Science.gov

Sample records for shared electronic medical

  1. Sharing electronic medical records across multiple heterogeneous and competing institutions.

    PubMed Central

    Kohane, I. S.; van Wingerde, F. J.; Fackler, J. C.; Cimino, C.; Kilbridge, P.; Murphy, S.; Chueh, H.; Rind, D.; Safran, C.; Barnett, O.; Szolovits, P.

    1996-01-01

    Most early reports of implemented World-Wide Web (W3) medical record systems describe single institution architectures. We describe W3-EMRS, a multi-institutional architecture, and its implementation. Thorny problems in data sharing underlined by the W3-EMRS project are reviewed. PMID:8947738

  2. Risk mitigation of shared electronic records system in campus institutions: medical social work practice in singapore.

    PubMed

    Ow Yong, Lai Meng; Tan, Amanda Wei Li; Loo, Cecilia Lay Keng; Lim, Esther Li Ping

    2014-10-01

    In 2013, the Singapore General Hospital (SGH) Campus initiated a shared electronic system where patient records and documentations were standardized and shared across institutions within the Campus. The project was initiated to enhance quality of health care, improve accessibility, and ensure integrated (as opposed to fragmented) care for best outcomes in our patients. In mitigating the risks of ICT, it was found that familiarity with guiding ethical principles, and ensuring adherence to regulatory and technical competencies in medical social work were important. The need to negotiate and maneuver in a large environment within the Campus to ensure proactive integrative process helped.

  3. Antiretroviral Therapy Adherence and Use of an Electronic Shared Medical Record Among People Living with HIV.

    PubMed

    Saberi, Parya; Catz, Sheryl L; Leyden, Wendy A; Stewart, Christine; Ralston, James D; Horberg, Michael A; Grothaus, Louis; Silverberg, Michael J

    2015-06-01

    Electronic shared medical records (SMR) are emerging healthcare technologies that allow patients to engage in their healthcare by communicating with providers, refilling prescriptions, scheduling appointments, and viewing portions of medical records. We conducted a pre-post cohort study of HIV-positive adults who used and did not use SMR in two integrated healthcare systems. We compared the difference in antiretroviral refill adherence between SMR users and age- and sex-frequency matched non-users from the 12-month period prior to SMR useto the 12-month period starting 6 months after initiation of SMR use. High adherence was maintained among SMR users (change = -0.11 %) but declined among non-users (change = -2.05 %; p = 0.003). Among SMR users, there was a steady improvement in adherence as monthly frequency of SMR use increased (p = 0.009). SMR use, particularly more frequent use, is associated with maintaining high adherence and non-use is associated with declines in adherence over time among patients with access to these online services.

  4. Medical high-resolution image sharing and electronic whiteboard system: A pure-web-based system for accessing and discussing lossless original images in telemedicine.

    PubMed

    Qiao, Liang; Li, Ying; Chen, Xin; Yang, Sheng; Gao, Peng; Liu, Hongjun; Feng, Zhengquan; Nian, Yongjian; Qiu, Mingguo

    2015-09-01

    There are various medical image sharing and electronic whiteboard systems available for diagnosis and discussion purposes. However, most of these systems ask clients to install special software tools or web plug-ins to support whiteboard discussion, special medical image format, and customized decoding algorithm of data transmission of HRIs (high-resolution images). This limits the accessibility of the software running on different devices and operating systems. In this paper, we propose a solution based on pure web pages for medical HRIs lossless sharing and e-whiteboard discussion, and have set up a medical HRI sharing and e-whiteboard system, which has four-layered design: (1) HRIs access layer: we improved an tile-pyramid model named unbalanced ratio pyramid structure (URPS), to rapidly share lossless HRIs and to adapt to the reading habits of users; (2) format conversion layer: we designed a format conversion engine (FCE) on server side to real time convert and cache DICOM tiles which clients requesting with window-level parameters, to make browsers compatible and keep response efficiency to server-client; (3) business logic layer: we built a XML behavior relationship storage structure to store and share users' behavior, to keep real time co-browsing and discussion between clients; (4) web-user-interface layer: AJAX technology and Raphael toolkit were used to combine HTML and JavaScript to build client RIA (rich Internet application), to meet clients' desktop-like interaction on any pure webpage. This system can be used to quickly browse lossless HRIs, and support discussing and co-browsing smoothly on any web browser in a diversified network environment. The proposal methods can provide a way to share HRIs safely, and may be used in the field of regional health, telemedicine and remote education at a low cost.

  5. Inviting patients and care partners to read doctors' notes: OpenNotes and shared access to electronic medical records.

    PubMed

    Wolff, Jennifer L; Darer, Jonathan D; Berger, Andrea; Clarke, Deserae; Green, Jamie A; Stametz, Rebecca A; Delbanco, Tom; Walker, Jan

    2016-08-07

    We examined the acceptability and effects of delivering doctors' visit notes electronically (via OpenNotes) to patients and care partners with authorized access to patients' electronic medical records. Adult patients and care partners at Geisinger Health System were surveyed at baseline and after 12 months of exposure to OpenNotes. Reporting on care partner access to OpenNotes, patients and care partners stated that they had better agreement about patient treatment plans and more productive discussions about their care. At follow-up, patients were more confident in their ability to manage their health, felt better prepared for office visits, and reported understanding their care better than at baseline. Care partners were more likely to access and use patient portal functionality and reported improved communication with patients' providers at follow-up. Our findings suggest that offering patients and care partners access to doctors' notes is acceptable and improves communication and patients' confidence in managing their care.

  6. To Share or Not to Share: Ethical Acquisition and Use of Medical Data

    PubMed Central

    Hollis, Kate Fultz

    2016-01-01

    The Health Information Technology for Economic and Clinical Health (HITECH) Act proposes the meaningful use of interoperable electronic health records throughout the United States health care delivery system as a critical national goal. As we have moved from medical records on paper to interoperable electronic health records, the rapid and easy sharing of medical data through the Internet makes medical data insecure. Electronic data is easy to share but many steps to ensure security of the data need to be taken. Beyond medical data security, we need to ethically acquire, use and manage data so that all people involved with the data from producer to data manager are recognized and respected. This paper advocates that sharing medical data can be ethically the right choice for everyone in health care if data sharing guidelines are available for people to use, modify and strengthen for specific purposes. PMID:27570683

  7. Coordinating shared care using electronic data interchange.

    PubMed

    Branger, P; van't Hooft, A; van der Wouden, H C

    1995-01-01

    Shared care is the situation in which physicians jointly treat the same patient. Shared care may occur with elderly patients suffering from several health problems, patients with chronic disorders such as diabetes, mellitus, obstructive pulmonary diseases, or cardiological disorders. For a number of health problems, including diabetes, shared care protocols have been developed involving division of tasks between health care providers from different disciplines [1]. Optimal communication is considered to be a vital aspect of shared care, both from medical and cost-effectiveness points of view, but at the same time communication forms the bottleneck as physicians often lack time to comply with the protocol [2]. At present, new technologies are emerging that hold the promise of improving communication between health care providers. One such technology is Electronic Data Interchange (EDI), defined as "the replacement of paper documents by standard electronic messages conveyed from one computer to another without manual intervention" [3]. In Europe, the ISO syntax standard EDIFACT has been adopted as the standard for defining EDI-messages [4]. In The Netherlands, coordination of the standardization of health care messages is performed by a national organization. At present, several standardized messages are available for a variety of purposes. One is a message for data exchange between physicians; in this message, however, only physician-patient- and hospital-identifying data are structured, and all medical data is transferred as free text. Consequently, using this message, the receiving system is unable to integrate the data into the computer-based patient record. In order to support shared care, a message is needed that can also transfer the structure of the data in a computer-based record in order to allow integration of records from multiple sources. Therefore, we developed a new message, called MEDEUR, that is designed for integrated patient data exchange between

  8. Why a shared care record is an official medical record.

    PubMed

    Gu, Yulong; Orr, Martin; Warren, Jim; Humphrey, Gayl; Day, Karen; Tibby, Sarah; Fitzpatrick, Jo

    2013-10-18

    The literature describes three categories of health records: the Official Medical Records held by healthcare providers, Personal Health Records owned by patients, and--a possible in between case--the Shared Care Record. New complications and challenges arise with electronic storage of this latter class of record; for instance, an electronic shared care record may have multiple authors, which presents challenges regarding the roles and responsibilities for record-keeping. This article discusses the definitions and implementations of official medical records, personal health records and shared care records. We also consider the case of a New Zealand pilot of developing and implementing a shared care record in the National Shared Care Planning Programme. The nature and purpose of an official medical record remains the same whether in paper or electronic form. We maintain that a shared care record is an official medical record; it is not a personal health record that is owned and controlled by patients, although it is able to be viewed and interacted with by patients. A shared care record needs to meet the same criteria for medico-legal and ethical duties in the delivery of shared care as pertain to any official medical record.

  9. Silicones in medical electronics.

    PubMed

    Bruner, Stephen

    2008-01-01

    The use of silicones, although already extensive, is set to grow in medical electronics. Silicones used in medical device applications as tubing or moulded parts should also be considered for electronic applications in the same device. This article outlines the potential reduction in complexity that this solution offers. Benefits include eliminating negative materials interactions and avoiding bonding problems.

  10. Secure medical information sharing in cloud computing.

    PubMed

    Shao, Zhiyi; Yang, Bo; Zhang, Wenzheng; Zhao, Yi; Wu, Zhenqiang; Miao, Meixia

    2015-01-01

    Medical information sharing is one of the most attractive applications of cloud computing, where searchable encryption is a fascinating solution for securely and conveniently sharing medical data among different medical organizers. However, almost all previous works are designed in symmetric key encryption environment. The only works in public key encryption do not support keyword trapdoor security, have long ciphertext related to the number of receivers, do not support receiver revocation without re-encrypting, and do not preserve the membership of receivers. In this paper, we propose a searchable encryption supporting multiple receivers for medical information sharing based on bilinear maps in public key encryption environment. In the proposed protocol, data owner stores only one copy of his encrypted file and its corresponding encrypted keywords on cloud for multiple designated receivers. The keyword ciphertext is significantly shorter and its length is constant without relation to the number of designated receivers, i.e., for n receivers the ciphertext length is only twice the element length in the group. Only the owner knows that with whom his data is shared, and the access to his data is still under control after having been put on the cloud. We formally prove the security of keyword ciphertext based on the intractability of Bilinear Diffie-Hellman problem and the keyword trapdoor based on Decisional Diffie-Hellman problem.

  11. 38 CFR 17.241 - Sharing medical information services.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ..., research centers, and individual members of the medical profession, under which medical information and... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Sharing medical... AFFAIRS MEDICAL Sharing of Medical Facilities, Equipment, and Information § 17.241 Sharing...

  12. 38 CFR 17.241 - Sharing medical information services.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ..., research centers, and individual members of the medical profession, under which medical information and... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Sharing medical... AFFAIRS MEDICAL Sharing of Medical Facilities, Equipment, and Information § 17.241 Sharing...

  13. 38 CFR 17.241 - Sharing medical information services.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ..., research centers, and individual members of the medical profession, under which medical information and... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Sharing medical... AFFAIRS MEDICAL Sharing of Medical Facilities, Equipment, and Information § 17.241 Sharing...

  14. 38 CFR 17.241 - Sharing medical information services.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ..., research centers, and individual members of the medical profession, under which medical information and... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Sharing medical... AFFAIRS MEDICAL Sharing of Medical Facilities, Equipment, and Information § 17.241 Sharing...

  15. Electronic Procedures for Medical Operations

    NASA Technical Reports Server (NTRS)

    2015-01-01

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

  16. Applying XDS for sharing CDA-based medical records

    NASA Astrophysics Data System (ADS)

    Kim, Joong Il; Jang, Bong Mun; Han, Dong Hoon; Yang, Keon Ho; Kang, Won-Suk; Jung, Haijo; Kim, Hee-Joung

    2006-03-01

    Many countries have set long-term objectives for establishing an Electronic Healthcare Records system(EHRs). Various IT Strategies note that integration of EHR systems has a high priority. Because the EHR systems are based on different information models and different technology platforms, one of the key integration problems in the realization of the EHRs for the continuity of patient care, is the inability to share patient records between various institutions. Integrating the Healthcare Enterprise (IHE) committee has defined the detailed implementations of existing standards such as DICOM, HL7, in a publicly available document called the IHE technical framework (IHE-TF). Cross-enterprise document sharing (XDS), one of IHE technical frameworks, is describing how to apply the standards into the information systems for the sharing of medical documents among hospitals. This study aims to design Clinical Document Architecture (CDA) schema based on HL7, and to apply implementation strategies of XDS using this CDA schema.

  17. Developing and sharing medical effectiveness information

    NASA Astrophysics Data System (ADS)

    Fitzmaurice, J. M.

    1995-10-01

    In our health care environment, managed care, capitated payments, and a growing national information infrastructure are becoming major forces that shape decisions about how medical resources are organized and used. Health care decision makers prize medical effectiveness information based on patient care data that are linked with other data, such as costs. Obtaining uniform, accurate patient care data requires determining conditions of access to the data and standards. Under the National Information Infrastructure Initiative, principles have been developed to guide users and providers of individually identifiable data, and U.S. standards developers are at work to improve the definitions and electronic transmission of patient care data. When aggregated, these data can serve many uses, including improving quality of care. Their use for computing clinical performance measures, such as the Health Plan Employer Data Set (HEDIS), and a study that classifies such sets are highlighted.

  18. 12 CFR 334.32 - Sharing medical information with affiliates.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Sharing medical information with affiliates... STATEMENTS OF GENERAL POLICY FAIR CREDIT REPORTING Medical Information § 334.32 Sharing medical information... of the Federal Reserve System) and insured State branches of foreign banks. (b) In general....

  19. 12 CFR 7.5010 - Shared electronic space.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 12 Banks and Banking 1 2012-01-01 2012-01-01 false Shared electronic space. 7.5010 Section 7.5010 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY BANK ACTIVITIES AND OPERATIONS Electronic Activities § 7.5010 Shared electronic space. National banks that share electronic space,...

  20. 12 CFR 7.5010 - Shared electronic space.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 12 Banks and Banking 1 2013-01-01 2013-01-01 false Shared electronic space. 7.5010 Section 7.5010 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY BANK ACTIVITIES AND OPERATIONS Electronic Activities § 7.5010 Shared electronic space. National banks that share electronic space,...

  1. 12 CFR 7.5010 - Shared electronic space.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 1 2014-01-01 2014-01-01 false Shared electronic space. 7.5010 Section 7.5010 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY BANK ACTIVITIES AND OPERATIONS Electronic Activities § 7.5010 Shared electronic space. National banks that share electronic space,...

  2. 12 CFR 7.5010 - Shared electronic space.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Shared electronic space. 7.5010 Section 7.5010 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY BANK ACTIVITIES AND OPERATIONS Electronic Activities § 7.5010 Shared electronic space. National banks that share electronic space,...

  3. 12 CFR 7.5010 - Shared electronic space.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 12 Banks and Banking 1 2011-01-01 2011-01-01 false Shared electronic space. 7.5010 Section 7.5010 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY BANK ACTIVITIES AND OPERATIONS Electronic Activities § 7.5010 Shared electronic space. National banks that share electronic space,...

  4. 38 CFR 17.240 - Sharing specialized medical resources.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... medical resources. 17.240 Section 17.240 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS... medical resources. Subject to such terms and conditions as the Under Secretary for Health shall prescribe, agreements may be entered into for sharing medical resources with other hospitals, including State or...

  5. 38 CFR 17.240 - Sharing specialized medical resources.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... medical resources. 17.240 Section 17.240 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS... medical resources. Subject to such terms and conditions as the Under Secretary for Health shall prescribe, agreements may be entered into for sharing medical resources with other hospitals, including State or...

  6. 38 CFR 17.240 - Sharing specialized medical resources.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... medical resources. 17.240 Section 17.240 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS... medical resources. Subject to such terms and conditions as the Under Secretary for Health shall prescribe, agreements may be entered into for sharing medical resources with other hospitals, including State or...

  7. 38 CFR 17.240 - Sharing specialized medical resources.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... medical resources. 17.240 Section 17.240 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS... medical resources. Subject to such terms and conditions as the Under Secretary for Health shall prescribe, agreements may be entered into for sharing medical resources with other hospitals, including State or...

  8. 38 CFR 17.240 - Sharing specialized medical resources.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... medical resources. 17.240 Section 17.240 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS... medical resources. Subject to such terms and conditions as the Under Secretary for Health shall prescribe, agreements may be entered into for sharing medical resources with other hospitals, including State or...

  9. Shared medical appointments save money for capitated groups.

    PubMed

    2003-02-01

    Shared medical appointments aren't money-makers for Palo Alto Medical Foundation, but they do cut expenses, improve patient healing and free up physician schedules. The group nature of the encounters also encourages patients to follow medical orders. Find out more.

  10. Access Control Model for Sharing Composite Electronic Health Records

    NASA Astrophysics Data System (ADS)

    Jin, Jing; Ahn, Gail-Joon; Covington, Michael J.; Zhang, Xinwen

    The adoption of electronically formatted medical records, so called Electronic Health Records (EHRs), has become extremely important in healthcare systems to enable the exchange of medical information among stakeholders. An EHR generally consists of data with different types and sensitivity degrees which must be selectively shared based on the need-to-know principle. Security mechanisms are required to guarantee that only authorized users have access to specific portions of such critical record for legitimate purposes. In this paper, we propose a novel approach for modelling access control scheme for composite EHRs. Our model formulates the semantics and structural composition of an EHR document, from which we introduce a notion of authorized zones of the composite EHR at different granularity levels, taking into consideration of several important criteria such as data types, intended purposes and information sensitivities.

  11. Electronic Medical Business Operations System

    SciTech Connect

    Cannon, D. T.; Metcalf, J. R.; North, M. P.; Richardson, T. L.; Underwood, S. A.; Shelton, P. M.; Ray, W. B.; Morrell, M. L.; Caldwell, III, D. C.

    2012-04-16

    Electronic Management of medical records has taken a back seat both in private industry and in the government. Record volumes continue to rise every day and management of these paper records is inefficient and very expensive. In 2005, the White House announced support for the development of electronic medical records across the federal government. In 2006, the DOE issued 10 CFR 851 requiring all medical records be electronically available by 2015. The Y-12 National Security Complex is currently investing funds to develop a comprehensive EMR to incorporate the requirements of an occupational health facility which are common across the Nuclear Weapons Complex (NWC). Scheduling, workflow, and data capture from medical surveillance, certification, and qualification examinations are core pieces of the system. The Electronic Medical Business Operations System (EMBOS) will provide a comprehensive health tool solution to 10 CFR 851 for Y-12 and can be leveraged to the Nuclear Weapon Complex (NWC); all site in the NWC must meet the requirements of 10 CFR 851 which states that all medical records must be electronically available by 2015. There is also potential to leverage EMBOS to the private4 sector. EMBOS is being developed and deployed in phases. When fully deployed the EMBOS will be a state-of-the-art web-enabled integrated electronic solution providing a complete electronic medical record (EMR). EMBOS has been deployed and provides a dynamic electronic medical history and surveillance program (e.g., Asbestos, Hearing Conservation, and Respirator Wearer) questionnaire. Table 1 below lists EMBOS capabilities and data to be tracked. Data to be tracked: Patient Demographics – Current/Historical; Physical Examination Data; Employee Medical Health History; Medical Surveillance Programs; Patient and Provider Schedules; Medical Qualification/Certifications; Laboratory Data; Standardized Abnormal Lab Notifications; Prescription Medication Tracking and Dispensing; Allergies

  12. Prescription Medication Sharing: A Systematic Review of the Literature

    PubMed Central

    Beyene, Kebede A.; Sheridan, Janie; Aspden, Trudi

    2014-01-01

    We reviewed the literature on nonrecreational prescription medication sharing. We searched PubMed, EMBASE, PsycINFO, and a customized multidatabase for all relevant articles published through 2013; our final sample comprised 19 studies from 9 countries with 36 182 participants, ranging in age from children to older adults, and published between 1990 and 2011. The prevalence rate for borrowing someone’s prescription medication was 5% to 51.9% and for lending prescription medication to someone else was 6% to 22.9%. A wide range of medicines were shared between family members, friends, and acquaintances. Sharing of many classes of prescription medication was common. Further research should explore why people share, how they decide to lend or borrow, whether they are aware of the risks, and how they assess the relevance of those risks. PMID:24524496

  13. ["MonDossierMedical.ch": an efficient tool for sharing medical data between patients and doctors].

    PubMed

    Rosemberg, Aurélie; Plaut, Olivier; Sepulchre, Xavier; Spahni, Stéphane

    2015-05-13

    "MonDossierMedical.ch" is a project led by the canton of Geneva, making it possible for every patient to access his own electronic health record (EHR) and to share the medical files with his doctors. It was introduced across the canton in mid-2013, and provided to all patients free of charge. it is based on the first Swiss-wide e-health-compliant pilot project "e-toile". The canton of Geneva developed "e-toile" as a public-private partnership together with Swiss Post and it was launched in 2009 in some of the canton's municipalities. Back then, Geneva's EHR represented the first Swiss attempt to link all healthcare professionals in the treatment chain. Today, it serves more than 4,600 patients and 380 physicians. This number is growing regularly, as well as the health care institutions (physicians, private hospitals, labs) joining the community. Added value tools, such as a shared care plan and a shared medication list will make the platform even more attractive.

  14. Patient cost sharing and medical expenditures for the Elderly.

    PubMed

    Fukushima, Kazuya; Mizuoka, Sou; Yamamoto, Shunsuke; Iizuka, Toshiaki

    2016-01-01

    Despite the rapidly aging population, relatively little is known about how cost sharing affects the elderly's medical spending. Exploiting longitudinal claims data and the drastic reduction of coinsurance from 30% to 10% at age 70 in Japan, we find that the elderly's demand responses are heterogeneous in ways that have not been previously reported. Outpatient services by orthopedic and eye specialties, which will continue to increase in an aging society, are particularly price responsive and account for a large share of the spending increase. Lower cost sharing increases demand for brand-name drugs but not for generics. These high price elasticities may call for different cost-sharing rules for these services. Patient health status also matters: receiving medical services appears more discretionary for the healthy than the sick in the outpatient setting. Finally, we found no evidence that additional medical spending improved short-term health outcomes.

  15. Streamlining medical image sharing for continuity of care.

    PubMed

    Rosenfeld, Ken H

    2013-01-01

    Sharing patient medical history can be inconvenient and unreliable. Massive strides have been made to address the wasteful aspects of healthcare today, but hospitals and healthcare providers are still searching for ways to improve the efficiency of medical image sharing. To ensure that a patient's historical medical images can be promptly accessed by all caregivers, a solution architecture is needed that anticipates and supports the need for images to be available along with the rest of the patient's required medical history. Healthcare facilities can quickly and affordably use existing technologies, combined with a unified approach for sharing images to greatly improve transitions of care for their patients. Images would no longer need to be burned on to CDs and transported.

  16. Lowering medical costs through the sharing of savings by physicians and patients: inclusive shared savings.

    PubMed

    Schmidt, Harald; Emanuel, Ezekiel J

    2014-12-01

    Current approaches to controlling health care costs have strengths and weaknesses. We propose an alternative, "inclusive shared savings," that aims to lower medical costs through savings that are shared by physicians and patients. Inclusive shared savings may be particularly attractive in situations in which treatments, such as those for gastric cancer, are similar in clinical effectiveness and have modest differences in convenience but substantially differ in cost. Inclusive shared savings incorporates features of typical insurance coverage, shared savings, and value-based insurance design but differs from value-based insurance design, which merely seeks to decrease or eliminate out-of-pocket costs. Inclusive shared savings offers financial incentives to physicians and patients to promote the use of lower-cost, but equally effective, interventions and should be evaluated in a rigorous trial or demonstration project.

  17. Medical Electronics and Physiological Measurement.

    ERIC Educational Resources Information Center

    Cochrane, T.

    1989-01-01

    Described are developments in medical electronics and physiological measurement. Discussed are electrocardiology, audiology, and urology as mature applications; applied potential tomography, magnetic stimulation of nerves, and laser Doppler flowmetry as new techniques; and optical sensors, ambulatory monitoring, and biosensors as future…

  18. Electronic Media: A Motif for Shared Resources.

    ERIC Educational Resources Information Center

    Lightner, Stanley L.; Johnson, W. C.

    2000-01-01

    A survey of trade and industrial education supervisors from 10 states determined the degree of use of electronic education methods. Instructors in these states used presentation software and web-based exercises most often; fewer used video, CD-ROM, and distance technologies; 70% had been taught electronic presentation methods in preservice or…

  19. Secure public cloud platform for medical images sharing.

    PubMed

    Pan, Wei; Coatrieux, Gouenou; Bouslimi, Dalel; Prigent, Nicolas

    2015-01-01

    Cloud computing promises medical imaging services offering large storage and computing capabilities for limited costs. In this data outsourcing framework, one of the greatest issues to deal with is data security. To do so, we propose to secure a public cloud platform devoted to medical image sharing by defining and deploying a security policy so as to control various security mechanisms. This policy stands on a risk assessment we conducted so as to identify security objectives with a special interest for digital content protection. These objectives are addressed by means of different security mechanisms like access and usage control policy, partial-encryption and watermarking.

  20. Curriculum inventory: Modeling, sharing and comparing medical education programs.

    PubMed

    Ellaway, Rachel H; Albright, Susan; Smothers, Valerie; Cameron, Terri; Willett, Timothy

    2014-03-01

    Abstract descriptions of how curricula are structured and run. The American National Standards Institute (ANSI) MedBiquitous Curriculum Inventory Standard provides a technical syntax through which a wide range of different curricula can be expressed and subsequently compared and analyzed. This standard has the potential to shift curriculum mapping and reporting from a somewhat disjointed and institution-specific undertaking to something that is shared among multiple medical schools and across whole medical education systems. Given the current explosion of different models of curricula (time-free, competency-based, socially accountable, distributed, accelerated, etc.), the ability to consider this diversity using a common model has particular value in medical education management and scholarship. This article describes the development and structure of the Curriculum Inventory Standard as a way of standardizing the modeling of different curricula for audit, evaluation and research purposes. It also considers the strengths and limitations of the current standard and the implications for a medical education world in which this level of commonality, precision, and accountability for curricular practice is the norm rather than the exception.

  1. Anonymization of Longitudinal Electronic Medical Records

    PubMed Central

    Tamersoy, Acar; Loukides, Grigorios; Nergiz, Mehmet Ercan; Saygin, Yucel; Malin, Bradley

    2013-01-01

    Electronic medical record (EMR) systems have enabled healthcare providers to collect detailed patient information from the primary care domain. At the same time, longitudinal data from EMRs are increasingly combined with biorepositories to generate personalized clinical decision support protocols. Emerging policies encourage investigators to disseminate such data in a deidentified form for reuse and collaboration, but organizations are hesitant to do so because they fear such actions will jeopardize patient privacy. In particular, there are concerns that residual demographic and clinical features could be exploited for reidentification purposes. Various approaches have been developed to anonymize clinical data, but they neglect temporal information and are, thus, insufficient for emerging biomedical research paradigms. This paper proposes a novel approach to share patient-specific longitudinal data that offers robust privacy guarantees, while preserving data utility for many biomedical investigations. Our approach aggregates temporal and diagnostic information using heuristics inspired from sequence alignment and clustering methods. We demonstrate that the proposed approach can generate anonymized data that permit effective biomedical analysis using several patient cohorts derived from the EMR system of the Vanderbilt University Medical Center. PMID:22287248

  2. A patient-centric distribution architecture for medical image sharing.

    PubMed

    Constantinescu, Liviu; Kim, Jinman; Kumar, Ashnil; Haraguchi, Daiki; Wen, Lingfeng; Feng, Dagan

    2013-01-01

    Over the past decade, rapid development of imaging technologies has resulted in the introduction of improved imaging devices, such as multi-modality scanners that produce combined positron emission tomography-computed tomography (PET-CT) images. The adoption of picture archiving and communication systems (PACS) in hospitals have dramatically improved the ability to digitally share medical image studies via portable storage, mobile devices and the Internet. This has in turn led to increased productivity, greater flexibility, and improved communication between hospital staff, referring physicians, and outpatients. However, many of these sharing and viewing capabilities are limited to proprietary vendor-specific applications. Furthermore, there are still interoperability and deployment issues which reduce the rate of adoption of such technologies, thus leaving many stakeholders, particularly outpatients and referring physicians, with access to only traditional still images with no ability to view or interpret the data in full. In this paper, we present a distribution architecture for medical image display across numerous devices and media, which uses a preprocessor and an in-built networking framework to improve compatibility and promote greater accessibility of medical data. Our INVOLVE2 system consists of three main software modules: 1) a preprocessor, which collates and converts imaging studies into a compressed and distributable format; 2) a PACS-compatible workflow for self-managing distribution of medical data, e.g. via CD USB, network etc; 3) support for potential mobile and web-based data access. The focus of this study was on cultivating patient-centric care, by allowing outpatient users to comfortably access and interpret their own data. As such, the image viewing software included on our cross-platform CDs was designed with a simple and intuitive user-interface (UI) for use by outpatients and referring physicians. Furthermore, digital image access via

  3. Electronic Medical Consultation: A New Zealand Perspective

    PubMed Central

    Brebner, Campbell; Jones, Raymond; Marshall, Wendy; Parry, Graham

    2001-01-01

    Electronic medical consultation is available worldwide through access to the World Wide Web (WWW). This article outlines a research study on the adoption of electronic medical consultation as a means of health delivery. It focuses on the delivery of healthcare specifically for New Zealanders, by New Zealanders. It is acknowledged that the WWW is a global marketplace and that it is therefore difficult to identify New Zealanders' use of such a global market; nevertheless, we attempt to provide a New Zealand perspective on electronic medical consultation. PMID:11720955

  4. Comparison of consumers’ views on electronic data sharing for healthcare and research

    PubMed Central

    Joseph, Jill G; Ohno-Machado, Lucila

    2015-01-01

    New models of healthcare delivery such as accountable care organizations and patient-centered medical homes seek to improve quality, access, and cost. They rely on a robust, secure technology infrastructure provided by health information exchanges (HIEs) and distributed research networks and the willingness of patients to share their data. There are few large, in-depth studies of US consumers’ views on privacy, security, and consent in electronic data sharing for healthcare and research together. Objective This paper addresses this gap, reporting on a survey which asks about California consumers’ views of data sharing for healthcare and research together. Materials and Methods The survey conducted was a representative, random-digit dial telephone survey of 800 Californians, performed in Spanish and English. Results There is a great deal of concern that HIEs will worsen privacy (40.3%) and security (42.5%). Consumers are in favor of electronic data sharing but elements of transparency are important: individual control, who has access, and the purpose for use of data. Respondents were more likely to agree to share deidentified information for research than to share identified information for healthcare (76.2% vs 57.3%, p < .001). Discussion While consumers show willingness to share health information electronically, they value individual control and privacy. Responsiveness to these needs, rather than mere reliance on Health Insurance Portability and Accountability Act (HIPAA), may improve support of data networks. Conclusion Responsiveness to the public’s concerns regarding their health information is a pre-requisite for patient-centeredness. This is one of the first in-depth studies of attitudes about electronic data sharing that compares attitudes of the same individual towards healthcare and research. PMID:25829461

  5. The "nuts and bolts" of implementing shared medical appointments: the Harvard Vanguard Medical Associates experience.

    PubMed

    Berger-Fiffy, Jill

    2012-01-01

    Harvard Vanguard Medical Associates (Harvard Vanguard) decided to develop a Shared Medical Appointment (SMA) program in 2007 for a variety of reasons. The program has launched 86 SMAs in 17 specialties at 12 sites and has exceeded 13 000 patient visits. Currently, the practice offers 54 SMAs and is believed to be the largest program in the country. This article provides an overview regarding staffing, space and equipment, project planning, promotional materials, training programs, workflow development, and the use of quality improvement (ie, LEAN) tools used to monitor the work to be completed and the metrics to date.

  6. Adoption of a Nationwide Shared Medical Record in France: Lessons Learnt after 5 Years of Deployment

    PubMed Central

    Séroussi, Brigitte; Bouaud, Jacques

    2016-01-01

    Information sharing among health practitioners, either for coordinated or unscheduled care, is necessary to guarantee care quality and patient safety. In most countries, nationwide programs have provided tools to support information sharing, from centralized care records to health information exchange between electronic health records (EHRs). The French personal medical record (DMP) is a centralized patient-controlled record, created according to the opt-in consent model. It contains the documents health practitioners voluntarily push into the DMP from their EHRs. Five years after the launching of the program in December 2010, there were nearly 570,000 DMPs covering only 1.5% of the target population in December 2015. Reasons for this poor level of adoption are discussed in the perspective of other countries’ initiatives. The new French governmental strategy for the DMP deployment in 2016 is outlined, with the implementation of measures similar to the US Meaningful Use. PMID:28269907

  7. The evaluation of the need to share medical data on the community medical ICT network service in Nagasaki, Japan.

    PubMed

    Matsumoto, Takehiro; Honda, Masayuki

    2013-01-01

    The Community Medical ICT Network service at the Nagasaki, Japan was established in 2009. Medical information network for sharing patients data was investigated focused on the access log data from April of 2009 and October of 2010. The total number of the access to the medical information was 30,914 of 2,213 patients. And the total number of access of the image including diagnostic imaging report, medical examination, treatment and medical documents was 10,278(33.2%), 8,949(28.9%), 6,896(22.3%) and 4,791(15.5%) respectively. These results showed that these medical information had enough valued for sharing in the regional medicine. In conclusion, many types of medical information should be required for sharing in the community medical ICT network in Japan.

  8. Privacy, confidentiality, and electronic medical records.

    PubMed Central

    Barrows, R C; Clayton, P D

    1996-01-01

    The enhanced availability of health information in an electronic format is strategic for industry-wide efforts to improve the quality and reduce the cost of health care, yet it brings a concomitant concern of greater risk for loss of privacy among health care participants. The authors review the conflicting goals of accessibility and security for electronic medical records and discuss nontechnical and technical aspects that constitute a reasonable security solution. It is argued that with guiding policy and current technology, an electronic medical record may offer better security than a traditional paper record. PMID:8653450

  9. Access Scheme for Controlling Mobile Agents and its Application to Share Medical Information.

    PubMed

    Liao, Yu-Ting; Chen, Tzer-Shyong; Chen, Tzer-Long; Chung, Yu-Fang; Chen, Yu- Xin; Hwang, Jen-Hung; Wang, Huihui; Wei, Wei

    2016-05-01

    This study is showing the advantage of mobile agents to conquer heterogeneous system environments and contribute to a virtual integrated sharing system. Mobile agents will collect medical information from each medical institution as a method to achieve the medical purpose of data sharing. Besides, this research also provides an access control and key management mechanism by adopting Public key cryptography and Lagrange interpolation. The safety analysis of the system is based on a network attacker's perspective. The achievement of this study tries to improve the medical quality, prevent wasting medical resources and make medical resources access to appropriate configuration.

  10. Consultation of medical narratives in the electronic medical record.

    PubMed

    Tange, H J

    1999-12-01

    This article presents an overview of a research project concerning the consultation of medical narratives in the electronic medical record (EMR). It describes an analysis of user needs, the design and implementation of a prototype EMR system, and the evaluation of the ease of consultation of medical narratives when using this system. In a questionnaire survey, 85 hospital physicians judged the quality of their paper-based medical record with respect to data entry, information retrieval and some other aspects. Participants were more positive about the paper medical record than the literature suggests. They wished to maintain the flexibility of data entry but indicated the need to improve the retrieval of information. A prototype EMR system was developed to facilitate the consultation of medical narratives. These parts were divided into labeled segments that could be arranged source-oriented and problem-oriented. This system was used to evaluate the ease of information retrieval of 24 internists and 12 residents at a teaching hospital when using free-text medical narratives divided at different levels of detail. They solved, without time pressure, some predefined problems concerning three voluminous, inpatient case records. The participants were randomly allocated to a sequence that was balanced by patient case and learning effect. The division of medical narratives affected speed, but not completeness of information retrieval. Progress notes divided into problem-related segments could be consulted 22% faster than when undivided. Medical history and physical examination divided into segments at organ-system level could be consulted 13% faster than when divided into separate questions and observations. These differences were statistically significant. The fastest divisions were also appreciated as the best combination of easy searching and best insight in the patient case. The results of our evaluation study suggest a trade-off between searching and reading: too much

  11. Integration services to enable regional shared electronic health records.

    PubMed

    Oliveira, Ilídio C; Cunha, João P S

    2011-01-01

    eHealth is expected to integrate a comprehensive set of patient data sources into a coherent continuum, but implementations vary and Portugal is still lacking on electronic patient data sharing. In this work, we present a clinical information hub to aggregate multi-institution patient data and bridge the information silos. This integration platform enables a coherent object model, services-oriented applications development and a trust framework. It has been instantiated in the Rede Telemática de Saúde (www.RTSaude.org) to support a regional Electronic Health Record approach, fed dynamically from production systems at eight partner institutions, providing access to more than 11,000,000 care episodes, relating to over 350,000 citizens. The network has obtained the necessary clearance from the Portuguese data protection agency.

  12. Electronic medical records in clinical teaching.

    PubMed

    Warboys, Ina; Mok, Wai Yin; Frith, Karen H

    2014-01-01

    The purpose of the project was to provide students with experiences to develop their technology competency and examine student perceptions about an academic electronic medical record (EMR) as a learning tool. Nurse educators need to integrate EMRs into their curricula to give students practice in the use of electronic documentation and retrieval of clinical information. The findings of this study indicated that students' use of EMRs at least 5 times resulted in the development of positive perceptions about their EMR experience.

  13. Enhancing Practice Efficiency and Patient Care by Sharing Electronic Health Records.

    PubMed

    Keller, Megan E; Kelling, Sarah E; Cornelius, Douglas C; Oni, Hafusat A; Bright, David R

    2015-01-01

    One primary function of community pharmacies is to dispense medications to patients. In doing so, pharmacists frequently communicate with physicians' offices to clarify prescription orders and obtain additional information to ensure the safe and accurate dispensing of medications. Such communication is often done by telephone or fax, which is inefficient for both the pharmacy and the physician's office. This problem was highlighted in a recent American Medical Association resolution defining certain pharmacy inquiries as "interference with the practice of medicine and unwarranted." As a result, many are seeking to understand how to balance the needs of the patient care process with the need for operational efficiency in the physician's office and pharmacy. This study presents one example of a health information technology-based solution involving shared access to an electronic health record (EHR), and describes a case in which a physician's office and a community pharmacy experimented with this model to promote practice efficiency while also providing enhanced access to clinical information in both directions. The rationale behind the process change, a brief description of how the new process came into existence, and a description of how information sharing can be helpful in related clinical situations are provided. Similar models that involve sharing of EHRs may create valuable opportunities for collaboration between physicians and pharmacists to enhance patient care and improve workflow efficiency.

