages on four aspects: product, implementation, design, and process. We found room for improvement in most seismology software packages. The principal areas of concern include a lack of adequate requirements and design specification documents, a lack of test data to assess reliability, a lack of examples to get new users started, and a lack of technological tools to assist with managing the development process. To assist going forward, we provide recommendations for a document-driven development process that includes a problem statement, development plan, requirement specification, verification and validation (V&V) plan, design specification, code, V&V report, and a user manual. We also provide advice on tool use, including issue tracking, version control, code documentation, and testing tools.

The Forest Inventory and Analysis Database: Database description and users manual version 4.0 for Phase 2

Treesearch

Sharon W. Woudenberg; Barbara L. Conkling; Barbara M. O' Connell; Elizabeth B. LaPoint; Jeffery A. Turner; Karen L. Waddell

2010-01-01

This document is based on previous documentation of the nationally standardized Forest Inventory and Analysis database (Hansen and others 1992; Woudenberg and Farrenkopf 1995; Miles and others 2001). Documentation of the structure of the Forest Inventory and Analysis database (FIADB) for Phase 2 data, as well as codes and definitions, is provided. Examples for...

REDUCED PROTECTIVE CLOTHING DETERMINATIONS

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

BROWN, R.L.

2003-06-13

This technical basis document defines conditions where reduced protective clothing can be allowed, defines reduced protective clothing, and documents the regulatory review that determines the process is compliant with the Tank Farm Radiological Control Manual (TFRCM) and Title 10, Part 835, of the Code of Federal Regulations (10CFR835). The criteria, standards, and requirements contained in this document apply only to Tank Farm Contractor (TFC) facilities.

Comparison of the performance of mental health, drug and alcohol comorbidities based on ICD-10-AM and medical records for predicting 12-month outcomes in trauma patients.

PubMed

Nguyen, Tu Q; Simpson, Pamela M; Braaf, Sandra C; Cameron, Peter A; Judson, Rodney; Gabbe, Belinda J

2018-06-05

Many outcome studies capture the presence of mental health, drug and alcohol comorbidities from administrative datasets and medical records. How these sources compare as predictors of patient outcomes has not been determined. The purpose of the present study was to compare mental health, drug and alcohol comorbidities based on ICD-10-AM coding and medical record documentation for predicting longer-term outcomes in injured patients. A random sample of patients (n = 500) captured by the Victorian State Trauma Registry was selected for the study. Retrospective medical record reviews were conducted to collect data about documented mental health, drug and alcohol comorbidities while ICD-10-AM codes were obtained from routinely collected hospital data. Outcomes at 12-months post-injury were the Glasgow Outcome Scale - Extended (GOS-E), European Quality of Life Five Dimensions (EQ-5D-3L), and return to work. Linear and logistic regression models, adjusted for age and gender, using medical record derived comorbidity and ICD-10-AM were compared using measures of calibration (Hosmer-Lemeshow statistic) and discrimination (C-statistic and R 2 ). There was no demonstrable difference in predictive performance between the medical record and ICD-10-AM models for predicting the GOS-E, EQ-5D-3L utility sore and EQ-5D-3L mobility, self-care, usual activities and pain/discomfort items. The area under the receiver operating characteristic (AUC) for models using medical record derived comorbidity (AUC 0.68, 95% CI: 0.63, 0.73) was higher than the model using ICD-10-AM data (AUC 0.62, 95% CI: 0.57, 0.67) for predicting the EQ-5D-3L anxiety/depression item. The discrimination of the model for predicting return to work was higher with inclusion of the medical record data (AUC 0.69, 95% CI: 0.63, 0.76) than the ICD-10-AM data (AUC 0.59, 95% CL: 0.52, 0.65). Mental health, drug and alcohol comorbidity information derived from medical record review was not clearly superior for predicting the majority of the outcomes assessed when compared to ICD-10-AM. While information available in medical records may be more comprehensive than in the ICD-10-AM, there appears to be little difference in the discriminative capacity of comorbidities coded in the two sources.

Development and Validation of a Primary Care-Based Family Health History and Decision Support Program (MeTree)

PubMed Central

Orlando, Lori A.; Buchanan, Adam H.; Hahn, Susan E.; Christianson, Carol A.; Powell, Karen P.; Skinner, Celette Sugg; Chesnut, Blair; Blach, Colette; Due, Barbara; Ginsburg, Geoffrey S.; Henrich, Vincent C.

2016-01-01

INTRODUCTION Family health history is a strong predictor of disease risk. To reduce the morbidity and mortality of many chronic diseases, risk-stratified evidence-based guidelines strongly encourage the collection and synthesis of family health history to guide selection of primary prevention strategies. However, the collection and synthesis of such information is not well integrated into clinical practice. To address barriers to collection and use of family health histories, the Genomedical Connection developed and validated MeTree, a Web-based, patient-facing family health history collection and clinical decision support tool. MeTree is designed for integration into primary care practices as part of the genomic medicine model for primary care. METHODS We describe the guiding principles, operational characteristics, algorithm development, and coding used to develop MeTree. Validation was performed through stakeholder cognitive interviewing, a genetic counseling pilot program, and clinical practice pilot programs in 2 community-based primary care clinics. RESULTS Stakeholder feedback resulted in changes to MeTree’s interface and changes to the phrasing of clinical decision support documents. The pilot studies resulted in the identification and correction of coding errors and the reformatting of clinical decision support documents. MeTree’s strengths in comparison with other tools are its seamless integration into clinical practice and its provision of action-oriented recommendations guided by providers’ needs. LIMITATIONS The tool was validated in a small cohort. CONCLUSION MeTree can be integrated into primary care practices to help providers collect and synthesize family health history information from patients with the goal of improving adherence to risk-stratified evidence-based guidelines. PMID:24044145

Software Engineering Laboratory (SEL) compendium of tools, revision 1

NASA Technical Reports Server (NTRS)

1982-01-01

A set of programs used to aid software product development is listed. Known as software tools, such programs include requirements analyzers, design languages, precompilers, code auditors, code analyzers, and software librarians. Abstracts, resource requirements, documentation, processing summaries, and availability are indicated for most tools.

Accuracy of Diagnosis Codes to Identify Febrile Young Infants Using Administrative Data

PubMed Central

Aronson, Paul L.; Williams, Derek J.; Thurm, Cary; Tieder, Joel S.; Alpern, Elizabeth R.; Nigrovic, Lise E.; Schondelmeyer, Amanda C.; Balamuth, Fran; Myers, Angela L.; McCulloh, Russell J.; Alessandrini, Evaline A.; Shah, Samir S.; Browning, Whitney L.; Hayes, Katie L.; Feldman, Elana A.; Neuman, Mark I.

2015-01-01

Background Administrative data can be used to determine optimal management of febrile infants and aid clinical practice guideline development. Objective Determine the most accurate International Classification of Diseases, 9th revision (ICD-9) diagnosis coding strategies for identification of febrile infants. Design Retrospective cross-sectional study. Setting Eight emergency departments in the Pediatric Health Information System. Patients Infants age < 90 days evaluated between July 1, 2012 and June 30, 2013 were randomly selected for medical record review from one of four ICD-9 diagnosis code groups: 1) discharge diagnosis of fever, 2) admission diagnosis of fever without discharge diagnosis of fever, 3) discharge diagnosis of serious infection without diagnosis of fever, and 4) no diagnosis of fever or serious infection. Exposure The ICD-9 diagnosis code groups were compared in four case-identification algorithms to a reference standard of fever ≥ 100.4°F documented in the medical record. Measurements Algorithm predictive accuracy was measured using sensitivity, specificity, negative and positive predictive values. Results Among 1790 medical records reviewed, 766 (42.8%) infants had fever. Discharge diagnosis of fever demonstrated high specificity (98.2%, 95% confidence interval [CI]: 97.8-98.6) but low sensitivity (53.2%, 95% CI: 50.0-56.4). A case-identification algorithm of admission or discharge diagnosis of fever exhibited higher sensitivity (71.1%, 95% CI: 68.2-74.0), similar specificity (97.7%, 95% CI: 97.3-98.1), and the highest positive predictive value (86.9%, 95% CI: 84.5-89.3). Conclusions A case-identification strategy that includes admission or discharge diagnosis of fever should be considered for febrile infant studies using administrative data, though under-classification of patients is a potential limitation. PMID:26248691

Progress in The Semantic Analysis of Scientific Code

NASA Technical Reports Server (NTRS)

Stewart, Mark

2000-01-01

This paper concerns a procedure that analyzes aspects of the meaning or semantics of scientific and engineering code. This procedure involves taking a user's existing code, adding semantic declarations for some primitive variables, and parsing this annotated code using multiple, independent expert parsers. These semantic parsers encode domain knowledge and recognize formulae in different disciplines including physics, numerical methods, mathematics, and geometry. The parsers will automatically recognize and document some static, semantic concepts and help locate some program semantic errors. These techniques may apply to a wider range of scientific codes. If so, the techniques could reduce the time, risk, and effort required to develop and modify scientific codes.

Scientific and Technical Publishing at Goddard Space Flight Center in Fiscal Year 1994

NASA Technical Reports Server (NTRS)

1994-01-01

This publication is a compilation of scientific and technical material that was researched, written, prepared, and disseminated by the Center's scientists and engineers during FY94. It is presented in numerical order of the GSFC author's sponsoring technical directorate; i.e., Code 300 is the Office of Flight Assurance, Code 400 is the Flight Projects Directorate, Code 500 is the Mission Operations and Data Systems Directorate, Code 600 is the Space Sciences Directorate, Code 700 is the Engineering Directorate, Code 800 is the Suborbital Projects and Operations Directorate, and Code 900 is the Earth Sciences Directorate. The publication database contains publication or presentation title, author(s), document type, sponsor, and organizational code. This is the second annual compilation for the Center.