  14. Fighting Cancer Together: Development and Implementation of Shared Medical Appointments to Standardize and Improve Chemotherapy Education

    PubMed Central

    Prescott, Lauren S.; Dickens, Andrea S.; Guerra, Sandra L.; Tanha, Jila M.; Phillips, Desiree G.; Patel, Katherine T.; Umberson, Katie M.; Lozano, Miguel A.; Lowe, Kathryn B.; Brown, Alaina J.; Taylor, Jolyn S.; Soliman, Pamela T.; Garcia, Elizabeth A.; Levenback, Charles F.; Bodurka, Diane C.

    2015-01-01

    Objective Shared medical appointments offer a novel approach to improve efficiency and quality of care consistent with the goals of the Institute of Medicine. Our objective was to develop and implement a shared medical appointment for gynecologic cancer patients initiating chemotherapy. Methods We first assessed the level of interest in shared medical appointments among our patients and providers through qualitative interviews. Both patients and providers identified pre-chemotherapy as an optimal area to pilot shared medical appointments. We subsequently created a multidisciplinary team comprised of physicians, advanced practice providers, nurses, pharmacists, administrators, health education specialists and members of the Quality Improvement Department to establish a Shared Medical Appointment and Readiness Teaching (SMART) program for all gynecologic oncology patients initiating chemotherapy with platinum- and/or taxane-based regimens. We developed a standardized chemotherapy education presentation and provided patients with a tool kit that consisted of chemotherapy drug education, a guide to managing side effects, advance directives, and center contact information. Results From May 9, 2014 to June 26, 2015, 144 patients participated in 51 SMART visits. The majority of patients had ovarian cancer and were treated with carboplatin/paclitaxel. Surveyed patients reported being highly satisfied with the group visit and would recommend shared medical appointments to other patients. Conclusions This model of care provides patient education within a framework of social support that empowers patients. Shared medical appointments for oncology patients initiating chemotherapy are both feasible and well accepted. PMID:26549108

  15. Do Continuing Medical Education Articles Foster Shared Decision Making?

    ERIC Educational Resources Information Center

    Labrecque, Michel; Lafortune, Valerie; Lajeunesse, Judith; Lambert-Perrault, Anne-Marie; Manrique, Hermes; Blais, Johanne; Legare, France

    2010-01-01

    Introduction: Defined as reviews of clinical aspects of a specific health problem published in peer-reviewed and non-peer-reviewed medical journals, offered without charge, continuing medical education (CME) articles form a key strategy for translating knowledge into practice. This study assessed CME articles for mention of evidence-based…

  16. A web service for enabling medical image retrieval integrated into a social medical image sharing platform.

    PubMed

    Niinimäki, Marko; Zhou, Xin; de la Vega, Enrique; Cabrer, Miguel; Müller, Henning

    2010-01-01

    Content-based visual image access is in the process from a research domain towards real applications. So far, most image retrieval applications have been in one specialized domain such as lung CTs as diagnosis aid or for classification of general images based on anatomic region, modality, and view. This article describes the use of a content-based image retrieval system in connection with the medical image sharing platform MEDTING, so a data set with a very large variety. Similarity retrieval is possible for all cases of the social image sharing platform, so cases can be linked by either visual similarity or similarity in keywords. The visual retrieval search is based on the GIFT (GNU Image Finding Tool). The technology for updating the index with new images added by users employs RSS (Really Simple Syndication) feeds. The ARC (Advanced Resource Connector) middleware is used for the implementation of a web service for similarity retrieval, simplifying the integration of this service. Novelty of this article is the application/integration and image updating strategy. Retrieval methods themselves employ existing techniques that are all open source and can easily be reproduced.

  17. Intelligent consumer-centric electronic medical record.

    PubMed

    Luo, Gang; Thomas, Selena B; Tang, Chunqiang

    2009-01-01

    Web-based, consumer-centric electronic medical records (CEMRs) are currently undergoing widespread deployment. Existing CEMRs, however, have limited intelligence and cannot satisfy users' many needs. This paper proposes the concept of intelligent CEMR. We introduce and extend expert system and web search technology into the CEMR domain. The resulting intelligent CEMRs can automatically provide users with personalized healthcare information to facilitate their daily activities. We use automatic home medical product recommendation as a concrete application to demonstrate the benefits offered by intelligent CEMRs.

  18. Recent perspectives of electronic medical record systems

    PubMed Central

    ZHANG, XIAO-YING; ZHANG, PEIYING

    2016-01-01

    Implementation of electronic medical record (EMR) systems within developing contexts as part of efforts to monitor and facilitate the attainment of health-related aims has been on the increase. However, these efforts have been concentrated on urban hospitals. Recent findings showed that development processes of EMR systems are associated with various discrepancies between protocols and work practices. These discrepancies were mainly caused by factors including high workload, lack of medical resources, misunderstanding of the protocols by health workers, and client/patient practices. The present review focused on the effects of EMRs on patient care work, and on appropriate EMR designs principles and strategies to ameliorate these systems. PMID:27284289

  19. Implementation methods of medical image sharing for collaborative health care based on IHE XDS-I profile

    PubMed Central

    Zhang, Jianguo; Zhang, Kai; Yang, Yuanyuan; Sun, Jianyong; Ling, Tonghui; Wang, Mingqing; Bak, Peter

    2015-01-01

    Abstract. IHE XDS-I profile proposes an architecture model for cross-enterprise medical image sharing, but there are only a few clinical implementations reported. Here, we investigate three pilot studies based on the IHE XDS-I profile to see whether we can use this architecture as a foundation for image sharing solutions in a variety of health-care settings. The first pilot study was image sharing for cross-enterprise health care with federated integration, which was implemented in Huadong Hospital and Shanghai Sixth People’s Hospital within the Shanghai Shen-Kang Hospital Management Center; the second pilot study was XDS-I–based patient-controlled image sharing solution, which was implemented by the Radiological Society of North America (RSNA) team in the USA; and the third pilot study was collaborative imaging diagnosis with electronic health-care record integration in regional health care, which was implemented in two districts in Shanghai. In order to support these pilot studies, we designed and developed new image access methods, components, and data models such as RAD-69/WADO hybrid image retrieval, RSNA clearinghouse, and extension of metadata definitions in both the submission set and the cross-enterprise document sharing (XDS) registry. We identified several key issues that impact the implementation of XDS-I in practical applications, and conclude that the IHE XDS-I profile is a theoretically good architecture and a useful foundation for medical image sharing solutions across multiple regional health-care providers. PMID:26835497

  20. [Nurse's coworking to electronic medical record].

    PubMed

    Maresca, M; Gavaciuto, D; Cappelli, G

    2007-01-01

    Nephrologists need to register and look at a great number of clinical data. The use of electronic medical records may improve efficiency and reduce errors. Aim of our work is to report the experience of Villa Scassi Hospital in Genoa, where a "patient file" has been performed to improve nephrology practice management. The file contains all clinical records, laboratory and radiology data, therapy, dialysis clinics, in addition to reports of out-patients department. This system allowed a better efficiency in diagnosis and treatment of the patient. Moreover experience of nurses in employing electronic medical records is reported. A reduced number of errors was found in therapy administering, because of a only one data source for physicians and nurses.

  1. Medical electronics: A need and a challenge

    NASA Technical Reports Server (NTRS)

    Dimeoff, J.

    1973-01-01

    Space programs have led to the development of telemetry pills for diagnosis of diseases of the digestive tract, reusable X-ray image storage plates that require no chemical processing, and muscular augmentation systems for the handicapped. These examples, together with countless other examples of technological innovation that can be drawn from research and development programs supported by government funds, offer a potential opportunity to stimulate growth and to control rising costs in medical electronics.

  2. Asymmetric electron energy sharing in electron-impact double ionization of helium

    NASA Astrophysics Data System (ADS)

    Silenou Mengoue, M.; Tetchou Nganso, H. M.

    2016-12-01

    We present the fully fivefold differential cross sections (FDCSs) for (e ,3 e ) processes in helium within the first Born approximation. The calculation is performed for a coplanar geometry in which the incident electron is fast (˜6 keV), the momentum transfer is small (0.24 a.u.), and for an asymmetric energy sharing between both slow ejected electrons at excess energy of 20 eV. Two cases have been considered: E1=15 eV, E2=5 eV and E1=8 eV, E2=12 eV. While waiting for new theoretical and experimental results for confrontations, in particular for asymmetric energy sharing, our results clearly demonstrate that, for the same incident energy, the same momentum transfer and the same excess energy, the (e ,3 e ) process in helium with asymmetric energy sharing between ejected electrons is more likely than the case with symmetric energy sharing. The two- and three-dimensional representation of the FDCSs covering all possible values of the angle of ejections are presented and discussed. The theoretical cross sections are calculated by using a compact-kernel-integral-equation approach associated with the Jacobi matrix method to calculate a three-body wave function and which leads to a full convergence in terms of the basis size.

  3. [Electronic medical record--interface specifications with medical informatics systems].

    PubMed

    Mocanu, Carmen; Mocanu, Mihai

    2007-01-01

    The paper presents the initial efforts of description and implementation for a new scheme of electronic patients recording, based on distributed database for chronic ophthalmologic diseases. Structural specifications derived from principal system's goals are the implementation of an efficient and flexible way of patients' data administration, using actual Web technologies, permitting future extensions, without reducing in performances and without exponential cost increasing. A very important aspect, that must be take into consideration is their interfacing with other medical programs and systems, as the systems for recording clinical data, monitoring systems (Patient Administrations Systems - PAS) for demographical data, systems for monitoring of treatment (Hippocrates program), web systems, including wireless.

  4. Effects of Shared Electronic Health Record Systems on Drug-Drug Interaction and Duplication Warning Detection.

    PubMed

    Rinner, Christoph; Grossmann, Wilfried; Sauter, Simone Katja; Wolzt, Michael; Gall, Walter

    2015-01-01

    Shared electronic health records (EHRs) systems can offer a complete medication overview of the prescriptions of different health care providers. We use health claims data of more than 1 million Austrians in 2006 and 2007 with 27 million prescriptions to estimate the effect of shared EHR systems on drug-drug interaction (DDI) and duplication warnings detection and prevention. The Austria Codex and the ATC/DDD information were used as a knowledge base to detect possible DDIs. DDIs are categorized as severe, moderate, and minor interactions. In comparison to the current situation where only DDIs between drugs issued by a single health care provider can be checked, the number of warnings increases significantly if all drugs of a patient are checked: severe DDI warnings would be detected for 20% more persons, and the number of severe DDI warnings and duplication warnings would increase by 17%. We show that not only do shared EHR systems help to detect more patients with warnings but DDIs are also detected more frequently. Patient safety can be increased using shared EHR systems.

  5. Physical understanding through variational reasoning: electron sharing and covalent bonding.

    PubMed

    Ruedenberg, Klaus; Schmidt, Michael W

    2009-03-12

    Energy changes of stationary states resulting from geometric parameter changes in the Hamiltonian can be understood by variational reasoning in terms of the physical attributes of the kinetic and the potential energy functionals. In atoms as well as molecules, the energy minimization determines the ground state as the optimal compromise between the potential pull of the nuclear attractions and the localization-resisting kinetic pressure of the electron cloud. This variational competition is analyzed for the exact ab initio ground-state wave function of the hydrogen molecule ion to elucidate the formation of the bond. Its electronic wave function is shown to differ from the ground-state wave function of the hydrogen atom by polarization, sharing, and contraction, and the corresponding contributions to the binding energy are examined in detail. All told, the critical feature is that a molecular orbital, contracting (in the variational context) toward two nuclei simultaneously, can lower its potential energy while maintaining a certain degree of delocalization. As a consequence, its kinetic energy functional has a lower value than that of an orbital contracting toward a single nucleus equally closely. By contrast, the potential energy functional is lowered equally effectively whether the orbital contracts toward one nucleus or simultaneously toward two nuclei. Because of this weaker kinetic energy pressure, the electrostatic potential pull of the nuclei in the molecule is able to attach the orbital more tightly to each of the nuclei than the pull of the single nucleus in the atom is able to do. The role of the virial theorem is clarified. Generalizations to other molecules are discussed.

  6. Can or can not? Electronic information sharing influence the participation behavior of the employees

    NASA Astrophysics Data System (ADS)

    Mohammed, M. A.; Eman, Y.; Huda, I.; Thamer, A.

    2015-12-01

    Information sharing refers to information being shared between employees inside or outside an agency, or by providing accessibility of their information and data to other agencies so as to allow effective decision making. Electronic information sharing is a key to effective government. This study is conducted to investigate the factors of electronic information sharing that influence the participation behavior so as to augment it amongst the employees in public organizations. Eleven domains of factors that are considered in this study are benefits, risk, social network, Information stewardship, information quality, trust, privacy, reciprocity. The paper proposes electronic information sharing factors in public sector to increase the participation.

  7. Can or can not? Electronic information sharing influence the participation behavior of the employees

    SciTech Connect

    Mohammed, M. A. Eman, Y. Huda, I. Thamer, A.

    2015-12-11

    Information sharing refers to information being shared between employees inside or outside an agency, or by providing accessibility of their information and data to other agencies so as to allow effective decision making. Electronic information sharing is a key to effective government. This study is conducted to investigate the factors of electronic information sharing that influence the participation behavior so as to augment it amongst the employees in public organizations. Eleven domains of factors that are considered in this study are benefits, risk, social network, Information stewardship, information quality, trust, privacy, reciprocity. The paper proposes electronic information sharing factors in public sector to increase the participation.

  8. Sharing and selling of prescription medications in a college student sample

    PubMed Central

    Garnier, Laura M.; Arria, Amelia M.; Caldeira, Kimberly M.; Vincent, Kathryn B.; O’Grady, Kevin E.; Wish, Eric D.

    2009-01-01

    Objectives To estimate the prevalence of prescription medication diversion among college students; to compare classes of medications with respect to the likelihood of diversion; to document the most common methods of diversion; and to examine the characteristics of students who diverted medications. Method A cross-sectional analysis of personal interview data collected between August 2006 and August 2007 as part of an ongoing longitudinal study. The cohort of students, who were between the ages 17 and 19 at study onset, attended a large public university in the mid-Atlantic region. Information was gathered regarding a wide variety of variables, including demographics, diversion of medically prescribed drugs, illicit drug use, and childhood conduct problems. Results Among 483 students prescribed a medication, 35.8% diverted a medication at least once in their lifetime. The most commonly diverted medication classes were prescription ADHD medication, with a 61.7% diversion rate, and prescription analgesics (35.1% diversion rate). Sharing was the most common method of diversion, with 33.6% of students sharing their medication(s) and 9.3% selling in their lifetime. Comparative analyses revealed that prescription medication diverters had used more illicit drugs in the past year and had more childhood conduct problems than non-diverters. Conclusions If confirmed, these findings have important clinical implications for improved physician-patient communication and vigilance regarding prescribing analgesic and stimulant medications for young adults. PMID:20331930

  9. The electronic medical office: optimizing solutions.

    PubMed

    Kirschenbaum, Ira H; Mabrey, Jay D; Wood, George W; Alexander, A Herbert; Rhoades, Charles E; Alexander, Ian J; Golladay, Gregory J; Wheeless, Clifford

    2008-01-01

    Optimizing the care for patients in the orthopaedic clinical setting involves a wide range of issues. Surgical techniques, preoperative and postoperative care, long-term outcomes follow-up, continuing education, and patient communication are a few of the important areas that surgeons deal with on a regular basis. Successful management of this information has an impact on clinical outcomes, direct patient care, financial decisions, and management of the surgeon's time. The development of a comprehensive electronic medical office is a powerful and probably necessary tool to successfully manage such information and achieve the goals of an effective and safe orthopaedic practice.

  10. Neutron yield of medical electron accelerators

    SciTech Connect

    McCall, R.C.

    1987-11-01

    Shielding calculations for medical electron accelerators above about 10 MeV require some knowledge of the neutron emission from the machine. This knowledge might come from the manufacturer's specifications or from published measurements of the neutron leakage of that particular model and energy of accelerator. In principle, the yield can be calculated if details of the accelerator design are known. These details are often not available because the manufacturer considers them proprietary. A broader knowledge of neutron emission would be useful and it is the purpose of this paper to present such information. 5 refs., 1 tab.

  11. Developing a framework to support shared decision making for youth mental health medication treatment.

    PubMed

    Crickard, Elizabeth L; O'Brien, Megan S; Rapp, Charles A; Holmes, Cheryl L

    2010-10-01

    Medical shared decision making has demonstrated success in increasing collaboration between clients and practitioners for various health decisions. As the importance of a shared decision making approach becomes increasingly valued in the adult mental health arena, transfer of these ideals to youth and families of youth in the mental health system is a logical next step. A review of the literature and preliminary, formative feedback from families and staff at a Midwestern urban community mental health center guided the development of a framework for youth shared decision making. The framework includes three functional areas (1) setting the stage for youth shared decision making, (2) facilitating youth shared decision making, and (3) supporting youth shared decision making. While still in the formative stages, the value of a specific framework for a youth model in support of moving from a client-practitioner value system to a systematic, intentional process is evident.

  12. SmartWADO: an Extensible WADO Middleware for Regional Medical Image Sharing.

    PubMed

    Liu, Lijun; Liu, Li; Fu, Xiaodong; Huang, Qingsong; Zhang, Yin; Luo, Qiaoyi; Xiong, Xin

    2015-10-01

    Medical image sharing is an important problem in modern radiology, with wide applications in Internet and mobile devices. Some important features need to be added and optimized to medical image sharing. In this paper, we present an extensible Web Access to DICOM Persistent Objects (WADO) middleware based on image cache and real-time Web monitor technology for regional medical image sharing. We first develop the extension method of WADO standard and workflow of extended WADO service. Then, we design a medical image cache method to improve the performance of medical image on-demand transmission. Using the real-time monitor can discover the performance bottlenecks and optimized critical points. The experimental results show that the middleware effectively delivers medical images and reports to Web clients over the Internet, regardless of the platform used for access. It can be deployed in one hospital to provide WADO service to medical workers and also can be applied to regional picture archiving and communication systems (PACS) to transmit medical images and reports to Internet users in a way that is transparent to end-user applications.

  13. A Model to Support Shared Decision Making in Electronic Health Records Systems

    PubMed Central

    Lenert, Leslie; Dunlea, Robert; Del Fio, Guilherme; KellyHall, Leslie

    2014-01-01

    Shared Decision Making (SDM) is an approach to medical care based on collaboration between provider and patient with both sharing in medical decisions. When patients’ values and preferences are incorporated in decision-making, then care is more appropriate, ethically sound, and often lower in cost. However, SDM is difficult to implement in routine practice because of the time required for SDM methods, the lack of integration of SDM approaches into electronic health records systems (EHRs), and absence of explanatory mechanisms for providers on the results of patients’ use of decision aids. This paper discusses potential solutions including the concept of a “Personalize Button” for EHRs. Leveraging a four-phased clinical model for SDM, this article describes how computer decision support (CDS) technologies integrated into EHRs can help insure that healthcare is delivered in a way that is respectful of those preferences. The architecture described herein, called CDS for SDM, is built upon recognized standards that are currently integrated into certification requirements for EHRs as part of Meaningful Use regulations. While additional work is needed on modeling of preferences and on techniques for rapid communication models of preferences to clinicians, unless EHRs are re-designed to support SDM around and during clinical encounters, they are likely to continue to be an unintended barrier to SDM. With appropriate development, EHRs could be a powerful tool to promote SDM by reminding providers of situations for SDM and monitoring on going care to insure treatments are consistent with patients’ preferences. PMID:25224366

  14. Electron-nuclear energy sharing in above-threshold multiphoton dissociative ionization of H2.

    PubMed

    Wu, J; Kunitski, M; Pitzer, M; Trinter, F; Schmidt, L Ph H; Jahnke, T; Magrakvelidze, M; Madsen, C B; Madsen, L B; Thumm, U; Dörner, R

    2013-07-12

    We report experimental observation of the energy sharing between electron and nuclei in above-threshold multiphoton dissociative ionization of H2 by strong laser fields. The absorbed photon energy is shared between the ejected electron and nuclei in a correlated fashion, resulting in multiple diagonal lines in their joint energy spectrum governed by the energy conservation of all fragment particles.

  15. mEducator: A Best Practice Network for Repurposing and Sharing Medical Educational Multi-type Content

    NASA Astrophysics Data System (ADS)

    Bamidis, Panagiotis D.; Kaldoudi, Eleni; Pattichis, Costas

    Although there is an abundance of medical educational content available in individual EU academic institutions, this is not widely available or easy to discover and retrieve, due to lack of standardized content sharing mechanisms. The mEducator EU project will face this lack by implementing and experimenting between two different sharing mechanisms, namely, one based one mashup technologies, and one based on semantic web services. In addition, the mEducator best practice network will critically evaluate existing standards and reference models in the field of e-learning in order to enable specialized state-of-the-art medical educational content to be discovered, retrieved, shared, repurposed and re-used across European higher academic institutions. Educational content included in mEducator covers and represents the whole range of medical educational content, from traditional instructional teaching to active learning and experiential teaching/studying approaches. It spans the whole range of types, from text to exam sheets, algorithms, teaching files, computer programs (simulators or games) and interactive objects (like virtual patients and electronically traced anatomies), while it covers a variety of topics. In this paper, apart from introducing the relevant project concepts and strategies, emphasis is also placed on the notion of (dynamic) user-generated content, its advantages and peculiarities, as well as, gaps in current research and technology practice upon its embedding into existing standards.

  16. Collaborative work and medical talk: opportunities for learning through knowledge sharing.

    PubMed

    Nilsen, Line Lundvoll; Ludvigsen, Sten R

    2010-01-01

    Teleconsultations provide new opportunities for learning in medical settings. This study explores the conditions under which learning among physicians takes place. The empirical context is 47 real-time video conferences carried out to examine collaborative work and the medical talk involved. Sixteen of the observations were consultations wherein general practitioners (GPs) and specialists shared knowledge with the purpose of solving a medical problem related to a patient under treatment. In this exploratory study, the learning opportunities are seen as what medical practitioners with different types of expertise achieve through interaction while working with patients over periods of time. The analysis of medical talk in consultations shows that collaborative work among GPs and specialists creates a shared understanding of the patient's clinical history and treatment trajectory. As knowledge is demanded and attributed and gaps of knowledge become shared, consultations create a work tool that expands the medical work and talk. Collaborative work in and between different levels of the health care service expands knowledge, creates opportunities for learning in everyday settings, and improves the quality of knowledge distribution in the health care system.

  17. Adapting electronic adherence monitors to standard packages of topical medications.

    PubMed

    Tusa, Mark G; Ladd, Mitchell; Kaur, Mandeep; Balkrishnan, Rajesh; Feldman, Steven R

    2006-11-01

    Adherence to topical medications is poorly characterized. Electronic monitors can provide objective adherence data, but these monitors are not designed to work with tubes of medications. We sought to adapt standard electronic monitors to commonly used medication tubes. An adapter was created to fit over standard medication tubes. Screw threads on the adapter were designed to fit standard electronic monitors. Adapters and monitors were tested with tubes of gel, ointment, and cream over an 8-week test period during which the adapters were opened and closed twice daily. The adapters were easily mated to both plastic and aluminum topical medication tubes. The bond between the adapter and the tube was maintained throughout the study. Electronic monitors were 100% accurate at identifying medication events over the study period. We conclude that adapting existing electronic monitors to medication tubes should facilitate a much better understanding of adherence to topical treatment.

  18. Sharing Medical Data for Health Research: The Early Personal Health Record Experience

    PubMed Central

    Kaci, Liljana; Mandl, Kenneth D

    2010-01-01

    Background Engaging consumers in sharing information from personally controlled health records (PCHRs) for health research may promote goals of improving care and advancing public health consistent with the federal Health Information Technology for Economic and Clinical Health (HITECH) Act. Understanding consumer willingness to share data is critical to advancing this model. Objective The objective was to characterize consumer willingness to share PCHR data for health research and the conditions and contexts bearing on willingness to share. Methods A mixed method approach integrating survey and narrative data was used. Survey data were collected about attitudes toward sharing PCHR information for health research from early adopters (n = 151) of a live PCHR populated with medical records and self-reported behavioral and social data. Data were analyzed using descriptive statistics and logistic regression to characterize willingness, conditions for sharing, and variations by sociodemographic factors. Narrative data were collected through semistructured focus group and one-on-one interviews with a separate sample of community members (n = 30) following exposure to PCHR demonstrations. Two independent analysts coded narrative data for major and minor themes using a shared rubric of a priori defined codes and an iterative inductive process. Findings were triangulated with survey results to identify patterns. Results Of PHCR users, 138 out of 151 (91%) were willing to share medical information for health research with 89 (59%) favoring an opt-in sharing model. Willingness to share was conditioned by anonymity, research use, engagement with a trusted intermediary, transparency around PCHR access and use, and payment. Consumer-determined restrictions on content and timing of sharing may be prerequisites to sharing. Select differences in support for sharing under different conditions were observed across social groups. No gender differences were observed; however differences

  19. How to conduct a workshop on medical writing: Tips, advice and experience sharing.

    PubMed

    Rathore, Farooq Azam; Mansoor, Sahibzada Nasir

    2015-06-01

    Medical writing has become an essential skill for anybody in academia and engaged in teaching. Workshops on medical writing are an effective way to teach the essential skills of medical writing to students and faculty members. There is a huge demand for these workshops all around the globe. Usually there is no curriculum of medical writing for the undergraduates or dedicated structured training sessions for the faculty members. One of the authors won an Author AID grant to conduct a series of workshops on medical writing. Eight workshops were conducted in three months, benefitting more than 200 students and faculty staff. We share our experience of holding this successful series of workshops with the aim that it might serve as a guide for researchers and faculty members who are eager to share and transfer their skills and knowledge. We also offer lessons learnt during this educational activity, tips to improve the quality and delivery of the content with limited resources and maximizing the impact. Experienced medical writers need to conduct these workshops to transfer their skills and to facilitate their colleagues and students to become better medical writers. Planning, rehearsal, motivation, resource management, good team work, audience analysis and feedback can make a workshop successful. Well prepared workshop content delivered in an interactive way with a variety of activities makes the workshop an engaging and interesting educational activity.

  20. Electronic business in the home medical equipment industry.

    PubMed

    Wei, June; Graham, Michael J; Liu, Lai C

    2011-01-01

    This paper aims at developing electronic business solutions to increase value for the home medical equipment industry. First, an electronic strategic value chain model was developed for the home medical equipment industry. Second, electronic business solutions were mapped from this model. Third, the top 20 dominant companies in the home medical equipment industry were investigated to see the current adoption patterns of these electronic business solutions. The solutions will be beneficial to decision-makers in the information technology adoptions in the home medical equipment industry to increase the business values.

  1. [Design and Implementation of a Mobile Operating Room Information Management System Based on Electronic Medical Record].

    PubMed

    Liu, Baozhen; Liu, Zhiguo; Wang, Xianwen

    2015-06-01

    A mobile operating room information management system with electronic medical record (EMR) is designed to improve work efficiency and to enhance the patient information sharing. In the operating room, this system acquires the information from various medical devices through the Client/Server (C/S) pattern, and automatically generates XML-based EMR. Outside the operating room, this system provides information access service by using the Browser/Server (B/S) pattern. Software test shows that this system can correctly collect medical information from equipment and clearly display the real-time waveform. By achieving surgery records with higher quality and sharing the information among mobile medical units, this system can effectively reduce doctors' workload and promote the information construction of the field hospital.

  2. Gauging the feasibility of cost-sharing and medical student interest groups to reduce interview costs.

    PubMed

    Lieber, Bryan A; Wilson, Taylor A; Bell, Randy S; Ashley, William W; Barrow, Daniel L; Wolfe, Stacey Quintero

    2014-11-01

    Indirect costs of the interview tour can be prohibitive. The authors sought to assess the desire of interviewees to mitigate these costs through ideas such as sharing hotel rooms and transportation, willingness to stay with local students, and the preferred modality to coordinate this collaboration. A survey link was posted on the Uncle Harvey website and the Facebook profile page of fourth-year medical students from 6 different medical schools shortly after the 2014 match day. There were a total of 156 respondents to the survey. The majority of the respondents were postinterview medical students (65.4%), but preinterview medical students (28.2%) and current residents (6.4%) also responded to the survey. Most respondents were pursuing a field other than neurosurgery (75.0%) and expressed a desire to share a hotel room and/or transportation (77.4%) as well as stay in the dorm room of a medical student at the program in which they are interviewing (70.0%). Students going into neurosurgery were significantly more likely to be interested in sharing hotel/transportation (89.2% neurosurgery vs 72.8% nonneurosurgery; p = 0.040) and in staying in the dorm room of a local student when on interviews (85.0% neurosurgery vs 57.1% nonneurosurgery; p = 0.040) than those going into other specialties. Among postinterview students, communication was preferred to be by private, email identification-only chat room. Given neurosurgery resident candidates' interest in collaborating to reduce interview costs, consideration should be given to creating a system that could allow students to coordinate cost sharing between interviewees. Moreover, interviewees should be connected to local students from neurosurgery interest groups as a resource.

  3. Proposal for a European Public Health Research Infrastructure for Sharing of health and Medical administrative data (PHRIMA).

    PubMed

    Burgun, Anita; Oksen, Dina V; Kuchinke, Wolfgang; Prokosch, Hans-Ulrich; Ganslandt, Thomas; Buchan, Iain; van Staa, Tjeerd; Cunningham, James; Gjerstorff, Marianne L; Dufour, Jean-Charles; Gibrat, Jean-Francois; Nikolski, Macha; Verger, Pierre; Cambon-Thomsen, Anne; Masella, Cristina; Lettieri, Emanuele; Bertele, Paolo; Salokannel, Marjut; Thiebaut, Rodolphe; Persoz, Charles; Chêne, Geneviève; Ohmann, Christian

    2015-01-01

    In Europe, health and medical administrative data is increasingly accumulating on a national level. Looking further than re-use of this data on a national level, sharing health and medical administrative data would enable large-scale analyses and European-level public health projects. There is currently no research infrastructure for this type of sharing. The PHRIMA consortium proposes to realise the Public Health Research Infrastructure for Sharing of health and Medical Administrative data (PHRIMA) which will enable and facilitate the efficient and secure sharing of healthcare data.

  4. Technology Acceptance of Electronic Medical Records by Nurses

    ERIC Educational Resources Information Center

    Stocker, Gary

    2010-01-01

    The purpose of this study was to evaluate the Technology Acceptance Model's (TAM) relevance of the intention of nurses to use electronic medical records in acute health care settings. The basic technology acceptance research of Davis (1989) was applied to the specific technology tool of electronic medical records (EMR) in a specific setting…

  5. The annual wellness visit shared medical appointment: innovative delivery of preventive care to the elderly.

    PubMed

    Kainkaryam, Vasanth

    2013-01-01

    The Hartford HealthCare Medical Group instituted 3 types of shared medical appointments (SMAs) in 2013, one being for the Medicare Annual Wellness Visit (AWV). While traditionally there have been 2 types of SMAs-either a chronic disease follow-up model or an annual physical examination model, the SMA AWV offers a preventive care focus in a dedicated visit for the elderly population, without co-pays and without logistics of conducting a physical examination. This article reviews the benefits and challenges of SMAs, including those specific to conducting the AWV, as well as the overall patient experience with the AWV SMA.

  6. Implementation of an Electronic Medical Records System

    DTIC Science & Technology

    2008-05-07

    their patients and their previous medical history. Capitalizing on progress made in the informational technology realm, which include more...example, medication and allergy list, problem list and past medical and family/ social history); • Building the descriptive tags for a lab or radiology...clinical trials. Arch Fam Med. 1996; 5: 271-278. 14. Mitchell E, Sullivan F. A descriptive feast but an evaluative famine: systematic review of

  7. Variation of the Occupancy of Two Medical Units with the Amount of Sharing Between the Units

    PubMed Central

    Parker, Rodger D.

    1968-01-01

    Prediction of gain in occupancy and reduction of overflow effected by sharing beds between two previously disjoint medical units is related to the number of beds in each unit and to a variable number of beds that each unit makes available to the other when not in use. The methodology, here applied to two wards at the Johns Hopkins Hospital, is applicable wherever it is desired to estimate the effect of making beds interchangeable between wards or services. PMID:5701983

  8. Integrated secure solution for electronic healthcare records sharing

    NASA Astrophysics Data System (ADS)

    Yao, Yehong; Zhang, Chenghao; Sun, Jianyong; Jin, Jin; Zhang, Jianguo

    2007-03-01

    The EHR is a secure, real-time, point-of-care, patient-centric information resource for healthcare providers. Many countries and regional districts have set long-term goals to build EHRs, and most of EHRs are usually built based on the integration of different information systems with different information models and platforms. A number of hospitals in Shanghai are also piloting the development of an EHR solution based on IHE XDS/XDS-I profiles with a service-oriented architecture (SOA). The first phase of the project targets the Diagnostic Imaging domain and allows seamless sharing of images and reports across the multiple hospitals. To develop EHRs for regional coordinated healthcare, some factors should be considered in designing architecture, one of which is security issue. In this paper, we present some approaches and policies to improve and strengthen the security among the different hospitals' nodes, which are compliant with the security requirements defined by IHE IT Infrastructure (ITI) Technical Framework. Our security solution includes four components: Time Sync System (TSS), Digital Signature Manage System (DSMS), Data Exchange Control Component (DECC) and Single Sign-On (SSO) System. We give a design method and implementation strategy of these security components, and then evaluate the performance and overheads of the security services or features by integrating the security components into an image-based EHR system.

  9. Shared decision-making in medical encounters regarding breast cancer treatment: the contribution of methodological triangulation.

    PubMed

    Durif-Bruckert, C; Roux, P; Morelle, M; Mignotte, H; Faure, C; Moumjid-Ferdjaoui, N

    2015-07-01

    The aim of this study on shared decision-making in the doctor-patient encounter about surgical treatment for early-stage breast cancer, conducted in a regional cancer centre in France, was to further the understanding of patient perceptions on shared decision-making. The study used methodological triangulation to collect data (both quantitative and qualitative) about patient preferences in the context of a clinical consultation in which surgeons followed a shared decision-making protocol. Data were analysed from a multi-disciplinary research perspective (social psychology and health economics). The triangulated data collection methods were questionnaires (n = 132), longitudinal interviews (n = 47) and observations of consultations (n = 26). Methodological triangulation revealed levels of divergence and complementarity between qualitative and quantitative results that suggest new perspectives on the three inter-related notions of decision-making, participation and information. Patients' responses revealed important differences between shared decision-making and participation per se. The authors note that subjecting patients to a normative behavioural model of shared decision-making in an era when paradigms of medical authority are shifting may undermine the patient's quest for what he or she believes is a more important right: a guarantee of the best care available.

  10. Electron sharing and anion-π recognition in molecular triangular prisms.

    PubMed

    Schneebeli, Severin T; Frasconi, Marco; Liu, Zhichang; Wu, Yilei; Gardner, Daniel M; Strutt, Nathan L; Cheng, Chuyang; Carmieli, Raanan; Wasielewski, Michael R; Stoddart, J Fraser

    2013-12-02

    Stacking on a full belly: Triangular molecular prisms display electron sharing among their triangularly arranged naphthalenediimide (NDI) redox centers. Their electron-deficient cavities encapsulate linear triiodide anions, leading to the formation of supramolecular helices in the solid state. Chirality transfer is observed from the six chiral centers of the filled prisms to the single-handed helices.

  11. Shared responsibility for electronic records: governance in perinatal data entry.

    PubMed

    Craswell, Alison; Moxham, Lorna; Broadbent, Marc

    2014-01-01

    This paper presents research undertaken as part of a larger research project to examine the factors that influence midwives when entering perinatal data. A grounded theory methodology was used to undertake qualitative interviews with 15 participants from 12 different hospitals across Queensland, Australia using three different systems for perinatal data collection. The findings surrounding accountability are presented revealing that a shift in governance relating to responsibility and accountability is not occurring in midwifery units across Queensland. Without assignation of responsibility for entries and accountability for mistakes or omissions, perinatal data records can be left incomplete or inaccurate. Increasing use of electronic health records and creation of digital hospitals indicates these issues are highly relevant in planning for these services.

  12. [Sharing information of urological cancer patient in terminal stage using Cybozulive® for home medical care].

    PubMed

    Yumura, Yasushi; Hattori, Yusuke; Gobara, Ayako; Takamoto, Daiji; Yasuda, Kengo; Nakamura, Masafumi; Noguchi, Kazumi; Asahina, Kan; Kamijo, Takeo

    2014-09-01

    It is very important to share patient information because home patient care involves several different specialties of care. We introduced Cybozulive ® , a cloud-based free groupware, for 14 terminal-stage patients with urological cancer to share information among doctors and co-medical staff. This system enables access to patient information regardless of time and place. Of the 14 patients (mean age 74.4 years), 11 died of cancer. The average period in which Cybozulive® was used for the patients was 210 days. The average number of entries to the electronic bulletin board in this period was 88.4. We were able to obtain more information about the patients from the website. There was no difference in the average number of times that the patient consulted the out patient clinic before and after the introduction of Cybozulive® (before 7.0 ; after 6.3). After introduction of this system, eleven patients were hospitalized in our department 21 times. Eighteen of these 21 times, since we had acquired patient information from the website beforehand, there was a quick response for management of the emergency admission. This system could be used to construct a network for home care and may be helpful for sharing patient information in homecare.

  13. Predictors of Difficulty in Medication Intake in Europe: a Cross-country Analysis Based on SHARE.

    PubMed

    Figueiredo, Daniela; Teixeira, Laetitia; Poveda, Veronica; Paúl, Constança; Santos-Silva, Alice; Costa, Elísio

    2016-05-01

    The aim of this study is to evaluate the prevalence and the predictors of difficulty in medication intake across Europe, using a cross-sectional design. We used data from all participants in the wave 4 of the SHARE (Survey of Health, Ageing, and Retirement in Europe) database, which is a cross national European survey. The difficulty in take medication was evaluated using an item from the "Limitations with activities of daily living". Clinical and sociodemographic variables were evaluated as potential predictors. A total of 58 124 individual have been included in this work (mean age=64.9 ± 10.4 years; 43.3% male). The rate of difficulty in taking medication across the 16 European evaluated countries was 2.1%, presenting Spain the highest rate (5.7%) and Switzerland the lowest (0.6%). Increasing age, physical inactivity, physical limitations (mobility, arms function and fine motor limitations, and difficulties in picking up a small coin from a table), a poor sense of meaning in life, and losses in memory and concentration are independent and significant variables associated with difficulty in medication intake across Europe. Predictors of difficulties in medication intake are multicausal, including factors related to physical, cognitive and psychological conditions. Interventions aiming to optimize adherence to medication, particularly in elderly population, need to consider this diversity of determinants.

  14. Predictors of Difficulty in Medication Intake in Europe: a Cross-country Analysis Based on SHARE

    PubMed Central

    Figueiredo, Daniela; Teixeira, Laetitia; Poveda, Veronica; Paúl, Constança; Santos-Silva, Alice; Costa, Elísio

    2016-01-01

    The aim of this study is to evaluate the prevalence and the predictors of difficulty in medication intake across Europe, using a cross-sectional design. We used data from all participants in the wave 4 of the SHARE (Survey of Health, Ageing, and Retirement in Europe) database, which is a cross national European survey. The difficulty in take medication was evaluated using an item from the “Limitations with activities of daily living”. Clinical and sociodemographic variables were evaluated as potential predictors. A total of 58 124 individual have been included in this work (mean age=64.9 ± 10.4 years; 43.3% male). The rate of difficulty in taking medication across the 16 European evaluated countries was 2.1%, presenting Spain the highest rate (5.7%) and Switzerland the lowest (0.6%). Increasing age, physical inactivity, physical limitations (mobility, arms function and fine motor limitations, and difficulties in picking up a small coin from a table), a poor sense of meaning in life, and losses in memory and concentration are independent and significant variables associated with difficulty in medication intake across Europe. Predictors of difficulties in medication intake are multicausal, including factors related to physical, cognitive and psychological conditions. Interventions aiming to optimize adherence to medication, particularly in elderly population, need to consider this diversity of determinants. PMID:27330839

  15. Risk perception about medication sharing among patients: a focus group qualitative study on borrowing and lending of prescription analgesics

    PubMed Central

    Markotic, Filipa; Vrdoljak, Davorka; Puljiz, Marijana; Puljak, Livia

    2017-01-01

    Background One form of self-medication is sharing of medications, defined as borrowing or lending medications in situations where the receiver of these drugs is not the individual to whom the medications were allocated. Objective To explore experiences and opinions of patients about sharing prescription analgesics, reasons for sharing prescription analgesics, the way in which patients choose to share those medications, their awareness of risk regarding sharing prescription analgesics, and how they estimated the potential risk. Methods This qualitative study was conducted by focus group discussions with 40 participants led by a moderator trained in focus group methodology using a semi-structured moderator guide. Adults aged ≥18 years who had received a prescription for an analgesic at least once in a lifetime were included. Six separate focus groups were conducted to discuss participants’ perception of risks associated with sharing of prescription analgesics among patients. Additionally, participants filled out two questionnaires on demographic data, their own behavior regarding sharing analgesics, and their attitudes about risks associated with sharing prescription analgesics. Results In a questionnaire, 55% of the participants indicated that they personally shared prescription analgesics, while subsequently in the focus group discussions, 76% confessed to such behavior. Participants recognized certain risks related to sharing of prescription analgesics, mentioned a number of reasons for engaging in such behavior, and indicated certain positive aspects of such behavior. Forty-five percent of the participants indicated that sharing prescription analgesics is riskier than sharing nonprescription analgesics. Conclusion There is a prevalent attitude among participants that sharing prescription analgesics is a positive behavior, where potential benefits outweigh risks. PMID:28243140

  16. Electronic Medical Records and Their Impact on Resident and Medical Student Education

    ERIC Educational Resources Information Center

    Keenan, Craig R.; Nguyen, Hien H.; Srinivasan, Malathi

    2006-01-01

    Objective: Electronic medical records (EMRs) are becoming prevalent and integral tools for residents and medical students. EMRs can integrate point-of-service information delivery within the context of patient care. Though it may be an educational tool, little is known about how EMR technology is currently used for medical learners. Method: The…

  17. Development of Mobile Platform Integrated with Existing Electronic Medical Records

    PubMed Central

    Kim, YoungAh; Kang, Simon; Kim, Kyungduk; Kim, Jun

    2014-01-01

    Objectives This paper describes a mobile Electronic Medical Record (EMR) platform designed to manage and utilize the existing EMR and mobile application with optimized resources. Methods We structured the mEMR to reuse services of retrieval and storage in mobile app environments that have already proven to have no problem working with EMRs. A new mobile architecture-based mobile solution was developed in four steps: the construction of a server and its architecture; screen layout and storyboard making; screen user interface design and development; and a pilot test and step-by-step deployment. This mobile architecture consists of two parts, the server-side area and the client-side area. In the server-side area, it performs the roles of service management for EMR and documents and for information exchange. Furthermore, it performs menu allocation depending on user permission and automatic clinical document architecture document conversion. Results Currently, Severance Hospital operates an iOS-compatible mobile solution based on this mobile architecture and provides stable service without additional resources, dealing with dynamic changes of EMR templates. Conclusions The proposed mobile solution should go hand in hand with the existing EMR system, and it can be a cost-effective solution if a quality EMR system is operated steadily with this solution. Thus, we expect this example to be shared with hospitals that currently plan to deploy mobile solutions. PMID:25152837

  18. Toward secure distribution of electronic health records: quantitative feasibility study on secure E-mail systems for sharing patient records.

    PubMed

    Gomi, Yuichiro; Nogawa, Hiroki; Tanaka, Hiroshi

    2005-12-01

    If the quality and efficiency of medical services are to be ensured, electronic health records (EHR) and EHR-supporting infrastructure must be prevalent. Many hospitals, however, have EHR systems for their internal use only, and the standardization process for the exchange of medical information is still in process. This standardization process addresses information security and is considering public key infrastructure (PKI) as one security measure, but PKI is rarely used by medical practioners because of its poor user-friendliness. Here we propose an effective use of the identity-based encryption (IBE) system as a security measure. This system enables us to send encrypted and signed messages without requiring the receiver to get a public key, and it enables us to deliver secured messages to ambiguous receivers like those to whom letters of reference are sent. We evaluated the feasibility of this technology by using the analytic hierarchy process, which is an effective analysis tool when selection and judgment depend on nonquantitative psychological factors, to analyze the results of an experiment in which medical workers used E-mail agents with and without PKI and IBE. We found that medical practioners and researchers avoid using PKI because of its poor user-friendliness and instead use IBE even though it is harder to install. We therefore think IBE would encourage medical institutions to share patient records.

  19. Navigating the Decision Space: Shared Medical Decision Making as Distributed Cognition.

    PubMed

    Lippa, Katherine D; Feufel, Markus A; Robinson, F Eric; Shalin, Valerie L

    2016-08-23

    Despite increasing prominence, little is known about the cognitive processes underlying shared decision making. To investigate these processes, we conceptualize shared decision making as a form of distributed cognition. We introduce a Decision Space Model to identify physical and social influences on decision making. Using field observations and interviews, we demonstrate that patients and physicians in both acute and chronic care consider these influences when identifying the need for a decision, searching for decision parameters, making actionable decisions Based on the distribution of access to information and actions, we then identify four related patterns: physician dominated; physician-defined, patient-made; patient-defined, physician-made; and patient-dominated decisions. Results suggests that (a) decision making is necessarily distributed between physicians and patients, (b) differential access to information and action over time requires participants to transform a distributed task into a shared decision, and (c) adverse outcomes may result from failures to integrate physician and patient reasoning. Our analysis unifies disparate findings in the medical decision-making literature and has implications for improving care and medical training.

  20. Truthful Channel Sharing for Self Coexistence of Overlapping Medical Body Area Networks

    PubMed Central

    Dutkiewicz, Eryk; Zheng, Guanglou

    2016-01-01

    As defined by IEEE 802.15.6 standard, channel sharing is a potential method to coordinate inter-network interference among Medical Body Area Networks (MBANs) that are close to one another. However, channel sharing opens up new vulnerabilities as selfish MBANs may manipulate their online channel requests to gain unfair advantage over others. In this paper, we address this issue by proposing a truthful online channel sharing algorithm and a companion protocol that allocates channel efficiently and truthfully by punishing MBANs for misreporting their channel request parameters such as time, duration and bid for the channel. We first present an online channel sharing scheme for unit-length channel requests and prove that it is truthful. We then generalize our model to settings with variable-length channel requests, where we propose a critical value based channel pricing and preemption scheme. A bid adjustment procedure prevents unbeneficial preemption by artificially raising the ongoing winner’s bid controlled by a penalty factor λ. Our scheme can efficiently detect selfish behaviors by monitoring a trust parameter α of each MBAN and punish MBANs from cheating by suspending their requests. Our extensive simulation results show our scheme can achieve a total profit that is more than 85% of the offline optimum method in the typical MBAN settings. PMID:26844888

  1. Instruments for evaluating shared medical decision making: a structured literature review.

    PubMed

    Dy, Sydney Morss

    2007-12-01

    The author conducted a structured literature review of instruments for evaluating shared medical decision making. She included relevant instruments that were generalizable beyond specific situations and had been formally evaluated and organized them by domains of values or preferences, information and communication in decision making, and other aspects of decision making. For values or preferences, the author identified 11 instruments, mostly on preferences for roles and information. For information and communication, she found a systematic review of instruments for observational assessment of decision making, 3 additional observational instruments, and 3 questionnaires. For other aspects of decision making, the author identified 3 instruments in domains such as decision self-efficacy and 4 multidimensional instruments. Although instrument development tended to cluster in several areas and there were clear gaps in the literature, the diversity of instruments demonstrates the broad range of constructs involved in assessing shared decision making.

  2. Medical Applications of Remote Electronic Browsing.

    ERIC Educational Resources Information Center

    Chadwick, Joseph

    The purposes of this study are to identify and define viable remote browsing techniques and the requirements for an interactive medical information system that would permit the use of such techniques. The main emphasis is in the areas of: (1) remote viewing of page material; and (2) remote interrogation of fact banks with question-answering…

  3. Shared learning in medical science education in the Islamic Republic of Iran: an investigation.

    PubMed

    Irajpour, Alireza; Barr, Hugh; Abedi, Heidarali; Salehi, Shayesteh; Changiz, Tahereh

    2010-03-01

    Almost all information about interprofessional education (IPE) comes from a few western countries; little from the rest of the world. This paper helps to rectify that omission. It reports the first phase of a study of "shared learning" between health professions in "medical sciences education" in the Islamic Republic of Iran based on a documentary search and national survey of all government affiliated medical sciences universities (MSUs) with examples which meet some of the criteria for IPE. The second phase, to be reported later, will present findings from an analysis of interviews with administrators at governmental level and teachers and organizers at institutional level regarding their perceptions, experience and expectations of such learning. The study is set in the context of reforms in the organization and delivery of higher education and health care services in Iran.

  4. Data-driven approach for creating synthetic electronic medical records

    PubMed Central

    2010-01-01

    Background New algorithms for disease outbreak detection are being developed to take advantage of full electronic medical records (EMRs) that contain a wealth of patient information. However, due to privacy concerns, even anonymized EMRs cannot be shared among researchers, resulting in great difficulty in comparing the effectiveness of these algorithms. To bridge the gap between novel bio-surveillance algorithms operating on full EMRs and the lack of non-identifiable EMR data, a method for generating complete and synthetic EMRs was developed. Methods This paper describes a novel methodology for generating complete synthetic EMRs both for an outbreak illness of interest (tularemia) and for background records. The method developed has three major steps: 1) synthetic patient identity and basic information generation; 2) identification of care patterns that the synthetic patients would receive based on the information present in real EMR data for similar health problems; 3) adaptation of these care patterns to the synthetic patient population. Results We generated EMRs, including visit records, clinical activity, laboratory orders/results and radiology orders/results for 203 synthetic tularemia outbreak patients. Validation of the records by a medical expert revealed problems in 19% of the records; these were subsequently corrected. We also generated background EMRs for over 3000 patients in the 4-11 yr age group. Validation of those records by a medical expert revealed problems in fewer than 3% of these background patient EMRs and the errors were subsequently rectified. Conclusions A data-driven method was developed for generating fully synthetic EMRs. The method is general and can be applied to any data set that has similar data elements (such as laboratory and radiology orders and results, clinical activity, prescription orders). The pilot synthetic outbreak records were for tularemia but our approach may be adapted to other infectious diseases. The pilot synthetic

  5. The electronic patient records of the Hannover Medical School.

    PubMed

    Porth, A J; Niehoff, C; Matthies, H K

    1999-01-01

    In this paper, the successful introduction of a commercially available electronic patient record archiving system at the Hannover Medical School is described. Since 1996, more than 11 million document sheets of 130,000 patient records have been stored electronically. Currently, 100,000 sheets are stored each week.

  6. Procurement of shared data instruments for Research Electronic Data Capture (REDCap).

    PubMed

    Obeid, Jihad S; McGraw, Catherine A; Minor, Brenda L; Conde, José G; Pawluk, Robert; Lin, Michael; Wang, Janey; Banks, Sean R; Hemphill, Sheree A; Taylor, Rob; Harris, Paul A

    2013-04-01

    REDCap (Research Electronic Data Capture) is a web-based software solution and tool set that allows biomedical researchers to create secure online forms for data capture, management and analysis with minimal effort and training. The Shared Data Instrument Library (SDIL) is a relatively new component of REDCap that allows sharing of commonly used data collection instruments for immediate study use by research teams. Objectives of the SDIL project include: (1) facilitating reuse of data dictionaries and reducing duplication of effort; (2) promoting the use of validated data collection instruments, data standards and best practices; and (3) promoting research collaboration and data sharing. Instruments submitted to the library are reviewed by a library oversight committee, with rotating membership from multiple institutions, which ensures quality, relevance and legality of shared instruments. The design allows researchers to download the instruments in a consumable electronic format in the REDCap environment. At the time of this writing, the SDIL contains over 128 data collection instruments. Over 2500 instances of instruments have been downloaded by researchers at multiple institutions. In this paper we describe the library platform, provide detail about experience gained during the first 25months of sharing public domain instruments and provide evidence of impact for the SDIL across the REDCap consortium research community. We postulate that the shared library of instruments reduces the burden of adhering to sound data collection principles while promoting best practices.

  7. Integrating TRENCADIS components in gLite to share DICOM medical images and structured reports.

    PubMed

    Blanquer, Ignacio; Hernández, Vicente; Salavert, José; Segrelles, Damià

    2010-01-01

    The problem of sharing medical information among different centres has been tackled by many projects. Several of them target the specific problem of sharing DICOM images and structured reports (DICOM-SR), such as the TRENCADIS project. In this paper we propose sharing and organizing DICOM data and DICOM-SR metadata benefiting from the existent deployed Grid infrastructures compliant with gLite such as EGEE or the Spanish NGI. These infrastructures contribute with a large amount of storage resources for creating knowledge databases and also provide metadata storage resources (such as AMGA) to semantically organize reports in a tree-structure. First, in this paper, we present the extension of TRENCADIS architecture to use gLite components (LFC, AMGA, SE) on the shake of increasing interoperability. Using the metadata from DICOM-SR, and maintaining its tree structure, enables federating different but compatible diagnostic structures and simplifies the definition of complex queries. This article describes how to do this in AMGA and it shows an approach to efficiently code radiology reports to enable the multi-centre federation of data resources.

  8. Good Neighbors: Shared Challenges and Solutions Toward Increasing Value at Academic Medical Centers and Universities.

    PubMed

    Clancy, Gerard P

    2015-12-01

    Academic medical centers (AMCs) and universities are experiencing increasing pressure to enhance the value they offer at the same time that they are facing challenges related to outcomes, controlling costs, new competition, and government mandates. Yet, rarely do the leaders of these academic neighbors work cooperatively to enhance value. In this Perspective the author, a former university regional campus president with duties in an AMC as an academic physician, shares his insights into the shared challenges these academic neighbors face in improving the value of their services in complex environments. He describes the successes some AMCs have had in generating revenues from new clinical programs that reduce the overall cost of care for larger populations. He also describes how several universities have taken a comprehensive approach to reduce overhead and administrative costs. The author identifies six themes related to successful value improvement efforts and provides examples of successful strategies used by AMCs and their university neighbors to improve the overall value of their programs. He concludes by encouraging leaders of AMCs and universities to share information about their successes in value improvements with each other, to seek additional joint value enhancement efforts, and to market their value improvements to the public.

  9. Constraints on Biological Mechanism from Disease Comorbidity Using Electronic Medical Records and Database of Genetic Variants

    PubMed Central

    Bagley, Steven C.; Sirota, Marina; Chen, Richard; Butte, Atul J.; Altman, Russ B.

    2016-01-01

    Patterns of disease co-occurrence that deviate from statistical independence may represent important constraints on biological mechanism, which sometimes can be explained by shared genetics. In this work we study the relationship between disease co-occurrence and commonly shared genetic architecture of disease. Records of pairs of diseases were combined from two different electronic medical systems (Columbia, Stanford), and compared to a large database of published disease-associated genetic variants (VARIMED); data on 35 disorders were available across all three sources, which include medical records for over 1.2 million patients and variants from over 17,000 publications. Based on the sources in which they appeared, disease pairs were categorized as having predominant clinical, genetic, or both kinds of manifestations. Confounding effects of age on disease incidence were controlled for by only comparing diseases when they fall in the same cluster of similarly shaped incidence patterns. We find that disease pairs that are overrepresented in both electronic medical record systems and in VARIMED come from two main disease classes, autoimmune and neuropsychiatric. We furthermore identify specific genes that are shared within these disease groups. PMID:27115429

  10. Increased electronic information sharing by sexual health services: confidentiality and consent.

    PubMed

    Hunter, Inga; Haining Ede, Gael; Whiddett, Richard

    2014-03-01

    New Zealand is moving towards an integrated health-care model with information accessible electronically regardless of location, linking existing health provider systems, regional clinical results repositories and a shared care record. However, such information sharing has been a major concern for patients attending sexual health services. In this study, we investigated patient attitudes towards a change in practice to support an integrated care model. Outcomes showed that confidentiality remains a significant concern, and routine sharing of patient information may create barriers to attendance for some, leading to a potential increase in untreated infections. We conclude that sexual health services may be able to change their information management practices to an opt-out consent system and routinely share health information with other health providers, but further public discussion to ensure informed consent is needed before this can happen. Regardless of national policy, it is still necessary to keep clinic visit details confidential for some patients attending sexual health services.

  11. Medication adherence and older renal transplant patients' perceptions of electronic medication monitoring.

    PubMed

    Russell, Cynthia L; Owens, Sarah; Hamburger, Karen Q; Thompson, Denise A; Leach, Rebecca R; Cetingok, Muammer; Hathaway, Donna; Conn, Vicki S; Ashbaugh, Catherine; Peace, Leanne; Madsen, Richard; Winsett, Rebecca P; Wakefield, Mark R

    2009-10-01

    This study evaluated older renal transplant recipients' perceptions of electronic medication monitoring and the influence of these perceptions on medication adherence. A sample of 73 older adult renal transplant recipients who used the Medication Event Monitoring System (MEMS(®)) TrackCaps for 12 months provided their perceptions of device use. Participants perceived that the MEMS had a neutral effect on their medication-taking routine (65%), believed the MEMS was practical (56%), and could not describe any instances in which using the MEMS was difficult (56%). No significant difference in medication adherence was found between those who perceived the MEMS's influence negatively/neutrally and those who perceived the MEMS positively (p = 0.22). Medication adherence data from older adult renal transplant recipients can be used regardless of their perceptions of the MEMS's influence on their medication taking without biasing medication adherence data.

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

    ERIC Educational Resources Information Center

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

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

  13. Electronic health records and online medical records: an asset or a liability under current conditions?

    PubMed

    Allen-Graham, Judith; Mitchell, Lauren; Heriot, Natalie; Armani, Roksana; Langton, David; Levinson, Michele; Young, Alan; Smith, Julian A; Kotsimbos, Tom; Wilson, John W

    2017-01-20

    Objective The aim of the present study was to audit the current use of medical records to determine completeness and concordance with other sources of medical information.Methods Medical records for 40 patients from each of five Melbourne major metropolitan hospitals were randomly selected (n=200). A quantitative audit was performed for detailed patient information and medical record keeping, as well as data collection, storage and utilisation. Using each hospital's current online clinical database, scanned files and paperwork available for each patient audited, the reviewers sourced as much relevant information as possible within a 30-min time allocation from both the record and the discharge summary.Results Of all medical records audited, 82% contained medical and surgical history, allergy information and patient demographics. All audited discharge summaries lacked at least one of the following: demographics, medication allergies, medical and surgical history, medications and adverse drug event information. Only 49% of records audited showed evidence the discharge summary was sent outside the institution.Conclusions The quality of medical data captured and information management is variable across hospitals. It is recommended that medical history documentation guidelines and standardised discharge summaries be implemented in Australian healthcare services.What is known about this topic? Australia has a complex health system, the government has approved funding to develop a universal online electronic medical record system and is currently trialling this in an opt-out style in the Napean Blue Mountains (NSW) and in Northern Queensland. The system was originally named the personally controlled electronic health record but has since been changed to MyHealth Record (2016). In Victoria, there exists a wide range of electronic health records used to varying degrees, with some hospitals still relying on paper-based records and many using scanned medical records. This

  14. Medical imaging document sharing solutions for various kinds of healthcare services based on IHE XDS/XDS-I profiles

    NASA Astrophysics Data System (ADS)

    Zhang, Jianguo; Yang, Yuanyuan; Zhang, Kai; Sun, Jianyong; Ling, Tonghui; Wang, Tusheng; Wang, Mingqing; Bak, Peter

    2014-03-01

    One key problem for continuity of patient care is identification of a proper method to share and exchange patient medical records among multiple hospitals and healthcare providers. This paper focuses in the imaging document component of medical record. The XDS-I (Cross- Enterprise Document Sharing - Image) Profile based on the IHE IT-Infrastructure extends and specializes XDS to support imaging "document" sharing in an affinity domain. We present three studies about image sharing solutions based on IHE XDS-I Profile. The first one is to adopt the IHE XDS-I profile as a technical guide to design image and report sharing mechanisms between hospitals for regional healthcare service in Shanghai. The second study is for collaborating image diagnosis in regional healthcare services. The latter study is to investigate the XDS-I based clearinghouse for patient controlled image sharing in the RSNA Image Sharing Network Project. We conclude that the IHE XDS/XDS-I profiles can be used as the foundation to design medical image document sharing for Various Healthcare Services.

  15. Building a national electronic medical record exchange system - experiences in Taiwan.

    PubMed

    Li, Yu-Chuan Jack; Yen, Ju-Chuan; Chiu, Wen-Ta; Jian, Wen-Shan; Syed-Abdul, Shabbir; Hsu, Min-Huei

    2015-08-01

    There are currently 501 hospitals and about 20,000 clinics in Taiwan. The National Health Insurance (NHI) system, which is operated by the NHI Administration, uses a single-payer system and covers 99.9% of the nation's total population of 23,000,000. Taiwan's NHI provides people with a high degree of freedom in choosing their medical care options. However, there is the potential concern that the available medical resources will be overused. The number of doctor consultations per person per year is about 15. Duplication of laboratory tests and prescriptions are not rare either. Building an electronic medical record exchange system is a good method of solving these problems and of improving continuity in health care. In November 2009, Taiwan's Executive Yuan passed the 'Plan for accelerating the implementation of electronic medical record systems in medical institutions' (2010-2012; a 3-year plan). According to this plan, a patient can, at any hospital in Taiwan, by using his/her health insurance IC card and physician's medical professional IC card, upon signing a written agreement, retrieve all important medical records for the past 6 months from other participating hospitals. The focus of this plan is to establish the National Electronic Medical Record Exchange Centre (EEC). A hospital's information system will be connected to the EEC through an electronic medical record (EMR) gateway. The hospital will convert the medical records for the past 6 months in its EMR system into standardized files and save them on the EMR gateway. The most important functions of the EEC are to generate an index of all the XML files on the EMR gateways of all hospitals, and to provide search and retrieval services for hospitals and clinics. The EEC provides four standard inter-institution EMR retrieval services covering medical imaging reports, laboratory test reports, discharge summaries, and outpatient records. In this system, we adopted the Health Level 7 (HL7) Clinical Document

  16. Security and confidentiality in an electronic medical record.

    PubMed

    Olson, L A; Peters, S G; Stewart, J B

    1998-01-01

    The maintenance of privacy and confidentially must remain a core principle of the interaction between patients and medical staff. Traditionally, the single paper copy of the medical history has been treated with systematic handling, careful tracking, and respect for the integrity and confidentiality of the contents. The widespread availability of computerized information requires that these principles be maintained in the electronic environment. Security measures should protect sensitive data without hindering medical practice. At Mayo, we have established data security policies and standards for the handling of all electronic information. Dissemination and communication of these standards and guidelines are an ongoing challenge. Technical maneuvers can be employed to protect data integrity, identify users, and monitor compliance. Personnel policies must be updated to reflect the responsibilities and liabilities of the electronic environment. Practice efficiencies and access to clinical data must be balanced by individual responsibility and accountability for privileged patient information.

  17. [Security specifications for electronic medical records on the Internet].

    PubMed

    Mocanu, Mihai; Mocanu, Carmen

    2007-01-01

    The extension for the Web applications of the Electronic Medical Record seems both interesting and promising. Correlated with the expansion of Internet in our country, it allows the interconnection of physicians of different specialties and their collaboration for better treatment of patients. In this respect, the ophthalmologic medical applications consider the increased possibilities for monitoring chronic ocular diseases and for the identification of some elements for early diagnosis and risk factors supervision. We emphasize in this survey some possible solutions to the problems of interconnecting medical information systems to the Internet: the achievement of interoperability within medical organizations through the use of open standards, the automated input and processing for ocular imaging, the use of data reduction techniques in order to increase the speed of image retrieval in large databases, and, last but not least, the resolution of security and confidentiality problems in medical databases.

  18. Shared medical appointments: improving access, outcomes, and satisfaction for patients with chronic cardiac diseases.

    PubMed

    Bartley, Kelly Bauer; Haney, Rebecca

    2010-01-01

    Improving access to care, health outcomes, and patient satisfaction are primary objectives for healthcare practices. This article outlines benefits, concerns, and possible challenges of shared medical appointments (SMAs) for patients and providers. The SMA model was designed to support providers' demanding schedules by allowing patients with the same chronic condition to be seen in a group setting. By concentrating on patient education and disease management, interactive meetings provide an opportunity for patients to share both successes and struggles with others experiencing similar challenges. Studies demonstrated that SMAs improved patient access, enhanced outcomes, and promoted patient satisfaction. This article describes the potential benefits of SMAs for patients with chronic heart disease, which consumes a large number of healthcare dollars related to hospital admissions, acute exacerbations, and symptom management. Education for self-management of chronic disease can become repetitive and time consuming. The SMA model introduces a fresh and unique style of healthcare visits, allowing providers to devote more time and attention to patients and improve productivity. The SMA model provides an outstanding method for nurse practitioners to demonstrate their role as a primary care provider, by leading patients in group discussions and evaluating their current health status. Patient selection, preparation, and facilitation of an SMA are discussed to demonstrate the complementary nature of an SMA approach in a healthcare practice.

  19. A secure semantic interoperability infrastructure for inter-enterprise sharing of electronic healthcare records.

    PubMed

    Boniface, Mike; Watkins, E Rowland; Saleh, Ahmed; Dogac, Asuman; Eichelberg, Marco

    2006-01-01

    Healthcare professionals need access to accurate and complete healthcare records for effective assessment, diagnosis and treatment of patients. The non-interoperability of healthcare information systems means that interenterprise access to a patient's history over many distributed encounters is difficult to achieve. The ARTEMIS project has developed a secure semantic web service infrastructure for the interoperability of healthcare information systems. Healthcare professionals share services and medical information using a web service annotation and mediation environment based on functional and clinical semantics derived from healthcare standards. Healthcare professionals discover medical information about individuals using a patient identification protocol based on pseudonymous information. The management of care pathways and access to medical information is based on a well-defined business process allowing healthcare providers to negotiate collaboration and data access agreements within the context of strict legislative frameworks.

  20. E-Cigarette Topics Shared by Medical Professionals: A Comparison of Tweets from the United States and United Kingdom.

    PubMed

    Glowacki, Elizabeth M; Lazard, Allison J; Wilcox, Gary B

    2017-02-01

    Medical professionals are now relying on social media platforms like Twitter to express their recommendations for the use or avoidance of products like electronic cigarettes (e-cigs), which may have long-term health consequences for users. The goal of this study is to compare how physicians from the United States and the United Kingdom talk about e-cigs on Twitter and identify the topics that these groups perceive as salient. Comparing tweets from the U.S. and U.K. will allow for a better understanding of how medical professionals from these countries differ in their attitudes toward e-cigs. This information can be also used to inform policies designed to regulate the use of e-cigs. Using a text-mining program, we analyzed approximately 3,800 original tweets sent by physicians from the U.S. and the U.K. within a 1-year time span (June 2015 through June 2016). The program clustered the tweets by topics, which allowed us to categorize the topics by importance. Both sets of tweets contained debates about the degree to which e-cigs pose a threat to health, but the U.S. tweets emphasized the dangers of e-cig use for teens, while the U.K. tweets focused more on the potential that e-cigs have to be used as a smoking cessation aid. Doctors are using Twitter to share timely information about the potential risks, benefits, and regulations associated with e-cigs. Evaluating these tweets allows researchers to collect information about topics that doctors find important and make comparisons about how medical professionals from the U.S. and the U.K. regard e-cigs.

  1. Public Trust in Health Information Sharing: Implications for Biobanking and Electronic Health Record Systems

    PubMed Central

    Platt, Jodyn; Kardia, Sharon

    2015-01-01

    Biobanks are made all the more valuable when the biological samples they hold can be linked to health information collected in research, electronic health records, or public health practice. Public trust in such systems that share health information for research and health care practice is understudied. Our research examines characteristics of the general public that predict trust in a health system that includes researchers, health care providers, insurance companies and public health departments. We created a 119-item survey of predictors and attributes of system trust and fielded it using Amazon’s MTurk system (n = 447). We found that seeing one’s primary care provider, having a favorable view of data sharing and believing that data sharing will improve the quality of health care, as well as psychosocial factors (altruism and generalized trust) were positively and significantly associated with system trust. As expected, privacy concern, but counterintuitively, knowledge about health information sharing were negatively associated with system trust. We conclude that, in order to assure the public’s trust, policy makers charged with setting best practices for governance of biobanks and access to electronic health records should leverage critical access points to engage a diverse public in joint decision making. PMID:25654300

  2. PAMFOnline: integrating EHealth with an electronic medical record system.

    PubMed

    Tang, Paul C; Black, William; Buchanan, Jenny; Young, Charles Y; Hooper, David; Lane, Steven R; Love, Barbara; Mitchell, Charlotte; Smith, Nancy; Turnbull, Jenifer R

    2003-01-01

    The Institute of Medicine stressed the need for continuous healing relationships, yet the delivery of health care has traditionally been confined to the physician office or hospital. We implemented an eHealth application tightly integrated with our electronic medical record system that provides patients with a convenient, continuously available communication channel to their physician's office. Patients can view summary data from their medical record, including the results of diagnostic tests, and request medical advice, prescription renewals, appointments, or updates to their demographic information. We have found that patients embrace this new communication channel and are using the service appropriately. Patients especially value electronic messaging with their physicians and timely access to their test results. While initially concerned about an increase in work, physicians have found that use of electronic messaging can be an efficient method for handling non-urgent communication with their patients. Online tools for patients, when integrated with an electronic medical record, can provide patients with better access to health information, improve patient satisfaction, and improve operational efficiency.

  3. Physician Sensemaking and Readiness for Electronic Medical Records

    ERIC Educational Resources Information Center

    Riesenmy, Kelly Rouse

    2010-01-01

    Purpose: The purpose of this paper is to explore physician sensemaking and readiness to implement electronic medical records (EMR) as a first step to finding strategies that enhance EMR adoption behaviors. Design/methodology/approach: The case study approach provides a detailed analysis of individuals within an organizational unit. Using a…

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

    PubMed Central

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

    2017-01-01

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

  5. Primary Care Provider Perspectives on Electronic Medication Refill History.

    PubMed

    Comer, Dominique; Mearns, Elizabeth; Olivere, Lindsey; Elliott, Daniel J

    Improvements in health information technology have made aggregate multipayer pharmacy claims data increasingly available through the electronic health record (EHR). The objective of this study was to assess the current awareness, utilization, and impact of pharmacy history data available in the EHR on primary care provider (PCP) decision making. A 14-question survey was distributed to all PCPs in a large medical practice. Of the 55/72 responding PCPs, 47 (85.5%) were aware of the EHR medication history function, and 36 (65.5%) had used it previously. Respondents indicated the medication history could be most useful when considering prescribing a narcotic (33/36, 92%) and when addressing nonadherence concerns (28/35, 80%). Barriers included delays in data loading and the time pressures of clinical practice. Access to aggregate multipayer pharmacy history data has the potential to affect medication reconciliation, yet future implementation should focus on making these data complete and easily available in routine practice.

  6. The comparison of different medical electronic endoscope systems

    NASA Astrophysics Data System (ADS)

    Ye, Wei; Wang, Liqiang; Duan, Huilong

    2011-11-01

    This paper presents a miniaturized CMOS camera for high-definition (HD) medical electronic endoscope system with resolution of 1.3 MegaPixel. LVDS technology is used for image data stream transmission between the sensor and the HD image workstation to realize a long distance, high speed, high signal integrity and low noise system. Considering the real-time video image processing and the complexity of the design of HD image workstation, four solutions for medical electronic endoscope systems, namely USB based image acquisition system, PCIe acquisition data board based method, ARM embedded system based solution and DSP based electronic endoscope system have been proposed, analyzed and compared with each other. We found that the four solutions have their own advantages and disadvantages. Taking into account the strong control capacity of ARM, powerful data processing ability and high operating speed of DSP, good portability and other factors, we decided to use ARM + DSP embedded based system.

  7. The politics of healthcare informatics: knowledge management using an electronic medical record system.

    PubMed

    Bar-Lev, Shirly

    2015-03-01

    The design and implementation of an electronic medical record system pose significant epistemological and practical complexities. Despite optimistic assessments of their potential contribution to the quality of care, their implementation has been problematic, and their actual employment in various clinical settings remains controversial. Little is known about how their use actually mediates knowing. Employing a variety of qualitative research methods, this article attempts an answer by illustrating how omitting, editing and excessive reporting were employed as part of nurses' and physicians' political efforts to shape knowledge production and knowledge sharing in a technologically mediated healthcare setting.

  8. Low power signal processing electronics for wearable medical devices.

    PubMed

    Casson, Alexander J; Rodriguez-Villegas, Esther

    2010-01-01

    Custom designed microchips, known as Application Specific Integrated Circuits (ASICs), offer the lowest possible power consumption electronics. However, this comes at the cost of a longer, more complex and more costly design process compared to one using generic, off-the-shelf components. Nevertheless, their use is essential in future truly wearable medical devices that must operate for long periods of time from physically small, energy limited batteries. This presentation will demonstrate the state-of-the-art in ASIC technology for providing online signal processing for use in these wearable medical devices.

  9. Focusing of a megavoltage electron beam in a medical accelerator

    NASA Astrophysics Data System (ADS)

    Friedrichs, P. B.; Konrad, G. T.

    1991-05-01

    Due to packaging constraints in the radiotherapy machine gantry of Siemens Mevatrons, the electron linac used in the lower energy models has a long drift tube between the end of the linae and the 270° achromatic bend assembly. Space charge effects cause the electron beam to grow so that it frequently impinges upon the entrance hole to the bend assembly. A compact solenoid has been designed that is effective in increasing the transmitted beam through the bend assembly by over 40%. A permanent magnet design proved to be unsuccessful because of high transverse fields within the magnet. Trajectory calculations obtained through the electron linac design code PARMELA (Public domain code supplied to Siemens Medical Laboratories, Inc. by L.M. Young, Los Alamos National Laboratories, Los Alamos, NM) support the experimentally observed results. Data is presented for several electron energies over the normal operating range of 4-6 MV photons from these Mevatrons.

  10. Materials Advances for Next-Generation Ingestible Electronic Medical Devices.

    PubMed

    Bettinger, Christopher J

    2015-10-01

    Electronic medical implants have collectively transformed the diagnosis and treatment of many diseases, but have many inherent limitations. Electronic implants require invasive surgeries, operate in challenging microenvironments, and are susceptible to bacterial infection and persistent inflammation. Novel materials and nonconventional device fabrication strategies may revolutionize the way electronic devices are integrated with the body. Ingestible electronic devices offer many advantages compared with implantable counterparts that may improve the diagnosis and treatment of pathologies ranging from gastrointestinal infections to diabetes. This review summarizes current technologies and highlights recent materials advances. Specific focus is dedicated to next-generation materials for packaging, circuit design, and on-board power supplies that are benign, nontoxic, and even biodegradable. Future challenges and opportunities are also highlighted.

  11. Northern Territory HealthConnect: shared electronic health record service implementation experiences and benefits realised in indigenous health.

    PubMed

    Moo, Stephen; Fletcher, John

    2007-01-01

    This presentation summarises the learnings from the HealthConnect Northern Territory (HCNT) Shared Electronic Health Record Service (SEHR) from Trial to Implementation and the emerging benefits realized as the project is implemented across the Northern Territory of Australia. The presentation: * explores the challenges and experiences of implementing a SEHR service in urban and in some of the remotest regions on the Australian continent. * demonstrates the emerging health benefits e-Health can provide in enabling the sharing of medical information between public and private health service providers in particular the service delivery and benefits provided to a highly mobile Indigenous population who currently experience the greatest health problems and experience difficulties accessing continuum of care created by factors which include remoteness, mobility and communication. * explores the evolvement of the "opt in" consumer consent model adopted by the Territory for the implementation of the HCNT SEHR.* advises of plans for future development, which inform other implementations, and NeHTA standards development for the implementation of the National SEHR Service. * Informs project plans to incorporate NeHTA standards as they are developed and transition the HCNT SEHR to the National SEHR Service when implemented recognising the importance of developing strong partnerships with key stakeholders, in particular consumers, health care providers and system vendors who inform project development and implementation.

  12. National electronic medical records integration on cloud computing system.

    PubMed

    Mirza, Hebah; El-Masri, Samir

    2013-01-01

    Few Healthcare providers have an advanced level of Electronic Medical Record (EMR) adoption. Others have a low level and most have no EMR at all. Cloud computing technology is a new emerging technology that has been used in other industry and showed a great success. Despite the great features of Cloud computing, they haven't been utilized fairly yet in healthcare industry. This study presents an innovative Healthcare Cloud Computing system for Integrating Electronic Health Record (EHR). The proposed Cloud system applies the Cloud Computing technology on EHR system, to present a comprehensive EHR integrated environment.

  13. Disciplined doctors: the electronic medical record and physicians' changing relationship to medical knowledge.

    PubMed

    Reich, Adam

    2012-04-01

    This study explores the effects of the electronic medical record (EMR) on the power of the medical profession. It is based on twenty-five in-depth interviews with administrators and physicians across three departments of a large, U.S. integrated health system, as well as ethnographic observation, all of which took place between September of 2009 and December of 2010. While scholarship on professional power has tended toward the opposite poles of professional dominance and deprofessionalization or proletarianization, I find that doctors' interactions with the EMR reconcile these perspectives by making physicians' professional identities consistent with their subordination to bureaucratic authority. After examining the electronic medical record as a disciplinary technology, the paper analyzes variation in the extent to which practitioners' professional identities are reconciled with bureaucratic subordination across the different departments studies.

  14. Ultrafast Photoinduced Symmetry-Breaking Charge Separation and Electron Sharing in Perylenediimide Molecular Triangles.