Macroeconomic Activity Module - NEMS Documentation

EIA Publications

2016-01-01

Documents the objectives, analytical approach, and development of the National Energy Modeling System (NEMS) Macroeconomic Activity Module (MAM) used to develop the Annual Energy Outlook for 2016 (AEO2016). The report catalogues and describes the module assumptions, computations, methodology, parameter estimation techniques, and mainframe source code

76 FR 69172 - Determination of Governmental Plan Status

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-08

...The Treasury Department and IRS anticipate issuing regulations under section 414(d) of the Internal Revenue Code (Code) to define the term ``governmental plan.'' This document describes the rules that the Treasury Department and IRS are considering proposing relating to the determination of whether a plan is a governmental plan within the meaning of section 414(d) and contains an appendix that includes a draft notice of proposed rulemaking on which the Treasury Department and IRS invite comments from the public. This document applies to sponsors of, and participants and beneficiaries in, employee benefit plans that are determined to be governmental plans.

User's guide for FRMOD, a zero dimensional FRM burn code

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

Driemeryer, D.; Miley, G.H.

1979-10-15

The zero-dimensional FRM plasma burn code, FRMOD is written in the FORTRAN language and is currently available on the Control Data Corporation (CDC) 7600 computer at the Magnetic Fusion Energy Computer Center (MFECC), sponsored by the US Department of Energy, in Livermore, CA. This guide assumes that the user is familiar with the system architecture and some of the utility programs available on the MFE-7600 machine, since online documentation is available for system routines through the use of the DOCUMENT utility. Users may therefore refer to it for answers to system related questions.

MDSplus quality improvement project

DOE PAGES

Fredian, Thomas W.; Stillerman, Joshua; Manduchi, Gabriele; ...

2016-05-31

MDSplus is a data acquisition and analysis system used worldwide predominantly in the fusion research community. Development began 29 years ago on the OpenVMS operating system. Since that time there have been many new features added and the code has been ported to many different operating systems. There have been contributions to the MDSplus development from the fusion community in the way of feature suggestions, feature implementations, documentation and porting to different operating systems. The bulk of the development and support of MDSplus, however, has been provided by a relatively small core developer group of three or four members. Givenmore » the size of the development team and the large number of users much more effort was focused on providing new features for the community than on keeping the underlying code and documentation up to date with the evolving software development standards. To ensure that MDSplus will continue to provide the needs of the community in the future, the MDSplus development team along with other members of the MDSplus user community has commenced on a major quality improvement project. The planned improvements include changes to software build scripts to better use GNU Autoconf and Automake tools, refactoring many of the source code modules using new language features available in modern compilers, using GNU MinGW-w64 to create MS Windows distributions, migrating to a more modern source code management system, improvement of source documentation as well as improvements to the www.mdsplus.org web site documentation and layout, and the addition of more comprehensive test suites to apply to MDSplus code builds prior to releasing installation kits to the community. This paper should lead to a much more robust product and establish a framework to maintain stability as more enhancements and features are added. Finally, this paper will describe these efforts that are either in progress or planned for the near future.« less

Report on FY15 alloy 617 code rules development

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

Sham, Sam; Jetter, Robert I; Hollinger, Greg

2015-09-01

Due to its strength at very high temperatures, up to 950°C (1742°F), Alloy 617 is the reference construction material for structural components that operate at or near the outlet temperature of the very high temperature gas-cooled reactors. However, the current rules in the ASME Section III, Division 5 Subsection HB, Subpart B for the evaluation of strain limits and creep-fatigue damage using simplified methods based on elastic analysis have been deemed inappropriate for Alloy 617 at temperatures above 650°C (1200°F) (Corum and Brass, Proceedings of ASME 1991 Pressure Vessels and Piping Conference, PVP-Vol. 215, p.147, ASME, NY, 1991). The rationalemore » for this exclusion is that at higher temperatures it is not feasible to decouple plasticity and creep, which is the basis for the current simplified rules. This temperature, 650°C (1200°F), is well below the temperature range of interest for this material for the high temperature gas-cooled reactors and the very high temperature gas-cooled reactors. The only current alternative is, thus, a full inelastic analysis requiring sophisticated material models that have not yet been formulated and verified. To address these issues, proposed code rules have been developed which are based on the use of elastic-perfectly plastic (EPP) analysis methods applicable to very high temperatures. The proposed rules for strain limits and creep-fatigue evaluation were initially documented in the technical literature (Carter, Jetter and Sham, Proceedings of ASME 2012 Pressure Vessels and Piping Conference, papers PVP 2012 28082 and PVP 2012 28083, ASME, NY, 2012), and have been recently revised to incorporate comments and simplify their application. Background documents have been developed for these two code cases to support the ASME Code committee approval process. These background documents for the EPP strain limits and creep-fatigue code cases are documented in this report.« less

A Three-Phase Decision Model of Computer-Aided Coding for the Iranian Classification of Health Interventions (IRCHI)

PubMed Central

Azadmanjir, Zahra; Safdari, Reza; Ghazisaeedi, Marjan; Mokhtaran, Mehrshad; Kameli, Mohammad Esmail

2017-01-01

Introduction: Accurate coded data in the healthcare are critical. Computer-Assisted Coding (CAC) is an effective tool to improve clinical coding in particular when a new classification will be developed and implemented. But determine the appropriate method for development need to consider the specifications of existing CAC systems, requirements for each type, our infrastructure and also, the classification scheme. Aim: The aim of the study was the development of a decision model for determining accurate code of each medical intervention in Iranian Classification of Health Interventions (IRCHI) that can be implemented as a suitable CAC system. Methods: first, a sample of existing CAC systems was reviewed. Then feasibility of each one of CAC types was examined with regard to their prerequisites for their implementation. The next step, proper model was proposed according to the structure of the classification scheme and was implemented as an interactive system. Results: There is a significant relationship between the level of assistance of a CAC system and integration of it with electronic medical documents. Implementation of fully automated CAC systems is impossible due to immature development of electronic medical record and problems in using language for medical documenting. So, a model was proposed to develop semi-automated CAC system based on hierarchical relationships between entities in the classification scheme and also the logic of decision making to specify the characters of code step by step through a web-based interactive user interface for CAC. It was composed of three phases to select Target, Action and Means respectively for an intervention. Conclusion: The proposed model was suitable the current status of clinical documentation and coding in Iran and also, the structure of new classification scheme. Our results show it was practical. However, the model needs to be evaluated in the next stage of the research. PMID:28883671

[Epilepsy and driving in Argentina. A new proposal].

PubMed

Casas Parera, Ignacio; Barreiro de Madariaga, Luis; Gimeno, Analía; Lehkuniec, Estela

2003-01-01

Current laws and regulations concerning epilepsy patients and driving exist in different countries all over the world. Patient's seizure-free intervals, physician's responsibilities, type of seizures and other requirements make these laws and regulations vary from country to country and even from state to state in the same country. In Argentina, in law No. 24.449, Decree Regulation No. 779/95, article 33 on Physical Aptitude, epilepsy is included, and the NE02 code "bans" anyone with epilepsy from being licensed; while NE03 "bans" anyone with an abnormal electroencephalogram. Based on laws from Argentina and foreign countries regarding driving and other issues that concern people with epilepsy, we propose that: 1) Physicians must counsel patients on their responsibilities over their disease and driving, and document on the medical record that this has been done. 2) Patients must take 1-year seizure-free period before being licensed again. 3) Patients are compelled to an annual medical update and to disclose the antiepileptic drugs (AED's) they are taking. 4) Driving restriction for patients having their AED's reduced or switched, during that period and up to six-months after finishing the process. 5) Doctors are not obliged to report to the State cases with seizures or epilepsy. 6) In paragraph "Neurological Aptitudes Criteria", about NE02 and NE03 Codes, the expression "inept" should be switched to "to be evaluated". 7) Ban a person with any history of seizure or epilepsy from being licensed to drive school buses, trucks and public transportation. These changes in our regulations will have the following advantages: 1) An increase in the number of reports to Motor Vehicle Authorities. 2) An improvement of the clinical/neurological controls. 3) They also will avoid, in great proportion, seizure-related motor vehicle crashes and property damage. 4) The up-dating of our laws/regulations/codes. 5) Not only because of medical, but also for its legal and social implications: a) protect physicians from being drawn into the legal foray, b) epileptic patients are legally protected, c) increase the security in the streets and therefore in our community.

Accuracy of external cause-of-injury coding in VA polytrauma patient discharge records.

PubMed

Carlson, Kathleen F; Nugent, Sean M; Grill, Joseph; Sayer, Nina A

2010-01-01

Valid and efficient methods of identifying the etiology of treated injuries are critical for characterizing patient populations and developing prevention and rehabilitation strategies. We examined the accuracy of external cause-of-injury codes (E-codes) in Veterans Health Administration (VHA) administrative data for a population of injured patients. Chart notes and E-codes were extracted for 566 patients treated at any one of four VHA Polytrauma Rehabilitation Center sites between 2001 and 2006. Two expert coders, blinded to VHA E-codes, used chart notes to assign "gold standard" E-codes to injured patients. The accuracy of VHA E-coding was examined based on these gold standard E-codes. Only 382 of 517 (74%) injured patients were assigned E-codes in VHA records. Sensitivity of VHA E-codes varied significantly by site (range: 59%-91%, p < 0.001). Sensitivity was highest for combat-related injuries (81%) and lowest for fall-related injuries (60%). Overall specificity of E-codes was high (92%). E-coding accuracy was markedly higher when we restricted analyses to records that had been assigned VHA E-codes. E-codes may not be valid for ascertaining source-of-injury data for all injuries among VHA rehabilitation inpatients at this time. Enhanced training and policies may ensure more widespread, standardized use and accuracy of E-codes for injured veterans treated in the VHA.