    PubMed

    Wu, Yilei; Young, Ryan M; Frasconi, Marco; Schneebeli, Severin T; Spenst, Peter; Gardner, Daniel M; Brown, Kristen E; Würthner, Frank; Stoddart, J Fraser; Wasielewski, Michael R

    2015-10-21

    We report on a visible-light-absorbing chiral molecular triangle composed of three covalently linked 1,6,7,12-tetra(phenoxy)perylene-3,4:9,10-bis(dicarboximide) (PDI) units. The rigid triangular architecture reduces the electronic coupling between the PDIs, so ultrafast symmetry-breaking charge separation is kinetically favored over intramolecular excimer formation, as revealed by femtosecond transient absorption spectroscopy. Photoexcitation of the PDI triangle dissolved in CH2Cl2 gives PDI(+•)-PDI(-•) in τCS = 12.0 ± 0.2 ps. Fast subsequent intramolecular electron/hole hopping can equilibrate the six possible energetically degenerate ion-pair states, as suggested by electron paramagnetic resonance/electron-nuclear double resonance spectroscopy, which shows that one-electron reduction of the PDI triangle results in complete electron sharing among the three PDIs. Charge recombination of PDI(+•)-PDI(-•) to the ground state occurs in τCR = 1.12 ± 0.01 ns with no evidence of triplet excited state formation.

  15. [The medical records of home health care patients: a complement or alternative to an electronic file?].

    PubMed

    Perrot, P; Baudier, F; Schmitt, B

    2005-06-01

    Home health care services for dependant people involve participation and interventions of professionals from the health care, medico-social and social sectors. In order to ensure quality care, the flow of information must appropriately circulate between all of the various care providers. The establishment of an electronic medical file for these patients is a possible solution which has been proposed to be conducted in next years. A paper medical record is the property of the patient and offers the possibility of an alternative and complementary solution. The electronic file would use the existing available file as a starting point, and without any additional organisational structures being implicated, it allows for better coordination of the health, medical and social activities. An experimental implementation of this in the Franch-Comte region of France demonstrated the advantages and benefits of such a tool based on a logic centered upon the individual and the open sharing of practices between professionals in the medical and social sectors.

  16. Medical free-electron laser: fact or fiction?

    NASA Astrophysics Data System (ADS)

    Bell, James P.; Ponikvar, Donald R.

    1994-07-01

    The free electron laser (FEL) has long been proposed as a flexible tool for a variety of medical applications, and yet the FEL has not seen widespread acceptance in the medical community. The issues have been the laser's size, cost, and complexity. Unfortunately, research on applications of FELs has outpaced the device development efforts. This paper describes the characteristics of the FEL, as they have been demonstrated in the U.S. Army's FEL technology development program, and identifies specific medical applications where demonstrated performance levels would suffice. This includes new photodynamic therapies for cancer and HIV treatment, orthopedic applications, tissue welding applications, and multiwavelength surgical techniques. A new tunable kilowatt class FEL device is described, which utilizes existing hardware from the U.S. Army program. An assessment of the future potential, based on realistic technology scaling is provided.

  17. [EHealth, health networks and electronic health record: towards a culture of sharing and trust].

    PubMed

    Nicolas, L

    2012-09-01

    In Belgium, the computerization of the ambulatory care sector and general practice in particular has been continuously progressing over the last ten years. Although regional differences exist, 75% of the Belgian general practitioners own today a software to assist them in the management of their patients. To date however, general practitioners have been hardly using their electronic system to share or communicate with other actors of the system. The silo culture remains the norm. Aside from certain group practices, computerization has thus not yet contributed to improve in a significant way the quality of care of the patient. The implementation in 2012 of the "shared electronic health record" thanks to the deployment in production of the 5 health networks connected via the federal directory of references is due to deeply change this situation. Communication flows between health care professionals will thus rapidly intensify and the amount of information available at the point of care will increase significantly. This is however only the first step. The future electronic patient record (EPR) will need to make room for a deep integration of the actors around the patient thanks--among other things--to the implementation of a global semantic interoperability strategy. This integration of actors together with the empowerment of the patient are indeed essential preliminary conditions in order to adapt our health system to the enormous challenges that we will all have to face in the next 10 years.

  18. Social work and medical care: electronic reminders to address adherence.

    PubMed

    Whisenhunt, Allison

    2014-01-01

    Social workers are often involved with patients and families around adherence, both to clinic appointments as well as to the medication regimen. An evidence-based practice project was created and implemented to determine the efficacy of electronic reminders such as text messaging on adherence. The implications of improving adherence can positively impact the patient on an individual level as well as reduce costs and increase revenue at a systems level.

  19. Views of Ethical Best Practices in Sharing Individual-Level Data From Medical and Public Health Research

    PubMed Central

    Roberts, Nia; Parker, Michael

    2015-01-01

    There is increasing support for sharing individual-level data generated by medical and public health research. This scoping review of empirical research and conceptual literature examined stakeholders’ perspectives of ethical best practices in data sharing, particularly in low- and middle-income settings. Sixty-nine empirical and conceptual articles were reviewed, of which, only five were empirical studies and eight were conceptual articles focusing on low- and middle-income settings. We conclude that support for sharing individual-level data is contingent on the development and implementation of international and local policies and processes to support ethical best practices. Further conceptual and empirical research is needed to ensure data sharing policies and processes in low- and middle-income settings are appropriately informed by stakeholders’ perspectives. PMID:26297745

  20. Report on audit of fire and emergency medical services cost sharing between the Department of Energy and Los Alamos County

    SciTech Connect

    1995-10-02

    Los Alamos County was created in 1964 as a response to a Congressional mandate, promulgated in the Atomic Energy Act of 1954. Because the county came into existence via the Atomic Energy Act, the Department provided fire and emergency medical services. In the intervening years, however, the Department and the county have worked toward making the county self-sufficient. The contract for fire and emergency medical services represented a step in the direction of self-sufficiency by requiring the county to begin paying for its share of the related costs. The purpose of the audit was to determine if the costs for fire and emergency medical services were shared appropriately commensurate with the use of the services.

  1. Implementation and Impact of Psychiatric Electronic Medical Records in a Public Medical Center

    PubMed Central

    Xiao, Anna Q.; Acosta, Frank X.

    2016-01-01

    Objectives This study describes the efforts to implement electronic charting in a large public psychiatric outpatient clinic with the objective to improve clinical documentation. Methods Data made available through the quality review process are utilized to evaluate the effectiveness of the electronic intervention. The study is a comparative analysis of the three years before and three years after the point of implementation of electronic charting. Results Statistical analyses indicate significant findings (p <.0001) in the comparison of the periods before and after implementation in terms of note completion and documentation of medication management, supporting the study's hypothesis that electronic intervention will improve the quality of clinical documentation. Conclusions This study contributes new knowledge to improve our understanding of the barriers and benefits of implementing and maintaining electronic charting in mental health settings. PMID:27843422

  2. RF-Medisys: a radio frequency identification-based electronic medical record system for improving medical information accessibility and services at point of care.

    PubMed

    Ting, Jacky S L; Tsang, Albert H C; Ip, Andrew W H; Ho, George T S

    2011-01-01

    This paper presents an innovative electronic medical records (EMR) system, RF-MediSys, which can perform medical information sharing and retrieval effectively and which is accessible via a 'smart' medical card. With such a system, medical diagnoses and treatment decisions can be significantly improved when compared with the conventional practice of using paper medical records systems. Furthermore, the entire healthcare delivery process, from registration to the dispensing or administration of medicines, can be visualised holistically to facilitate performance review. To examine the feasibility of implementing RF-MediSys and to determine its usefulness to users of the system, a survey was conducted within a multi-disciplinary medical service organisation that operates a network of medical clinics and paramedical service centres throughout Hong Kong Island, the Kowloon Peninsula and the New Territories. Questionnaires were distributed to 300 system users, including nurses, physicians and patients, to collect feedback on the operation and performance of RF-MediSys in comparison with conventional paper-based medical record systems. The response rate to the survey was 67%. Results showed a medium to high level of user satisfaction with the radiofrequency identification (RFID)-based EMR system. In particular, respondents provided high ratings on both 'user-friendliness' and 'system performance'. Findings of the survey highlight the potential of RF-MediSys as a tool to enhance quality of medical services and patient safety.

  3. MDPHnet: secure, distributed sharing of electronic health record data for public health surveillance, evaluation, and planning.

    PubMed

    Vogel, Joshua; Brown, Jeffrey S; Land, Thomas; Platt, Richard; Klompas, Michael

    2014-12-01

    Electronic health record systems contain clinically detailed data from large populations of patients that could significantly enrich public health surveillance. Clinical practices' security, privacy, and proprietary concerns, however, have limited their willingness to share these data with public health agencies. We describe a novel distributed network for public health surveillance called MDPHnet. The system allows the Massachusetts Department of Public Health (MDPH) to initiate custom queries against participating practices' electronic health records while the data remain behind each practice's firewall. Practices can review proposed queries before execution and approve query results before releasing them to the health department. MDPH is using the system for routine surveillance for priority conditions and to evaluate the impact of public health interventions.

  4. Advancing medical education: connecting interprofessional collaboration and education opportunities with integrative medicine initiatives to build shared learning.

    PubMed

    Templeman, Kate; Robinson, Anske; McKenna, Lisa

    2016-12-01

    BackgroundImproved teamwork between conventional and complementary medicine (CM) practitioners is indicated to achieve effective healthcare. However, little is known about interprofessional collaboration and education in the context of integrative medicine (IM). MethodsThis paper reports the findings from a constructivist-grounded theory method study that explored and highlighted Australian medical students' experiences and opportunities for linking interprofessional collaboration and learning in the context of IM. Following ethical approval, in-depth semi-structured interviews were conducted with 30 medical students from 10 medical education faculties across Australian universities. Results Medical students recognised the importance of interprofessional teamwork between general medical practitioners and CM professionals in patient care and described perspectives of shared responsibilities, profession-specific responsibilities, and collaborative approaches within IM. While students identified that limited interprofessional collaboration currently occurred in the medical curriculum, interprofessional education was considered a means of increasing communication and collaboration between healthcare professionals, helping coordinate effective patient care, and understanding each healthcare team members' professional role and value. Conclusions The findings suggest that medical curricula should include opportunities for medical students to develop required skills, behaviours, and attitudes for interprofessional collaboration and interprofessional education within the context of IM. While this is a qualitative study that reflects theoretical saturation from a selected cohort of medical students, the results also point to the importance of including CM professionals within interprofessional collaboration, thus contributing to more person-centred care.

  5. A Pharmacy Blueprint for Electronic Medical Record Implementation Success

    PubMed Central

    Bach, David S.; Risko, Kenneth R.; Farber, Margo S.; Polk, Gregory J.

    2015-01-01

    Objective: Implementation of an integrated, electronic medical record (EMR) has been promoted as a means of improving patient safety and quality. While there are a few reports of such processes that incorporate computerized prescriber order entry, pharmacy verification, an electronic medication administration record (eMAR), point-of-care barcode scanning, and clinical decision support, there are no published reports on how a pharmacy department can best participate in implementing such a process across a multihospital health care system. Method: This article relates the experience of the design, build, deployment, and maintenance of an integrated EMR solution from the pharmacy perspective. It describes a 9-month planning and build phase and the subsequent rollout at 8 hospitals over the following 13 months. Results: Key components to success are identified, as well as a set of guiding principles that proved invaluable in decision making and dispute resolution. Labor/personnel requirements for the various stages of the process are discussed, as are issues involving medication workflow analysis, drug database considerations, the development of clinical order sets, and incorporation of bar-code scanning of medications. Recommended implementation and maintenance strategies are presented, and the impact of EMR implementation on the pharmacy practice model and revenue analysis are examined. Conclusion: Adherence to the principles and practices outlined in this article can assist pharmacy administrators and clinicians during all medication-related phases of the development, implementation, and maintenance of an EMR solution. Furthermore, review and incorporation of some or all of practices presented may help ease the process and ensure its success. PMID:26405340

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

    PubMed Central

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

    2015-01-01

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

  7. Shared responsibility for managing electronic waste: a case study of Maine, USA.

    PubMed

    Wagner, Travis P

    2009-12-01

    Based on high disposal and low recycling rates of electronic waste (e-waste) and continued exportation to developing countries, reliance on municipal responsibility for e-waste management has been unsuccessful in the United States. This case study examines Maine's program, which was the first US state to mandate producer responsibility for recycling household e-waste. Maine's program established a shared cost responsibility among producers, municipalities, and consumers. The study found that Maine's program resulted in a significant reduction in disposal and a corresponding increase in environmentally sound recycling. In the first 3 years of the program, 6.406 million kg of household e-waste was collected and recycled for a population of 1.32 million. The new program, implemented in 2006, increased the number of e-waste items collected and recycled by 108% in the first year, 170% in the second year, and 221% in the third year. The program decreased direct economic costs to municipalities and households because of the shared cost approach and for the first time established costs for producers. There was no empirical evidence indicating that producers have or will improve the recyclability of electronic products to reduce recycling costs. While other weaknesses were that found potentially limit the adoption of Maine's program, its positive aspects warrant consideration by other governments.

  8. Shared responsibility for managing electronic waste: A case study of Maine, USA

    SciTech Connect

    Wagner, Travis P.

    2009-12-15

    Based on high disposal and low recycling rates of electronic waste (e-waste) and continued exportation to developing countries, reliance on municipal responsibility for e-waste management has been unsuccessful in the United States. This case study examines Maine's program, which was the first US state to mandate producer responsibility for recycling household e-waste. Maine's program established a shared cost responsibility among producers, municipalities, and consumers. The study found that Maine's program resulted in a significant reduction in disposal and a corresponding increase in environmentally sound recycling. In the first 3 years of the program, 6.406 million kg of household e-waste was collected and recycled for a population of 1.32 million. The new program, implemented in 2006, increased the number of e-waste items collected and recycled by 108% in the first year, 170% in the second year, and 221% in the third year. The program decreased direct economic costs to municipalities and households because of the shared cost approach and for the first time established costs for producers. There was no empirical evidence indicating that producers have or will improve the recyclability of electronic products to reduce recycling costs. While other weaknesses were that found potentially limit the adoption of Maine's program, its positive aspects warrant consideration by other governments.

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

    NASA Astrophysics Data System (ADS)

    Liu, Xia; Peyton, Liam; Kuziemsky, Craig

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

  10. In-silico bonding schemes to encode chemical bonds involving sharing of electrons in molecular structures.

    PubMed

    Punnaivanam, Sankar; Sathiadhas, Jerome Pastal Raj; Panneerselvam, Vinoth

    2016-05-01

    Encoding of covalent and coordinate covalent bonds in molecular structures using ground state valence electronic configuration is achieved. The bonding due to electron sharing in the molecular structures is described with five fundamental bonding categories viz. uPair-uPair, lPair-uPair, uPair-lPair, vPair-lPair, and lPair-lPair. The involvement of lone pair electrons and the vacant electron orbitals in chemical bonding are explained with bonding schemes namely "target vacant promotion", "source vacant promotion", "target pairing promotion", "source pairing promotion", "source cation promotion", "source pairing double bond", "target vacant occupation", and "double pairing promotion" schemes. The bonding schemes are verified with a chemical structure editor. The bonding in the structures like ylides, PCl5, SF6, IF7, N-Oxides, BF4(-), AlCl4(-) etc. are explained and encoded unambiguously. The encoding of bonding in the structures of various organic compounds, transition metals compounds, coordination complexes and metal carbonyls is accomplished.

  11. Evaluation of a BCMA’s Electronic Medication Administration Record

    PubMed Central

    Staggers, Nancy; Iribarren, Sarah; Guo, Jia-Wen; Weir, Charlene

    2015-01-01

    Barcode medication administration (BCMA) systems can reduce medication errors, but sociotechnical issues are quite common. Although crucial to nurses’ work, few usability evaluations are available for electronic medication administration record screens (eMARs). The purpose of this research was to identify current usability problems in the VA’s eMAR/BCMA system and explore how these might impact nurses’ situation awareness. Three expert evaluators used 10 tasks/elements, heuristic evaluation techniques and explored potential impacts using a situation awareness perspective. The results yielded 99 usability problems categorized into 440 heuristic violations with the largest volume in the category of Match with the Real World. Fifteen usability issues were rated as catastrophic with the Administer/Chart medications task having the most. Situational awareness was impacted at all levels, especially at Level 2, Comprehension. Usability problems point to important areas for improvement because these issues have the potential to impact nurses’ situation awareness, “at a glance” information, nurse productivity and patient safety. PMID:25601936

  12. Medical guidelines presentation and comparing with Electronic Health Record.

    PubMed

    Veselý, Arnost; Zvárová, Jana; Peleska, Jan; Buchtela, David; Anger, Zdenek

    2006-01-01

    Electronic Health Record (EHR) systems are now being developed in many places. More advanced systems provide also reminder facilities, usually based on if-then rules. In this paper we propose a method how to build the reminder facility directly upon the guideline interchange format (GLIF) model of medical guidelines. The method compares data items on the input of EHR system with medical guidelines GLIF model and is able to reveal if the input data item, that represents patient diagnosis or proposed patient treatment, contradicts with medical guidelines or not. The reminder facility can be part of EHR system itself or it can be realized by a stand-alone reminder system (SRS). The possible architecture of stand-alone reminder system is described in this paper and the advantages of stand-alone solution are discussed. The part of the EHR system could be also a browser that would present graphical GLIF model in easy to understand manner on the user screen. This browser can be data driven and focus attention of user to the relevant part of medical guidelines GLIF model.

  13. Using Organizational Development for Electronic Medical Record Transformation.

    PubMed

    Kiel, Joan M

    With mandates requiring the transition from paper medical records to the use of electronic medical records, organizations are embarking on a change process. To engender this process, organizational development models and interventions based predominantly on the theories of Chris Argyris, Warren Bennis, and the team of Paul Lawrence and Jay Lorsch are explored. Interventions are subdivided into behavioral and structural as organizations benefit by recognizing a need for change and, perhaps, a cultural shift in addition to refocusing their mission. To support these interventions, a champion or super user is recommended to maintain the momentum of the transformation and enculturation. With so many changes in the internal and external environments, organizations must respond systematically for, in health care, lives depend on it.

  14. The University of Washington electronic medical record experience*

    PubMed Central

    Welton, Nanette J

    2010-01-01

    The Health Sciences Library at the University of Washington initiated and continues to develop a role in the electronic medical record, starting with the development of the first integrated web-based interface, called MINDscape. An Integrated Academic Information Management System (IAIMS) grant in 1992 began the process, which also led to the development of a clinical medical librarian position. Over the years, the librarian's role in the clinical environment became more established, and with the advent of clinical online resources, it offered further opportunities for librarians to provide the expertise needed to incorporate the appropriate resources. The collaborative journey continues as librarians, now able to directly access the EMRs, provide information about what resources to use and where best to place them and design how best to provide notes or feedback to clinicians. PMID:20648254

  15. A qualitative analysis of information sharing for children with medical complexity within and across health care organizations

    PubMed Central

    2014-01-01

    Background Children with medical complexity (CMC) are characterized by substantial family-identified service needs, chronic and severe conditions, functional limitations, and high health care use. Information exchange is critically important in high quality care of complex patients at high risk for poor care coordination. Written care plans for CMC are an excellent test case for how well information sharing is currently occurring. The purpose of this study was to identify the barriers to and facilitators of information sharing for CMC across providers, care settings, and families. Methods A qualitative study design with data analysis informed by a grounded theory approach was utilized. Two independent coders conducted secondary analysis of interviews with parents of CMC and health care professionals involved in the care of CMC, collected from two studies of healthcare service delivery for this population. Additional interviews were conducted with privacy officers of associated organizations to supplement these data. Emerging themes related to barriers and facilitators to information sharing were identified by the two coders and the research team, and a theory of facilitators and barriers to information exchange evolved. Results Barriers to information sharing were related to one of three major themes; 1) the lack of an integrated, accessible, secure platform on which summative health care information is stored, 2) fragmentation of the current health system, and 3) the lack of consistent policies, standards, and organizational priorities across organizations for information sharing. Facilitators of information sharing were related to improving accessibility to a common document, expanding the use of technology, and improving upon a structured communication plan. Conclusions Findings informed a model of how various barriers to information sharing interact to prevent optimal information sharing both within and across organizations and how the use of technology to

  16. Financial analysis projects clear returns from electronic medical records.

    PubMed

    Schmitt, Karl F; Wofford, David A

    2002-01-01

    Implementing an electronic medical record (EMR) is a major initiative that should be undertaken only after a thoughtful analysis of the costs and benefits involved. Unfortunately, demonstrating financial returns on an EMR often is regarded as an inexact science at best, which has caused many healthcare executives to avoid adopting this technology. With the right approach, however, it is possible to demonstrate convincingly that the financial benefits will far outweigh the costs. To do this, it is necessary to involve representatives from operational areas throughout the organization, because they are best able to identify the potential for cost savings and additional revenue opportunities.

  17. Application of an Electronic Medical Record in Space Medicine

    NASA Technical Reports Server (NTRS)

    McGinnis, Patrick J.

    2000-01-01

    Electronic Medical Records (EMR) have been emerging over the past decade. Today, they are replacing the paper chart in clinics throughout the nation. Approximately three years ago, the NASA-JSC Flight Medicine Clinic initiated an assessment of the EMRs available on the market. This assessment included comparing these products with the particular scope of practice at JSC. In 1998, the Logician EMR from Medicalogic was selected for the JSC Flight Medicine Clinic. This presentation reviews the process of selection and implementation of the EMR into the unique practice of aerospace medicine at JSC.

  18. SU-E-E-03: Shared Space Fosters Didactic and Professional Learning Across Professions for Medical and Physics Residents

    SciTech Connect

    Dieterich, S; Perks, J; Fragoso, R

    2015-06-15

    Purpose: Medical Physicists and Radiation Oncologists are two professions who should be working as a team for optimal patient care, yet lack of mutual understanding about each others respective role and work environment creates barriers To improve collaboration and learning, we designed a shared didactic and work space for physics and radiation oncology residents to maximize interaction throughout their professional training. Methods: Physician and Physics residents are required to take the same didactic classes, including journal clubs and respective seminars. The residents also share an office environment among the seven physician and two physic residents. Results: By maximizing didactic overlap and sharing office space, the two resident groups have developed a close professional relationship and supportive work environment. Several joint research projects have been initiated by the residents. Awareness of physics tasks in the clinic has led to a request by the physician residents to change physics didactics, converting the physics short course into a lab-oriented course for the medical residents which is in part taught by the physics residents. The physics seminar is given by both residency groups; increased motivation and interest in learning about physics has led to several medical resident-initiated topic selections which generated lively discussion. The physics long course has changed toward including more discussion among residents to delve deeper into topics and study beyond what passing the boards would require. A supportive work environment has developed, embedding the two physics residents into a larger residents group, allowing them to find mentor and peers more easily. Conclusion: By creating a shared work and didactic environment, physician and physics residents have improved their understanding of respective professional practice. Resident-initiated changes in didactic practice have led to improved learning and joint research. A strong social

  19. Sustainability and shared smart and mutual--green growth (SSaM-GG) in Korean medical waste management.

    PubMed

    Koo, Ja-Kong; Jeong, Seung-Ik

    2015-05-01

    Since medical insurance was introduced in the Republic of Korea, there have been several increases concerning medical waste. In order to solve these problems, we have applied life cycle assessment and life cycle cost. But these methods cannot be a perfect decision-making tool because they can only evaluate environmental and economic burdens. Thus, as one of many practical methods the shared smart and mutual - green growth considers economic growth, environmental protection, social justice, science technology and art, and mutual voluntarism when applied to medical waste management in the Republic of Korea. Four systems were considered: incineration, incineration with heat recovery, steam sterilisation, and microwave disinfection. This research study aimed to assess pollutant emissions from treatment, transport, and disposal. Global warming potential, photochemical oxidant creation potential, acidifications potential, and human toxicity are considered to be environmental impacts. Total investment cost, transport cost, operation, and maintenance cost for the medical waste are considered in the economy evaluations though life cycle cost. The social development, science technology and art, and mutual voluntarism are analysed through the Delphi-method conducted by expert groups related to medical waste. The result is that incineration with heat recovery is the best solution. However, when heat recovery is impossible, incineration without heat recovery becomes the next best choice. That is why 95% of medical waste is currently treated by both incineration and incineration with heat recovery within the Republic of Korea.

  20. Measuring the success of electronic medical record implementation using electronic and survey data.

    PubMed Central

    Keshavjee, K.; Troyan, S.; Holbrook, A. M.; VanderMolen, D.

    2001-01-01

    Computerization of physician practices is increasing. Stakeholders are demanding demonstrated value for their Electronic Medical Record (EMR) implementations. We developed survey tools to measure medical office processes, including administrative and physician tasks pre- and post-EMR implementation. We included variables that were expected to improve with EMR implementation and those that were not expected to improve, as controls. We measured the same processes pre-EMR, at six months and 18 months post-EMR. Time required for most administrative tasks decreased within six months of EMR implementation. Staff time spent on charting increased with time, in keeping with our anecdotal observations that nurses were given more responsibility for charting in many offices. Physician time to chart increased initially by 50%, but went down to original levels by 18 months. However, this may be due to the drop-out of those physicians who had a difficult time charting electronically. PMID:11825201

  1. Measuring the success of electronic medical record implementation using electronic and survey data.

    PubMed

    Keshavjee, K; Troyan, S; Holbrook, A M; VanderMolen, D

    2001-01-01

    Computerization of physician practices is increasing. Stakeholders are demanding demonstrated value for their Electronic Medical Record (EMR) implementations. We developed survey tools to measure medical office processes, including administrative and physician tasks pre- and post-EMR implementation. We included variables that were expected to improve with EMR implementation and those that were not expected to improve, as controls. We measured the same processes pre-EMR, at six months and 18 months post-EMR. Time required for most administrative tasks decreased within six months of EMR implementation. Staff time spent on charting increased with time, in keeping with our anecdotal observations that nurses were given more responsibility for charting in many offices. Physician time to chart increased initially by 50%, but went down to original levels by 18 months. However, this may be due to the drop-out of those physicians who had a difficult time charting electronically.

  2. Top 10 Lessons Learned from Electronic Medical Record Implementation in a Large Academic Medical Center.

    PubMed

    Rizer, Milisa K; Kaufman, Beth; Sieck, Cynthia J; Hefner, Jennifer L; McAlearney, Ann Scheck

    2015-01-01

    Electronic medical record (EMR) implementation efforts face many challenges, including individual and organizational barriers and concerns about loss of productivity during the process. These issues may be particularly complex in large and diverse settings with multiple specialties providing inpatient and outpatient care. This case report provides an example of a successful EMR implementation that emphasizes the importance of flexibility and adaptability on the part of the implementation team. It also presents the top 10 lessons learned from this EMR implementation in a large midwestern academic medical center. Included are five overarching lessons related to leadership, initial approach, training, support, and optimization as well as five lessons related to the EMR system itself that are particularly important elements of a successful implementation.

  3. The Cooperative Sharing of Audiovisual Materials in Medical Schools; a Network Approach. Case Study 1.

    ERIC Educational Resources Information Center

    National Medical Audiovisual Center of the National Library of Medicine, Atlanta, GA.

    The evolution of medical schools from their post-Renaissance Italian prototypes to present modern facilities has been marked by a variety of philosophies, methodologies, and pedagogical styles. Pressures to improve medical curriculum led to the educational media movement of the 1950's. By 1970, the Association of Professors of Gynecology and…

  4. Shared Genetic Etiology of Autoimmune Diseases in Patients from a Biorepository Linked to De-identified Electronic Health Records

    PubMed Central

    Restrepo, Nicole A.; Butkiewicz, Mariusz; McGrath, Josephine A.; Crawford, Dana C.

    2016-01-01

    Autoimmune diseases represent a significant medical burden affecting up to 5–8% of the U.S. population. While genetics is known to play a role, studies of common autoimmune diseases are complicated by phenotype heterogeneity, limited sample sizes, and a single disease approach. Here we performed a targeted genetic association study for cases of multiple sclerosis (MS), rheumatoid arthritis (RA), and Crohn's disease (CD) to assess which common genetic variants contribute individually and pleiotropically to disease risk. Joint modeling and pathway analysis combining the three phenotypes were performed to identify common underlying mechanisms of risk of autoimmune conditions. European American cases of MS, RA, and CD, (n = 119, 53, and 129, respectively) and 1924 controls were identified using de-identified electronic health records (EHRs) through a combination of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) billing codes, Current Procedural Terminology (CPT) codes, medication lists, and text matching. As expected, hallmark SNPs in MS, such as DQA1 rs9271366 (OR = 1.91; p = 0.008), replicated in the present study. Both MS and CD were associated with TIMMDC1 rs2293370 (OR = 0.27, p = 0.01; OR = 0.25, p = 0.02; respectively). Additionally, PDE2A rs3781913 was significantly associated with both CD and RA (OR = 0.46, p = 0.02; OR = 0.32, p = 0.02; respectively). Joint modeling and pathway analysis identified variants within the KEGG NOD-like receptor signaling pathway and Shigellosis pathway as being correlated with the combined autoimmune phenotype. Our study replicated previously-reported genetic associations for MS and CD in a population derived from de-identified EHRs. We found evidence to support a shared genetic etiology between CD/MS and CD/RA outside of the major histocompatibility complex region and identified KEGG pathways indicative of a bacterial pathogenesis risk for autoimmunity in a joint model. Future work to

  5. Development and psychometric testing of a scale assessing the sharing of medical information and interprofessional communication: the CSI scale

    PubMed Central

    2014-01-01

    Background Interprofessional collaboration is essential in creating a safer patient environment. It includes the need to develop communication and coordination between professionals, implying a better sharing of medical information. Several questionnaires exist in the literature, but none of them have been developed in the French context. The objective was to develop and test the psychometric properties of the communication and sharing information (CSI) scale which assesses specifically interprofessional communication, especially the sharing of medical information and the effectiveness of communication between members of the team. Methods The questionnaire construction process used a literature review and involved a panel of voluntary professionals. A list of 32 items explored the quality of shared information delivered to patients and the effectiveness of interprofessional communication. The study was conducted in 16 voluntary units in a University Hospital (France), which included medical, surgical, obstetrics, intensive care, pediatrics, oncology and rehabilitation care. The scale-development process comprised an exploratory principal component analysis, Cronbach’s α-coefficients and structural equation modeling (SEM). Results From these 16 units, a total of 503 health professionals took part in the study. Among them, 23.9% were physicians (n = 120), 43.9% nurses (n = 221) and 32.2% nurse assistants (n = 162). The validated questionnaire comprised 13 items and 3 dimensions relative to “the sharing of medical information” (5 items), “communication between physicians” (4 items) and “communication between nurses and nurse assistants” (4 items). The 3 dimensions accounted for 63.7% of the variance of the final questionnaire. Their respective Cronbach’s alpha coefficients were 0.80, 0.87 and 0.81. SEM confirmed the existence of the 3 latent dimensions but the best characteristics were obtained with a hierarchical model including the three

  6. Medical Image Resource Center--making electronic teaching files from PACS.

    PubMed

    Lim, C C Tchoyoson; Yang, Guo Liang; Nowinski, Wieslaw L; Hui, Francis

    2003-12-01

    A picture archive and communications system (PACS) is a rich source of images and data suitable for creating electronic teaching files (ETF). However, the potential for PACS to support nonclinical applications has not been fully realized: at present there is no mechanism for PACS to identify and store teaching files; neither is there a standardized method for sharing such teaching images. The Medical Image Resource Center (MIRC) is a new central image repository that defines standards for data exchange among different centers. We developed an ETF server that retrieves digital imaging and communication in medicine (DICOM) images from PACS, and enables users to create teaching files that conform to the new MIRC schema. We test-populated our ETF server with illustrative images from the clinical case load of the National Neuroscience Institute, Singapore. Together, PACS and MIRC have the potential to benefit radiology teaching and research.

  7. Impact of the Development of a Light Microscopy Shared Resource for the University of Rochester Medical Center: A Quantitative Assessment

    PubMed Central

    Jepson, M.; Jordan, P.; Kasischke, K.; Brown, E.; Reed, A.; Lentine, M.; Bushnell, T.; Puzas, E.; Callahan, L.M.

    2014-01-01

    The University of Rochester Medical Center (URMC) determined the need for a shared Light Microscopy facility to support researchers requiring high-end light microscopy for their research programs. URMC Shared Resource Laboratories (SRLs) represent a strategic investment in technology, targeted expertise, and space administration to systematically support and advance the research mission of the institution. Recognizing the need for centralized light microscopy resources to support the University of Rochester Medical Center, a task force of senior researchers, investigators, and administration developed a plan to create a light microscopy resource. Through strategic investment for instrument upgrades and acquisition as well as hiring of additional staff, the LM resource has grown since its inception in 2008 with expanded capacity and capabilities to support the diverse needs and studies of the URMC researchers. The data presented here address the impact of the LM Shared Resource on the URMC research community in quantitative areas such as publications, new grant funding, and training as well as addressing qualitative measures of success including impact on graduate education and new research avenues.

  8. A next generation electronic triage to aid mass casualty emergency medical response.

    PubMed

    Gao, Tia; White, D

    2006-01-01

    For years, emergency medical response communities have relied upon paper triage tags, clipboards of notes, and voice communications to share information during medical emergencies. This workflow, however, has proven labor intensive, time consuming, and prone to human error [1]. In collaboration with three EMS groups in the Washington, DC Metropolitan area, we have developed a next generation triage system to improve the effectiveness of emergency response. This system includes: 1) electronic triage tags, 2) wearable vital sign sensors, 3) base stations laptops to monitor and manage patients, 4) pervasive tracking software to locate patients at all stages of the disaster response process, and 5) PDAs to support documentation and communication. Our system has evolved through three iterations of rapid-development, field-studies, usability reviews, and focus-group interview. This paper summarizes engineering considerations for technologies that must operate under constraints of medical emergencies. It is our hope that the lessons reported in this paper will help technologists in developing future emergency response systems.

  9. Pulsed-Electron-Beam Processing of Materials for Medical Applications

    NASA Astrophysics Data System (ADS)

    Koval, N. N.; Ivanov, Yu. F.; Teresov, A. D.; Denisova, Yu. A.; Petrikova, E. A.

    2014-02-01

    The data on investigation of sample materials used for fabrication of medical implants (stainless steel 316L, and VT1-0 and CoCrMo (Wironit) alloys) are reported, which were subjected to surface treatment with the pulsed electron beam having the following parameters: pulse duration - 20-200 μs, energy density per pulse - 8-20 J/cm2, number of pulses - 1-5, and pulse repetition frequency - 0.3-1 Hz. A significant structure rearrangement is revealed, which is followed by changes in the modified surface layer properties of these materials. The surface roughness is found to decrease, while the corrosion resistance is improved; slight changes are also observed in the modified layer microhardness compared to the initial state.

  10. Change Management – Recommendations for Successful Electronic Medical Records Implementation

    PubMed Central

    Shoolin, J.S.

    2010-01-01

    Summary Change is difficult and managing change even more so. With the advent of Electronic Medical Records (EMRs) and the difficulty of its acceptance, understanding physician’s attitudes and the psychology of change management is imperative. While many authors describe change management theories, one comes nearest to describing this particularly difficult transition. In 1969, Elizabeth Kübler-Ross wrote her seminal treatise, On Death and Dying, detailing the psychological changes terminally ill patients undergo. Her grieving model is a template to examine the impact of change. By following a physician through the EMR maze, understanding the difficulties he/she perceives and developing a plan other change agents are able to use, the paper gives practical recommendations to EMR change management. PMID:23616842

  11. Forward secure digital signature for electronic medical records.

    PubMed

    Yu, Yao-Chang; Huang, To-Yeh; Hou, Ting-Wei

    2012-04-01

    The Technology Safeguard in Health Insurance Portability and Accountability Act (HIPAA) Title II has addressed a way to maintain the integrity and non-repudiation of Electronic Medical Record (EMR). One of the important cryptographic technologies is mentioned in the ACT is digital signature; however, the ordinary digital signature (e.g. DSA, RSA, GQ...) has an inherent weakness: if the key (certificate) is updated, than all signatures, even the ones generated before the update, are no longer trustworthy. Unfortunately, the current most frequently used digital signature schemes are categorized into the ordinary digital signature scheme; therefore, the objective of this paper is to analyze the shortcoming of using ordinary digital signatures in EMR and to propose a method to use forward secure digital signature to sign EMR to ensure that the past EMR signatures remain trustworthy while the key (certificate) is updated.

  12. Development of medical electronic devices in the APL space department

    NASA Technical Reports Server (NTRS)

    Newman, A. L.

    1985-01-01

    Several electronic devices for automatically correcting specific defects in a body's physiologic regulation and allowing approximately normal functioning are described. A self-injurious behavior inhibiting system (SIBIS) is fastened to the arm of a person with chronic self-injurious behavior patterns. An electric shock is delivered into the arm whenever the device senses above-threshold acceleration of the head such as occur with head-bangers. Sounding a buzzer tone with the shock eventually allows transference of the aversive stimulus to the buzzer so shocks are no longer necessary. A programmable implantable medication system features a solenoid pump placed beneath the skin and refueled by hypodermic needle. The pump functions are programmable and can deliver insulin, chemotherapy mixes and/or pain killers according to a preset schedule or on patient demand. Finally, an automatic implantible defibrillator has four electrodes attached directly to the heart for sensing electrical impulses or emitting them in response to cardiac fibrillation.

  13. Construction and Validation of Synthetic Electronic Medical Records

    PubMed Central

    Moniz, Linda; Buczak, Anna L.; Hung, Lang; Babin, Steven; Dorko, Michael; Lombardo, Joseph

    2009-01-01

    There is a current and pressing need for a test bed of electronic medical records (EMRs) to insure consistent development, validation and verification of public health related algorithms that operate on EMRs. However, access to full EMRs is limited and not generally available to the academic algorithm developers who support the public health community. This paper describes a set of algorithms that produce synthetic EMRs using real EMRs as a model. The algorithms were used to generate a pilot set of over 3000 synthetic EMRs that are currently available on CDC’s Public Health grid. The properties of the synthetic EMRs were validated, both in the entire aggregate data set and for individual (synthetic) patients. We describe how the algorithms can be extended to produce records beyond the initial pilot data set. PMID:23569572

  14. Key success factors behind electronic medical record adoption in Thailand.

    PubMed

    Narattharaksa, Kanida; Speece, Mark; Newton, Charles; Bulyalert, Damrongsak

    2016-09-19

    Purpose The purpose of this paper is to investigate the elements that health care personnel in Thailand believe are necessary for successful adoption of electronic medical record (EMR) systems. Design/methodology/approach Initial qualitative in-depth interviews with physicians to adapt key elements from the literature to the Thai context. The 12 elements identified included things related to managing the implementation and to IT expertise. The nationwide survey was supported by the Ministry of Public Health and returned 1,069 usable questionnaires (response rate 42 percent) from a range of medical personnel. Findings The key elements clearly separated into a managerial dimension and an IT dimension. All were considered fairly important, but managerial expertise was more critical. In particular, there should be clear EMR project goals and scope, adequate budget allocation, clinical staff must be involved in implementation, and the IT should facilitate good electronic communication. Research limitations/implications Thailand is representative of middle-income developing countries, but there is no guarantee findings can be generalized. National policies differ, as do economic structures of health care industries. The focus is on management at the organizational level, but future research must also examine macro-level issues, as well as gain more depth into thinking of individual health care personnel. Practical implications Technical issues of EMR implementation are certainly important. However, it is clear actual adoption and use of the system also depends very heavily on managerial issues. Originality/value Most research on EMR implementation has been in developed countries, and has often focussed more on technical issues rather than examining managerial issues closely. Health IT is also critical in developing economies, and management of health IT implementation must be well understood.

  15. Analysis Of Electronic Medication Orders With Large Overdoses

    PubMed Central

    Kirkendall, E.S.; Kouril, M.; Minich, T.; Spooner, SA.

    2014-01-01

    Summary Background Users of electronic health record (EHR) systems frequently prescribe doses outside recommended dose ranges, and tend to ignore the alerts that result. Since some of these dosing errors are the result of system design flaws, analysis of large overdoses can lead to the discovery of needed system changes. Objectives To develop database techniques for detecting and extracting large overdose orders from our EHR. To identify and characterize users’ responses to these large overdoses. To identify possible causes of large-overdose errors and to mitigate them. Methods We constructed a data mart of medication-order and dosing-alert data from a quaternary pediatric hospital from June 2011 to May 2013. The data mart was used along with a test version of the EHR to explain how orders were processed and alerts were generated for large (>500%) and extreme (>10,000%) overdoses. User response was characterized by the dosing alert salience rate, which expresses the proportion of time users take corrective action. Results We constructed an advanced analytic framework based on workflow analysis and order simulation, and evaluated all 5,402,504 medication orders placed within the 2 year timeframe as well as 2,232,492 dose alerts associated with some of the orders. 8% of orders generated a visible alert, with ¼ of these related to overdosing. Alerts presented to trainees had higher salience rates than those presented to senior colleagues. Salience rates were low, varying between 4–10%, and were lower with larger overdoses. Extreme overdoses fell into eight causal categories, each with a system design mitigation. Conclusions Novel analytic systems are required to accurately understand prescriber behavior and interactions with medication-dosing CDS. We described a novel analytic system that can detect apparent large overdoses (≥500%) and explain the sociotechnical factors that drove the error. Some of these large overdoses can be mitigated by system changes. EHR

  16. Electronic Resource Sharing in Community Colleges: A Snapshot of Florida, Wisconsin, Texas, and Louisiana.

    ERIC Educational Resources Information Center

    Mahoney, Brian D.

    2000-01-01

    States that several states are establishing networks for resource sharing. Florida offers these resources through the Florida Distance Learning Library Initiative, Wisconsin has BadgerLink and WISCAT, TexShare provides library resource sharing in Texas, and Louisiana has LOUIS and LLN. These are some of the states successfully demonstrating…

  17. A context-aware approach for progression tracking of medical concepts in electronic medical records.

    PubMed

    Chang, Nai-Wen; Dai, Hong-Jie; Jonnagaddala, Jitendra; Chen, Chih-Wei; Tsai, Richard Tzong-Han; Hsu, Wen-Lian

    2015-12-01

    Electronic medical records (EMRs) for diabetic patients contain information about heart disease risk factors such as high blood pressure, cholesterol levels, and smoking status. Discovering the described risk factors and tracking their progression over time may support medical personnel in making clinical decisions, as well as facilitate data modeling and biomedical research. Such highly patient-specific knowledge is essential to driving the advancement of evidence-based practice, and can also help improve personalized medicine and care. One general approach for tracking the progression of diseases and their risk factors described in EMRs is to first recognize all temporal expressions, and then assign each of them to the nearest target medical concept. However, this method may not always provide the correct associations. In light of this, this work introduces a context-aware approach to assign the time attributes of the recognized risk factors by reconstructing contexts that contain more reliable temporal expressions. The evaluation results on the i2b2 test set demonstrate the efficacy of the proposed approach, which achieved an F-score of 0.897. To boost the approach's ability to process unstructured clinical text and to allow for the reproduction of the demonstrated results, a set of developed .NET libraries used to develop the system is available at https://sites.google.com/site/hongjiedai/projects/nttmuclinicalnet.

  18. Personal health records as portal to the electronic medical record.

    PubMed

    Cahill, Jennifer E; Gilbert, Mark R; Armstrong, Terri S

    2014-03-01

    This topic review discusses the evolving clinical challenges associated with the implementation of electronic personal health records (PHR) that are fully integrated with electronic medical records (EMR). The benefits of facilitating patient access to the EMR through web-based, PHR-portals may be substantial; foremost is the potential to enhance the flow of information between patient and healthcare practitioner. The benefits of improved communication and transparency of care are presumed to be a reduction in clinical errors, increased quality of care, better patient-management of disease, and better disease and symptom comprehension. Yet PHR databases allow patients open access to newly-acquired clinical data without the benefit of concurrent expert clinical interpretation, and therefore may create the potential for greater patient distress and uncertainty. With specific attention to neuro-oncology patients, this review focuses on the developing conflicts and consequences associated with the use of a PHR that parallels data acquisition of the EMR in real-time. We conclude with a discussion of recommendations for implementing fully-integrated PHR for neuro-oncology patients.

  19. Rapid Identification of Myocardial Infarction Risk Associated With Diabetes Medications Using Electronic Medical Records

    PubMed Central

    Brownstein, John S.; Murphy, Shawn N.; Goldfine, Allison B.; Grant, Richard W.; Sordo, Margarita; Gainer, Vivian; Colecchi, Judith A.; Dubey, Anil; Nathan, David M.; Glaser, John P.; Kohane, Isaac S.

    2010-01-01

    OBJECTIVE To assess the ability to identify potential association(s) of diabetes medications with myocardial infarction using usual care clinical data obtained from the electronic medical record. RESEARCH DESIGN AND METHODS We defined a retrospective cohort of patients (n = 34,253) treated with a sulfonylurea, metformin, rosiglitazone, or pioglitazone in a single academic health care network. All patients were aged >18 years with at least one prescription for one of the medications between 1 January 2000 and 31 December 2006. The study outcome was acute myocardial infarction requiring hospitalization. We used a cumulative temporal approach to ascertain the calendar date for earliest identifiable risk associated with rosiglitazone compared with that for other therapies. RESULTS Sulfonylurea, metformin, rosiglitazone, or pioglitazone therapy was prescribed for 11,200, 12,490, 1,879, and 806 patients, respectively. A total of 1,343 myocardial infarctions were identified. After adjustment for potential myocardial infarction risk factors, the relative risk for myocardial infarction with rosiglitazone was 1.3 (95% CI 1.1–1.6) compared with sulfonylurea, 2.2 (1.6–3.1) compared with metformin, and 2.2 (1.5–3.4) compared with pioglitazone. Prospective surveillance using these data would have identified increased risk for myocardial infarction with rosiglitazone compared with metformin within 18 months of its introduction with a risk ratio of 2.1 (95% CI 1.2–3.8). CONCLUSIONS Our results are consistent with a relative adverse cardiovascular risk profile for rosiglitazone. Our use of usual care electronic data sources from a large hospital network represents an innovative approach to rapid safety signal detection that may enable more effective postmarketing drug surveillance. PMID:20009093

  20. Sharing Wisdom(s) to Enrich Knowledge: Working in a Transdisciplinary Research Team in Medical Anthropology.

    PubMed

    Carceller-Maicas, Natalia

    2015-06-01

    This paper explains our experience working in a transdisciplinary research team focused on adolescence mental health. It introduces briefly the two key theoretical concepts: participation and transdisciplinarity. In order to be followed with a deep description of the methodology and the creation of the two principal materials resulting from our research: a guide of best practices in adolescent mental health, and a documentary film. Showing in a practical way how the research could be enhanced by the sharing of knowledge.

  1. Medical Data Management in Time-Sharing: Findings of the DIRAC Project.

    ERIC Educational Resources Information Center

    Ludwig, Herbert; Vallee, Jacques

    In terms of examples drawn from clinical and research data files, one of the objectives of this study is to illustrate several factors that have combined to delay the implementation of medical data bases. A primary factor has been inherent in the design of computer software. The languages currently on the market are procedural in nature: they…

  2. Voluntary Electronic Reporting of Medical Errors and Adverse Events

    PubMed Central

    Milch, Catherine E; Salem, Deeb N; Pauker, Stephen G; Lundquist, Thomas G; Kumar, Sanjaya; Chen, Jack

    2006-01-01

    OBJECTIVE To describe the rate and types of events reported in acute care hospitals using an electronic error reporting system (e-ERS). DESIGN Descriptive study of reported events using the same e-ERS between January 1, 2001 and September 30, 2003. SETTING Twenty-six acute care nonfederal hospitals throughout the U.S. that voluntarily implemented a web-based e-ERS for at least 3 months. PARTICIPANTS Hospital employees and staff. INTERVENTION A secure, standardized, commercially available web-based reporting system. RESULTS Median duration of e-ERS use was 21 months (range 3 to 33 months). A total of 92,547 reports were obtained during 2,547,154 patient-days. Reporting rates varied widely across hospitals (9 to 95 reports per 1,000 inpatient-days; median=35). Registered nurses provided nearly half of the reports; physicians contributed less than 2%. Thirty-four percent of reports were classified as nonmedication-related clinical events, 33% as medication/infusion related, 13% were falls, 13% as administrative, and 6% other. Among 80% of reports that identified level of impact, 53% were events that reached a patient (“patient events”), 13% were near misses that did not reach the patient, and 14% were hospital environment problems. Among 49,341 patient events, 67% caused no harm, 32% temporary harm, 0.8% life threatening or permanent harm, and 0.4% contributed to patient deaths. CONCLUSIONS An e-ERS provides an accessible venue for reporting medical errors, adverse events, and near misses. The wide variation in reporting rates among hospitals, and very low reporting rates by physicians, requires investigation. PMID:16390502

  3. Osteoporosis guideline implementation in family medicine using electronic medical records

    PubMed Central

    Pritchard, Janet; Karampatos, Sarah; Ioannidis, George; Adachi, Jonathan; Thabane, Lehana; Nash, Lynn; Mehan, Upe; Kozak, Joseph; Feldman, Sid; Hirsch, Steve; Jovaisas, Algis V.; Cheung, Angela; Lohfeld, Lynne; Papaioannou, Alexandra

    2016-01-01

    Abstract Objective To identify family physicians’ learning needs related to osteoporosis care; determine family physicians’ preferred modes of learning; and identify barriers to using electronic medical records (EMRs) to implement osteoporosis guidelines in practice. Design Web-based survey. Setting Ontario. Participants Family physicians. Main outcome measures Quantitative and qualitative data about learning needs related to osteoporosis diagnosis and management; preferred mode of learning about guidelines; and barriers to using EMRs to implement guidelines. Results Of the 12 332 family physicians invited to participate in the survey, 8.5% and 7.0% provided partial or fully completed surveys, respectively. More than 80% of respondents agreed that the priority areas for education were as follows: selecting laboratory tests for secondary osteoporosis and interpreting the test results; interpreting bone mineral density results; determining appropriate circumstances for ordering anterior-posterior lumbar spine x-ray scans; and understanding duration, types, and adverse effects of pharmacotherapy. Qualitative analysis revealed that managing moderate-risk patients was a learning need. Continuing medical education was the preferred mode of learning. Approximately 80% of respondents agreed that the scarcity of EMR tools to aid in guideline implementation was a barrier to using guidelines, and 50% of respondents agreed that if EMR-embedded tools were available, time would limit their ability to use them. Conclusion This survey identified key diagnostic- and treatment-related topics in osteoporosis care that should be the focus of future continuing professional development for family physicians. Developers of EMR tools, physicians, and researchers aiming to implement guidelines to improve osteoporosis care should consider the potential barriers indicated in this study.

  4. The REEME project: a cooperative model for sharing international medical education materials.

    PubMed

    Iserson, Kenneth V

    2008-07-01

    Although the Internet has become an excellent source of medical education materials, in many specialties, including Emergency Medicine (EM), most of the information is in English. Few international EM practitioners can attend costly specialty conferences, importing foreign experts to teach at these conferences is costly and, even then, these experts are available for a limited time to relatively few people. Countries with minimal health care or medical education budgets find providing even basic materials for professional medical education difficult. An exciting international project now freely distributes Spanish language educational programs to health care professionals on topics relating to EM. The Recursos Educacionales en Español para Medicina de Emergencia (REEME; Educational Resources in Spanish for EM) Project (www.reeme.arizona.edu) was developed to overcome some of these problems by providing language-specific specialty information and widespread international availability, and by promoting international cooperation among professional health care educators. It also provides a ready source of Spanish medical vocabulary for those trying to learn the language. With computer support from the University of Arizona's Learning and Technology Center, REEME first went "live" on November 1, 2004. Three years later, as of November 1, 2007, the site had 575 programs from 411 donors representing 19 countries and the United Nations. There are currently about 645 downloads per month to users in 73 countries. The REEME Project demonstrates the power of the Internet as a means to achieve international cooperation in medical education, and can serve as a model for similar projects in other specialties and languages.

  5. Consumers' Perceptions of Patient-Accessible Electronic Medical Records

    PubMed Central

    Vaughon, Wendy L; Czaja, Sara J; Levy, Joslyn; Rockoff, Maxine L

    2013-01-01

    Background Electronic health information (eHealth) tools for patients, including patient-accessible electronic medical records (patient portals), are proliferating in health care delivery systems nationally. However, there has been very limited study of the perceived utility and functionality of portals, as well as limited assessment of these systems by vulnerable (low education level, racial/ethnic minority) consumers. Objective The objective of the study was to identify vulnerable consumers’ response to patient portals, their perceived utility and value, as well as their reactions to specific portal functions. Methods This qualitative study used 4 focus groups with 28 low education level, English-speaking consumers in June and July 2010, in New York City. Results Participants included 10 males and 18 females, ranging in age from 21-63 years; 19 non-Hispanic black, 7 Hispanic, 1 non-Hispanic White and 1 Other. None of the participants had higher than a high school level education, and 13 had less than a high school education. All participants had experience with computers and 26 used the Internet. Major themes were enhanced consumer engagement/patient empowerment, extending the doctor’s visit/enhancing communication with health care providers, literacy and health literacy factors, improved prevention and health maintenance, and privacy and security concerns. Consumers were also asked to comment on a number of key portal features. Consumers were most positive about features that increased convenience, such as making appointments and refilling prescriptions. Consumers raised concerns about a number of potential barriers to usage, such as complex language, complex visual layouts, and poor usability features. Conclusions Most consumers were enthusiastic about patient portals and perceived that they had great utility and value. Study findings suggest that for patient portals to be effective for all consumers, portals must be designed to be easy to read, visually

  6. Progress in electronic medical record adoption in Canada

    PubMed Central

    Chang, Feng; Gupta, Nishi

    2015-01-01

    Objective To determine the rate of adoption of electronic medical records (EMRs) by physicians across Canada, provincial incentives, and perceived benefits of and barriers to EMR adoption. Data sources Data on EMR adoption in Canada were collected from CINAHL, MEDLINE, PubMed, EMBASE, the Cochrane Library, the Health Council of Canada, Canada Health Infoway, government websites, regional EMR associations, and health professional association websites. Study selection After removal of duplicate articles, 236 documents were found matching the original search. After using the filter Canada, 12 documents remained. Additional documents were obtained from each province’s EMR website and from the Canada Health Infoway website. Synthesis Since 2006, Canadian EMR adoption rates have increased from about 20% of practitioners to an estimated 62% of practitioners in 2013, with substantial regional disparities ranging from roughly 40% of physicians in New Brunswick and Quebec to more than 75% of physicians in Alberta. Provincial incentives vary widely but appear to have only a weak relationship with the rate of adoption. Many adopters use only a fraction of their software’s available functions. User-cited benefits to adoption include time savings, improved record keeping, heightened patient safety, and confidence in retrieved data when EMRs are used efficiently. Barriers to adoption include financial and time constraints, lack of knowledgeable support personnel, and lack of interoperability with hospital and pharmacy systems. Conclusion Canadian physicians remain at the stage of EMR adoption. Progression in EMR use requires experienced, knowledgeable technical support during implementation, and financial support for the transcription of patient data from paper to electronic media. The interoperability of EMR offerings for hospitals, pharmacies, and clinics is the rate-limiting factor in achieving a unified EMR solution for Canada. PMID:27035020

  7. A Survey Aimed at General Citizens of the US and Japan about Their Attitudes toward Electronic Medical Data Handling

    PubMed Central

    Kimura, Michio; Nakaya, Jun; Watanabe, Hiroshi; Shimizu, Toshiro; Nakayasu, Kazuyuki

    2014-01-01

    Objectives: To clarify the views of the general population of two countries (US and Japan), concerning the handling of their medical records electronically. Methods: We contacted people nationwide in the United States at random via Random Digit Dialing (RDD) to obtain 200 eligible responders. The questionnaire was for obtaining the information on their attitudes towards handling of their medical records, disclosure of the name of disease, secondary usage of information, compiling their records into a lifelong medical record, and access to their medical records on the Internet. We had also surveyed people of Shizuoka prefecture in Japan using same questionnaires sent by mail, for which we obtained 457 valid answers. Results: Even in an unidentifiable manner, US people feel profit-oriented usage of medical data without specific consent is not acceptable. There is a significant difference between usage of unidentifiable medical data for profit (about 50% feel negatively) and for official/research purposes (about 30% feel negatively). About 60% of the US responders have a negative view on the proposal that unidentifiable medical information be utilized for profit by private companies to attain healthcare cost savings. As regards compiling a lifelong medical record, positive answers and negative answers are almost equally divided in the US (46% vs. 38%) while more positive attitudes are seen in Japan (74% vs. 12%). However, any incentive measures aimed at changing attitudes to such a compiling including the discount of healthcare costs or insurance fees are unwelcomed by people regardless of their age or health condition in both surveys. Regarding the access to their own medical record via the Internet, 38% of the US responders feel this is unacceptable while 50.5% were willing to accept it. Conclusions: Participants from the US think that the extent of the sharing their identifiable medical records should be limited to the doctors-in-charge and specified doctors

  8. DRUG-DRUG INTERACTION PROFILES OF MEDICATION REGIMENS EXTRACTED FROM A DE-IDENTIFIED ELECTRONIC MEDICAL RECORDS SYSTEM

    PubMed Central

    Butkiewicz, Mariusz; Restrepo, Nicole A.; Haines, Jonathan L.; Crawford, Dana C.

    2016-01-01

    With age, the number of prescribed medications increases and subsequently raises the risk for adverse drug-drug interactions. These adverse effects lower quality of life and increase health care costs. Quantifying the potential burden of adverse effects before prescribing medications can be a valuable contribution to health care. This study evaluated medication lists extracted from a subset of the Vanderbilt de-identified electronic medical record system. Reported drugs were cross-referenced with the Kyoto Encyclopedia of Genes and Genomes DRUG database to identify known drug-drug interactions. On average, a medication regimen contained 6.58 medications and 2.68 drug-drug interactions. Here, we quantify the burden of potential adverse events from drug-drug interactions through drug-drug interaction profiles and include a number of alternative medications as provided by the Anatomical Therapeutic Chemical Classification System. PMID:27570646

  9. A critical pathway for electronic medical record selection.

    PubMed

    Holbrook, A; Keshavjee, K; Langton, K; Troyan, S; Millar, S; Olantunji, S; Pray, M; Tytus, R; Ford, P T

    2001-01-01

    Electronic medical records (EMRs) are increasingly becoming a necessary tool in health care. Given their potential to influence every aspect of health care, there has been surprisingly little rigorous research applied to this important piece of emerging health technology. An initial phase of the COMPETE study, which is examining the impact of EMRs on efficiency, quality of care and privacy concerns, involved a rigorous "critical pathway" approach to EMR selection for the study. A multidisciplinary team with clinical, technical and research expertise led an 8-stage evaluation process with direct input from user physicians at each stage. An iterative sequence of review of EMR specifications and features, live product demonstrations, site visits, and negotiations with vendors led to a progressive narrowing of the field of eligible EMR systems. Final scoring was based on 3 main themes of clinical usability, data quality and support/vendor issues. We believe that a rigorous, multidisciplinary process such as this is required to maximize success of any EMR implementation project.

  10. A critical pathway for electronic medical record selection.

    PubMed Central

    Holbrook, A.; Keshavjee, K.; Langton, K.; Troyan, S.; Millar, S.; Olantunji, S.; Pray, M.; Tytus, R.; Ford, P. T.

    2001-01-01

    Electronic medical records (EMRs) are increasingly becoming a necessary tool in health care. Given their potential to influence every aspect of health care, there has been surprisingly little rigorous research applied to this important piece of emerging health technology. An initial phase of the COMPETE study, which is examining the impact of EMRs on efficiency, quality of care and privacy concerns, involved a rigorous "critical pathway" approach to EMR selection for the study. A multidisciplinary team with clinical, technical and research expertise led an 8-stage evaluation process with direct input from user physicians at each stage. An iterative sequence of review of EMR specifications and features, live product demonstrations, site visits, and negotiations with vendors led to a progressive narrowing of the field of eligible EMR systems. Final scoring was based on 3 main themes of clinical usability, data quality and support/vendor issues. We believe that a rigorous, multidisciplinary process such as this is required to maximize success of any EMR implementation project. PMID:11825192

  11. Characterization of Statin Dose-response within Electronic Medical Records

    PubMed Central

    Wei, Wei-Qi; Feng, Qiping; Jiang, Lan; Waitara, Magarya S.; Iwuchukwu, Otito F.; Roden, Dan M.; Jiang, Min; Xu, Hua; Krauss, Ronald M.; Rotter, Jerome I.; Nickerson, Deborah A.; Davis, Robert L.; Berg, Richard L.; Peissig, Peggy L.; McCarty, Catherine A.; Wilke, Russell A.; Denny, Joshua C.

    2013-01-01

    Efforts to define the genetic architecture underlying variable statin response have met with limited success possibly because previous studies were limited to effect based on one-single-dose. We leveraged electronic medical records (EMRs) to extract potency (ED50) and efficacy (Emax) of statin dose-response curves and tested them for association with 144 pre-selected variants. Two large biobanks were used to construct dose-response curves for 2,026 (simvastatin) and 2,252 subjects (atorvastatin). Atorvastatin was more efficacious, more potent, and demonstrated less inter-individual variability than simvastatin. A pharmacodynamic variant emerging from randomized trials (PRDM16) was associated with Emax for both. For atorvastatin, Emax was 51.7 mg/dl in homozygous for the minor allele versus 75.0 mg/dl for those homozygous for the major allele. We also identified several loci associated with ED50. The extraction of rigorously defined traits from EMRs for pharmacogenetic studies represents a promising approach to further understand of genetic factors contributing to drug response. PMID:24096969

  12. An Efficient Searchable Encryption Against Keyword Guessing Attacks for Sharable Electronic Medical Records in Cloud-based System.

    PubMed

    Wu, Yilun; Lu, Xicheng; Su, Jinshu; Chen, Peixin

    2016-12-01

    Preserving the privacy of electronic medical records (EMRs) is extremely important especially when medical systems adopt cloud services to store patients' electronic medical records. Considering both the privacy and the utilization of EMRs, some medical systems apply searchable encryption to encrypt EMRs and enable authorized users to search over these encrypted records. Since individuals would like to share their EMRs with multiple persons, how to design an efficient searchable encryption for sharable EMRs is still a very challenge work. In this paper, we propose a cost-efficient secure channel free searchable encryption (SCF-PEKS) scheme for sharable EMRs. Comparing with existing SCF-PEKS solutions, our scheme reduces the storage overhead and achieves better computation performance. Moreover, our scheme can guard against keyword guessing attack, which is neglected by most of the existing schemes. Finally, we implement both our scheme and a latest medical-based scheme to evaluate the performance. The evaluation results show that our scheme performs much better performance than the latest one for sharable EMRs.

  13. Low energy electron-impact ionization of hydrogen atom for coplanar equal-energy-sharing kinematics in Debye plasmas

    NASA Astrophysics Data System (ADS)

    Li, Jun; Zhang, Song Bin; Ye, Bang Jiao; Wang, Jian Guo; Janev, R. K.

    2016-12-01

    Low energy electron-impact ionization of hydrogen atom in Debye plasmas has been investigated by employing the exterior complex scaling method. The interactions between the charged particles in the plasma have been represented by Debye-Hückel potentials. Triple differential cross sections (TDCS) in the coplanar equal-energy-sharing geometry at an incident energy of 15.6 eV for different screening lengths are reported. As the screening strength increases, TDCS change significantly. The evolutions of dominant typical peak structures of the TDCS are studied in detail for different screening lengths and for different coplanar equal-energy-sharing geometries.

  14. Towards improved knowledge sharing: assessment of the HL7 Reference Information Model to support medical logic module queries.

    PubMed

    Jenders, R A; Sujansky, W; Broverman, C A; Chadwick, M

    1997-01-01

    Because clinical databases vary in structure, access methods and vocabulary used to represent data, the Arden Syntax does not define a standard model for querying databases. Consequently, database queries are encoded in ad hoc ways and enclosed in "curly braces" in Medical Logic Modules (MLMs). However, the nonstandard representation of queries impairs sharing of MLMs, an impediment that has come to be known as the "curly braces problem." As a first step in solving this problem, we evaluated the proposed HL7 Reference Information Model (RIM) as a foundation for a standard query model for the Arden Syntax. Specifically, we analyzed the MLM knowledge base at the Columbia-Presbyterian Medical Center and compared the queries in these MLMs to the RIM. We studied 488 queries in 104 MLMs, identifying 674 total query data elements. Laboratory tests accounted for 45.8% of these elements, while demographic and ADT data accounted for 37.6%. Pharmacy orders accounted for 10.5%, medical problems for 4.3% and MLM output messages for 1.6%. We found that the RIM encompasses all but those data elements signifying MLM output (1.6% of the total). We conclude that the majority of queries in the CPMC knowledge base access a relatively small set of data elements and that the RIM encompasses these elements. We propose extensions of this analysis to continue construction of an Arden query model capable of solving the "curly braces problem."

  15. Meaningful use: an electronic medical record tool for cerebrospinal fluid shunt history.

    PubMed

    Governale, Lance S; Hoffman, Jeffrey M

    2017-02-10

    The care of patients with shunted hydrocephalus can be complicated. The best assessment is provided when all data are available to the neurosurgery practitioner. However, data can be time-consuming to gather, especially in the setting of a busy practice, a trainee environment with duty-hour restrictions, and an electronic medical record (EMR) not specifically designed for the needs of subspecialists. For these reasons, the complete clinical picture, especially the historical component, is sometimes not assembled. To address these shortcomings, the authors created a patient-level electronic CSF shunt history tool that leverages the power of the EMR concordant with the United States Centers for Medicare and Medicaid Services meaningful use principles. It is immediately available within the EMR for all users in all patient care contexts (e.g., outpatient, inpatient, perioperative, emergency, and remote access), centrally located, and designed to capture the vast range of circumstances inherent to the hydrocephalus population. Essential shunt data can be rapidly acquired and, as such, may decrease the likelihood of error in diagnosis and/or treatment. The tool also has the potential to aid the practicing neurosurgeon from clinical, quality improvement, and research standpoints. The authors have endeavored to describe this tool in a manner that would allow an interested neurosurgeon to share this publication with health information technology professionals to facilitate the development of a similar tool within their institution's own EMR platform.

  16. Anonymization of DICOM electronic medical records for radiation therapy.

    PubMed

    Newhauser, Wayne; Jones, Timothy; Swerdloff, Stuart; Newhauser, Warren; Cilia, Mark; Carver, Robert; Halloran, Andy; Zhang, Rui

    2014-10-01

    Electronic medical records (EMR) and treatment plans are used in research on patient outcomes and radiation effects. In many situations researchers must remove protected health information (PHI) from EMRs. The literature contains several studies describing the anonymization of generic Digital Imaging and Communication in Medicine (DICOM) files and DICOM image sets but no publications were found that discuss the anonymization of DICOM radiation therapy plans, a key component of an EMR in a cancer clinic. In addition to this we were unable to find a commercial software tool that met the minimum requirements for anonymization and preservation of data integrity for radiation therapy research. The purpose of this study was to develop a prototype software code to meet the requirements for the anonymization of radiation therapy treatment plans and to develop a way to validate that code and demonstrate that it properly anonymized treatment plans and preserved data integrity. We extended an open-source code to process all relevant PHI and to allow for the automatic anonymization of multiple EMRs. The prototype code successfully anonymized multiple treatment plans in less than 1min/patient. We also tested commercial optical character recognition (OCR) algorithms for the detection of burned-in text on the images, but they were unable to reliably recognize text. In addition, we developed and tested an image filtering algorithm that allowed us to isolate and redact alpha-numeric text from a test radiograph. Validation tests verified that PHI was anonymized and data integrity, such as the relationship between DICOM unique identifiers (UID) was preserved.

  17. A qualitative study of Swedes' opinions about shared electronic health records.

    PubMed

    Lehnbom, Elin C; McLachlan, Andrew J; Brien, Jo-anne E

    2013-01-01

    European countries are world-leading in the development and implementation of e-Health. In Sweden, all primary healthcare centres and most hospitals use digital records. Some regions use the same software which allows for clinical information to be shared (regionally shared EHRs), but there is a movement towards making all EHRs inter-operable to allow for a National Patient Summary (NPS). The aim of this study was to explore the opinions of Swedish consumers and health professionals about shared EHRs and the NPS. Semi-structered phone interviews were conducted with consumers and health professionals. The majority of interviewed health professionals were currently using regionally shared EHRs. In their experience, having access to regionally shared EHRs facilitated a holistic patient approach, assisted in patient follow-up, and reduced inappropriate (over)prescribing. Consumers had a poor level of knowledge about shared EHRs and the NPS. Unlike health professionals, consumers perceived a NPS to be of great value. The findings indicate that there was a discrepancy between health professionals and consumers' knowledge of, and the perceived need for, a NPS.

  18. Shared Medical Appointments: A Promising Innovation to Improve Patient Engagement and Ease the Primary Care Provider Shortage.

    PubMed

    Stults, Cheryl D; McCuistion, Mary H; Frosch, Dominick L; Hung, Dorothy Y; Cheng, Peter H; Tai-Seale, Ming

    2016-02-01

    The Affordable Care Act has extended coverage for uninsured and underinsured Americans, but it could exacerbate existing problems of access to primary care. Shared medical appointments (SMAs) are one way to improve access and increase practice productivity, but few studies have examined the patient's perspective on participation in SMAs. To understand patient experiences, 5 focus group sessions were conducted with a total of 30 people in the San Francisco Bay Area. The sessions revealed that most participants felt that they received numerous tangible and intangible benefits from SMAs, particularly enhanced engagement with other patients and physicians, learning, and motivation for health behavior change. Most importantly, participants noted changes in the power dynamic during SMA visits as they increasingly saw themselves empowered to impart information to the physician. Although SMAs improve access, engagement with physicians and other patients, and knowledge of patients' health, they also help to ease the workload for physicians.

  19. Putting the Medical Library Online: Electronic Bulletin Boards. . . and Beyond.

    ERIC Educational Resources Information Center

    Kittle, Paul W.

    1985-01-01

    Describes use of microcomputers with system called "TBBS" ("The Bread Board System") at Loma Linda University Medical Center to allow users enhanced services from home, whether library facilities are open or not. Flexibility and security, dialing into medical library, and suggestions for setting up similar computerized…

  20. The Genetic Intersection of Neurodevelopmental Disorders and Shared Medical Comorbidities – Relations that Translate from Bench to Bedside

    PubMed Central

    Plummer, Jasmine T.; Gordon, Alexis J.; Levitt, Pat

    2016-01-01

    Most psychiatric disorders are considered neurodevelopmental, and the associated genes often are expressed in tissues outside of the brain. This suggests a biological relatedness with medical co-occurrences that could have broad clinical implications for diagnosis and patient management over a lifetime. A qualitative integration of public data from genetic consortia of psychiatric disorders and medical comorbidities explores the question of whether genetically associated psychiatric illnesses present with co-occurring disturbances can be used to define specific mental–physical health relations. Novel patterns of gene-disorder relations appear with approximately one-third of conservatively defined, consortia-generated candidate risk genes with multiple psychiatric diagnoses. Moreover, nearly as many genes overlap with non-psychiatric phenotypes, including cardiovascular, renal, respiratory, and metabolic disturbances. While the landscape of genetic risk will change as study populations are expanded and biological confirmations accrue, the current relationships suggest that a mostly siloed perspective of gene relatedness to one categorical psychiatric diagnosis is not clinically useful. The future holds the promise that once candidates are fully validated, genome screening and mutation identification will bring more precision for predicting the risk for complex health conditions. Our view is that as genetic data are refined, continuing to decipher a shared pattern of genetic risk for brain and peripheral organ pathophysiology is not simply an academic exercise. Rather, determining relatedness will impact predictions of multifaceted health risks, patient treatment, and management. PMID:27597832

  1. Electronic security systems and active implantable medical devices.

    PubMed

    Irnich, Werner

    2002-08-01

    How do active implantable medical devices react in the presence of strong magnetic fields in the frequency range between extremely low frequency (ELF) to radiofrequency (RF) as they are emitted by electronic security systems (ESS)? There are three different sorts of ESSs: electronic article surveillance (EAS) devices, metal detector (MDS) devices, and radiofrequency identification (RFID) systems. Common to all is the production of magnetic fields. There is an abundance of literature concerning interference by ESS gates with respect to if there is an influence possible and if such an influence can bear a risk for the AIMD wearers. However, there has been no attempt to study the physical mechanism nor to develop a model of how and under which conditions magnetic fields can influence pacemakers and defibrillators and how they could be disarmed by technological means. It is too often assumed that interference of AIMD with ESS is inevitable. Exogenous signals of similar intensity and rhythm to heart signals can be misinterpreted and, thus, confuse the implant. Important for the interference coupling mechanism is the differentiation between a "unipolar" and a "bipolar" system. With respect to magnetic fields, the left side implanted pacemaker is the most unfavorable case as the lead forms approximately a semicircular area of maximum 225 cm2 into which a voltage can be induced. This assumption yields an interference coupling model that can be expressed by simple mathematics. The worst-case conditions for induced interference voltages are a coupling area of 225 cm2 that is representative for a large human, a homogeneous magnetic field perpendicular to the area formed by the lead, and a unipolar ventricular pacemaker system that is implanted on the left side of the thorax and has the highest interference sensitivity. In bipolar systems the fields must be 17 times larger when compared to a unipolar system to have the same effect. The magnetic field for interfering with ICDs

  2. Special requirements of electronic medical record systems in obstetrics and gynecology.

    PubMed

    McCoy, Michael J; Diamond, Anne M; Strunk, Albert L

    2010-07-01

    There is growing recognition of the importance and potential benefit of information technology and electronic medical records in providing quality care for women. Incorporation of obstetrician-gynecologist-specific requirements by electronic medical record vendors is essential to achieve appropriate electronic medical record functionality for obstetrician-gynecologists. Obstetricians and gynecologists record and document patient care in ways that are unique to medicine. Current electronic medical record systems are often limited in their usefulness for the practice of obstetrics and gynecology because of the absence of obstetrician-gynecologist specialty-specific requirements and functions. The Certification Commission on Health Information Technology is currently the only federally recognized body for certification of electronic medical record systems. As Certification Commission on Health Information Technology expands the certification criteria for electronic medical records, the special requirements identified in this report will be used as a framework for developing obstetrician-gynecologist specialty-specific criteria to be incorporated into the Certification Commission on Health Information Technology endorsement for electronic medical records used by obstetrician-gynecologists.

  3. World Bank's Global Development Learning Network: Sharing Knowledge Electronically between Nations To "Fight Poverty."

    ERIC Educational Resources Information Center

    Lorenzo, George

    2002-01-01

    Describes the Global Development Learning Network (GDLN), a satellite-driven global communication system developed by the World Bank to help developing countries fight poverty and share in a global exchange of information. Explains Distance Learning Centers that are used by private and public organizations and institutions for distance education…

  4. Why Does Electron Sharing Lead to Covalent Bonding? A Variational Analysis

    SciTech Connect

    Ruedenberg, K.; Schmidt, M.

    2006-07-20

    Ground state energy differences between related systems can be elucidated by a comparative variational analysis of the energy functional, in which the concepts of variational kinetic pressure and variational electrostatic potential pull are found useful. This approach is applied to the formation of the bond in the hydrogen molecule ion. A highly accurate wavefunction is shown to be the superposition of two quasiatomic orbitals, each of which consists to 94% of the respective atomic 1s orbital, the remaining 6% deformation being 73% spherical and 27% nonspherical in character. The spherical deformation can be recovered to 99.9% by scaling the 1s orbital. These results quantify the conceptual metamorphosis of the free-atom wavefunction into the molecular wavefunction by orbital sharing, orbital contraction, and orbital polarization. Starting with the 1s orbital on one atom as the initial trial function, the value of the energy functional of the molecule at the equilibrium distance is stepwise lowered along several sequences of wavefunction modifications, whose energies monotonically decrease to the ground state energy of H{sub 2}{sup +}. The contributions of sharing, contraction and polarization to the overall lowering of the energy functional and their kinetic and potential components exhibit a consistent pattern that can be related to the wavefunction changes on the basis of physical reasoning, including the virial theorem. It is found that orbital sharing lowers the variational kinetic energy pressure and that this is the essential cause of covalent bonding in this molecule.

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

    PubMed Central

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

    2015-01-01

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

  6. Practical considerations to guide development of access controls and decision support for genetic information in electronic medical records

    PubMed Central

    2011-01-01

    Background Genetic testing is increasingly used as a tool throughout the health care system. In 2011 the number of clinically available genetic tests is approaching 2,000, and wide variation exists between these tests in their sensitivity, specificity, and clinical implications, as well as the potential for discrimination based on the results. Discussion As health care systems increasingly implement electronic medical record systems (EMRs) they must carefully consider how to use information from this wide spectrum of genetic tests, with whom to share information, and how to provide decision support for clinicians to properly interpret the information. Although some characteristics of genetic tests overlap with other medical test results, there are reasons to make genetic test results widely available to health care providers and counterbalancing reasons to restrict access to these test results to honor patient preferences, and avoid distracting or confusing clinicians with irrelevant but complex information. Electronic medical records can facilitate and provide reasonable restrictions on access to genetic test results and deliver education and decision support tools to guide appropriate interpretation and use. Summary This paper will serve to review some of the key characteristics of genetic tests as they relate to design of access control and decision support of genetic test information in the EMR, emphasizing the clear need for health information technology (HIT) to be part of optimal implementation of genetic medicine, and the importance of understanding key characteristics of genetic tests when designing HIT applications. PMID:22047175

  7. Medication counseling: analysis of electronic documentation using the clinical care classification system.

    PubMed

    Saranto, Kaija; Moss, Jacqueline; Jylhä, Virpi

    2010-01-01

    Medication counseling is a central aspect of medication safety. Counseling refers to the process of informing, advising and administering medication to help patients manage their medication regimen. This pilot study examined 379 descriptions of medication counseling carried out in surgical care and documented in an electronic patient record system by using the Clinical Care Classification System. The objective was to identify counseling methods and to evaluate the need for additional counseling descriptor codes in the record. Eleven counseling methods were identified and the data were classified according to counseling methods with and without documentation of the nature of the interaction with patients. There were no descriptions of the nature of counseling conducted in 127 of the documented entries. These results can be used when developing the documentation of medication care in electronic patient records.