The revised APTA code of ethics for the physical therapist and standards of ethical conduct for the physical therapist assistant: theory, purpose, process, and significance.

PubMed

Swisher, Laura Lee; Hiller, Peggy

2010-05-01

In June 2009, the House of Delegates (HOD) of the American Physical Therapy Association (APTA) passed a major revision of the APTA Code of Ethics for physical therapists and the Standards of Ethical Conduct for the Physical Therapist Assistant. The revised documents will be effective July 1, 2010. The purposes of this article are: (1) to provide a historical, professional, and theoretical context for this important revision; (2) to describe the 4-year revision process; (3) to examine major features of the documents; and (4) to discuss the significance of the revisions from the perspective of the maturation of physical therapy as a doctoring profession. PROCESS OF REVISION: The process for revision is delineated within the context of history and the Bylaws of APTA. FORMAT, STRUCTURE, AND CONTENT OF REVISED CORE ETHICS DOCUMENTS: The revised documents represent a significant change in format, level of detail, and scope of application. Previous APTA Codes of Ethics and Standards of Ethical Conduct for the Physical Therapist Assistant have delineated very broad general principles, with specific obligations spelled out in the Ethics and Judicial Committee's Guide for Professional Conduct and Guide for Conduct of the Physical Therapist Assistant. In contrast to the current documents, the revised documents address all 5 roles of the physical therapist, delineate ethical obligations in organizational and business contexts, and align with the tenets of Vision 2020. The significance of this revision is discussed within historical parameters, the implications for physical therapists and physical therapist assistants, the maturation of the profession, societal accountability and moral community, potential regulatory implications, and the inclusive and deliberative process of moral dialogue by which changes were developed, revised, and approved.

75 FR 3053 - Application Numbers and Proposed Exemptions

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-19

...This document contains notices of pendency before the Department of Labor (the Department) of proposed exemptions from certain of the prohibited transaction restrictions of the Employee Retirement Income Security Act of 1974 (ERISA or the Act) and/or the Internal Revenue Code of 1986 (the Code).

SPAR improved structure-fluid dynamic analysis capability, phase 2

NASA Technical Reports Server (NTRS)

Pearson, M. L.

1984-01-01

An efficient and general method of analyzing a coupled dynamic system of fluid flow and elastic structures is investigated. The improvement of Structural Performance Analysis and Redesign (SPAR) code is summarized. All error codes are documented and the SPAR processor/subroutine cross reference is included.

Data Documentation for Navy Civilian Manpower Study,

DTIC Science & Technology

1986-09-01

Engineering 0830 Mechanical Engineer 0840 Nuclear Engineering 0850 Electrical Engineering 0855 Electronics Engineering 0856 Electronics ...OCCUPATIONAL LEVEL (DONOL) CODES DONOL code Title 1060 Engineering Drafting 1061 Electronics Technician w 1062 Engineering Technician 1063 Industrial...Architect 2314 Electrical Engineer 2315 Electronic Engineer 2316 Industrial Engineer 2317 Mechanical Engineer 2318

Fabrication and Evaluation of InSb CID Arrays

DTIC Science & Technology

1976-08-01

Eck l Mail Stop 55 Santa Barbara Research Center 75 Coromar Drive Goleta, California 93017 Stephen P. Emmons ’■ Mail Stop 134 Texas Instruments...Attn: Code 2629 ° Attn: Code 2627 6 Defense Documentation Center, Bldg. 5 - S47031 Cameron Station, Alexandrias Va. 22314 12

GEN-IV Benchmarking of Triso Fuel Performance Models under accident conditions modeling input data

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

Collin, Blaise Paul

This document presents the benchmark plan for the calculation of particle fuel performance on safety testing experiments that are representative of operational accidental transients. The benchmark is dedicated to the modeling of fission product release under accident conditions by fuel performance codes from around the world, and the subsequent comparison to post-irradiation experiment (PIE) data from the modeled heating tests. The accident condition benchmark is divided into three parts: • The modeling of a simplified benchmark problem to assess potential numerical calculation issues at low fission product release. • The modeling of the AGR-1 and HFR-EU1bis safety testing experiments. •more » The comparison of the AGR-1 and HFR-EU1bis modeling results with PIE data. The simplified benchmark case, thereafter named NCC (Numerical Calculation Case), is derived from “Case 5” of the International Atomic Energy Agency (IAEA) Coordinated Research Program (CRP) on coated particle fuel technology [IAEA 2012]. It is included so participants can evaluate their codes at low fission product release. “Case 5” of the IAEA CRP-6 showed large code-to-code discrepancies in the release of fission products, which were attributed to “effects of the numerical calculation method rather than the physical model” [IAEA 2012]. The NCC is therefore intended to check if these numerical effects subsist. The first two steps imply the involvement of the benchmark participants with a modeling effort following the guidelines and recommendations provided by this document. The third step involves the collection of the modeling results by Idaho National Laboratory (INL) and the comparison of these results with the available PIE data. The objective of this document is to provide all necessary input data to model the benchmark cases, and to give some methodology guidelines and recommendations in order to make all results suitable for comparison with each other. The participants should read this document thoroughly to make sure all the data needed for their calculations is provided in the document. Missing data will be added to a revision of the document if necessary. 09/2016: Tables 6 and 8 updated. AGR-2 input data added« less

Generation IV benchmarking of TRISO fuel performance models under accident conditions: Modeling input data

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

Collin, Blaise P.

2014-09-01

This document presents the benchmark plan for the calculation of particle fuel performance on safety testing experiments that are representative of operational accidental transients. The benchmark is dedicated to the modeling of fission product release under accident conditions by fuel performance codes from around the world, and the subsequent comparison to post-irradiation experiment (PIE) data from the modeled heating tests. The accident condition benchmark is divided into three parts: the modeling of a simplified benchmark problem to assess potential numerical calculation issues at low fission product release; the modeling of the AGR-1 and HFR-EU1bis safety testing experiments; and, the comparisonmore » of the AGR-1 and HFR-EU1bis modeling results with PIE data. The simplified benchmark case, thereafter named NCC (Numerical Calculation Case), is derived from ''Case 5'' of the International Atomic Energy Agency (IAEA) Coordinated Research Program (CRP) on coated particle fuel technology [IAEA 2012]. It is included so participants can evaluate their codes at low fission product release. ''Case 5'' of the IAEA CRP-6 showed large code-to-code discrepancies in the release of fission products, which were attributed to ''effects of the numerical calculation method rather than the physical model''[IAEA 2012]. The NCC is therefore intended to check if these numerical effects subsist. The first two steps imply the involvement of the benchmark participants with a modeling effort following the guidelines and recommendations provided by this document. The third step involves the collection of the modeling results by Idaho National Laboratory (INL) and the comparison of these results with the available PIE data. The objective of this document is to provide all necessary input data to model the benchmark cases, and to give some methodology guidelines and recommendations in order to make all results suitable for comparison with each other. The participants should read this document thoroughly to make sure all the data needed for their calculations is provided in the document. Missing data will be added to a revision of the document if necessary.« less

An Introduction to Natural Language Processing: How You Can Get More From Those Electronic Notes You Are Generating.

PubMed

Kimia, Amir A; Savova, Guergana; Landschaft, Assaf; Harper, Marvin B

2015-07-01

Electronically stored clinical documents may contain both structured data and unstructured data. The use of structured clinical data varies by facility, but clinicians are familiar with coded data such as International Classification of Diseases, Ninth Revision, Systematized Nomenclature of Medicine-Clinical Terms codes, and commonly other data including patient chief complaints or laboratory results. Most electronic health records have much more clinical information stored as unstructured data, for example, clinical narrative such as history of present illness, procedure notes, and clinical decision making are stored as unstructured data. Despite the importance of this information, electronic capture or retrieval of unstructured clinical data has been challenging. The field of natural language processing (NLP) is undergoing rapid development, and existing tools can be successfully used for quality improvement, research, healthcare coding, and even billing compliance. In this brief review, we provide examples of successful uses of NLP using emergency medicine physician visit notes for various projects and the challenges of retrieving specific data and finally present practical methods that can run on a standard personal computer as well as high-end state-of-the-art funded processes run by leading NLP informatics researchers.

Clarifications on Secondary Emissions as Defined in the Code of Federal Regulations (CFR)

EPA Pesticide Factsheets

This document may be of assistance in applying the New Source Review (NSR) air permitting regulations including the Prevention of Significant Deterioration (PSD) requirements. This document is part of the NSR Policy and Guidance Database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

Quality improvement activity for improving pain management in acute extremity injuries in the emergency department.

PubMed

Chang, Hyung Lan; Jung, Jin Hee; Kwak, Young Ho; Kim, Do Kyun; Lee, Jin Hee; Jung, Jae Yun; Kwon, Hyuksool; Paek, So Hyun; Park, Joong Wan; Shin, Jonghwan

2018-03-01

The aim of this study was to investigate the effectiveness of a quality improvement activity for pain management in patients with extremity injury in the emergency department (ED). This was a retrospective interventional study. The patient group consisted of those at least 19 years of age who visited the ED and were diagnosed with International Classification of Diseases codes S40-S99 (extremity injuries). The quality improvement activity consisted of three measures: a survey regarding activities, education, and the triage nurse's pain assessment, including change of pain documentation on electronic medical records. The intervention was conducted from January to April in 2014 and outcome was compared between May and August in 2013 and 2014. The primary outcome was the rate of analgesic prescription, and the secondary outcome was the time to analgesic prescription. A total of 1,739 patients were included, and 20.3% of 867 patients in the pre-intervention period, and 28.8% of 872 patients in the post-intervention period received analgesics (P< 0.001). The prescription rate of analgesics for moderate-to-severe injuries was 36.4% in 2013 and 44.5% in 2014 (P=0.026). The time to analgesics prescription was 116.6 minutes (standard deviation 225.6) in 2013 and 64 minutes (standard deviation 75.5) in 2014 for all extremity injuries. The pain scoring increased from 1.4% to 51.6%. ED-based quality improvement activities including education and change of pain score documentation can improve the rate of analgesic prescription and time to prescription for patients with extremity injury in the ED.