  8. Electronic Medical Record and Quality Ratings of Long Term Care Facilities Long-Term Care Facility Characteristics and Reasons and Barriers for Adoption of Electronic Medical Record

    ERIC Educational Resources Information Center

    Daniels, Cheryl Andrea

    2013-01-01

    With the growing elderly population, compounded by the retirement of the babyboomers, the need for long-term care (LTC) facilities is expected to grow. An area of great concern for those that are seeking a home for their family member is the quality of care provided by the nursing home to the residents. Electronic medical records (EMR) are often…

  9. Medical faculty's use of print and electronic journals: changes over time and in comparison with scientists

    PubMed Central

    Tenopir, Carol; King, Donald W.; Bush, Amy

    2004-01-01

    Objectives: The objectives are to determine how medical faculty members use scholarly journals, whether print or electronic journals are read more, whether there is a pattern among types of users, and what similarities and differences there are between the use of journals by medical faculty and faculty in other disciplines. Methods: Medical faculty of the University of Tennessee Health Science Center (UTHSC) multi-campus system were surveyed, and their responses estimated using critical incident technique to characterize the different aspects of their use of print and electronic journals. Results: Medical faculty read a great deal, especially compared to scientists. The most frequently reported principal purpose of reading is to support their primary research (30% of reading). The majority of reading comes from recently published articles, mostly from personal subscriptions. Medical faculty continue to rely on print journals (approximately 70% of readings) versus electronic journals. Age of faculty does not appear to influence the choice of print or electronic format. Medical faculty read more articles than others on average and need information digested and verified in a way to save them time. Convenience and currency are highly valued attributes. Conclusions: It can be asserted that librarians and publishers must find ways to provide the attributes of convenience and currency and match the portability of personal subscriptions in an electronic journal format for medical faculty. PMID:15098053

  10. Optimizing Inpatient Urine Culture Ordering Practices Using the Electronic Medical Record: A Pilot Study.

    PubMed

    Shirley, Daniel; Scholtz, Harry; Osterby, Kurt; Musuuza, Jackson; Fox, Barry; Safdar, Nasia

    2017-04-01

    A prospective quasi-experimental before-and-after study of an electronic medical record-anchored intervention of embedded education on appropriate urine culture indications and indication selection reduced the number of urine cultures ordered for catheterized patients at an academic medical center. This intervention could be a component of CAUTI-reduction bundles. Infect Control Hosp Epidemiol 2017;38:486-488.

  11. Organizational Learning and Large-Scale Change: Adoption of Electronic Medical Records

    ERIC Educational Resources Information Center

    Chavis, Virginia D.

    2010-01-01

    Despite implementation of electronic medical record (EMR) systems in the United States and other countries, there is no organizational development model that addresses medical professionals' attitudes toward technology adoption in a learning organization. The purpose of this study was to assess whether a model would change those attitudes toward…

  12. Urban Alabama Physicians and the Electronic Medical Record: A Qualitative Study

    ERIC Educational Resources Information Center

    Tiggle, Michele

    2012-01-01

    The electronic medical record (EMR) is an information technology tool supporting the examination, treatment, and care of a patient. The EMR allows physicians to view a patient's record showing current medications, a history of visits from health care providers with notes from those visits, a problem list, a functional status assessment, a schedule…

  13. Factors Influencing Electronic Clinical Information Exchange in Small Medical Group Practices

    ERIC Educational Resources Information Center

    Kralewski, John E.; Zink, Therese; Boyle, Raymond

    2012-01-01

    Purpose: The purpose of this study was to identify the organizational factors that influence electronic health information exchange (HIE) by medical group practices in rural areas. Methods: A purposive sample of 8 small medical group practices in 3 experimental HIE regions were interviewed to determine the extent of clinical information exchange…

  14. Current status and trends in performance-based risk-sharing arrangements between healthcare payers and medical product manufacturers.

    PubMed

    Carlson, Josh J; Gries, Katharine S; Yeung, Kai; Sullivan, Sean D; Garrison, Louis P

    2014-06-01

    Our objective was to identify and characterize publicly available cases and related trends for performance-based risk-sharing arrangements (PBRSAs). We performed a review of PBRSAs over the past 20 years (1993-2013) using available databases and reports from colleagues and healthcare experts. These were categorized according to a previously published taxonomy of scheme types and assessed in terms of the underlying product and market attributes for each scheme. Macro-level trends were identified related to the timing of scheme adoption, countries involved, types of arrangements, and product and market factors. Our search yielded 148 arrangements. From this set, 65 arrangements included a coverage with an evidence development component, 20 included a conditional treatment continuation component, 54 included a performance-linked reimbursement component, and 42 included a financial utilization component. Each type of scheme addresses fundamental uncertainties that exist when products enter the market. The pace of adoption appears to be slowing, but new countries continue to implement PBRSAs. Over this 20-year period, there has been a consistent movement toward arrangements that minimize administrative burden. In conclusion, the pace of PBRSA adoption appears to be slowing but still has traction in many health systems. These remain a viable coverage and reimbursement mechanism for a wide range of medical products. The long-term viability and growth of these arrangements will rest in the ability of the parties to develop mutually beneficial arrangements that entail minimal administrative burden in their development and implementation.

  15. The Affordable Care Act and the Burden of High Cost Sharing and Utilization Management Restrictions on Access to HIV Medications for People Living with HIV/AIDS.

    PubMed

    Zamani-Hank, Yasamean

    2016-08-01

    The HIV/AIDS epidemic continues to be a critical public health issue in the United States, where an estimated 1.2 million individuals live with HIV infection. Viral suppression is one of the primary public health goals for People Living with HIV/AIDS (PLWHA). A crucial component of this goal involves adequate access to health care, specifically anti-retroviral HIV medications. The enactment of the Affordable Care Act (ACA) in 2010 raised hopes for millions of PLWHA without access to health care coverage. High cost-sharing requirements enacted by health plans place a financial burden on PLWHA who need ongoing access to these life-saving medications. Plighted with poverty, Detroit, Michigan, is a center of attention for examining the financial burden of HIV medications on PLWHA under the new health plans. From November 2014 to January 2015, monthly out-of-pocket costs and medication utilization requirements for 31 HIV medications were examined for the top 12 insurance carriers offering Qualified Health Plans on Michigan's Health Insurance Marketplace Exchange. The percentage of medications requiring quantity limits and prior authorization were calculated. The average monthly out-of-pocket cost per person ranged from $12 to $667 per medication. Three insurance carriers placed all 31 HIV medications on the highest cost-sharing tier, charging 50% coinsurance. High out-of-pocket costs and medication utilization restrictions discourage PLWHA from enrolling in health plans and threaten interrupted medication adherence, drug resistance, and increased risk of viral transmission. Health plans inflicting high costs and medication restrictions violate provisions of the ACA and undermine health care quality for PLWHA. (Population Health Management 2016;19:272-278).

  16. Medical Content Searching, Retrieving, and Sharing Over the Internet: Lessons Learned From the mEducator Through a Scenario-Based Evaluation

    PubMed Central

    Spachos, Dimitris; Mylläri, Jarkko; Giordano, Daniela; Dafli, Eleni; Mitsopoulou, Evangelia; Schizas, Christos N; Pattichis, Constantinos; Nikolaidou, Maria

    2015-01-01

    Background The mEducator Best Practice Network (BPN) implemented and extended standards and reference models in e-learning to develop innovative frameworks as well as solutions that enable specialized state-of-the-art medical educational content to be discovered, retrieved, shared, and re-purposed across European Institutions, targeting medical students, doctors, educators and health care professionals. Scenario-based evaluation for usability testing, complemented with data from online questionnaires and field notes of users’ performance, was designed and utilized for the evaluation of these solutions. Objective The objective of this work is twofold: (1) to describe one instantiation of the mEducator BPN solutions (mEducator3.0 - “MEdical Education LINnked Arena” MELINA+) with a focus on the metadata schema used, as well as on other aspects of the system that pertain to usability and acceptance, and (2) to present evaluation results on the suitability of the proposed metadata schema for searching, retrieving, and sharing of medical content and with respect to the overall usability and acceptance of the system from the target users. Methods A comprehensive evaluation methodology framework was developed and applied to four case studies, which were conducted in four different countries (ie, Greece, Cyprus, Bulgaria and Romania), with a total of 126 participants. In these case studies, scenarios referring to creating, sharing, and retrieving medical educational content using mEducator3.0 were used. The data were collected through two online questionnaires, consisting of 36 closed-ended questions and two open-ended questions that referred to mEducator 3.0 and through the use of field notes during scenario-based evaluations. Results The main findings of the study showed that even though the informational needs of the mEducator target groups were addressed to a satisfactory extent and the metadata schema supported content creation, sharing, and retrieval from an end

  17. Medical device integration: CIOs must bridge the digital divide between devices and electronic medical records.

    PubMed

    Raths, David

    2009-02-01

    To get funding approved for medical device integration, ClOs suggest focusing on specific patient safety or staff efficiency pain points. Organizations that make clinical engineering part of their IT team report fewer chain-of-command issues. It also helps IT people understand the clinical goals because the engineering people have been working closely with clinicians for years. A new organization has formed to work on collaboration between clinical engineers and IT professionals. For more information, go to www.ceitcollaboration.org. ECRI Institute has written a guide to handling the convergence of medical technology and hospital networks. Its "Medical Technology for the IT Professional: An Essential Guide for Working in Today's Healthcare Setting" also details how IT professionals can assist hospital technology planning and acquisition, and provide ongoing support for IT-based medical technologies. For more information, visit www.ecri.org/ITresource.

  18. Photon momentum sharing between an electron and an ion in photoionization: from one-photon (photoelectric effect) to multiphoton absorption.

    PubMed

    Chelkowski, Szczepan; Bandrauk, André D; Corkum, Paul B

    2014-12-31

    We investigate photon-momentum sharing between an electron and an ion following different photoionization regimes. We find very different partitioning of the photon momentum in one-photon ionization (the photoelectric effect) as compared to multiphoton processes. In the photoelectric effect, the electron acquires a momentum that is much greater than the single photon momentum ℏω/c [up to (8/5) ℏω/c] whereas in the strong-field ionization regime, the photoelectron only acquires the momentum corresponding to the photons absorbed above the field-free ionization threshold plus a momentum corresponding to a fraction (3/10) of the ionization potential Ip. In both cases, due to the smallness of the electron-ion mass ratio, the ion takes nearly the entire momentum of all absorbed N photons (via the electron-ion center of mass). Additionally, the ion takes, as a recoil, the photoelectron momentum resulting from mutual electron-ion interaction in the electromagnetic field. Consequently, the momentum partitioning of the photofragments is very different in both regimes. This suggests that there is a rich, unexplored physics to be studied between these two limits which can be generated with current ultrafast laser technology.

  19. Impact of electronic medication reconciliation at hospital admission on clinician workflow.

    PubMed

    Vawdrey, David K; Chang, Nancy; Compton, Audrey; Tiase, Vicky; Hripcsak, George

    2010-11-13

    Many hospitals have experienced challenges with accomplishing the Joint Commission's National Patient Safety Goal for medication reconciliation. Our institution implemented a fully electronic process for performing and documenting medication reconciliation at hospital admission. The process used a commercial EHR and relied on a longitudinal medication list called the "Outpatient Medication Profile" (OMP). Clinician compliance with documenting medication reconciliation was difficult to achieve, but approached 100% after a "hard-stop" reminder was implemented. We evaluated the impact of the process at a large urban academic medical center. Before the new process was adopted, the average number of medications contained in the OMP for a patient upon admission was <2. One year after adoption, the average number had increased to 4.7, and there were regular updates made to the list. Updating the OMP was predominantly done by physicians, NPs, and PAs (94%), followed by nurses (5%) and pharmacists (1%).

  20. Physician Interaction with Electronic Medical Records: A Qualitative Study

    ERIC Educational Resources Information Center

    Noteboom, Cherie Bakker

    2010-01-01

    The integration of EHR (Electronic Health Records) in IT infrastructures supporting organizations enable improved access to and recording of patient data, enhanced ability to make better and more-timely decisions, and improved quality and reduced errors. Despite these benefits, there are mixed results as to the use of EHR. The literature suggests…

  1. User Preferences in the Classification of Electronic Bookmarks: Implications for a Shared System.

    ERIC Educational Resources Information Center

    Gottlieb, Lisa; Dilevko, Juris

    2001-01-01

    Using the financial industry as a context, this study addresses the issue of the classification of electronic bookmarks in a multi-user system by investigating the factors that influence how individuals develop categories for bookmarks and how they choose to classify bookmarks within those organizational categories. Sample participant…

  2. Family Registration Card as electronic medical carrier in Bosnia and Herzegovina.

    PubMed

    Novo, Ahmed; Masic, Izet; Toromanovic, Selim; Loncarevic, Nedim; Junuzovic, Dzelaludin; Dizdarevic, Jadranka

    2004-01-01

    Medical documentation is a very important part of the medical documentalistics and is occupies a large part of daily work of medical staff working in Primary Health Care. Paper documentation is going to be replaced by electronic cards in Bosnia and Herzegovina and a new Health Care System is under development, based on an Electronic Family Registration Card. Developed countries proceeded from the manual and semiautomatic method of medical data processing to the new method of entering, storage, transferring, searching and protecting data, using electronic equipment. Currently, many European countries have developed a Medical Card Based Electronic Information System. Three types of electronic card are currently in use: a Hybrid Card, a Smart Card and a Laser Card. The dilemma is which card should be used as a data carrier. The Electronic Family Registration Cared is a question of strategic interest for B&H, but also a great investment. We should avoid the errors of other countries that have been developing card-based system. In this article we present all mentioned cards and compare advantages and disadvantages of different technologies.

  3. Neurophysiological analytics for all! Free open-source software tools for documenting, analyzing, visualizing, and sharing using electronic notebooks.

    PubMed

    Rosenberg, David M; Horn, Charles C

    2016-08-01

    Neurophysiology requires an extensive workflow of information analysis routines, which often includes incompatible proprietary software, introducing limitations based on financial costs, transfer of data between platforms, and the ability to share. An ecosystem of free open-source software exists to fill these gaps, including thousands of analysis and plotting packages written in Python and R, which can be implemented in a sharable and reproducible format, such as the Jupyter electronic notebook. This tool chain can largely replace current routines by importing data, producing analyses, and generating publication-quality graphics. An electronic notebook like Jupyter allows these analyses, along with documentation of procedures, to display locally or remotely in an internet browser, which can be saved as an HTML, PDF, or other file format for sharing with team members and the scientific community. The present report illustrates these methods using data from electrophysiological recordings of the musk shrew vagus-a model system to investigate gut-brain communication, for example, in cancer chemotherapy-induced emesis. We show methods for spike sorting (including statistical validation), spike train analysis, and analysis of compound action potentials in notebooks. Raw data and code are available from notebooks in data supplements or from an executable online version, which replicates all analyses without installing software-an implementation of reproducible research. This demonstrates the promise of combining disparate analyses into one platform, along with the ease of sharing this work. In an age of diverse, high-throughput computational workflows, this methodology can increase efficiency, transparency, and the collaborative potential of neurophysiological research.

  4. University of Arkansas for Medical Sciences electronic health record and medical informatics training for undergraduate health professionals.

    PubMed

    Hart, Jan K; Newton, Bruce W; Boone, Steven E

    2010-07-01

    The University of Arkansas for Medical Sciences (UAMS) is planning interprofessional training in electronic health records (EHRs) and medical informatics. Training will be integrated throughout the curricula and will include seminars on broad concepts supplemented with online modules, didactic lectures, and hands-on experiences. Training will prepare future health professionals to use EHRs, evidence-based medicine, medical decision support, and point-of-care tools to reduce errors, improve standards of care, address Health Insurance Portability and Accountability Act requirements and accreditation standards, and promote appropriate documentation to enable data retrieval for clinical research. UAMS will ensure that graduates are ready for the rapidly evolving practice environment created by the HITECH Act.

  5. University of Arkansas for Medical Sciences electronic health record and medical informatics training for undergraduate health professionals*

    PubMed Central

    Hart, Jan K; Newton, Bruce W; Boone, Steven E

    2010-01-01

    The University of Arkansas for Medical Sciences (UAMS) is planning interprofessional training in electronic health records (EHRs) and medical informatics. Training will be integrated throughout the curricula and will include seminars on broad concepts supplemented with online modules, didactic lectures, and hands-on experiences. Training will prepare future health professionals to use EHRs, evidence-based medicine, medical decision support, and point-of-care tools to reduce errors, improve standards of care, address Health Insurance Portability and Accountability Act requirements and accreditation standards, and promote appropriate documentation to enable data retrieval for clinical research. UAMS will ensure that graduates are ready for the rapidly evolving practice environment created by the HITECH Act. PMID:20648253

  6. Seamless Management of Paper and Electronic Documents for Task Knowledge Sharing

    NASA Astrophysics Data System (ADS)

    Kojima, Hiroyuki; Iwata, Ken

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

  7. Analysis of an electronic medication reconciliation and information at discharge programme for frail elderly patients.

    PubMed

    Moro Agud, Marta; Menéndez Colino, Rocío; Mauleón Ladrero, María Del Coro; Ruano Encinar, Margarita; Díez Sebastián, Jesús; Villamañán Bueno, Elena; Herrero Ambrosio, Alicia; González Montalvo, Juan Ignacio

    2016-08-01

    Background During care transitions, discrepancies and medication errors often occur, putting patients at risk, especially older patients with polypharmacy. Objective To assess the results of a medication reconciliation and information programme for discharge of geriatric patients conducted through hospital information systems. Setting A 1300-bed university hospital in Madrid, Spain. Method A prospective observational study. Geriatricians selected candidates for medication reconciliation at discharge, and sent an electronic inter-consultation request to the pharmacy department. Pharmacists reviewed the medication list, comparing it with electronic prescriptions, medication previously prescribed by primary care physicians and other medical records, and resolved any discrepancies. An individualized and tailored drug information at discharge sheet was sent to geriatricians and made available to primary care physicians. Main outcome measure The number and type of discrepancies, the number, type and severity of errors, and the main pharmacological groups involved. Results Medication reconciliation was performed for 118 patients with a mean age of 87 years (SD 5.9), involving a total of 2054 medications, or 17.4 per patient. Discrepancies were found in 723 (35 %) drugs, 105 of which were considered medication errors (15 %); 66 patients (56 %) had at least one error. This gave 0.9 reconciliation errors per patient reviewed and 1.6 per patient with errors. Of the 105 errors, 14 (13 %) were considered serious. The most frequent errors were incomplete prescriptions (40 %) and omissions (35 %). Conclusion An electronic medication reconciliation programme helps pharmacists detect serious medication errors in frail elderly patients and provides complete and up-to-date written information to prevent additional errors at home.

  8. Overcoming Electronic Medical Record Challenges on the Obstetrics and Gynecology Clerkship.

    PubMed

    Buery-Joyner, Samantha D; Dalrymple, John L; Abbott, Jodi F; Craig, LaTasha B; Forstein, David A; Graziano, Scott C; Hampton, Brittany S; Hopkins, Laura; Page-Ramsey, Sarah M; Pradhan, Archana; Wolf, Abigail; Mckenzie, Margaret L

    2015-09-01

    This article, for the "To the Point" series prepared by the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee, supplies educators with a review of best practices regarding incorporation of the electronic medical record (EMR) into undergraduate medical education. The unique circumstances of the obstetrics and gynecology clerkship require specific attention as it pertains to medical student use of the EMR. An outline of the regulatory requirements and authoritative body recommendations provides some guidance for implementation in the undergraduate medical education setting. A review of the basic framework for development of an EMR curriculum and examples of curricular innovations published in the literature offers solutions for obstacles that may be encountered by students and medical educators.

  9. Medical assistants' roles in electronic health record processes in primary care practices: the untold story.

    PubMed

    Adewale, Victoria; Anthony, David; Borkan, Jeffery

    2014-01-01

    The role of the medical assistant has been undervalued in the past. Many publications have detailed the integral role of the nursing staff and physicians, but the medical assistant role has come last in formal recognition. As healthcare settings move toward a more Patient-Centered Medical Home (PCMH) model, the attitudes of this model will need to be adopted, two of which are team-based care and adoption of the electronic health record (EHR). As the EHR continues to gain more traction in healthcare, a thorough understanding of it, by everyone, will be vital for its success. In this article, the medical assistant's relationship with the EHR is outlined through qualitative interviews and observations with medical assistants in PCMH programs. The data describe diverse EHR experiences and how these experiences are influenced by and reflected in workflow issues, training, patient care, and an expanding role of the medical assistant.

  10. Views of patients and professionals about electronic multicompartment medication devices: a qualitative study

    PubMed Central

    Hall, Jill; Bond, Christine; Kinnear, Moira; McKinstry, Brian

    2016-01-01

    Objectives To explore the perceived acceptability, advantages and disadvantages of electronic multicompartment medication devices. Design Qualitative study using 8 focus groups and 10 individual semistructured interviews. Recordings were transcribed and analysed thematically. Strategies were employed to ensure the findings were credible and trustworthy. Participants and setting Community pharmacists (n=11), general practitioners (n=9), community nurses (n=12) and social care managers (n=8) were recruited from the National Health Service (NHS) and local authority services. Patients (n=15) who were current conventional or electronic multicompartment medication device users or had medication adherence problems were recruited from community pharmacies. 3 informal carers participated. Results Electronic multicompartment medication devices which prompt the patient to take medication may be beneficial for selected individuals, particularly those with cognitive impairment, but who are not seriously impaired, provided they have a good level of dexterity. They may also assist individuals where it is important that medication is taken at fixed time intervals. These are likely to be people who are being supported to live alone. No single device suited everybody; smaller/lighter devices were preferred but their usefulness was limited by the small number/size of storage compartments. Removing medications was often challenging. Transportability was an important factor for patients and carers. A carer's alert if medication is not taken was problematic with multiple barriers to implementation and no consensus as to who should receive the alert. There was a lack of enthusiasm among professionals, particularly among pharmacists, due to concerns about responsibility and funding for devices as well as ensuring devices met regulatory standards for storage and labelling. Conclusions This study provides indicators of which patients might benefit from an electronic multicompartment

  11. Patient experiences with electronic medical records: Lessons learned

    PubMed Central

    Rose, Dale; Richter, Louiseann T; Kapustin, Jane

    2014-01-01

    Purpose To describe the lived experience of patients communicating with their nurse practitioners and physicians while using paper health records (PHRs) and electronic health records (EHRs) in the examination rooms. The significance of the study lies in the salience of communication between the patient and provider in promoting optimal clinical outcomes and the highest level of patient satisfaction. Data sources The study used a qualitative, phenomenological design. Audio-taped focus group interviews were conducted with 21 patients from a diabetes clinic in Baltimore, Maryland. Patients had visits with the provider before and after implementation of EHRs in the clinic. Conclusions The four themes that emerged from the three focus groups included communication issues, patient preferences for electronic records, safety and security concerns, and transition problems with implementation of EHRs. Implications for practice Potential benefits for nurse practitioners implementing the recommendations in this study include enhanced communication between patients and providers while using EHRs, increased patient satisfaction, higher levels of nurse practitioner and physician satisfaction, and avoidance of communication issues during implementation of EHR systems. PMID:25234112

  12. Effects of shared medical appointments on quality of life and cost-effectiveness for patients with a chronic neuromuscular disease. Study protocol of a randomized controlled trial

    PubMed Central

    2011-01-01

    Background Shared medical appointments are a series of one-to-one doctor-patient contacts, in presence of a group of 6-10 fellow patients. This group visits substitute the annual control visits of patients with the neurologist. The same items attended to in a one-to- one appointment are addressed. The possible advantages of a shared medical appointment could be an added value to the present management of neuromuscular patients. The currently problem-focused one-to-one out-patient visits often leave little time for the patient's psychosocial needs, patient education, and patient empowerment. Methods/design A randomized, prospective controlled study (RCT) with a follow up of 6 months will be conducted to evaluate the clinical and cost-effectiveness of shared medical appointments compared to usual care for 300 neuromuscular patients and their partners at the Radboud University Nijmegen Medical Center. Every included patient will be randomly allocated to one of the two study arms. This study has been reviewed and approved by the medical ethics committee of the region Arnhem-Nijmegen, the Netherlands. The primary outcome measure is quality of life as measured by the EQ-5D, SF-36 and the Individualized neuromuscular Quality of Life Questionnaire. The primary analysis will be an intention-to-treat analysis on the area under the curve of the quality of life scores. A linear mixed model will be used with random factor group and fixed factors treatment, baseline score and type of neuromuscular disease. For the economic evaluation an incremental cost-effectiveness analysis will be conducted from a societal perspective, relating differences in costs to difference in health outcome. Results are expected in 2012. Discussion This study will be the first randomized controlled trial which evaluates the effect of shared medical appointments versus usual care for neuromuscular patients. This will enable to determine if there is additional value of shared medical appointments to the

  13. Inferring Clinical Workflow Efficiency via Electronic Medical Record Utilization.

    PubMed

    Chen, You; Xie, Wei; Gunter, Carl A; Liebovitz, David; Mehrotra, Sanjay; Zhang, He; Malin, Bradley

    Complexity in clinical workflows can lead to inefficiency in making diagnoses, ineffectiveness of treatment plans and uninformed management of healthcare organizations (HCOs). Traditional strategies to manage workflow complexity are based on measuring the gaps between workflows defined by HCO administrators and the actual processes followed by staff in the clinic. However, existing methods tend to neglect the influences of EMR systems on the utilization of workflows, which could be leveraged to optimize workflows facilitated through the EMR. In this paper, we introduce a framework to infer clinical workflows through the utilization of an EMR and show how such workflows roughly partition into four types according to their efficiency. Our framework infers workflows at several levels of granularity through data mining technologies. We study four months of EMR event logs from a large medical center, including 16,569 inpatient stays, and illustrate that over approximately 95% of workflows are efficient and that 80% of patients are on such workflows. At the same time, we show that the remaining 5% of workflows may be inefficient due to a variety of factors, such as complex patients.

  14. Inferring Clinical Workflow Efficiency via Electronic Medical Record Utilization

    PubMed Central

    Chen, You; Xie, Wei; Gunter, Carl A; Liebovitz, David; Mehrotra, Sanjay; Zhang, He; Malin, Bradley

    2015-01-01

    Complexity in clinical workflows can lead to inefficiency in making diagnoses, ineffectiveness of treatment plans and uninformed management of healthcare organizations (HCOs). Traditional strategies to manage workflow complexity are based on measuring the gaps between workflows defined by HCO administrators and the actual processes followed by staff in the clinic. However, existing methods tend to neglect the influences of EMR systems on the utilization of workflows, which could be leveraged to optimize workflows facilitated through the EMR. In this paper, we introduce a framework to infer clinical workflows through the utilization of an EMR and show how such workflows roughly partition into four types according to their efficiency. Our framework infers workflows at several levels of granularity through data mining technologies. We study four months of EMR event logs from a large medical center, including 16,569 inpatient stays, and illustrate that over approximately 95% of workflows are efficient and that 80% of patients are on such workflows. At the same time, we show that the remaining 5% of workflows may be inefficient due to a variety of factors, such as complex patients. PMID:26958173

  15. Using an iconic language to improve access to electronic medical records in general medicine.

    PubMed

    Simon, Christian; Hassler, Sylvain; Beuscart-Zephir, Marie-Catherine; Favre, Madeleine; Venot, Alain; Duclos, Catherine; Lamy, Jean-Baptiste

    2014-01-01

    Physicians have difficulties to access and analyse information in a medical record. In a previous work on drug databanks, we have shown that with an iconic language as VCM, an icon-based presentation can help physicians to access medical information. Our objective, herein, is to study whether VCM can be used in an electronic medical record for facilitating physician access in general practice. We identify the data and the functionalities of an electronic medical record that could benefit from VCM icons representing clinical findings, patient history, etc. We also present a preliminary evaluation of this new icon-focused interface. We conclude by discussing the results like the assessment of the user's satisfaction and pointing out the importance of coding data.

  16. Survey of electronic veterinary medical record adoption and use by independent small animal veterinary medical practices in Massachusetts

    PubMed Central

    Krone, Lauren M.; Brown, Catherine M.; Lindenmayer, Joann M.

    2016-01-01

    Objective To estimate the proportion of independent small animal veterinary medical practices in Massachusetts that use electronic veterinary medical records (EVMRs), determine the purposes for which EVMRs are used, and identify perceived barriers to their use. Design Survey. Sample 100 veterinarians. Procedures 213 of 517 independent small animal veterinary practices operating in Massachusetts were randomly chosen for study recruitment. One veterinarian at each practice was invited by telephone to answer a hardcopy survey regarding practice demographics, medical records type (electronic, paper, or both), purposes of EVMR use, and perceived barriers to adoption. Surveys were mailed to the first 100 veterinarians who agreed to participate. Practices were categorized by record type and size (large [≥ 5 veterinarians], medium [3 to 4 veterinarians], or small [1 to 2 veterinarians]). Results 84 surveys were returned; overall response was 84 of 213 (39.4%). The EVMRs were used alone or together with paper records in 66 of 82 (80.5%) practices. Large and medium-sized practices were significantly more likely to use EVMRs combined with paper records than were small practices. The EVMRs were most commonly used for ensuring billing, automating reminders, providing cost estimates, scheduling, recording medical and surgical information, and tracking patient health. Least common uses were identifying emerging infectious diseases, research, and insurance. Eleven veterinarians in paper record–only practices indicated reluctance to change, anticipated technological problems, time constraints, and cost were barriers to EVMR use. Conclusions and Clinical Relevance Results indicated EVMRs were underutilized as a tool for tracking and improving population health and identifying emerging infectious diseases. Efforts to facilitate adoption of EVMRs for these purposes should be strengthened by the veterinary medical, human health, and public health professions. PMID:25029312

  17. SynapticDB, effective web-based management and sharing of data from serial section electron microscopy.

    PubMed

    Shi, Bitao; Bourne, Jennifer; Harris, Kristen M

    2011-03-01

    Serial section electron microscopy (ssEM) is rapidly expanding as a primary tool to investigate synaptic circuitry and plasticity. The ultrastructural images collected through ssEM are content rich and their comprehensive analysis is beyond the capacity of an individual laboratory. Hence, sharing ultrastructural data is becoming crucial to visualize, analyze, and discover the structural basis of synaptic circuitry and function in the brain. We devised a web-based management system called SynapticDB (http://synapses.clm.utexas.edu/synapticdb/) that catalogues, extracts, analyzes, and shares experimental data from ssEM. The management strategy involves a library with check-in, checkout and experimental tracking mechanisms. We developed a series of spreadsheet templates (MS Excel, Open Office spreadsheet, etc) that guide users in methods of data collection, structural identification, and quantitative analysis through ssEM. SynapticDB provides flexible access to complete templates, or to individual columns with instructional headers that can be selected to create user-defined templates. New templates can also be generated and uploaded. Research progress is tracked via experimental note management and dynamic PDF forms that allow new investigators to follow standard protocols and experienced researchers to expand the range of data collected and shared. The combined use of templates and tracking notes ensures that the supporting experimental information is populated into the database and associated with the appropriate ssEM images and analyses. We anticipate that SynapticDB will serve future meta-analyses towards new discoveries about the composition and circuitry of neurons and glia, and new understanding about structural plasticity during development, behavior, learning, memory, and neuropathology.

  18. Injectable 3-D Fabrication of Medical Electronics at the Target Biological Tissues

    NASA Astrophysics Data System (ADS)

    Jin, Chao; Zhang, Jie; Li, Xiaokang; Yang, Xueyao; Li, Jingjing; Liu, Jing

    2013-12-01

    Conventional transplantable biomedical devices generally request sophisticated surgery which however often causes big trauma and serious pain to the patients. Here, we show an alternative way of directly making three-dimensional (3-D) medical electronics inside the biological body through sequential injections of biocompatible packaging material and liquid metal ink. As the most typical electronics, a variety of medical electrodes with different embedded structures were demonstrated to be easily formed at the target tissues. Conceptual in vitro experiments provide strong evidences for the excellent performances of the injectable electrodes. Further in vivo animal experiments disclosed that the formed electrode could serve as both highly efficient ECG (Electrocardiograph) electrode and stimulator electrode. These findings clarified the unique features and practicability of the liquid metal based injectable 3-D fabrication of medical electronics. The present strategy opens the way for directly manufacturing electrophysiological sensors or therapeutic devices in situ via a truly minimally invasive approach.

  19. Injectable 3-D Fabrication of Medical Electronics at the Target Biological Tissues

    PubMed Central

    Jin, Chao; Zhang, Jie; Li, Xiaokang; Yang, Xueyao; Li, Jingjing; Liu, Jing

    2013-01-01

    Conventional transplantable biomedical devices generally request sophisticated surgery which however often causes big trauma and serious pain to the patients. Here, we show an alternative way of directly making three-dimensional (3-D) medical electronics inside the biological body through sequential injections of biocompatible packaging material and liquid metal ink. As the most typical electronics, a variety of medical electrodes with different embedded structures were demonstrated to be easily formed at the target tissues. Conceptual in vitro experiments provide strong evidences for the excellent performances of the injectable electrodes. Further in vivo animal experiments disclosed that the formed electrode could serve as both highly efficient ECG (Electrocardiograph) electrode and stimulator electrode. These findings clarified the unique features and practicability of the liquid metal based injectable 3-D fabrication of medical electronics. The present strategy opens the way for directly manufacturing electrophysiological sensors or therapeutic devices in situ via a truly minimally invasive approach. PMID:24309385

  20. The role of frontline RNs in the selection of an electronic medical record business partner.

    PubMed

    Wilhoit, Kathryn; Mustain, Jane; King, Marjorie

    2006-01-01

    Frontline RNs knowledgeable in the strategic objectives of their organization made a difference in the selection of an electronic medical record business partner for a large, complex healthcare system. Their impact was significant because of the chief nurse executive's personal articulation of the organization's strategic goals and of her investment in their education. These factors provided the frontline RNs with a foundational base of knowledge about a variety of electronic medical record systems. The preparation and exposure enabled the frontline RNs to make a valuable contribution to the selection of an electronic medical record business partner. The RNs were a major force in affecting philosophical change from the organization's original pursuit of "best-of-breed" interfaced systems to a fully integrated, "best-of-class" vendor business partner. The learning experiences of the frontline RNs are explored to answer the following question: Why must frontline RNs play a key role in this process?

  1. Application of Traditional and Nanostructure Materials for Medical Electron Beams Collimation: Numerical Simulation

    NASA Astrophysics Data System (ADS)

    Miloichikova, I. A.; Stuchebrov, S. G.; Zhaksybayeva, G. K.; Wagner, A. R.

    2015-11-01

    Nowadays, the commercial application of the electron accelerators grows in the industry, in the research investigations, in the medical diagnosis and treatment. In this regard, the electron beam profile modification in accordance with specific purposes is an actual task. In this paper the model of the TPU microtron extracted electron beam developed in the program “Computer Laboratory (PCLab)” is described. The internal beam divergence influence for the electron beam profile and depth dose distribution in the air is considered. The possibility of using the nanostructure materials for the electron beam formation was analyzed. The simulation data of the electron beam shape collimated by different materials (lead, corund- zirconia nanoceramic, gypsum) are shown. The collimator material influence for the electron beam profile and shape are analyzed.

  2. Design and implementation of web-based mobile electronic medication administration record.

    PubMed

    Hsieh, Sung-Huai; Hou, I-Ching; Cheng, Po-Hsun; Tan, Ching-Ting; Shen, Po-Chao; Hsu, Kai-Ping; Hsieh, Sheau-Ling; Lai, Feipei

    2010-10-01

    Patients' safety is the most essential, critical issue, however, errors can hardly prevent, especially for human faults. In order to reduce the errors caused by human, we construct Electronic Health Records (EHR) in the Health Information System (HIS) to facilitate patients' safety and to improve the quality of medical care. During the medical care processing, all the tasks are based upon physicians' orders. In National Taiwan University Hospital (NTUH), the Electronic Health Record committee proposed a standard of order flows. There are objectives of the standard: first, to enhance medical procedures and enforce hospital policies; secondly, to improve the quality of medical care; third, to collect sufficient, adequate data for EHR in the near future. Among the proposed procedures, NTUH decides to establish a web-based mobile electronic medication administration record (ME-MAR) system. The system, build based on the service-oriented architecture (SOA) as well as embedded the HL7/XML standard, is installed in the Mobile Nursing Carts. It also implement accompany with the advanced techniques like Asynchronous JavaScript and XML (Ajax) or Web services to enhance the system usability. According to researches, it indicates that medication errors are highly proportion to total medical faults. Therefore, we expect the ME-MAR system can reduce medication errors. In addition, we evaluate ME-MAR can assist nurses or healthcare practitioners to administer, manage medication properly. This successful experience of developing the NTUH ME-MAR system can be easily applied to other related system. Meanwhile, the SOA architecture of the system can also be seamless integrated to NTUH or other HIS system.

  3. Risk factors for medication errors in the electronic and manual prescription 1

    PubMed Central

    Volpe, Cris Renata Grou; de Melo, Eveline Maria Magalhães; de Aguiar, Lucas Barbosa; Pinho, Diana Lúcia Moura; Stival, Marina Morato

    2016-01-01

    ABSTRACT Objective: to compare electronic and manual prescriptions of a public hospital of Brasilia, identifying risk factors for the occurrence of medication errors. Method: descriptive-exploratory, comparative and retrospective study. Data collection occurred from July 2012 to January 2013, using an instrument for the review of the information contained in medical records related to the medication process. A total of 190 manual and 199 electronic records composed the sample, with 2027 prescriptions each. Results: compared to the manual prescription, a significant reduction was observed in the risk factors after implantation of the electronic prescription, in items such as "lack of the form of dilution" (71.1% to 22.3%) and "prescription with brand name" (99.5% to 31.5%). Conversely, the risk factors "no check" and "lack of CRM of the prescriber" increased. The lack of the allergy registration and the occurrences related to medication were the same for both groups. Conclusion: generally, the use of the electronic prescription system was associated with a significant reduction in risk factors for medication errors, concerning the following aspects: illegibility, prescription with brand name and presence of essential items that provide a safe and effective prescription. PMID:27508913

  4. [Medical decision making in hospital--results of an exploratory study on the value of shared decision making from the physicians point of view].

    PubMed

    Ernst, J; Holze, S; Sonnefeld, C; Götze, H; Schwarz, R

    2007-04-01

    The changes in the relationship between doctors and patients and the transfer of shared decision making into medical treatment has often been discussed. The role and the perspective of the patients are primarily described. The aim of our study is to examine the attitudes of physicians regarding the shared decision making concept, based on 15 interviews with clinical doctors. Our findings show that most doctors know the content of the concept and mostly agree with it. Practical barriers for the realisation of shared decision making are often stressed. The meaning of the concept of shared decision making for the physicians is in some respects different from the meaning of this concept for the patients. It is important to examine this concept more particularly with standardised instruments. It will be necessary to explore not only the role of patients and physicians in the medical decision making process but also the position of other relevant persons like the relatives of the patients or the nursing staff.

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

    ERIC Educational Resources Information Center

    Wrenn, Jesse

    2010-01-01

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

  6. Medical Device Safety

    MedlinePlus

    ... Home Medical Devices Medical Device Safety Medical Device Safety Share Tweet Linkedin Pin it More sharing options ... 17 More Medical Device Recalls Recent Medical Device Safety Communications FDA analyses and recommendations for patients and ...