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

PubMed

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

2012-08-01

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

Emergency department arrival times after acute ischemic stroke during the 1990s.

PubMed

Kleindorfer, Dawn O; Broderick, Joseph P; Khoury, Jane; Flaherty, Matthew L; Woo, Daniel; Alwell, Kathleen; Moomaw, Charles J; Pancioli, Arthur; Jauch, Edward; Miller, Rosie; Kissela, Brett M

2007-01-01

Only 8% of ischemic stroke (IS) patients are eligible for rt-PA, and the largest exclusion criterion is delayed time of presentation to the ED. We sought to investigate whether patients are arriving to the ED more quickly in 1999 than in 1993/94 within our large biracial population of 1.3 million. Using ICD-9 codes 430-436, we ascertained all stroke events that presented to a local ED within our population in 7/93-6/94 and again in 1999. Times were recorded as documented in the medical record. There were 1,792 IS patients that presented to an ED in 1993/94 and 1,973 in 1999. The percentage of patients with documented times arriving in under 3 h improved slightly in 1999 (26% vs. 23% in 93/94, P = 0.03), however, the percentage arriving in under 2 h did not. Blacks significantly improved in arrivals under 3 h: 26% in 1999 compared to 17% in 1993/94 (P = 0.01), while whites did not (26% vs. 25%, P = 0.29). In 1999, only 9% of patients arrived from 3-8 h after symptom onset, the large majority of times were either estimated, unknown, or >8 h. We found only marginal improvement in arrival times during the 1990s. In our population, blacks improved in early arrival after symptom onset, while whites did not. Very few patients arrive 3-8 h after onset; therefore expansion of the acute treatment time window to 8 h is unlikely to dramatically affect acute treatment of ischemic stroke.

The grout/glass performance assessment code system (GPACS) with verification and benchmarking

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

Piepho, M.G.; Sutherland, W.H.; Rittmann, P.D.

1994-12-01

GPACS is a computer code system for calculating water flow (unsaturated or saturated), solute transport, and human doses due to the slow release of contaminants from a waste form (in particular grout or glass) through an engineered system and through a vadose zone to an aquifer, well and river. This dual-purpose document is intended to serve as a user`s guide and verification/benchmark document for the Grout/Glass Performance Assessment Code system (GPACS). GPACS can be used for low-level-waste (LLW) Glass Performance Assessment and many other applications including other low-level-waste performance assessments and risk assessments. Based on all the cses presented, GPACSmore » is adequate (verified) for calculating water flow and contaminant transport in unsaturated-zone sediments and for calculating human doses via the groundwater pathway.« less

Sierra/SolidMechanics 4.48 User's Guide: Addendum for Shock Capabilities.

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

Plews, Julia A.; Crane, Nathan K; de Frias, Gabriel Jose

This is an addendum to the Sierra/SolidMechanics 4.48 User's Guide that documents additional capabilities available only in alternate versions of the Sierra/SolidMechanics (Sierra/SM) code. These alternate versions are enhanced to provide capabilities that are regulated under the U.S. Department of State's International Traffic in Arms Regulations (ITAR) export-control rules. The ITAR regulated codes are only distributed to entities that comply with the ITAR export-control requirements. The ITAR enhancements to Sierra/SM in- clude material models with an energy-dependent pressure response (appropriate for very large deformations and strain rates) and capabilities for blast modeling. Since this is an addendum to the standardmore » Sierra/SM user's guide, please refer to that document first for general descriptions of code capability and use.« less

A Claims-Based Examination of Health Care Costs Among Spouses of Patients With Alzheimer's Disease.

PubMed

Gilden, Daniel M; Kubisiak, Joanna M; Kahle-Wrobleski, Kristin; Ball, Daniel E; Bowman, Lee

2017-06-01

Spouses of Alzheimer's disease patients (AD spouses) may experience substantial health effects associated with their partner's chronic cognitive and behavioral dysfunction. Studies examining associations between the medical experiences of AD spouses in the period before and after their partner's AD diagnosis are limited, particularly those which measure health care resource use and cost. AD patients were identified through multiple Medicare claims containing an AD diagnostic code. Their spouses were identified through special coding in the Medicare eligibility records. The AD spouses were matched demographically to the spouses of Medicare beneficiaries without a history of AD. Longitudinal and annual cross-sectional Medicare cost comparisons utilized log-transformed linear regression. The longitudinal period of observation began 12 months before the AD patient's initial claim listing AD and continued for up to 38 months afterwards. The study identified 16,322 AD spouses. Total per person costs were 24% higher in AD spouses than in the controls ($694/month vs $561/month). AD spouses' excess costs began 3 months before their partners' AD diagnoses and continued for ≥30 months. Being an AD spouse predicted 29% higher Medicare costs after adjustment for chronic health status (P < .001). Increasing AD patient care complexity had a substantial impact on AD spouse Medicare costs (P < .001). This study documents a link between the health status of AD spouses and AD patients. Additional research is required to elicit the mechanism behind the association between AD spouse and AD patient diagnosis. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Implications of electronic health record downtime: an analysis of patient safety event reports.

PubMed

Larsen, Ethan; Fong, Allan; Wernz, Christian; Ratwani, Raj M

2018-02-01

We sought to understand the types of clinical processes, such as image and medication ordering, that are disrupted during electronic health record (EHR) downtime periods by analyzing the narratives of patient safety event report data. From a database of 80 381 event reports, 76 reports were identified as explicitly describing a safety event associated with an EHR downtime period. These reports were analyzed and categorized based on a developed code book to identify the clinical processes that were impacted by downtime. We also examined whether downtime procedures were in place and followed. The reports were coded into categories related to their reported clinical process: Laboratory, Medication, Imaging, Registration, Patient Handoff, Documentation, History Viewing, Delay of Procedure, and General. A majority of reports (48.7%, n = 37) were associated with lab orders and results, followed by medication ordering and administration (14.5%, n = 11). Incidents commonly involved patient identification and communication of clinical information. A majority of reports (46%, n = 35) indicated that downtime procedures either were not followed or were not in place. Only 27.6% of incidents (n = 21) indicated that downtime procedures were successfully executed. Patient safety report data offer a lens into EHR downtime-related safety hazards. Important areas of risk during EHR downtime periods were patient identification and communication of clinical information; these should be a focus of downtime procedure planning to reduce safety hazards. EHR downtime events pose patient safety hazards, and we highlight critical areas for downtime procedure improvement. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

A video to improve patient and surrogate understanding of cardiopulmonary resuscitation choices in the ICU: a randomized controlled trial.

PubMed

Wilson, Michael E; Krupa, Artur; Hinds, Richard F; Litell, John M; Swetz, Keith M; Akhoundi, Abbasali; Kashyap, Rahul; Gajic, Ognjen; Kashani, Kianoush

2015-03-01

To determine if a video depicting cardiopulmonary resuscitation and resuscitation preference options would improve knowledge and decision making among patients and surrogates in the ICU. Randomized, unblinded trial. Single medical ICU. Patients and surrogate decision makers in the ICU. The usual care group received a standard pamphlet about cardiopulmonary resuscitation and cardiopulmonary resuscitation preference options plus routine code status discussions with clinicians. The video group received usual care plus an 8-minute video that depicted cardiopulmonary resuscitation, showed a simulated hospital code, and explained resuscitation preference options. One hundred three patients and surrogates were randomized to usual care. One hundred five patients and surrogates were randomized to video plus usual care. Median total knowledge scores (0-15 points possible for correct answers) in the video group were 13 compared with 10 in the usual care group, p value of less than 0.0001. Video group participants had higher rates of understanding the purpose of cardiopulmonary resuscitation and resuscitation options and terminology and could correctly name components of cardiopulmonary resuscitation. No statistically significant differences in documented resuscitation preferences following the interventions were found between the two groups, although the trial was underpowered to detect such differences. A majority of participants felt that the video was helpful in cardiopulmonary resuscitation decision making (98%) and would recommend the video to others (99%). A video depicting cardiopulmonary resuscitation and explaining resuscitation preference options was associated with improved knowledge of in-hospital cardiopulmonary resuscitation options and cardiopulmonary resuscitation terminology among patients and surrogate decision makers in the ICU, compared with receiving a pamphlet on cardiopulmonary resuscitation. Patients and surrogates found the video helpful in decision making and would recommend the video to others.

National Earthquake Information Center systems overview and integration

USGS Publications Warehouse

Guy, Michelle R.; Patton, John M.; Fee, Jeremy; Hearne, Mike; Martinez, Eric; Ketchum, D.; Worden, Charles; Quitoriano, Vince; Hunter, Edward; Smoczyk, Gregory; Schwarz, Stan

2015-08-18

It is important to note that this document provides a brief introduction to the work of dozens of software developers and IT specialists, spanning in many cases more than a decade. References to significant amounts of supporting documentation, code, and information are supplied within.

Investigating the feasibility of using quick response codes in highway construction for document control.

DOT National Transportation Integrated Search

2015-07-01

Highway construction takes place in remote locations, making document control challenging. Frequent changes in a project can cause errors, : reworks, and schedule delays due to the time taken to disseminate these changes to the field or due to using ...

Commercial Demand Module - NEMS Documentation

EIA Publications

2017-01-01

Documents the objectives, analytical approach and development of the National Energy Modeling System (NEMS) Commercial Sector Demand Module. The report catalogues and describes the model assumptions, computational methodology, parameter estimation techniques, model source code, and forecast results generated through the synthesis and scenario development based on these components.

Variable & Recode Definitions - SEER Documentation

Cancer.gov

Resources that define variables and provide documentation for reporting using SEER and related datasets. Choose from SEER coding and staging manuals plus instructions for recoding behavior, site, stage, cause of death, insurance, and several additional topics. Also guidance on months survived, calculating Hispanic mortality, and site-specific surgery.

Royal College of Nursing (Rcn) code of professional conduct: a discussion document.

PubMed Central

Dawson, J D; Altschul, A T; Sampson, C; Smith, A M

1977-01-01

We are printing in its entirety the discussion document which sets out a code of professional conduct for nurses published by the Royal College of Nursing in November 1976 together with commentaries by the Assistant Secretary of the British Medical Association, a professor of nursing studies, student nurses and a lawyer. The image of the nurse is still that of one of Florence Nightingale's young ladies or of a member of a religious order who is wholly dedicated to caring for the sick. Today, as this document and the comments upon it show, 'dedication' is still part of the motive which leads a man or woman to become a nurse but in addition, and this is where the public may be ignorant or choose to be ignorant, nursing offers a career where intellectual achievement and the satisfaction of a demanding job bring their proper financial reward and place in the professional community. We are grateful to the Royal College of Nursing for permission to publish this document. PMID:926130

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

PubMed

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

2014-09-01

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

In-service documentation tools and statements on palliative sedation in Germany--do they meet the EAPC framework recommendations? A qualitative document analysis.

PubMed

Stiel, Stephanie; Heckel, Maria; Christensen, Britta; Ostgathe, Christoph; Klein, Carsten

2016-01-01

Numerous (inter-)national guidelines and frameworks have been developed to provide recommendations for the application of palliative sedation (PS). However, they are still not widely known, and large variations in PS clinical practice can be found. This study aims to collect and describe contents from documents used in clinical practice and to compare to what extent they match the European Association for Palliative Care (EAPC) framework recommendations. In a national survey on PS in Germany 2012, participants were asked to upload their in-service templates, assessment tools, specific protocols, and in-service statements for the application and documentation of PS. These documents are analyzed by using systematic structured content analysis. Three hundred seven content units of 52 provided documents were coded. The analyzed templates are very heterogeneous and also contain items not mentioned in the EAPC framework. Among 11 scales for the evaluation of sedation level, the Ramsey Sedation Score (n = 5) and the Richmond-Agitation-Sedation-Scale (n = 2) were found most often. For symptom assessment, three different scales were provided one time respectively. In all six PS statements, the common core elements were possible indications for PS, instructions on dose titration, patient monitoring, and care. Wide congruency exists for physical and psychological indications. Most documents coincide on midazolam as a preferred drug and basic monitoring in regular intervals. Aspects such as pre-emptive discussion of the potential role of sedation, informational needs of relatives, and care for the medical professionals are mentioned rarely. The analyzed templates do neglect some points of the EAPC recommendations. However, they expand the ten-point scheme of the framework in some details. The findings may facilitate the development of standardized consensus documentation and monitoring draft as an operational statement.

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

Dr. George L Mesina

Our ultimate goal is to create and maintain RELAP5-3D as the best software tool available to analyze nuclear power plants. This begins with writing excellent programming and requires thorough testing. This document covers development of RELAP5-3D software, the behavior of the RELAP5-3D program that must be maintained, and code testing. RELAP5-3D must perform in a manner consistent with previous code versions with backward compatibility for the sake of the users. Thus file operations, code termination, input and output must remain consistent in form and content while adding appropriate new files, input and output as new features are developed. As computermore » hardware, operating systems, and other software change, RELAP5-3D must adapt and maintain performance. The code must be thoroughly tested to ensure that it continues to perform robustly on the supported platforms. The coding must be written in a consistent manner that makes the program easy to read to reduce the time and cost of development, maintenance and error resolution. The programming guidelines presented her are intended to institutionalize a consistent way of writing FORTRAN code for the RELAP5-3D computer program that will minimize errors and rework. A common format and organization of program units creates a unifying look and feel to the code. This in turn increases readability and reduces time required for maintenance, development and debugging. It also aids new programmers in reading and understanding the program. Therefore, when undertaking development of the RELAP5-3D computer program, the programmer must write computer code that follows these guidelines. This set of programming guidelines creates a framework of good programming practices, such as initialization, structured programming, and vector-friendly coding. It sets out formatting rules for lines of code, such as indentation, capitalization, spacing, etc. It creates limits on program units, such as subprograms, functions, and modules. It establishes documentation guidance on internal comments. The guidelines apply to both existing and new subprograms. They are written for both FORTRAN 77 and FORTRAN 95. The guidelines are not so rigorous as to inhibit a programmer’s unique style, but do restrict the variations in acceptable coding to create sufficient commonality that new readers will find the coding in each new subroutine familiar. It is recognized that this is a “living” document and must be updated as languages, compilers, and computer hardware and software evolve.« less

Creation of an Accurate Algorithm to Detect Snellen Best Documented Visual Acuity from Ophthalmology Electronic Health Record Notes.

PubMed

Mbagwu, Michael; French, Dustin D; Gill, Manjot; Mitchell, Christopher; Jackson, Kathryn; Kho, Abel; Bryar, Paul J

2016-05-04

Visual acuity is the primary measure used in ophthalmology to determine how well a patient can see. Visual acuity for a single eye may be recorded in multiple ways for a single patient visit (eg, Snellen vs. Jäger units vs. font print size), and be recorded for either distance or near vision. Capturing the best documented visual acuity (BDVA) of each eye in an individual patient visit is an important step for making electronic ophthalmology clinical notes useful in research. Currently, there is limited methodology for capturing BDVA in an efficient and accurate manner from electronic health record (EHR) notes. We developed an algorithm to detect BDVA for right and left eyes from defined fields within electronic ophthalmology clinical notes. We designed an algorithm to detect the BDVA from defined fields within 295,218 ophthalmology clinical notes with visual acuity data present. About 5668 unique responses were identified and an algorithm was developed to map all of the unique responses to a structured list of Snellen visual acuities. Visual acuity was captured from a total of 295,218 ophthalmology clinical notes during the study dates. The algorithm identified all visual acuities in the defined visual acuity section for each eye and returned a single BDVA for each eye. A clinician chart review of 100 random patient notes showed a 99% accuracy detecting BDVA from these records and 1% observed error. Our algorithm successfully captures best documented Snellen distance visual acuity from ophthalmology clinical notes and transforms a variety of inputs into a structured Snellen equivalent list. Our work, to the best of our knowledge, represents the first attempt at capturing visual acuity accurately from large numbers of electronic ophthalmology notes. Use of this algorithm can benefit research groups interested in assessing visual acuity for patient centered outcome. All codes used for this study are currently available, and will be made available online at https://phekb.org.

Creation of an Accurate Algorithm to Detect Snellen Best Documented Visual Acuity from Ophthalmology Electronic Health Record Notes

PubMed Central

French, Dustin D; Gill, Manjot; Mitchell, Christopher; Jackson, Kathryn; Kho, Abel; Bryar, Paul J

2016-01-01

Background Visual acuity is the primary measure used in ophthalmology to determine how well a patient can see. Visual acuity for a single eye may be recorded in multiple ways for a single patient visit (eg, Snellen vs. Jäger units vs. font print size), and be recorded for either distance or near vision. Capturing the best documented visual acuity (BDVA) of each eye in an individual patient visit is an important step for making electronic ophthalmology clinical notes useful in research. Objective Currently, there is limited methodology for capturing BDVA in an efficient and accurate manner from electronic health record (EHR) notes. We developed an algorithm to detect BDVA for right and left eyes from defined fields within electronic ophthalmology clinical notes. Methods We designed an algorithm to detect the BDVA from defined fields within 295,218 ophthalmology clinical notes with visual acuity data present. About 5668 unique responses were identified and an algorithm was developed to map all of the unique responses to a structured list of Snellen visual acuities. Results Visual acuity was captured from a total of 295,218 ophthalmology clinical notes during the study dates. The algorithm identified all visual acuities in the defined visual acuity section for each eye and returned a single BDVA for each eye. A clinician chart review of 100 random patient notes showed a 99% accuracy detecting BDVA from these records and 1% observed error. Conclusions Our algorithm successfully captures best documented Snellen distance visual acuity from ophthalmology clinical notes and transforms a variety of inputs into a structured Snellen equivalent list. Our work, to the best of our knowledge, represents the first attempt at capturing visual acuity accurately from large numbers of electronic ophthalmology notes. Use of this algorithm can benefit research groups interested in assessing visual acuity for patient centered outcome. All codes used for this study are currently available, and will be made available online at https://phekb.org. PMID:27146002

Continuous integration and quality control for scientific software

NASA Astrophysics Data System (ADS)

Neidhardt, A.; Ettl, M.; Brisken, W.; Dassing, R.

2013-08-01

Modern software has to be stable, portable, fast and reliable. This is going to be also more and more important for scientific software. But this requires a sophisticated way to inspect, check and evaluate the quality of source code with a suitable, automated infrastructure. A centralized server with a software repository and a version control system is one essential part, to manage the code basis and to control the different development versions. While each project can be compiled separately, the whole code basis can also be compiled with one central “Makefile”. This is used to create automated, nightly builds. Additionally all sources are inspected automatically with static code analysis and inspection tools, which check well-none error situations, memory and resource leaks, performance issues, or style issues. In combination with an automatic documentation generator it is possible to create the developer documentation directly from the code and the inline comments. All reports and generated information are presented as HTML page on a Web server. Because this environment increased the stability and quality of the software of the Geodetic Observatory Wettzell tremendously, it is now also available for scientific communities. One regular customer is already the developer group of the DiFX software correlator project.