  7. SOCIAL SECURITY DISABILITY; Additional Outreach and Collaboration on Sharing Medical Records Would Improve Wounded Warriors’ Access to Benefits

    DTIC Science & Technology

    2009-09-01

    Record MEB medical evaluation board MTF military treatment facility NHIN Nationwide Health Information Network ODAR Office of Disability...outreach and case management policies at each agency. We selected seven DOD and five VA medical treatment facilities in order to examine local-level...for benefits in cases when an applicant is receiving military pay, but is also receiving medical treatment or is on limited duty status, SSA assesses

  8. 38 CFR 17.142 - Authority to approve sharing agreements, contracts for scarce medical specialist services and...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...) Contracts with schools and colleges of medicine, osteopathy, dentistry, podiatry, optometry, and nursing... function dental auxiliaries, technicians, and other medical support personnel); and (c) When a...

  9. 38 CFR 17.142 - Authority to approve sharing agreements, contracts for scarce medical specialist services and...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...) Contracts with schools and colleges of medicine, osteopathy, dentistry, podiatry, optometry, and nursing... function dental auxiliaries, technicians, and other medical support personnel); and (c) When a...

  10. 38 CFR 17.142 - Authority to approve sharing agreements, contracts for scarce medical specialist services and...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...) Contracts with schools and colleges of medicine, osteopathy, dentistry, podiatry, optometry, and nursing... function dental auxiliaries, technicians, and other medical support personnel); and (c) When a...

  11. 38 CFR 17.142 - Authority to approve sharing agreements, contracts for scarce medical specialist services and...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...) Contracts with schools and colleges of medicine, osteopathy, dentistry, podiatry, optometry, and nursing... function dental auxiliaries, technicians, and other medical support personnel); and (c) When a...

  12. 38 CFR 17.142 - Authority to approve sharing agreements, contracts for scarce medical specialist services and...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...) Contracts with schools and colleges of medicine, osteopathy, dentistry, podiatry, optometry, and nursing... function dental auxiliaries, technicians, and other medical support personnel); and (c) When a...

  13. [The development and operation of a package inserts service system for electronic medical records].

    PubMed

    Yamada, Hidetoshi; Nishimura, Sachiho; Shimamori, Yoshimitsu; Sato, Seiji; Hayase, Yukitoshi

    2003-03-01

    To promote the appropriate use of pharmaceuticals and to prevent side effects, physicians need package inserts on medicinal drugs as soon as possible. A medicinal drug information service system was established for electronic medical records to speed up and increase the efficiency of package insert communications within a medical institution. Development of this system facilitates access to package inserts by, for example, physicians. The time required to maintain files of package inserts was shortened, and the efficiency of the drug information service increased. As a source of package inserts for this system, package inserts using a standard generalized markup language (SGML) form were used, which are accessible to the public on the homepage of the Organization for Pharmaceutical Safety and Research (OPSR). This study found that a delay occurred in communicating revised package inserts from pharmaceutical companies to the OPSR. Therefore a pharmaceutical department page was set up as part of the homepage of the medical institution for electronic medical records to shorten the delay in the revision of package inserts posted on the medicinal drug information service homepage of the OPSR. The usefulness of this package insert service system for electronic medical records is clear. For more effective use of this system based on the OPSR homepage pharmaceutical companies have been requested to provide quicker updating of package inserts.

  14. An Evaluation of Authentic Learning in an Electronic Medical Records System

    ERIC Educational Resources Information Center

    Stuart, Sandra L.

    2013-01-01

    This study examined participants' perceptions of the effectiveness of a new job-training program designed to enhance the authentic learning in adult learners using an electronic medical records system at a naval health clinic. This job-training program lacked data about participants' perceptions of this learning process by which to gauge its…

  15. Integrating traditional nursing service orientation content with electronic medical record orientation.

    PubMed

    Harton, Brenda B; Borrelli, Larry; Knupp, Ann; Rogers, Necolen; West, Vickie R

    2009-01-01

    Traditional nursing service orientation classes at an acute care hospital were integrated with orientation to the electronic medical record to blend the two components in a user-friendly format so that the learner is introduced to the culture, processes, and documentation methods of the organization, with an opportunity to document online in a practice domain while lecture and discussion information is fresh.

  16. Are In-Bed Electronic Weights Recorded in the Medical Record Accurate?

    PubMed

    Gerl, Heather; Miko, Alexandra; Nelson, Mandy; Godaire, Lori

    2016-01-01

    This study found large discrepancies between in-bed weights recorded in the medical record and carefully obtained standing weights with a calibrated, electronic bedside scale. This discrepancy appears to be related to inadequate bed calibration before patient admission and having excessive linen, clothing, and/or equipment on the bed during weighing by caregivers.

  17. Strategies Nurse Managers Used to Offset Challenges during Electronic Medical Records Implementation: A Case Study

    ERIC Educational Resources Information Center

    Easterling, Latasha

    2015-01-01

    The purpose of this qualitative, descriptive case study was to discover successful approaches used, by nurse managers, to reduce barriers during the implementation of electronic medical record system in one hospital. Fourteen nurse managers were interviewed from an academic health science center in Mississippi. A pilot study was conducted to…

  18. Evolution of Medication Administration Workflow in Implementing Electronic Health Record System

    ERIC Educational Resources Information Center

    Huang, Yuan-Han

    2013-01-01

    This study focused on the clinical workflow evolutions when implementing the health information technology (HIT). The study especially emphasized on administrating medication when the electronic health record (EHR) systems were adopted at rural healthcare facilities. Mixed-mode research methods, such as survey, observation, and focus group, were…

  19. Electronic Medical Records Adoption and Usage among Osteopathic Physicians in New York State

    ERIC Educational Resources Information Center

    Rosenthal, Jon I.

    2012-01-01

    In 2010, the U.S. Department of Health and Human Services Office of the National Coordinator for Health Information Technology reported a slow rate of adoption of electronic medical records. The present research sought to explore possible reasons for this situation by examining factors that distinguished between users and nonusers of electronic…

  20. Developing a Systematic Architecture Approach for Designing an Enhanced Electronic Medical Record (EEMR) System

    ERIC Educational Resources Information Center

    Aldukheil, Maher A.

    2013-01-01

    The Healthcare industry is characterized by its complexity in delivering care to the patients. Accordingly, healthcare organizations adopt and implement Information Technology (IT) solutions to manage complexity, improve quality of care, and transform to a fully integrated and digitized environment. Electronic Medical Records (EMR), which is…

  1. Health Care Professionals' Perceptions of the Use of Electronic Medical Records

    ERIC Educational Resources Information Center

    Adeyeye, Adebisi

    2015-01-01

    Electronic medical record (EMR) use has improved significantly in health care organizations. However, many barriers and factors influence the success of EMR implementation and adoption. The purpose of the descriptive qualitative single-case study was to explore health care professionals' perceptions of the use of EMRs at a hospital division of a…

  2. Possible electromagnetic interference with electronic medical equipment by radio waves coming from outside the hospital.

    PubMed

    Hanada, E; Kodama, K; Takano, K; Watanabe, Y; Nose, Y

    2001-08-01

    Electromagnetic interference (EMI) with electronic medical equipment by radio waves from mobile telephone handsets has been reported and is currently receiving wide attention. The possibility of EMI with electronic medical equipment by radio waves coming into the hospital has also been pointed out. But so far, there are no reports measuring the frequency distribution of electric field intensity induced by incoming radio waves. Therefore, we measured electric field intensity induced by radio waves coming into our 11-floor hospital, which was under construction. The maximum intensity observed was about 200 V/m at 2.79 GHz, from airport surveillance radar waves. The maximum intensity induced by radio waves from cellular phone base stations was 1.78 V/m. These data show that various frequencies of radio waves are common in this urban area, and that they induce strong electricfield intensity. This strong electric field intensity might cause EMI with electronic medical equipment. Measurement of the electromagnetic environment should be done by each hospital in urban areas to prevent EMI with electronic medical equipment.

  3. Organizational Leader Sensemaking in Healthcare Process Changes: The Development of the Electronic Medical Records Expectation Questionnaire

    ERIC Educational Resources Information Center

    Riesenmy, Kelly Rouse

    2011-01-01

    Physicians play a unique role in the adoption of electronic medical records (EMR) within the healthcare organization. As leaders, they are responsible for setting the standards for this new technology within their sphere of influence while concurrently being required to learn and integrate EMR into their own workflow and process as the recipients…

  4. Novel multi-beam X-ray source for vacuum electronics enabled medical imaging applications

    NASA Astrophysics Data System (ADS)

    Neculaes, V. Bogdan

    2013-10-01

    For almost 100 of years, commercial medical X-ray applications have relied heavily on X-ray tube architectures based on the vacuum electronics design developed by William Coolidge at the beginning of the twentieth century. Typically, the Coolidge design employs one hot tungsten filament as the electron source; the output of the tube is one X-ray beam. This X-ray source architecture is the state of the art in today's commercial medical imaging applications, such as Computed Tomography. Recently, GE Global Research has demonstrated the most dramatic extension of the Coolidge vacuum tube design for Computed Tomography (CT) in almost a century: a multi-beam X-ray source containing thirty two cathodes emitting up to 1000 mA, in a cathode grounded - anode at potential architecture (anode up to 140 kV). This talk will present the challenges of the X-ray multi-beam vacuum source design - space charge electron gun design, beam focusing to compression ratios needed in CT medical imaging applications (image resolution is critically dependent on how well the electron beam is focused in vacuum X-ray tubes), electron emitter choice to fit the aggressive beam current requirements, novel electronics for beam control and focusing, high voltage and vacuum solutions, as well as vacuum chamber design to sustain the considerable G forces typically encountered on a CT gantry (an X-ray vacuum tube typically rotates on the CT gantry at less than 0.5 s per revolution). Consideration will be given to various electron emitter technologies available for this application - tungsten emitters, dispenser cathodes and carbon nano tubes (CNT) - and their tradeoffs. The medical benefits potentially enabled by this unique vacuum multi-beam X-ray source are: X-ray dose reduction, reduction of image artifacts and improved image resolution. This work was funded in part by NIH grant R01EB006837.

  5. Electron beam ion sources for use in second generation synchrotrons for medical particle therapy.

    PubMed

    Zschornack, G; Ritter, E; Schmidt, M; Schwan, A

    2014-02-01

    Cyclotrons and first generation synchrotrons are the commonly applied accelerators in medical particle therapy nowadays. Next generation accelerators such as Rapid Cycling Medical Synchrotrons (RCMS), direct drive accelerators, or dielectric wall accelerators have the potential to improve the existing accelerator techniques in this field. Innovative accelerator concepts for medical particle therapy can benefit from ion sources which meet their special requirements. In the present paper we report on measurements with a superconducting Electron Beam Ion Source, the Dresden EBIS-SC, under the aspect of application in combination with RCMS as a well proven technology. The measurements indicate that this ion source can offer significant advantages for medical particle therapy. We show that a superconducting EBIS can deliver ion pulses of medically relevant ions such as protons, C(4 +) and C(6 +) ions with intensities and frequencies required for RCMS [S. Peggs and T. Satogata, "A survey of Hadron therapy accelerator technology," in Proceedings of PAC07, BNL-79826- 2008-CP, Albuquerque, New Mexico, USA, 2007; A. Garonna, U. Amaldi et al., "Cyclinac medical accelerators using pulsed C(6 +)/H2(+) ion sources," in Proceedings of EBIST 2010, Stockholm, Sweden, July 2010]. Ion extraction spectra as well as individual ion pulses have been measured. For example, we report on the generation of proton pulses with up to 3 × 10(9) protons per pulse and with frequencies of up to 1000 Hz at electron beam currents of 600 mA.

  6. Utilizing Electronic Health Record Information to Optimize Medication Infusion Devices: A Manual Data Integration Approach.

    PubMed

    Chuk, Amanda; Maloney, Robert; Gawron, Joyce; Skinner, Colin

    Health information technology is increasingly utilized within healthcare delivery systems today. Two examples of this type of technology include the capture of patient-specific information within an electronic health record and intravenous medication infusion devices equipped with dose error reduction software known as drug libraries. Automatic integration of these systems, termed intravenous (IV) interoperability, should serve as the goal toward which all healthcare systems work to maximize patient safety. For institutions lacking IV interoperability, we describe a manual approach of querying the electronic health record to incorporate medication administration information with data from infusion device software to optimize drug library settings. This approach serves to maximize utilization of available information to optimize medication safety provided by drug library software.

  7. Utilizing Electronic Health Record Information to Optimize Medication Infusion Devices: A Manual Data Integration Approach.

    PubMed

    Chuk, Amanda; Maloney, Robert; Gawron, Joyce; Skinner, Colin

    2015-05-23

    Health information technology is increasingly utilized within healthcare delivery systems today. Two examples of this type of technology include the capture of patient-specific information within an electronic health record and intravenous medication infusion devices equipped with dose error reduction software known as drug libraries. Automatic integration of these systems, termed intravenous (IV) interoperability, should serve as the goal toward which all healthcare systems work to maximize patient safety. For institutions lacking IV interoperability, we describe a manual approach of querying the electronic health record to incorporate medication administration information with data from infusion device software to optimize drug library settings. This approach serves to maximize utilization of available information to optimize medication safety provided by drug library software.

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

    PubMed

    Delichatsios, Helen K; Hauser, Michelle E; Burgess, Jonathan D; Eisenberg, David M

    2015-11-01

    简介:与肥胖有关的疾病,比如 心血管疾病、糖尿病、退行性关 节病、胃食管反流和睡眠呼吸暂 停,是初级护理访视的很大一部 分内容。患有这些疾病的患者往 往缺乏保持健康所需的知识、技 能和支持。包括烹饪技术和营养 教育的共享医疗约诊(shared medical appointments, SMA)为 在初级护理中解决这些疾病提供 了一种新颖、成本效益高的方式。方法:在马萨诸塞州波士顿一家 大型学术性医院接受初级护理、 有至少 1 项心血管风险因素的成 人患者受邀参加 SMA,这些约诊 除对其病情进行医学管理外,还 包括烹饪示范和营养教学。作为 试点可行性项目的一部分,课程 由一名医生和一名助理在传统初 级护理工作会议室进行。结果:在 4 年时间内,七十名患 者,共进行了 156 次患者访视, 参加了 17 次以营养为焦点的 SMA。在每次访视后对患者进行了 调查,他们表示很喜欢 SMA,将 考虑用 SMA 代替传统的一对一访 视,并愿意向其他人推荐 SMA。 半数患者愿意自行付费或支付较 高自付比例参加 SMA。在费用方 面,这种诊疗方式和传统的一对 一诊所访视旗鼓相当。结论:在该可行性研究中,所开 展的关注烹饪/营养的慢性疾病 SMA 是可行的,不仅成本效益 高 , 而 且 患 者 也 能 够 很 好 地 接 受。需要进行后续研究以评估该 SMA 模式对肥胖相关疾病的短期 和长期结果。.

  9. Extracting Concepts Related to Homelessness from the Free Text of VA Electronic Medical Records.

    PubMed

    Gundlapalli, Adi V; Carter, Marjorie E; Divita, Guy; Shen, Shuying; Palmer, Miland; South, Brett; Durgahee, B S Begum; Redd, Andrew; Samore, Matthew

    2014-01-01

    Mining the free text of electronic medical records (EMR) using natural language processing (NLP) is an effective method of extracting information not always captured in administrative data. We sought to determine if concepts related to homelessness, a non-medical condition, were amenable to extraction from the EMR of Veterans Affairs (VA) medical records. As there were no off-the-shelf products, a lexicon of terms related to homelessness was created. A corpus of free text documents from outpatient encounters was reviewed to create the reference standard for NLP training and testing. V3NLP Framework was used to detect instances of lexical terms and was compared to the reference standard. With a positive predictive value of 77% for extracting relevant concepts, this study demonstrates the feasibility of extracting positively asserted concepts related to homelessness from the free text of medical records.

  10. Integrating Client and Clinician Perspectives on Psychotropic Medication Decisions: Developing a Communication-Centered Epistemic Model of Shared Decision Making for Mental Health Contexts.

    PubMed

    Mikesell, Lisa; Bromley, Elizabeth; Young, Alexander S; Vona, Pamela; Zima, Bonnie

    2016-01-01

    Shared decision making (SDM) interventions aim to improve client autonomy, information sharing, and collaborative decision making, yet implementation of these interventions has been variably perceived. Using interviews and focus groups with clients and clinicians from mental health clinics, we explored experiences with and perceptions about decision support strategies aimed to promote SDM around psychotropic medication treatment. Using thematic analysis, we identified themes regarding beliefs about participant involvement, information management, and participants' broader understanding of their epistemic expertise. Clients and clinicians highly valued client-centered priorities such as autonomy and empowerment when making decisions. However, two frequently discussed themes revealed complex beliefs about what that involvement should look like in practice: (a) the role of communication and information exchange and (b) the value and stability of clinician and client epistemic expertise. Complex beliefs regarding these two themes suggested a dynamic and reflexive approach to information management. Situating these findings within the Theory of Motivated Information Management, we discuss implications for conceptualizing SDM in mental health services and adapt Siminoff and Step's Communication Model of Shared Decision Making (CMSDM) to propose a Communication-centered Epistemic Model of Shared Decision Making (CEM-SDM).

  11. Why patient summaries in electronic health records do not provide the cognitive support necessary for nurses' handoffs on medical and surgical units: insights from interviews and observations.

    PubMed

    Staggers, Nancy; Clark, Lauren; Blaz, Jacquelyn W; Kapsandoy, Seraphine

    2011-09-01

    Patient care handoffs are cognitively intense activities, especially on medical and surgical units where nurses synthesize information across an average of four to five patients every shift. The objective of this study was to examine handoffs and nurses' use of computerized patient summary reports in an electronic health record after computerized provider order entry (CPOE) was installed. We observed and audio taped 93 patient handoffs on 25 occasions on 5 acute care units in 2 different facilities sharing a vendor's electronic health record. We found that the computerized patient summary report and the electronic health record were minimally used during the handoff and that the existing patient summary reports did not provide adequate cognitive support for nurses. The patient summary reports were incomplete, rigid and did not offer "at a glance" information, or help nurses encode information. We make recommendations about a redesign of patient summary reports and technology to support the cognitive needs of nurses during handoffs at the change of shift.

  12. Transforming patient care by introducing an electronic medical records initiative in a developing country.

    PubMed

    Shuaib, Waqas; Suarez, Julia Marielly; Romero, Juan David; Pamello, Carlos Dillon; Alweis, Richard; Khan, Aizaaz Ali; Shah, Syed Raza; Shahid, Hassan; PierreCharles, Serge B; Sanchez, Laura Rosemary

    2016-12-01

    The incorporation of an electronic medical record into patient care is a priority in developed countries, but faces significant obstacles for adoption in developing countries. The goal of our study was to define and assess the efficiency of a personalized intervention on village physicians' use of electronic medical records in rural community health services of underprivileged areas. Six towns were selected with two bordering local health stations from each town. One was randomly given to the intervention group and the other to the control group. A structured on-site intervention was provided to village physicians in the intervention group, for 7 months. The results showed that in the intervention group, the percentage of households with complete records increased. The percentage of clinic medical records and complete child vaccination in the intervention group also increased from 2 to 14 percent (p = <0.05) and from 10 to 23 percent (p = 0.05), respectively. Our investigation demonstrated that on-site education, supervision, and technical support directly correlate with improved use of electronic medical record. Our results report the challenges in implementing such a system and the steps being taken to enhance likelihood of sustainability.

  13. The Determination of a Technical Core Curriculum for a Two Year Technical Program in Bio-Medical Electronics.

    ERIC Educational Resources Information Center

    Welch, William G., Sr.

    The major concerns of this study were to determine the extent of need for bio-medical electronic technicians and to determine what would constitute a functional technical core curriculum for training to fill that need. Following a review of medical and electronic literature, a survey instrument was developed and sent to hospitals, manufacturers,…

  14. 75 FR 64749 - Request for Comments on the Use of Electronic Signatures for NRC Documents Related to the Medical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-20

    ... the use of electronic signatures on documents related to the medical use of byproduct material which... COMMISSION Request for Comments on the Use of Electronic Signatures for NRC Documents Related to the Medical Use of Byproduct Material Maintained at Licensees' Facilities AGENCY: Nuclear Regulatory...

  15. The Electronic Medical Records and Genomics (eMERGE) Network: past, present, and future

    PubMed Central

    Gottesman, Omri; Kuivaniemi, Helena; Tromp, Gerard; Faucett, W. Andrew; Li, Rongling; Manolio, Teri A.; Sanderson, Saskia C.; Kannry, Joseph; Zinberg, Randi; Basford, Melissa A.; Brilliant, Murray; Carey, David J.; Chisholm, Rex L.; Chute, Christopher G.; Connolly, John J.; Crosslin, David; Denny, Joshua C.; Gallego, Carlos J.; Haines, Jonathan L.; Hakonarson, Hakon; Harley, John; Jarvik, Gail P.; Kohane, Isaac; Kullo, Iftikhar J.; Larson, Eric B.; McCarty, Catherine; Ritchie, Marylyn D.; Roden, Dan M.; Smith, Maureen E.; Böttinger, Erwin P.; Williams, Marc S.

    2013-01-01

    The Electronic Medical Records and Genomics Network is a National Human Genome Research Institute–funded consortium engaged in the development of methods and best practices for using the electronic medical record as a tool for genomic research. Now in its sixth year and second funding cycle, and comprising nine research groups and a coordinating center, the network has played a major role in validating the concept that clinical data derived from electronic medical records can be used successfully for genomic research. Current work is advancing knowledge in multiple disciplines at the intersection of genomics and health-care informatics, particularly for electronic phenotyping, genome-wide association studies, genomic medicine implementation, and the ethical and regulatory issues associated with genomics research and returning results to study participants. Here, we describe the evolution, accomplishments, opportunities, and challenges of the network from its inception as a five-group consortium focused on genotype–phenotype associations for genomic discovery to its current form as a nine-group consortium pivoting toward the implementation of genomic medicine. Genet Med 15 10, 761–771. PMID:23743551

  16. The Electronic Medical Records and Genomics (eMERGE) Network: past, present, and future.

    PubMed

    Gottesman, Omri; Kuivaniemi, Helena; Tromp, Gerard; Faucett, W Andrew; Li, Rongling; Manolio, Teri A; Sanderson, Saskia C; Kannry, Joseph; Zinberg, Randi; Basford, Melissa A; Brilliant, Murray; Carey, David J; Chisholm, Rex L; Chute, Christopher G; Connolly, John J; Crosslin, David; Denny, Joshua C; Gallego, Carlos J; Haines, Jonathan L; Hakonarson, Hakon; Harley, John; Jarvik, Gail P; Kohane, Isaac; Kullo, Iftikhar J; Larson, Eric B; McCarty, Catherine; Ritchie, Marylyn D; Roden, Dan M; Smith, Maureen E; Böttinger, Erwin P; Williams, Marc S

    2013-10-01

    The Electronic Medical Records and Genomics Network is a National Human Genome Research Institute-funded consortium engaged in the development of methods and best practices for using the electronic medical record as a tool for genomic research. Now in its sixth year and second funding cycle, and comprising nine research groups and a coordinating center, the network has played a major role in validating the concept that clinical data derived from electronic medical records can be used successfully for genomic research. Current work is advancing knowledge in multiple disciplines at the intersection of genomics and health-care informatics, particularly for electronic phenotyping, genome-wide association studies, genomic medicine implementation, and the ethical and regulatory issues associated with genomics research and returning results to study participants. Here, we describe the evolution, accomplishments, opportunities, and challenges of the network from its inception as a five-group consortium focused on genotype-phenotype associations for genomic discovery to its current form as a nine-group consortium pivoting toward the implementation of genomic medicine.

  17. Pilot study examining the efficacy of an electronic intervention to promote HIV medication adherence.

    PubMed

    Claborn, Kasey R; Leffingwell, Thad R; Miller, Mary Beth; Meier, Ellen; Stephens, Johnny R

    2014-01-01

    Widespread dissemination of current interventions designed to improve HIV medication adherence is limited by several barriers, including additional time and expense burdens on the health care systems. Electronic interventions could aid in dissemination of interventions in the clinic setting. This study developed and tested the feasibility and acceptability of a computer-based adaption of an empirically supported face-to-face adherence promotion intervention. HIV-positive individuals (N = 92) on antiretroviral therapy with self-reported adherence <95% were randomized to the electronic intervention + treatment as usual (TAU) or TAU only. Study outcome variables which included treatment self-efficacy and self-reported medication adherence were assessed at baseline and follow-up. Time × condition interaction effects in mixed model analysis of variance (ANOVAs) examined the differences in patterns of change in the outcome variables over time between the two groups. Participants in the electronic intervention condition reported higher levels of self-efficacy to adhere to their medication at follow-up compared to the control condition. Although nonsignificant, levels of adherence tended to improve over time in the intervention condition, while TAU adherence remained constant. This was the first study to investigate a single-session, computer-based adherence intervention. Results suggest that electronic interventions are feasible and this method may be effective at increasing self-efficacy and adherence among patients reporting suboptimal adherence levels.

  18. A practical procedure to prevent electromagnetic interference with electronic medical equipment.

    PubMed

    Hanada, Eisuke; Takano, Kyoko; Antoku, Yasuaki; Matsumura, Kouji; Watanabe, Yoshiaki; Nose, Yoshiaki

    2002-02-01

    Problems involving electromagnetic interference (EMI) with electronic medical equipment are well-documented. However, no systematic investigation of EMI has been done. We have systematically investigated the causes of EMI. The factors involved in EMI were determined as follows: 1) Electric-field intensity induced by invasive radio waves from outside a hospital. 2) Residual magnetic-flux density at welding points in a building. 3) Electric-field intensity induced by conveyance systems with a linear motor. 4) The shielding capacity of hospital walls. 5) The shielding capacity of commercial shields against a wide range frequency radio waves. 6) The immunity of electronic medical equipment. 7) EMI by cellular telephone and personal handy-phone system handsets. From the results of our investigation, we developed a following practical procedure to prevent EMI. 1) Measurement of electric-field intensity induced by invasive radio waves from outside the hospital and industrial systems in the hospital. 2) Measurement of residual magnetic-flux density at electric welding points of hospital buildings with steel frame structures. 3) Control of the electromagnetic environment by utilizing the shielding capacity of walls. 4) Measurement of the immunity of electronic medical equipment. And 5) Installation of electronic gate equipment at the building entrance to screen for handsets.

  19. Object-oriented framework for high-performance electronic medical imaging

    NASA Astrophysics Data System (ADS)

    Schmidt, Douglas C.; Harrison, Timothy H.; Pyarali, Irfan

    1996-02-01

    This paper describes the design and performance of an object-oriented communication framework we developed to meet the demands of next-generation distributed electronic medical imaging systems. Our framework combines the flexibility of high-level distributed object computing middleware (like CORBA) with the performance of low-level network programming mechanisms (like sockets). In the paper, we outline the design goals and software architecture of our framework, illustrate the performance of the framework over ATM, and describe how we resolved design challenges we faced when developing an object- oriented communication framework for distributed medical imaging.

  20. Performance analysis of distributed and centralized models for electronic medical record exchanges.

    PubMed

    Huang, Ean-Wen; Lee, Chiung-San; Jiang, Wey-Wen; Chiou, Shwu-Fen; Liu, Fei-Ying; Liou, Der-Ming

    2007-01-01

    Electronic medical record exchanges can save time and reduce cost by eliminating redundant data and typing errors. The major steps of record exchange consist of querying information from database, encoding data into messages, and sending and decoding messages. Three medical-record-exchange models were proposed in the past, including the distributed, centralized, and indexed models. In this paper, the queuing theory is applied to evaluate the performance of the three models. We estimate the service time for each queue of the CPU, database and network, and predict the response time, probable bottlenecks and system capacities of each model.

  1. Implementation of a Cloud-Based Electronic Medical Record to Reduce Gaps in the HIV Treatment Continuum in Rural Kenya

    PubMed Central

    Haskew, John; Rø, Gunnar; Turner, Kenrick; Kimanga, Davies; Sirengo, Martin; Sharif, Shahnaaz

    2015-01-01

    Background Electronic medical record (EMR) systems are increasingly being adopted to support the delivery of health care in developing countries and their implementation can help to strengthen pathways of care and close gaps in the HIV treatment cascade by improving access to and use of data to inform clinical and public health decision-making. Methods This study implemented a novel cloud-based electronic medical record system in an HIV outpatient setting in Western Kenya and evaluated its impact on reducing gaps in the HIV treatment continuum including missing data and patient eligibility for ART. The impact of the system was assessed using a two-sample test of proportions pre- and post-implementation of EMR-based data verification and clinical decision support. Results Significant improvements in data quality and provision of clinical care were recorded through implementation of the EMR system, helping to ensure patients who are eligible for HIV treatment receive it early. A total of 2,169 and 764 patient records had missing data pre-implementation and post-implementation of EMR-based data verification and clinical decision support respectively. A total of 1,346 patients were eligible for ART, but not yet started on ART, pre-implementation compared to 270 patients pre-implementation. Conclusion EMR-based data verification and clinical decision support can reduce gaps in HIV care, including missing data and eligibility for ART. A cloud-based model of EMR implementation removes the need for local clinic infrastructure and has the potential to enhance data sharing at different levels of health care to inform clinical and public health decision-making. A number of issues, including data management and patient confidentiality, must be considered but significant improvements in data quality and provision of clinical care are recorded through implementation of this EMR model. PMID:26252212

  2. A study on agent-based secure scheme for electronic medical record system.

    PubMed

    Chen, Tzer-Long; Chung, Yu-Fang; Lin, Frank Y S

    2012-06-01

    Patient records, including doctors' diagnoses of diseases, trace of treatments and patients' conditions, nursing actions, and examination results from allied health profession departments, are the most important medical records of patients in medical systems. With patient records, medical staff can instantly understand the entire medical information of a patient so that, according to the patient's conditions, more accurate diagnoses and more appropriate in-depth treatments can be provided. Nevertheless, in such a modern society with booming information technologies, traditional paper-based patient records have faced a lot of problems, such as lack of uniform formats, low data mobility, slow data transfer, illegible handwritings, enormous and insufficient storage space, difficulty of conservation, being easily damaged, and low transferability. To improve such drawbacks, reduce medical costs, and advance medical quality, paper-based patient records are modified into electronic medical records and reformed into electronic patient records. However, since electronic patient records used in various hospitals are diverse and different, in consideration of cost, it is rather difficult to establish a compatible and complete integrated electronic patient records system to unify patient records from heterogeneous systems in hospitals. Moreover, as the booming of the Internet, it is no longer necessary to build an integrated system. Instead, doctors can instantly look up patients' complete information through the Internet access to electronic patient records as well as avoid the above difficulties. Nonetheless, the major problem of accessing to electronic patient records cross-hospital systems exists in the security of transmitting and accessing to the records in case of unauthorized medical personnels intercepting or stealing the information. This study applies the Mobile Agent scheme to cope with the problem. Since a Mobile Agent is a program, which can move among hosts and

  3. A hospital information system based on Common Object Request Broker Architecture (CORBA) for exchanging distributed medical objects--an approach to future environment of sharing healthcare information.

    PubMed

    Ohe, K

    1998-01-01

    Tightly related subsystems in a HIS have to exchange medical data flexibly by the data object rather than by the battery of the data. We developed a CPR subsystem based on Common Object Request Broker Architecture (CORBA) that retrieves and stores clinical information in the object-oriented database via Internet Intra-ORB Protocol (IIOP). The system is hybridized with the legacy HIS applications on the client terminals. We believe that our solution and the experiences will contribute to the future CORBA-based environment in which computerized patient information is shared among hospitals, clinics, and tightly related systems.

  4. Use of the electronic medical record for trauma resuscitations: how does this impact documentation completeness?

    PubMed

    Bilyeu, Pam; Eastes, Lynn

    2013-01-01

    Although many trauma centers across the country have implemented electronic medical records (EMRs) for inpatient documentation, they have avoided the use of EMR during the fast-paced trauma resuscitations. The objective of this study was to determine whether documenting electronically during trauma resuscitations has resulted in improvement or degradation of the completeness of data recorded. Forty critical data points were evaluated in 100 pre-EMR charts and 100 post-EMR charts. There was improvement in completeness of charting in 25% of the electronic records reviewed and degradation of completeness of charting in 18% of the records, for a net improvement in completeness of charting of 7% in the electronic records reviewed.

  5. ChRIS--A web-based neuroimaging and informatics system for collecting, organizing, processing, visualizing and sharing of medical data.

    PubMed

    Pienaar, Rudolph; Rannou, Nicolas; Bernal, Jorge; Hahn, Daniel; Grant, P Ellen

    2015-01-01

    The utility of web browsers for general purpose computing, long anticipated, is only now coming into fruition. In this paper we present a web-based medical image data and information management software platform called ChRIS ([Boston] Children's Research Integration System). ChRIS' deep functionality allows for easy retrieval of medical image data from resources typically found in hospitals, organizes and presents information in a modern feed-like interface, provides access to a growing library of plugins that process these data - typically on a connected High Performance Compute Cluster, allows for easy data sharing between users and instances of ChRIS and provides powerful 3D visualization and real time collaboration.

  6. The Impact of an Electronic Medical Record on Repeat Laboratory Test Ordering Across Four Australian Hospitals.

    PubMed

    Georgiou, Andrew; Vecellio, Elia; Li, Ling; Westbrook, Johanna I

    2015-01-01

    In this study we examined the impact of an Electronic Medical Record (EMR) on repeat test rates (i.e., the same test ordered within a specified window of time) for a commonly ordered set of laboratory tests; Electrolytes, Urea, Creatinine [EUC], Full Blood Counts [FBC] and Liver Function Tests [LFT]. The results point to the potential that timely, evidence-based electronic decision support features can have on the efficiency and effectiveness of the pathology laboratory process and its contribution to quality patient care.

  7. The Automatic Clinical Trial: Leveraging the Electronic Medical Record in Multi-site Cancer Clinical Trials

    PubMed Central

    Krueger, Judy; Crowley, John

    2012-01-01

    Submission of data into clinical trial electronic data capture (EDC) systems currently requires redundant entry of data that already exist in the electronic medical record (EMR). Being able to automatically transfer data from the EMR to the EDC would save many hours of arduous effort, especially for multi-site data-intensive oncology trials. Standardization of the way in which data is stored and retrieved in the medical record and techniques for mining data from the unstructured narrative will provide opportunities for transferring data from EMR to EDC. As different EMRs proliferate, other technology in the form of data mining or middle tier applications are certain to provide assistance in this effort. PMID:22907283

  8. The mini electronic medical record: a low-cost, low-risk partial solution.

    PubMed

    Chambliss, M L; Rasco, T; Clark, R D; Gardner, J P

    2001-12-01

    Electronic medical records (EMRs) offer many advantages. However, there are also risks involved with adopting a full commercial EMR. These include high cost, the disruption of clinic routines, and poor or no vendor support. We created and implemented a partial, or miniature EMR (mini EMR) based on Microsoft Access 97 (Microsoft Corporation; Redmond, Wash). This program serves as an electronic front sheet for the patient chart that records International Classification of Diseases--9th revision codes and chronic medications and allergies, and provides reminders for prevention procedures. The mini EMR has been inexpensive, adaptable, easy to maintain, and very well accepted, and it has caused little interruption of our clinical activities. We believe the program can serve as a bridge to a future commercial EMR once that market has matured.

  9. Electronic medical record in the simulation hospital: does it improve accuracy in charting vital signs, intake, and output?

    PubMed

    Mountain, Carel; Redd, Roxanne; O'Leary-Kelly, Colleen; Giles, Kim

    2015-04-01

    Nursing care delivery has shifted in response to the introduction of electronic health records. Adequate education using computerized documentation heavily influences a nurse's ability to navigate and utilize electronic medical records. The risk for treatment error increases when a bedside nurse lacks the correct knowledge and skills regarding electronic medical record documentation. Prelicensure nursing education should introduce electronic medical record documentation and provide a method for feedback from instructors to ensure proper understanding and use of this technology. RN preceptors evaluated two groups of associate degree nursing students to determine if introduction of electronic medical record in the simulation hospital increased accuracy in documenting vital signs, intake, and output in the actual clinical setting. During simulation, the first group of students documented using traditional paper and pen; the second group used an academic electronic medical record. Preceptors evaluated each group during their clinical rotations at two local inpatient facilities. RN preceptors provided information by responding to a 10-question Likert scale survey regarding the use of student electronic medical record documentation during the 120-hour inpatient preceptor rotation. The implementation of the electronic medical record into the simulation hospital, although a complex undertaking, provided students a safe and supportive environment in which to practice using technology and receive feedback from faculty regarding accurate documentation.

  10. Design of electronic medical record user interfaces: a matrix-based method for improving usability.

    PubMed

    Kuqi, Kushtrim; Eveleigh, Tim; Holzer, Thomas; Sarkani, Shahryar; Levin, James E; Crowley, Rebecca S

    2013-01-01

    This study examines a new approach of using the Design Structure Matrix (DSM) modeling technique to improve the design of Electronic Medical Record (EMR) user interfaces. The usability of an EMR medication dosage calculator used for placing orders in an academic hospital setting was investigated. The proposed method captures and analyzes the interactions between user interface elements of the EMR system and groups elements based on information exchange, spatial adjacency, and similarity to improve screen density and time-on-task. Medication dose adjustment task time was recorded for the existing and new designs using a cognitive simulation model that predicts user performance. We estimate that the design improvement could reduce time-on-task by saving an average of 21 hours of hospital physicians' time over the course of a month. The study suggests that the application of DSM can improve the usability of an EMR user interface.

  11. Underdiagnosis of pediatric hypertension-an example of a new era of clinical research enabled by electronic medical records.

    PubMed

    Gunn, Paul W; Hansen, Matthew L; Kaelber, David C

    2007-10-11

    Previously, large scale clinical research required large budgets, significant staff, and long periods of time. Typically most of these resources were spent on data collection to develop electronic research databases. With the proliferation of electronic medical records this clinical research paradigm changes. Here we present a large clinical study of pediatric hypertension (14,187 patients) conducted through an electronic medical record without any budget and within about 70 hours over 6 months.