Using Embedded Visual Coding to Support Contextualization of Historical Texts

ERIC Educational Resources Information Center

Baron, Christine

2016-01-01

This mixed-method study examines the think-aloud protocols of 48 randomly assigned undergraduate students to understand what effect embedding a visual coding system, based on reliable visual cues for establishing historical time period, would have on novice history students' ability to contextualize historic documents. Results indicate that using…

Analysis and calculation of macrosegregation in a casting ingot. MPS solidification model. Volume 2: Software documentation

NASA Technical Reports Server (NTRS)

Maples, A. L.

1980-01-01

The software developed for the solidification model is presented. A link between the calculations and the FORTRAN code is provided, primarily in the form of global flow diagrams and data structures. A complete listing of the solidification code is given.

The Impact of Codes of Conduct on Stakeholders

ERIC Educational Resources Information Center

Newman, Wayne R.

2015-01-01

The purpose of this study was to determine how an urban school district's code of conduct aligned with actual school/class behaviors, and how stakeholders perceived the ability of this document to achieve its number one goal: safe and productive learning environments. Twenty participants including students, teachers, parents, and administrators…

76 FR 57982 - Building Energy Codes Cost Analysis

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-19

... DEPARTMENT OF ENERGY Office of Energy Efficiency and Renewable Energy [Docket No. EERE-2011-BT-BC-0046] Building Energy Codes Cost Analysis Correction In notice document 2011-23236 beginning on page... heading ``Table 1. Cash flow components'' should read ``Table 7. Cash flow components''. [FR Doc. C1-2011...

Standards for Evaluation of Instructional Materials with Respect to Social Content. 1986 Edition.

ERIC Educational Resources Information Center

California State Dept. of Education, Sacramento. Curriculum Framework and Textbook Development Unit.

The California Legislature recognized the significant place of instructional materials in the formation of a child's attitudes and beliefs when it adopted "Educational Code" sections 60040 through 60044. The "Education Code" sections referred to in this document are intended to help dispel negative stereotypes by emphasizing…

The Therapy Process Observational Coding System for Child Psychotherapy Strategies Scale

ERIC Educational Resources Information Center

McLeod, Bryce D.; Weisz, John R.

2010-01-01

Most everyday child and adolescent psychotherapy does not follow manuals that document the procedures. Consequently, usual clinical care has remained poorly understood and rarely studied. The Therapy Process Observational Coding System for Child Psychotherapy-Strategies scale (TPOCS-S) is an observational measure of youth psychotherapy procedures…

40 CFR 80.171 - Product transfer documents (PTDs).

Code of Federal Regulations, 2010 CFR

2010-07-01

... being transferred is exempt base gasoline to be used for research, development, or test purposes only, the following warning must also be stated on the PTD: “For use in research, development, and test... codes and other non-regulatory language. (1) Product codes and other non-regulatory language may not be...

FAPRS Manual: Manual for the Functional Analytic Psychotherapy Rating Scale

ERIC Educational Resources Information Center

Callaghan, Glenn M.; Follette, William C.

2008-01-01

The Functional Analytic Psychotherapy Rating Scale (FAPRS) is behavioral coding system designed to capture those essential client and therapist behaviors that occur during Functional Analytic Psychotherapy (FAP). The FAPRS manual presents the purpose and rules for documenting essential aspects of FAP. The FAPRS codes are exclusive and exhaustive…

Processes of code status transitions in hospitalized patients with advanced cancer.

PubMed

El-Jawahri, Areej; Lau-Min, Kelsey; Nipp, Ryan D; Greer, Joseph A; Traeger, Lara N; Moran, Samantha M; D'Arpino, Sara M; Hochberg, Ephraim P; Jackson, Vicki A; Cashavelly, Barbara J; Martinson, Holly S; Ryan, David P; Temel, Jennifer S

2017-12-15

Although hospitalized patients with advanced cancer have a low chance of surviving cardiopulmonary resuscitation (CPR), the processes by which they change their code status from full code to do not resuscitate (DNR) are unknown. We conducted a mixed-methods study on a prospective cohort of hospitalized patients with advanced cancer. Two physicians used a consensus-driven medical record review to characterize processes that led to code status order transitions from full code to DNR. In total, 1047 hospitalizations were reviewed among 728 patients. Admitting clinicians did not address code status in 53% of hospitalizations, resulting in code status orders of "presumed full." In total, 275 patients (26.3%) transitioned from full code to DNR, and 48.7% (134 of 275 patients) of those had an order of "presumed full" at admission; however, upon further clarification, the patients expressed that they had wished to be DNR before the hospitalization. We identified 3 additional processes leading to order transition from full code to DNR acute clinical deterioration (15.3%), discontinuation of cancer-directed therapy (17.1%), and education about the potential harms/futility of CPR (15.3%). Compared with discontinuing therapy and education, transitions because of acute clinical deterioration were associated with less patient involvement (P = .002), a shorter time to death (P < .001), and a greater likelihood of inpatient death (P = .005). One-half of code status order changes among hospitalized patients with advanced cancer were because of full code orders in patients who had a preference for DNR before hospitalization. Transitions due of acute clinical deterioration were associated with less patient engagement and a higher likelihood of inpatient death. Cancer 2017;123:4895-902. © 2017 American Cancer Society. © 2017 American Cancer Society.

The multidimensional Self-Adaptive Grid code, SAGE, version 2

NASA Technical Reports Server (NTRS)

Davies, Carol B.; Venkatapathy, Ethiraj

1995-01-01

This new report on Version 2 of the SAGE code includes all the information in the original publication plus all upgrades and changes to the SAGE code since that time. The two most significant upgrades are the inclusion of a finite-volume option and the ability to adapt and manipulate zonal-matching multiple-grid files. In addition, the original SAGE code has been upgraded to Version 1.1 and includes all options mentioned in this report, with the exception of the multiple grid option and its associated features. Since Version 2 is a larger and more complex code, it is suggested (but not required) that Version 1.1 be used for single-grid applications. This document contains all the information required to run both versions of SAGE. The formulation of the adaption method is described in the first section of this document. The second section is presented in the form of a user guide that explains the input and execution of the code. The third section provides many examples. Successful application of the SAGE code in both two and three dimensions for the solution of various flow problems has proven the code to be robust, portable, and simple to use. Although the basic formulation follows the method of Nakahashi and Deiwert, many modifications have been made to facilitate the use of the self-adaptive grid method for complex grid structures. Modifications to the method and the simple but extensive input options make this a flexible and user-friendly code. The SAGE code can accommodate two-dimensional and three-dimensional, finite-difference and finite-volume, single grid, and zonal-matching multiple grid flow problems.

Incorporating diagnosis and treatment of hyperhidrosis into clinical practice.

PubMed

Pariser, David M

2014-10-01

Proper billing and coding are essential to document the diagnosis of hyperhidrosis and to assure proper reimbursement for treatment. Providers should become familiar with the payment policies of local health plans to streamline the preauthorization process that is often needed for many treatments commonly used for hyperhidrosis. Having a preprinted letter of medical necessity and patient intake forms that record the necessary historical information about the disease, previous treatments, and other pertinent information will help increase the speed of the office flow. This article presents algorithms for treatment of the various forms of primary focal hyperhidrosis. Copyright © 2014 Elsevier Inc. All rights reserved.

Dermatology practice management enhancement: implications for dermatology in the age of managed care.

PubMed

Nestor, M S

2000-09-01

Health care delivery in the United States has changed dramatically during the past 10 years. Dermatologists are faced with challenging changes in the way they learn new skills, practice, and provide dermatologic care. Dermatologists can survive and flourish in this environment if they learn proper management and enhancement skills. These skills include proper coding and documentation, regulatory compliance, and new levels of practice effectiveness and efficiency. Dermatologists can offer also the benefit of cosmetic procedures and ethical office-based dispensing to their patients. Greater future unification of this specialty will allow dermatology to flourish and show its need, efficiency, and cost-effectiveness.

Global Nursing Issues and Development: Analysis of World Health Organization Documents.

PubMed

Wong, Frances Kam Yuet; Liu, Huaping; Wang, Hui; Anderson, Debra; Seib, Charrlotte; Molasiotis, Alex

2015-11-01

To analyze World Health Organization (WHO) documents to identify global nursing issues and development. Qualitative content analysis. Documents published by the six WHO regions between 2007 and 2012 and with key words related to nurse/midwife or nursing/midwifery were included. Themes, categories, and subcategories were derived. The final coding reached 80% agreement among three independent coders, and the final coding for the discrepant coding was reached by consensus. Thirty-two documents from the regions of Europe (n = 19), the Americas (n = 6), the Western Pacific (n = 4), Africa (n = 1), the Eastern Mediterranean (n = 1), and Southeast Asia (n = 1) were examined. A total of 385 units of analysis dispersed in 31 subcategories under four themes were derived. The four themes derived (number of unit of analysis, %) were Management & Leadership (206, 53.5), Practice (75, 19.5), Education (70, 18.2), and Research (34, 8.8). The key nursing issues of concern at the global level are workforce, the impacts of nursing in health care, professional status, and education of nurses. International alliances can help advance nursing, but the visibility of nursing in the WHO needs to be strengthened. Organizational leadership is important in order to optimize the use of nursing competence in practice and inform policy makers regarding the value of nursing to promote people's health. © 2015 Sigma Theta Tau International.

Guide to AERO2S and WINGDES Computer Codes for Prediction and Minimization of Drag Due to Lift

NASA Technical Reports Server (NTRS)

Carlson, Harry W.; Chu, Julio; Ozoroski, Lori P.; McCullers, L. Arnold

1997-01-01

The computer codes, AER02S and WINGDES, are now widely used for the analysis and design of airplane lifting surfaces under conditions that tend to induce flow separation. These codes have undergone continued development to provide additional capabilities since the introduction of the original versions over a decade ago. This code development has been reported in a variety of publications (NASA technical papers, NASA contractor reports, and society journals). Some modifications have not been publicized at all. Users of these codes have suggested the desirability of combining in a single document the descriptions of the code development, an outline of the features of each code, and suggestions for effective code usage. This report is intended to supply that need.

Ethical behavior of nurses in decision-making in Iran

PubMed Central

Ebrahimi, Hossein; Nikravesh, Mansoure; Oskouie, Fatemeh; Ahmadi, Fazlollah

2015-01-01

Background: Ethical caring is an essential in nursing practice. Nurses are confronted with complex situations in which they are expected to autonomously make decisions in delivering good care to patients. Although a wide range of studies have examined ethical behavior of nurses, there are still many issues requiring further investigation. The aim of this article is to describe the ethical behavior of nurses in decision-making in patients’ care in Iran. Materials and Methods: This study was conducted through grounded theory method. Participants were 17 Iranian nurses, employed in Tabriz University of Medical Sciences hospitals. Unstructured, semi-structured, and in-depth interviews were used for data gathering. Interviews were transcribed and coded according to Strauss and Corbin method in open, axial, and selective coding. Results: Nurses showed three major approaches in ethical behavior: Beyond the legal duty and protection of the patients, which includes dedication and full availability to nurses’ job and the client, spending time for the patients and delayed exit from the workplace, and arbitrary practice; legal duty and the protection of patients and nurses, which includes caretaking for the patient, responding to the client, and implementing the physician's prescription; and below the legal duty and the protection of one's self, that is, finding evidence and having witness in case of false documentation, and shortcoming, negligence, and mistake. Conclusions: Because of the importance of the ethical behavior of nurses in decision-making, it is necessary to find ways to promote moral reasoning and moral development of nurses. Empowerment of nurses, nurse educators, and nursing students to acquire knowledge and develop ethical behavior skills is important. PMID:25709704

A work sampling study of provider activities in school-based health centers.

PubMed

Mavis, Brian; Pearson, Rachel; Stewart, Gail; Keefe, Carole

2009-06-01

The purpose of this study was to describe provider activities in a convenience sample of School-Based Health Centers (SBHCs). The goal was to determine the relative proportion of time that clinic staff engaged in various patient care and non-patient care activities. All provider staff at 4 urban SBHCs participated in this study; 2 were in elementary schools, 1 in a middle school, and 1 in a school with kindergarten through grade 8. The study examined provider activity from 6 days sampled at random from the school year. Participants were asked to document their activities in 15-minute intervals from 8:00 a.m. to 5:00 p.m. A structured recording form was used that included 35 activity categories. Overall, 1492 records were completed, accounting for 2708 coded activities. Almost half (48%) of all staff activities were coded as direct patient contact, with clinic operations the second largest category. Limited variations in activities were found across clinic sites and according to season. A significant amount of provider activity was directed at the delivery of health care; direct patient care and clinic operations combined accounted for approximately 75% of clinic activity. Patient, classroom, and group education activities, as well as contacts with parents and school staff accounted for 20% of all clinic activity and represent important SBHC functions that other productivity measures such as billing data might not consistently track. Overall, the method was acceptable to professional staff as a means of tracking activity and was adaptable to meet their needs.

Thrust Chamber Modeling Using Navier-Stokes Equations: Code Documentation and Listings. Volume 2

NASA Technical Reports Server (NTRS)

Daley, P. L.; Owens, S. F.

1988-01-01

A copy of the PHOENICS input files and FORTRAN code developed for the modeling of thrust chambers is given. These copies are contained in the Appendices. The listings are contained in Appendices A through E. Appendix A describes the input statements relevant to thrust chamber modeling as well as the FORTRAN code developed for the Satellite program. Appendix B describes the FORTRAN code developed for the Ground program. Appendices C through E contain copies of the Q1 (input) file, the Satellite program, and the Ground program respectively.

Methodology of decreasing software complexity using ontology

NASA Astrophysics Data System (ADS)

DÄ browska-Kubik, Katarzyna

2015-09-01

In this paper a model of web application`s source code, based on the OSD ontology (Ontology for Software Development), is proposed. This model is applied to implementation and maintenance phase of software development process through the DevOntoCreator tool [5]. The aim of this solution is decreasing software complexity of that source code, using many different maintenance techniques, like creation of documentation, elimination dead code, cloned code or bugs, which were known before [1][2]. Due to this approach saving on software maintenance costs of web applications will be possible.

3 CFR - Unified Command Plan 2011

Code of Federal Regulations, 2012 CFR

2012-01-01

... 3 The President 1 2012-01-01 2012-01-01 false Unified Command Plan 2011 Presidential Documents Other Presidential Documents Memorandum of April 6, 2011 Unified Command Plan 2011 Memorandum for the... implementation of the revised Unified Command Plan. Consistent with title 10, United States Code, section 161(b...

Generating Code Review Documentation for Auto-Generated Mission-Critical Software

NASA Technical Reports Server (NTRS)

Denney, Ewen; Fischer, Bernd

2009-01-01

Model-based design and automated code generation are increasingly used at NASA to produce actual flight code, particularly in the Guidance, Navigation, and Control domain. However, since code generators are typically not qualified, there is no guarantee that their output is correct, and consequently auto-generated code still needs to be fully tested and certified. We have thus developed AUTOCERT, a generator-independent plug-in that supports the certification of auto-generated code. AUTOCERT takes a set of mission safety requirements, and formally verifies that the autogenerated code satisfies these requirements. It generates a natural language report that explains why and how the code complies with the specified requirements. The report is hyper-linked to both the program and the verification conditions and thus provides a high-level structured argument containing tracing information for use in code reviews.

Cracking the code: the accuracy of coding shoulder procedures and the repercussions.

PubMed

Clement, N D; Murray, I R; Nie, Y X; McBirnie, J M

2013-05-01

Coding of patients' diagnosis and surgical procedures is subject to error levels of up to 40% with consequences on distribution of resources and financial recompense. Our aim was to explore and address reasons behind coding errors of shoulder diagnosis and surgical procedures and to evaluate a potential solution. A retrospective review of 100 patients who had undergone surgery was carried out. Coding errors were identified and the reasons explored. A coding proforma was designed to address these errors and was prospectively evaluated for 100 patients. The financial implications were also considered. Retrospective analysis revealed the correct primary diagnosis was assigned in 54 patients (54%) had an entirely correct diagnosis, and only 7 (7%) patients had a correct procedure code assigned. Coders identified indistinct clinical notes and poor clarity of procedure codes as reasons for errors. The proforma was significantly more likely to assign the correct diagnosis (odds ratio 18.2, p < 0.0001) and the correct procedure code (odds ratio 310.0, p < 0.0001). Using the proforma resulted in a £28,562 increase in revenue for the 100 patients evaluated relative to the income generated from the coding department. High error levels for coding are due to misinterpretation of notes and ambiguity of procedure codes. This can be addressed by allowing surgeons to assign the diagnosis and procedure using a simplified list that is passed directly to coding.

Transmutation Fuel Performance Code Thermal Model Verification

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

Gregory K. Miller; Pavel G. Medvedev

2007-09-01

FRAPCON fuel performance code is being modified to be able to model performance of the nuclear fuels of interest to the Global Nuclear Energy Partnership (GNEP). The present report documents the effort for verification of the FRAPCON thermal model. It was found that, with minor modifications, FRAPCON thermal model temperature calculation agrees with that of the commercial software ABAQUS (Version 6.4-4). This report outlines the methodology of the verification, code input, and calculation results.

ADESSA: A Real-Time Decision Support Service for Delivery of Semantically Coded Adverse Drug Event Data

PubMed Central

Duke, Jon D.; Friedlin, Jeff

2010-01-01

Evaluating medications for potential adverse events is a time-consuming process, typically involving manual lookup of information by physicians. This process can be expedited by CDS systems that support dynamic retrieval and filtering of adverse drug events (ADE’s), but such systems require a source of semantically-coded ADE data. We created a two-component system that addresses this need. First we created a natural language processing application which extracts adverse events from Structured Product Labels and generates a standardized ADE knowledge base. We then built a decision support service that consumes a Continuity of Care Document and returns a list of patient-specific ADE’s. Our database currently contains 534,125 ADE’s from 5602 product labels. An NLP evaluation of 9529 ADE’s showed recall of 93% and precision of 95%. On a trial set of 30 CCD’s, the system provided adverse event data for 88% of drugs and returned these results in an average of 620ms. PMID:21346964

Primary Payer at DX: Issues with Collection and Assessment of Data Quality.

PubMed

Sherman, Recinda L; Williamson, Laura; Andrews, Patricia; Kahn, Amy

2016-01-01

An individual's access to health insurance influences the amount and type of health services a patient receives for prevention and treatment, and, ultimately, influences survival. The North American Association of Central Cancer Registries (NAACCR) Item #630, Primary Payer at DX, is a required field intended to document health insurance status for the purpose of supporting patterns-of-care studies and other research. However, challenges related to the uniformity of collection and availability of data needed to populate this field diminish the value of the Primary Payer at DX data. A NAACCR taskforce worked on issues surrounding the collection of Primary Payer at DX; including proposing a crosswalk between Primary Payer at DX and the new Public Health Payment Typology standard, often available in hospital discharge databases. However, there are issues with compatibility between coding systems, intent of data collection, timelines for coding insurance, and changes in insurance coverage (partly due to the Affordable Care Act) that continue to complicate the collection and use of Primary Payer at DX data.

Using natural language processing to identify problem usage of prescription opioids.

PubMed

Carrell, David S; Cronkite, David; Palmer, Roy E; Saunders, Kathleen; Gross, David E; Masters, Elizabeth T; Hylan, Timothy R; Von Korff, Michael

2015-12-01

Accurate and scalable surveillance methods are critical to understand widespread problems associated with misuse and abuse of prescription opioids and for implementing effective prevention and control measures. Traditional diagnostic coding incompletely documents problem use. Relevant information for each patient is often obscured in vast amounts of clinical text. We developed and evaluated a method that combines natural language processing (NLP) and computer-assisted manual review of clinical notes to identify evidence of problem opioid use in electronic health records (EHRs). We used the EHR data and text of 22,142 patients receiving chronic opioid therapy (≥70 days' supply of opioids per calendar quarter) during 2006-2012 to develop and evaluate an NLP-based surveillance method and compare it to traditional methods based on International Classification of Disease, Ninth Edition (ICD-9) codes. We developed a 1288-term dictionary for clinician mentions of opioid addiction, abuse, misuse or overuse, and an NLP system to identify these mentions in unstructured text. The system distinguished affirmative mentions from those that were negated or otherwise qualified. We applied this system to 7336,445 electronic chart notes of the 22,142 patients. Trained abstractors using a custom computer-assisted software interface manually reviewed 7751 chart notes (from 3156 patients) selected by the NLP system and classified each note as to whether or not it contained textual evidence of problem opioid use. Traditional diagnostic codes for problem opioid use were found for 2240 (10.1%) patients. NLP-assisted manual review identified an additional 728 (3.1%) patients with evidence of clinically diagnosed problem opioid use in clinical notes. Inter-rater reliability among pairs of abstractors reviewing notes was high, with kappa=0.86 and 97% agreement for one pair, and kappa=0.71 and 88% agreement for another pair. Scalable, semi-automated NLP methods can efficiently and accurately identify evidence of problem opioid use in vast amounts of EHR text. Incorporating such methods into surveillance efforts may increase prevalence estimates by as much as one-third relative to traditional methods. Copyright © 2015. Published by Elsevier Ireland Ltd.

Indianapolis emergency medical service and the Indiana Network for Patient Care: evaluating the patient match algorithm.

PubMed

Park, Seong C; Finnell, John T

2012-01-01

In 2009, Indianapolis launched an electronic medical record system within their ambulances1 and started to exchange patient data with the Indiana Network for Patient Care (INPC) This unique system allows EMS personnel to get important information prior to the patient's arrival to the hospital. In this descriptive study, we found EMS personnel requested patient data on 14% of all transports, with a "success" match rate of 46%, and a match "failure" rate of 17%. The three major factors for causing match "failure" were ZIP code 55%, Patient Name 22%, and Birth date 12%. We conclude that the ZIP code matching process needs to be improved by applying a limitation of 5 digits in ZIP code instead of using ZIP+4 code. Non-ZIP code identifiers may be a better choice due to inaccuracies and changes of the ZIP code in a patient's record.

Nosocomial transmission of respiratory syncytial virus in an outpatient cancer center.

PubMed

Chu, Helen Y; Englund, Janet A; Podczervinski, Sara; Kuypers, Jane; Campbell, Angela P; Boeckh, Michael; Pergam, Steven A; Casper, Corey

2014-06-01

Respiratory syncytial virus (RSV) outbreaks in inpatient settings are associated with poor outcomes in cancer patients. The use of molecular epidemiology to document RSV transmission in the outpatient setting has not been well described. We performed a retrospective cohort study of 2 nosocomial outbreaks of RSV at the Seattle Cancer Care Alliance. Subjects included patients seen at the Seattle Cancer Care Alliance with RSV detected in 2 outbreaks in 2007-2008 and 2012 and all employees with respiratory viruses detected in the 2007-2008 outbreak. A subset of samples was sequenced using semi-nested PCR targeting the RSV attachment glycoprotein coding region. Fifty-one cases of RSV were identified in 2007-2008. Clustering of identical viral strains was detected in 10 of 15 patients (67%) with RSV sequenced from 2007 to 2008. As part of a multimodal infection control strategy implemented as a response to the outbreak, symptomatic employees had nasal washes collected. Of 254 employee samples, 91 (34%) tested positive for a respiratory virus, including 14 with RSV. In another RSV outbreak in 2012, 24 cases of RSV were identified; 9 of 10 patients (90%) had the same viral strain, and 1 (10%) had another viral strain. We document spread of clonal strains within an outpatient cancer care setting. Infection control interventions should be implemented in outpatient, as well as inpatient, settings to reduce person-to-person transmission and limit progression of RSV outbreaks. Copyright © 2014 American Society for Blood and Marrow Transplantation. All rights reserved.

Nosocomial Transmission of Respiratory Syncytial Virus in an Outpatient Cancer Center

PubMed Central

Chu, Helen Y.; Englund, Janet A.; Podczervinski, Sara; Kuypers, Jane; Campbell, Angela P.; Boeckh, Michael; Pergam, Steven A.; Casper, Crey

2014-01-01

Background Respiratory syncytial virus (RSV) outbreaks in inpatient settings are associated with poor outcomes in cancer patients. The use of molecular epidemiology to document RSV transmission in the outpatient setting has not been well described. Methods We performed a retrospective cohort study of two nosocomial outbreaks of RSV at the Seattle Cancer Care Alliance (SCCA). Subjects included patients seen at the SCCA with RSV detected in two outbreaks in 2007-2008 and 2012, and all employees with respiratory viruses detected in the 2007-2008 outbreak. A subset of samples was sequenced using semi-nested polymerase chain reaction targeting the RSV attachment glycoprotein coding region. Results Fifty-one cases of RSV were identified in 2007-2008. Clustering of identical viral strains was detected in 10 (67%) of 15 patients with RSV sequenced from 2007-2008. As part of a multimodal infection control strategy implemented as a response to the outbreak, symptomatic employees had nasal washes collected. Of 254 employee samples, 91 (34%) tested positive for a respiratory virus, including 14 with RSV. In another RSV outbreak in 2012, 24 cases of RSV were identified; nine (90%) of 10 patients had the same viral strain, and 1 (10%) had another viral strain. Conclusions We document spread of clonal strains within an outpatient cancer care setting. Infection control interventions should be implemented in outpatient, as well as inpatient, settings to reduce person-to-person transmission and limit progression of RSV outbreaks. PMID:24607551

Nonlinear Transient Problems Using Structure Compatible Heat Transfer Code

NASA Technical Reports Server (NTRS)

Hou, Gene

2000-01-01

The report documents the recent effort to enhance a transient linear heat transfer code so as to solve nonlinear problems. The linear heat transfer code was originally developed by Dr. Kim Bey of NASA Largely and called the Structure-Compatible Heat Transfer (SCHT) code. The report includes four parts. The first part outlines the formulation of the heat transfer problem of concern. The second and the third parts give detailed procedures to construct the nonlinear finite element equations and the required Jacobian matrices for the nonlinear iterative method, Newton-Raphson method. The final part summarizes the results of the numerical experiments on the newly enhanced SCHT code.

Public Reporting of MRI of the Lumbar Spine for Low Back Pain and Changes in Clinical Documentation.

PubMed

Flug, Jonathan A; Lind, Kimberly E

2017-12-01

OP-8 is the Medicare imaging efficiency metric for MRI of the lumbar spine for low back pain in the outpatient hospital. We studied trends in exclusion criteria coding over time by site of service after implementation of OP-8 to evaluate provider's response to public reporting. We conducted a secondary data analysis using the Medicare Limited Data Set 5% sample for beneficiaries with MRI lumbar spine and lower back pain during 2009 to 2014. We evaluated the association between excluding condition prevalence and site by using generalized estimating equations regression. We produced model-based estimates of excluding condition prevalence by site and year. As a sensitivity analysis, we repeated the analysis while including additional conditions in the outcome measure. We included 285,911 MRIs of the lumbar spine for low back pain. Generalized estimating equations regression found that outpatient hospitals had a higher proportion of MRIs with at least one excluding condition documented compared with outpatient clinics (P < .05), but increases in excluding condition prevalence were similar across all sites during 2009 to 2014. Our results were not sensitive to the inclusion of additional conditions. Documentation of excluding conditions and other clinically reasonable exclusions for OP-8 increased over time for outpatient hospitals and clinics. Increases in documentation of comorbidities may not translate to actual improvement in imaging appropriateness for low back pain. When accounting for all relevant conditions, the proportion of patients with low back pain considered uncomplicated and being measured by OP-8 would be small, reflecting a small proportion of patients with low back pain. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Use of the MATRIXx Integrated Toolkit on the Microwave Anisotropy Probe Attitude Control System

NASA Technical Reports Server (NTRS)

Ward, David K.; Andrews, Stephen F.; McComas, David C.; ODonnell, James R., Jr.

1999-01-01

Recent advances in analytical software tools allow the analysis, simulation, flight code, and documentation of an algorithm to be generated from a single source, all within one integrated analytical design package. NASA's Microwave Anisotropy Probe project has used one such package, Integrated Systems' MATRIXx suite, in the design of the spacecraft's Attitude Control System. The project's experience with the linear analysis, simulation, code generation, and documentation tools will be presented and compared with more traditional development tools. In particular, the quality of the flight software generated will be examined in detail. Finally, lessons learned on each of the tools will be shared.