  12. A Prospective Analysis of Patients Presenting for Medical Attention at a Large Electronic Dance Music Festival.

    PubMed

    Friedman, Matt S; Plocki, Alex; Likourezos, Antonios; Pushkar, Illya; Bazos, Andrew N; Fromm, Christian; Friedman, Benjamin W

    2017-02-01

    Mass-Gathering Medicine studies have identified variables that predict greater patient presentation rates (PPRs) and transport to hospital rates (TTHRs). This is a descriptive report of patients who presented for medical attention at an annual electronic dance music festival (EDMF). At this large, single EDMF in New York City (NYC; New York, USA), the frequency of patient presentation, the range of presentations, and interventions performed were identified. This descriptive report examined consecutive patients who presented to the medical tent of a summertime EDMF held at an outdoor venue with an active, mobile, bounded crowd. Alcohol was available for sale. Entry was restricted to persons 18 years and older. The festival occurred on three consecutive days with a total cumulative attendance of 58,000. Medical staffing included two Emergency Medicine physicians, four registered nurses, and 86 Emergency Medical Services (EMS) providers. Data collected included demographics, past medical history, vital signs, physical exam, drug and alcohol use, interventions performed, and transport decisions. Eighty-four patients were enrolled over 2.5 days. Six were transported and zero died. The ages of the subjects ranged from 17 to 61 years. Forty-three (51%) were male. Thirty-eight (45%) initially presented with abnormal vital signs; four (5%) were hyperthermic. Of these latter patients, 34 (90%) reported ingestions with 3,4-methylenedioxymethamphetamine (MDMA) or other drugs. Eleven (65%) patients were diaphoretic or mydriatic. The most common prehospital interventions were intravenous normal saline (8/84; 10%), ondansetron (6/84; 7%), and midazolam (3/84; 4%). Electronic dance music festivals are a growing trend and a new challenge for Mass-Gathering Medicine as new strategies must be employed to decrease TTHR and mortality. Addressing common and expected medical emergencies at mass-gathering events through awareness, preparation, and early, focused medical interventions may

  13. Identifying risk factors for healthcare-associated infections from electronic medical record home address data

    PubMed Central

    2010-01-01

    Background Residential address is a common element in patient electronic medical records. Guidelines from the U.S. Centers for Disease Control and Prevention specify that residence in a nursing home, skilled nursing facility, or hospice within a year prior to a positive culture date is among the criteria for differentiating healthcare-acquired from community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections. Residential addresses may be useful for identifying patients residing in healthcare-associated settings, but methods for categorizing residence type based on electronic medical records have not been widely documented. The aim of this study was to develop a process to assist in differentiating healthcare-associated from community-associated MRSA infections by analyzing patient addresses to determine if residence reported at the time of positive culture was associated with a healthcare facility or other institutional location. Results We identified 1,232 of the patients (8.24% of the sample) with positive cultures as probable cases of healthcare-associated MRSA based on residential addresses contained in electronic medical records. Combining manual review with linking to institutional address databases improved geocoding rates from 11,870 records (79.37%) to 12,549 records (83.91%). Standardization of patient home address through geocoding increased the number of matches to institutional facilities from 545 (3.64%) to 1,379 (9.22%). Conclusions Linking patient home address data from electronic medical records to institutional residential databases provides useful information for epidemiologic researchers, infection control practitioners, and clinicians. This information, coupled with other clinical and laboratory data, can be used to inform differentiation of healthcare-acquired from community-acquired infections. The process presented should be extensible with little or no added data costs. PMID:20849635

  14. Strategies to accelerate translation of research into primary care within practices using electronic medical records.

    PubMed

    Nemeth, Lynne S; Wessell, Andrea M; Jenkins, Ruth G; Nietert, Paul J; Liszka, Heather A; Ornstein, Steven M

    2007-01-01

    This research describes implementation strategies used by primary care practices using electronic medical records in a national quality improvement demonstration project, Accelerating Translation of Research into Practice, conducted within the Practice Partner Research Network. Qualitative methods enabled identification of strategies to improve 36 quality indicators. Quantitative survey results provide mean scores reflecting the integration of these strategies by practices. Nursing staff plays important roles to facilitate quality improvement within collaborative primary care practices.

  15. Advanced search of the electronic medical record: augmenting safety and efficiency in radiology.

    PubMed

    Zalis, Michael; Harris, Mitchell

    2010-08-01

    The integration of electronic medical record (EMR) systems into clinical practice has been spurred by general consensus and recent federal incentives and is set to become a standard feature of clinical practice in the US. We discuss how the addition of advanced search capabilities to the EMR can improve the radiologist's ability to integrate contextual data into workflows associated with both for diagnostic and interventional procedures.

  16. Technology Transfer: Learning from Lost Opportunities and Sharing Best Practices--Experiences at Cedars-Sinai Medical Center, USA

    ERIC Educational Resources Information Center

    Vari, Sandor G.; Laur, James D.

    2006-01-01

    One significant aspect of Cedars-Sinai Medical Center's charitable mission is to ensure that its research results benefit society at large. This is accomplished through researcher education, securing appropriate intellectual property protection and licensing so that inventions are developed into useful products. The Swan-Ganz and Barath balloon…

  17. Shared Agency and Collaboration between the Family and Professionals in Medical Rehabilitation of Children with Severe Disabilities

    ERIC Educational Resources Information Center

    Jarvikoski, Aila; Martin, Marjatta; Autti-Ramo, Ilona; Harkapaa, Kristiina

    2013-01-01

    Implementation of medical rehabilitation for children with severe disabilities, arranged by the Social Insurance Institution of Finland, is based on collaboration of the family with several professionals and organizations providing the necessary services. Therefore, it sets special challenges for service provision. Parents' experiences of shared…

  18. Evaluation of Electromagnetic Fields in a Hospital for Safe Use of Electronic Medical Equipment.

    PubMed

    Ishida, Kai; Fujioka, Tomomi; Endo, Tetsuo; Hosokawa, Ren; Fujisaki, Tetsushi; Yoshino, Ryoji; Hirose, Minoru

    2016-03-01

    Establishment of electromagnetic compatibility is important in use of electronic medical equipment in hospitals. To evaluate the electromagnetic environment, the electric field intensity induced by electromagnetic radiation in broadcasting spectra coming from outside the hospital was measured in a new hospital building before any patients visited the hospital and 6 months after the opening of the hospital. Various incoming radio waves were detected on the upper floors, with no significant difference in measured levels before and after opening of the hospital. There were no cellphone terminal signals before the hospital opened, but these signals were strongly detected at 6 months thereafter. Cellphone base stations signals were strongly detected on the upper floors, but there were no signals at most locations in the basement and in the center of the building on the lower floors. A maximum electrical intensity of 0.28 V/m from cellphone base stations (2.1 GHz) was detected at the south end of the 2nd floor before the hospital opened. This value is lower than the EMC marginal value for general electronic medical equipment specified in IEC 60601-1-2 (3 V/m). Therefore, electromagnetic interference with electronic medical equipment is unlikely in this situation. However, cellphone terminal signals were frequently detected in non-base station signal areas. This is a concern, and understanding signal strength from cellphone base stations at a hospital is important for promotion of greater safety.

  19. [Choice and disclosure of preferences, towards sharing the therapeutic decision in cancerology: from economic theory to medical practice].

    PubMed

    Protière, C; Moatti, J P; Maraninchi, D; Viens, P

    1998-02-01

    Today, as it is often difficult to demonstrate the superiority of a new molecule or a therapeutic strategy in term of plain efficacy on disease, the incitement is strong to provide some complementary argument of assessment, we are assisting to the emergence of a new concept: shared therapeutic decision making. Is the application of this concept--with make the paternalistic model questionnable--adapted to all cases? What are the different levels of participation that could be envisaged? Are there favourable methods for this participations? This shared decision making--direct (patients' choice between treatment options) or indirect (integration of elicited preferences in the decision process)--if it has to be efficient, must surround with care: to define its application limitation, to protect itself of manipulation. It shall require to consider information transmission difficulties, to establish some elicitation preference method. Some technical, such as time trade off, standard gamble or willingness to pay, supported by economic theory of expected utility, permit to help eliciting patients' preferences and to structure the therapeutic choice. Some empirical study of preference elicitation shall permit to get clear the complexity of trade off between the different choice element that could enter in the acceptability of the treatment for patients.

  20. Laser-driven electron beam and radiation sources for basic, medical and industrial sciences.

    PubMed

    Nakajima, Kazuhisa

    2015-01-01

    To date active research on laser-driven plasma-based accelerators have achieved great progress on production of high-energy, high-quality electron and photon beams in a compact scale. Such laser plasma accelerators have been envisaged bringing a wide range of applications in basic, medical and industrial sciences. Here inheriting the groundbreaker's review article on "Laser Acceleration and its future" [Toshiki Tajima, (2010)],(1)) we would like to review recent progress of producing such electron beams due to relativistic laser-plasma interactions followed by laser wakefield acceleration and lead to the scaling formulas that are useful to design laser plasma accelerators with controllability of beam energy and charge. Lastly specific examples of such laser-driven electron/photon beam sources are illustrated.

  1. Laser-driven electron beam and radiation sources for basic, medical and industrial sciences

    PubMed Central

    NAKAJIMA, Kazuhisa

    2015-01-01

    To date active research on laser-driven plasma-based accelerators have achieved great progress on production of high-energy, high-quality electron and photon beams in a compact scale. Such laser plasma accelerators have been envisaged bringing a wide range of applications in basic, medical and industrial sciences. Here inheriting the groundbreaker’s review article on “Laser Acceleration and its future” [Toshiki Tajima, (2010)],1) we would like to review recent progress of producing such electron beams due to relativistic laser-plasma interactions followed by laser wakefield acceleration and lead to the scaling formulas that are useful to design laser plasma accelerators with controllability of beam energy and charge. Lastly specific examples of such laser-driven electron/photon beam sources are illustrated. PMID:26062737

  2. ClinicalCodes: an online clinical codes repository to improve the validity and reproducibility of research using electronic medical records.

    PubMed

    Springate, David A; Kontopantelis, Evangelos; Ashcroft, Darren M; Olier, Ivan; Parisi, Rosa; Chamapiwa, Edmore; Reeves, David

    2014-01-01

    Lists of clinical codes are the foundation for research undertaken using electronic medical records (EMRs). If clinical code lists are not available, reviewers are unable to determine the validity of research, full study replication is impossible, researchers are unable to make effective comparisons between studies, and the construction of new code lists is subject to much duplication of effort. Despite this, the publication of clinical codes is rarely if ever a requirement for obtaining grants, validating protocols, or publishing research. In a representative sample of 450 EMR primary research articles indexed on PubMed, we found that only 19 (5.1%) were accompanied by a full set of published clinical codes and 32 (8.6%) stated that code lists were available on request. To help address these problems, we have built an online repository where researchers using EMRs can upload and download lists of clinical codes. The repository will enable clinical researchers to better validate EMR studies, build on previous code lists and compare disease definitions across studies. It will also assist health informaticians in replicating database studies, tracking changes in disease definitions or clinical coding practice through time and sharing clinical code information across platforms and data sources as research objects.

  3. The impact of university provided nurse electronic medical record training on health care organizations: an exploratory simulation approach.

    PubMed

    Abrahamson, Kathleen; Anderson, James G; Borycki, Elizabeth M; Kushniruk, Andre W; Malovec, Shannon; Espejo, Angela; Anderson, Marilyn

    2015-01-01

    Training providers appropriately, particularly early in their caregiving careers, is an important aspect of electronic medical record (EMR) implementation. Considerable time and resources are needed to bring the newly hired providers 'up to speed' with the actual use practices of the organization. Similarly, universities lose valuable clinical training hours when students are required to spend those hours learning organization-specific EMR systems in order to participate in care during clinical rotations. Although there are multiple real-world barriers to university/health care organization training partnerships, the investment these entities share in training care providers, specifically nurses, to use and understand EMR technology encourages a question: What would be the cumulative effect of integrating a mutually agreed upon EMR system training program in to nursing classroom training on downstream hospital costs in terms of hours of direct caregiving lost, and benefits in terms of number of overall EMR trained nurses hired? In order to inform the development of a large scale study, we employed a dynamic systems modeling approach to simulate the theoretical relationships between key model variables and determine the possible effect of integrating EMR training into nursing classrooms on hospital outcomes. The analysis indicated that integrating EMR training into the nursing classroom curriculum results in more available time for nurse bedside care. Also, the simulation suggests that efficiency of clinical training can be potentially improved by centralizing EMR training within the nursing curriculum.

  4. ClinicalCodes: An Online Clinical Codes Repository to Improve the Validity and Reproducibility of Research Using Electronic Medical Records

    PubMed Central

    Springate, David A.; Kontopantelis, Evangelos; Ashcroft, Darren M.; Olier, Ivan; Parisi, Rosa; Chamapiwa, Edmore; Reeves, David

    2014-01-01

    Lists of clinical codes are the foundation for research undertaken using electronic medical records (EMRs). If clinical code lists are not available, reviewers are unable to determine the validity of research, full study replication is impossible, researchers are unable to make effective comparisons between studies, and the construction of new code lists is subject to much duplication of effort. Despite this, the publication of clinical codes is rarely if ever a requirement for obtaining grants, validating protocols, or publishing research. In a representative sample of 450 EMR primary research articles indexed on PubMed, we found that only 19 (5.1%) were accompanied by a full set of published clinical codes and 32 (8.6%) stated that code lists were available on request. To help address these problems, we have built an online repository where researchers using EMRs can upload and download lists of clinical codes. The repository will enable clinical researchers to better validate EMR studies, build on previous code lists and compare disease definitions across studies. It will also assist health informaticians in replicating database studies, tracking changes in disease definitions or clinical coding practice through time and sharing clinical code information across platforms and data sources as research objects. PMID:24941260

  5. Key role of social work in effective communication and conflict resolution process: Medical Orders for Life-Sustaining Treatment (MOLST) Program in New York and shared medical decision making at the end of life.

    PubMed

    Bomba, Patricia A; Morrissey, Mary Beth; Leven, David C

    2011-01-01

    In this article, the authors review the development of the Medical Orders for Life-Sustaining Treatment (MOLST) Program and recent landmark legislation in New York State in the context of advance care planning and shared medical decision making at the end of life. Social workers are central health care professionals in working with patients, families, practitioners, health care agents, and surrogates in the health systems and in the communication and conflict resolution process that is integral to health care decision making. The critical importance of ethics and end-of-life training and education for social workers is also addressed. Data from a pilot study evaluating interdisciplinary ethics training on legal and ethical content in communication and conflict resolution skills in health care decision making are reported. Recommendations are made for research on education and training of social workers, and investigation of the role and influence of systems in shaping social work involvement in end-of-life and palliative care.

  6. Security of electronic medical information and patient privacy: what you need to know.

    PubMed

    Andriole, Katherine P

    2014-12-01

    The responsibility that physicians have to protect their patients from harm extends to protecting the privacy and confidentiality of patient health information including that contained within radiological images. The intent of HIPAA and subsequent HIPAA Privacy and Security Rules is to keep patients' private information confidential while allowing providers access to and maintaining the integrity of relevant information needed to provide care. Failure to comply with electronic protected health information (ePHI) regulations could result in financial or criminal penalties or both. Protected health information refers to anything that can reasonably be used to identify a patient (eg, name, age, date of birth, social security number, radiology examination accession number). The basic tools and techniques used to maintain medical information security and patient privacy described in this article include physical safeguards such as computer device isolation and data backup, technical safeguards such as firewalls and secure transmission modes, and administrative safeguards including documentation of security policies, training of staff, and audit tracking through system logs. Other important concepts related to privacy and security are explained, including user authentication, authorization, availability, confidentiality, data integrity, and nonrepudiation. Patient privacy and security of medical information are critical elements in today's electronic health care environment. Radiology has led the way in adopting digital systems to make possible the availability of medical information anywhere anytime, and in identifying and working to eliminate any risks to patients.

  7. Contribution of Electronic Medical Records to the Management of Rare Diseases

    PubMed Central

    Bremond-Gignac, Dominique; Lewandowski, Elisabeth; Copin, Henri

    2015-01-01

    Purpose. Electronic health record systems provide great opportunity to study most diseases. Objective of this study was to determine whether electronic medical records (EMR) in ophthalmology contribute to management of rare eye diseases, isolated or in syndromes. Study was designed to identify and collect patients' data with ophthalmology-specific EMR. Methods. Ophthalmology-specific EMR software (Softalmo software Corilus) was used to acquire ophthalmological ocular consultation data from patients with five rare eye diseases. The rare eye diseases and data were selected and collected regarding expertise of eye center. Results. A total of 135,206 outpatient consultations were performed between 2011 and 2014 in our medical center specialized in rare eye diseases. The search software identified 29 congenital aniridia, 6 Axenfeld/Rieger syndrome, 11 BEPS, 3 Nanophthalmos, and 3 Rubinstein-Taybi syndrome. Discussion. EMR provides advantages for medical care. The use of ophthalmology-specific EMR is reliable and can contribute to a comprehensive ocular visual phenotype useful for clinical research. Conclusion. Routinely EMR acquired with specific software dedicated to ophthalmology provides sufficient detail for rare diseases. These software-collected data appear useful for creating patient cohorts and recording ocular examination, avoiding the time-consuming analysis of paper records and investigation, in a University Hospital linked to a National Reference Rare Center Disease. PMID:26539543

  8. Usability Evaluation of An Electronic Medication Administration Record (eMAR) Application

    PubMed Central

    Guo, J.; Iribarren, S.; Kapsandoy, S.; Perri, S.; Staggers, N.

    2011-01-01

    Background Electronic medication administration records (eMARs) have been widely used in recent years. However, formal usability evaluations are not yet available for these vendor applications, especially from the perspective of nurses, the largest group of eMAR users. Objective To conduct a formal usability evaluation of an implemented eMAR. Methods Four evaluators examined a commercial vendor eMAR using heuristic evaluation techniques. The evaluators defined seven tasks typical of eMAR use and independently evaluated the application. Consensus techniques were used to obtain 100% agreement of identified usability problems and severity ratings. Findings were reviewed with 5 clinical staff nurses and the Director of Clinical Informatics who verified findings with a small group of clinical nurses. Results Evaluators found 60 usability problems categorized into 233 heuristic violations. Match, Error, and Visibility heuristics were the most frequently violated. Administer Medication and Order and Modify Medications tasks had the highest number of heuristic violations and usability problems rated as major or catastrophic. Conclusion The high number of usability problems could impact the effectiveness, efficiency and satisfaction of nurses’ medication administration activities and may include concerns about patient safety. Usability is a joint responsibility between sites and vendors. We offer a call to action for usability evaluations at all sites and eMAR application redesign as necessary to improve the user experience and promote patient safety. PMID:23616871

  9. Development of Electron Tracking Compton Camera using micro pixel gas chamber for medical imaging

    NASA Astrophysics Data System (ADS)

    Kabuki, Shigeto; Hattori, Kaori; Kohara, Ryota; Kunieda, Etsuo; Kubo, Atsushi; Kubo, Hidetoshi; Miuchi, Kentaro; Nakahara, Tadaki; Nagayoshi, Tsutomu; Nishimura, Hironobu; Okada, Yoko; Orito, Reiko; Sekiya, Hiroyuki; Shirahata, Takashi; Takada, Atsushi; Tanimori, Toru; Ueno, Kazuki

    2007-10-01

    We have developed the Electron Tracking Compton Camera (ETCC) with reconstructing the 3-D tracks of the scattered electron in Compton process for both sub-MeV and MeV gamma rays. By measuring both the directions and energies of not only the recoil gamma ray but also the scattered electron, the direction of the incident gamma ray is determined for each individual photon. Furthermore, a residual measured angle between the recoil electron and scattered gamma ray is quite powerful for the kinematical background rejection. For the 3-D tracking of the electrons, the Micro Time Projection Chamber (μ-TPC) was developed using a new type of the micro pattern gas detector. The ETCC consists of this μ-TPC (10×10×8 cm 3) and the 6×6×13 mm 3 GSO crystal pixel arrays with a flat panel photo-multiplier surrounding the μ-TPC for detecting recoil gamma rays. The ETCC provided the angular resolution of 6.6° (FWHM) at 364 keV of 131I. A mobile ETCC for medical imaging, which is fabricated in a 1 m cubic box, has been operated since October 2005. Here, we present the imaging results for the line sources and the phantom of human thyroid gland using 364 keV gamma rays of 131I.

  10. Risk factor detection for heart disease by applying text analytics in electronic medical records.

    PubMed

    Torii, Manabu; Fan, Jung-Wei; Yang, Wei-Li; Lee, Theodore; Wiley, Matthew T; Zisook, Daniel S; Huang, Yang

    2015-12-01

    In the United States, about 600,000 people die of heart disease every year. The annual cost of care services, medications, and lost productivity reportedly exceeds 108.9 billion dollars. Effective disease risk assessment is critical to prevention, care, and treatment planning. Recent advancements in text analytics have opened up new possibilities of using the rich information in electronic medical records (EMRs) to identify relevant risk factors. The 2014 i2b2/UTHealth Challenge brought together researchers and practitioners of clinical natural language processing (NLP) to tackle the identification of heart disease risk factors reported in EMRs. We participated in this track and developed an NLP system by leveraging existing tools and resources, both public and proprietary. Our system was a hybrid of several machine-learning and rule-based components. The system achieved an overall F1 score of 0.9185, with a recall of 0.9409 and a precision of 0.8972.

  11. Developing image-based electronic patient records for collaborative medical applications

    NASA Astrophysics Data System (ADS)

    Zhang, Jianguo; Sun, Jianyong; Yong, Yuanyuan; Chen, Xiaomeng; Yu, Fenghai; Zhang, Xiaoyan; Lian, Ping; Sun, Kun; Huang, H. K.

    2004-04-01

    We developed a Web-based system to interactively display image-based electronic patient records (EPR) for intranet and Internet collaborative medical applications. The system consists of four major components: EPR DICOM gateway (EPR-GW), Image-based EPR repository server (EPR-Server), Web Server and EPR DICOM viewer (EPR-Viewer). We have successfully used this system two times for the teleconsultation on Severe acute respiratory syndrome (SARS) in Shanghai Xinhua Hospital and Shanghai Infection Hospital. During the consultation, both the physicians in infection control area and the experts outside the control area could interactively study, manipulate and navigate the EPR of the SARS patients to make more precise diagnosis on images with this system assisting. This presentation gave a new approach to create and manage image-based EPR from actual patient records, and also presented a way to use Web technology and DICOM standard to build an open architecture for collaborative medical applications.

  12. A Way to Understand Inpatients Based on the Electronic Medical Records in the Big Data Environment

    PubMed Central

    2017-01-01

    In recent decades, information technology in healthcare, such as Electronic Medical Record (EMR) system, is potential to improve service quality and cost efficiency of the hospital. The continuous use of EMR systems has generated a great amount of data. However, hospitals tend to use these data to report their operational efficiency rather than to understand their patients. Base on a dataset of inpatients' medical records from a Chinese general public hospital, this study applies a configuration analysis from a managerial perspective and explains inpatients management in a different way. Four inpatient configurations (valued patients, managed patients, normal patients, and potential patients) are identified by the measure of the length of stay and the total hospital cost. The implications of the finding are discussed. PMID:28280506

  13. The "epic" challenge of optimizing antimicrobial stewardship: the role of electronic medical records and technology.

    PubMed

    Kullar, Ravina; Goff, Debra A; Schulz, Lucas T; Fox, Barry C; Rose, Warren E

    2013-10-01

    Antimicrobial stewardship programs (ASPs) are established means for institutions to improve patient outcomes while reducing the emergence of resistant bacteria. With the increased adoption and evolution of electronic medical records (EMRs), there is a need to assimilate the tools of ASPs into EMRs, using decision support and feedback. Third-party software vendors provide the mainstay for integration of individual institutional EMR and ASP efforts. Epic is the leading implementer of EMR technology in the United States. A collaboration of physicians and pharmacists are working closely with Epic to provide a more comprehensive platform of ASP tools that may be institutionally individualized. We review the historical relationship between ASPs and the EMR, cite examples of Epic stewardship tools from 3 academic medical centers' ASPs, discuss limitations of these Epic tools, and conclude with the current process in evolution to integrate ASP tools and decision support capacities directly into Epic's EMR.

  14. A Way to Understand Inpatients Based on the Electronic Medical Records in the Big Data Environment.

    PubMed

    Mao, Hongyi; Sun, Yang

    2017-01-01

    In recent decades, information technology in healthcare, such as Electronic Medical Record (EMR) system, is potential to improve service quality and cost efficiency of the hospital. The continuous use of EMR systems has generated a great amount of data. However, hospitals tend to use these data to report their operational efficiency rather than to understand their patients. Base on a dataset of inpatients' medical records from a Chinese general public hospital, this study applies a configuration analysis from a managerial perspective and explains inpatients management in a different way. Four inpatient configurations (valued patients, managed patients, normal patients, and potential patients) are identified by the measure of the length of stay and the total hospital cost. The implications of the finding are discussed.

  15. Electronic prescribing in pediatrics: toward safer and more effective medication management.

    PubMed

    Johnson, Kevin B; Lehmann, Christoph U

    2013-04-01

    This technical report discusses recent advances in electronic prescribing (e-prescribing) systems, including the evidence base supporting their limitations and potential benefits. Specifically, this report acknowledges that there are limited but positive pediatric data supporting the role of e-prescribing in mitigating medication errors, improving communication with dispensing pharmacists, and improving medication adherence. On the basis of these data and on the basis of federal statutes that provide incentives for the use of e-prescribing systems, the American Academy of Pediatrics recommends the adoption of e-prescribing systems with pediatric functionality. This report supports the accompanying policy statement from the American Academy of Pediatrics recommending the adoption of e-prescribing by pediatric health care providers.

  16. SHARE and Share Alike

    ERIC Educational Resources Information Center

    Baird, Jeffrey Marshall

    2006-01-01

    This article describes a reading comprehension program adopted at J. E. Cosgriff Memorial Catholic School in Salt Lake City, Utah. The program is called SHARE: Students Helping Achieve Reading Excellence, and involves seventh and eighth grade students teaching first and second graders reading comprehension strategies learned in middle school…

  17. Patients' consent preferences for research uses of information in electronic medical records: interview and survey data

    PubMed Central

    Willison, Donald J; Keshavjee, Karim; Nair, Kalpana; Goldsmith, Charlie; Holbrook, Anne M

    2003-01-01

    Objectives To assess patients' preferred method of consent for the use of information from electronic medical records for research. Design Interviews and a structured survey of patients in practices with electronic medical records. Setting Family practices in southern Ontario, Canada. Participants 123 patients: 17 were interviewed and 106 completed a survey. Main outcome measures Patients' opinions and concerns on use of information from their medical records for research and their preferences for method of consent. Results Most interviewees were willing to allow the use of their information for research purposes, although the majority preferred that consent was sought first. The seeking of consent was considered an important element of respect for the individual. Most interviewees made little distinction between identifiable and anonymised data. Research sponsored by private insurance firms generated the greatest concern, and research sponsored by foundation the least. Sponsorship by drug companies evoked negative responses during interview and positive responses in the survey. Conclusions Patients are willing to allow information from their medical records to be used for research, but most prefer to be asked for consent either verbally or in writing. What is already known on this topicLegislation is being introduced worldwide to restrict the circumstances under which personal information may be used for secondary purposes without consentLittle empirical information exists about patients' concerns over privacy and preferences for consent for use of such information for researchWhat this study addsPatients are willing to allow personal information to be used for research purposes but want to be actively consulted firstPatients make little distinction between identifiable and non-identifiable informationMost patients prefer a time limit for their consent PMID:12586673

  18. An electronic medical record-linked biorepository to identify novel biomarkers for atherosclerotic cardiovascular disease

    PubMed Central

    Ye, Zi; Kalloo, Fara S; Dalenberg, Angela K.; Kullo, Iftikhar J

    2013-01-01

    Background: Atherosclerotic vascular disease (AVD), a leading cause of morbidity and mortality, is increasing in prevalence in the developing world. We describe an approach to establish a biorepository linked to medical records with the eventual goal of facilitating discovery of biomarkers for AVD. Methods: The Vascular Disease Biorepository at Mayo Clinic was established to archive DNA, plasma, and serum from patients with suspected AVD. AVD phenotypes, relevant risk factors and comorbid conditions were ascertained by electronic medical record (EMR)-based electronic algorithms that included diagnosis and procedure codes, laboratory data and text searches to ascertain medication use. Results: Up to December 2012, 8800 patients referred for vascular ultrasound examination and non-invasive lower extremity arterial evaluation were approached, of whom 5268 consented. The mean age of the initial 2182 patients recruited was 70.4 ± 11.2 years, 62.6% were men and 97.6% were whites. The prevalences of AVD phenotypes were: carotid artery stenosis 48%, abdominal aortic aneurysm 21% and peripheral arterial disease 38%. Positive predictive values for electronic phenotyping algorithms were>0.90 for cases (and>0.95 for controls) for each AVD phenotype, using manual review of the EMR as the gold standard. The prevalences of risk factors and comorbidities were as follows: hypertension 78%, diabetes 29%, dyslipidemia 73%, smoking 70%, coronary heart disease 37%, heart failure 12%, cerebrovascular disease 20% and chronic kidney disease 19%. Conclusions: Our study demonstrates the feasibility of establishing a biorepository of plasma, serum and DNA, with relatively rapid annotation of clinical variables using EMR-based algorithms. PMID:24689004

  19. A Probabilistic Reasoning Method for Predicting the Progression of Clinical Findings from Electronic Medical Records

    PubMed Central

    Goodwin, Travis; Harabagiu, Sanda M.

    2015-01-01

    In this paper, we present a probabilistic reasoning method capable of generating predictions of the progression of clinical findings (CFs) reported in the narrative portion of electronic medical records. This method benefits from a probabilistic knowledge representation made possible by a graphical model. The knowledge encoded in the graphical model considers not only the CFs extracted from the clinical narratives, but also their chronological ordering (CO) made possible by a temporal inference technique described in this paper. Our experiments indicate that the predictions about the progression of CFs achieve high performance given the COs induced from patient records. PMID:26306238

  20. Nursing Students' Satisfaction with Mobile Academic Electronic Medical Records for Undergraduate Clinical Practicum.

    PubMed

    Choi, Mona; Park, Joon Ho; Lee, Hyeong Suk

    2016-01-01

    The purpose of study was to evaluate satisfaction with and usability of mobile academic electronic medical records (AEMR) for undergraduate nursing students' clinical practicum. After an AEMR application on mobile devices was applied to the experimental group while a PC-based EMR system was used for the control group as usual in the fall semester, 2014. Two items of practicum satisfaction such as preparation of lab test and understanding of the results, and nursing intervention and documentation were significantly higher in the experiment group. The findings of usability survey showed that students in the experiment group consider the use of mobile AEMR in their job would increase their productivity.

  1. Using the NASA Task Load Index to Assess Workload in Electronic Medical Records.

    PubMed

    Hudson, Darren; Kushniruk, Andre W; Borycki, Elizabeth M

    2015-01-01

    Electronic medical records (EMRs) has been expected to decrease health professional workload. The NASA Task Load Index has become an important tool for assessing workload in many domains. However, its application in assessing the impact of an EMR on nurse's workload has remained to be explored. In this paper we report the results of a study of workload and we explore the utility of applying the NASA Task Load Index to assess impact of an EMR at the end of its lifecycle on nurses' workload. It was found that mental and temporal demands were the most responsible for the workload. Further work along these lines is recommended.

  2. Task and error analysis balancing benefits over business of electronic medical records.

    PubMed

    Carstens, Deborah Sater; Rodriguez, Walter; Wood, Michael B

    2014-01-01

    Task and error analysis research was performed to identify: a) the process for healthcare organisations in managing healthcare for patients with mental illness or substance abuse; b) how the process can be enhanced and; c) if electronic medical records (EMRs) have a role in this process from a business and safety perspective. The research question is if EMRs have a role in enhancing the healthcare for patients with mental illness or substance abuse. A discussion on the business of EMRs is addressed to understand the balancing act between the safety and business aspects of an EMR.

  3. Defusing Complexity in Intermetallics: How Covalently Shared Electron Pairs Stabilize the FCC Variant Mo2Cu(x)Ga(6-x) (x ≈ 0.9).

    PubMed

    Kilduff, Brandon J; Yannello, Vincent J; Fredrickson, Daniel C

    2015-08-17

    Simple sphere packings of metallic atoms are generally assumed to exhibit highly delocalized bonding, often visualized in terms of a lattice of metal cations immersed in an electron gas. In this Article, we present a compound that demonstrates how covalently shared electron pairs can, in fact, play a key role in the stability of such structures: Mo2Cu(x)Ga(6-x) (x ≈ 0.9). Mo2Cu(x)Ga(6-x) adopts a variant of the common TiAl3 structure type, which itself is a binary coloring of the fcc lattice. Electronic structure calculations trace the formation of this compound to a magic electron count of 14 electrons/T atom (T = transition metal) for the TiAl3 type, for which the Fermi energy coincides with an electronic pseudogap. This count is one electron/T atom lower than the electron concentration for a hypothetical MoGa3 phase, making this structure less competitive relative to more complex alternatives. The favorable 14 electron count can be reached, however, through the partial substitution of Ga with Cu. Using DFT-calibrated Hückel calculations and the reversed approximation Molecular Orbital (raMO) method, we show that the favorability of the 14 electron count has a simple structural origin in terms of the 18 - n rule of T-E intermetallics (E = main group element): the T atoms of the TiAl3 type are arranged into square nets whose edges are bridged by E atoms. The presence of shared electron pairs along these T-T contacts allows for 18 electron configurations to be achieved on the T atoms despite possessing only 18 - 4 = 14 electrons/T atom. This bonding scheme provides a rationale for the observed stability range of TiAl3 type TE3 phases of ca. 13-14 electrons/T atom, and demonstrates how the concept of the covalent bond can extend even to the most metallic of structure types.

  4. Shared component modelling as an alternative to assess geographical variations in medical practice: gender inequalities in hospital admissions for chronic diseases

    PubMed Central

    2011-01-01

    Background Small area analysis is the most prevalent methodological approach in the study of unwarranted and systematic variation in medical practice at geographical level. Several of its limitations drive researchers to use disease mapping methods -deemed as a valuable alternative. This work aims at exploring these techniques using - as a case of study- the gender differences in rates of hospitalization in elderly patients with chronic diseases. Methods Design and study setting: An empirical study of 538,358 hospitalizations affecting individuals aged over 75, who were admitted due to a chronic condition in 2006, were used to compare Small Area Analysis (SAVA), the Besag-York-Mollie (BYM) modelling and the Shared Component Modelling (SCM). Main endpoint: Gender spatial variation was measured, as follows: SAVA estimated gender-specific utilization ratio; BYM estimated the fraction of variance attributable to spatial correlation in each gender; and, SCM estimated the fraction of variance shared by the two genders, and those specific for each one. Results Hospitalization rates due to chronic diseases in the elderly were higher in men (median per area 21.4 per 100 inhabitants, interquartile range: 17.6 to 25.0) than in women (median per area 13.7 per 100, interquartile range: 10.8 to 16.6). Whereas Utilization Ratios showed a similar geographical pattern of variation in both genders, BYM found a high fraction of variation attributable to spatial correlation in both men (71%, CI95%: 50 to 94) and women (62%, CI95%: 45 to 77). In turn, SCM showed that the geographical admission pattern was mainly shared, with just 6% (CI95%: 4 to 8) of variation specific to the women component. Conclusions Whereas SAVA and BYM focused on the magnitude of variation and on allocating where variability cannot be due to chance, SCM signalled discrepant areas where latent factors would differently affect men and women. PMID:22188979

  5. Internet integrated in the daily medical practice within an electronic patient record.

    PubMed

    Lovis, C; Baud, R H; Scherrer, J R

    1998-09-01

    Healthcare enters the information age and professionals are finding an ever-growing role for computers in the daily practice of medicine. However, a number of problematic issues are associated with electronic publications, especially through Internet. Whilst access to any information has been improved, access to specific information has become more and more difficult [1], due to the lack of a general meta-knowledge allowing to structure Internet resources. Physicians have to learn and adapt themselves to computers and Internet, but Internet has to meet the specific requirements of Healthcare. Important issues must therefore be addressed to allow a real and daily use of Internet in the medical practice. The paper discusses most of these issues and proposes a solution developed at the University Hospital of Geneva that integrates an Electronic Patient Record with Internet, without compromises on security or on performances and that runs on standard PCs'.

  6. Comparative analysis of pharmacovigilance methods in the detection of adverse drug reactions using electronic medical records

    PubMed Central

    Liu, Mei; McPeek Hinz, Eugenia Renne; Matheny, Michael Edwin; Denny, Joshua C; Schildcrout, Jonathan Scott; Miller, Randolph A; Xu, Hua

    2013-01-01

    Objective Medication  safety requires that each drug be monitored throughout its market life as early detection of adverse drug reactions (ADRs) can lead to alerts that prevent patient harm. Recently, electronic medical records (EMRs) have emerged as a valuable resource for pharmacovigilance. This study examines the use of retrospective medication orders and inpatient laboratory results documented in the EMR to identify ADRs. Methods Using 12 years of EMR data from Vanderbilt University Medical Center (VUMC), we designed a study to correlate abnormal laboratory results with specific drug administrations by comparing the outcomes of a drug-exposed group and a matched unexposed group. We assessed the relative merits of six pharmacovigilance measures used in spontaneous reporting systems (SRSs): proportional reporting ratio (PRR), reporting OR (ROR), Yule's Q (YULE), the χ2 test (CHI), Bayesian confidence propagation neural networks (BCPNN), and a gamma Poisson shrinker (GPS). Results We systematically evaluated the methods on two independently constructed reference standard datasets of drug–event pairs. The dataset of Yoon et al contained 470 drug–event pairs (10 drugs and 47 laboratory abnormalities). Using VUMC's EMR, we created another dataset of 378 drug–event pairs (nine drugs and 42 laboratory abnormalities). Evaluation on our reference standard showed that CHI, ROR, PRR, and YULE all had the same F score (62%). When the reference standard of Yoon et al was used, ROR had the best F score of 68%, with 77% precision and 61% recall. Conclusions Results suggest that EMR-derived laboratory measurements and medication orders can help to validate previously reported ADRs, and detect new ADRs. PMID:23161894

  7. Solid-state pulse modulator using Marx generator for a medical linac electron-gun

    NASA Astrophysics Data System (ADS)

    Lim, Heuijin; Hyeok Jeong, Dong; Lee, Manwoo; Lee, Mujin; Yi, Jungyu; Yang, Kwangmo; Ro, Sung Chae

    2016-04-01

    A medical linac is used for the cancer treatment and consists of an accelerating column, waveguide components, a magnetron, an electron-gun, a pulse modulator, and an irradiation system. The pulse modulator based on hydrogen thyratron-switched pulse-forming network is commonly used in linac. As the improvement of the high power semiconductors in switching speed, voltage rating, and current rating, an insulated gate bipolar transistor has become the more popular device used for pulsed power systems. We propose a solid-state pulse modulator to generator high voltage by multi-stacked storage-switch stages based on the Marx generator. The advantage of our modulator comes from the use of two semiconductors to control charging and discharging of the storage capacitor at each stage and it allows to generate the pulse with various amplitudes, widths, and shapes. In addition, a gate driver for two semiconductors is designed to reduce the control channels and to protect the circuits. It is developed for providing the pulsed power to a medical linac electron-gun that requires 25 kV and 1 A as the first application. In order to improve the power efficiency and achieve the compactness modulator, a capacitor charging power supply, a Marx pulse generator, and an electron-gun heater isolated transformer are constructed and integrated. This technology is also being developed to extend the high power pulsed system with > 1 MW and also other applications such as a plasma immersed ion implantation and a micro pulse electrostatic precipitator which especially require variable pulse shape and high repetition rate > 1 kHz. The paper describes the design features and the construction of this solid-state pulse modulator. Also shown are the performance results into the linac electron-gun.

  8. The transition to electronic documentation on a teaching hospital medical service.

    PubMed

    Payne, Thomas H; Perkins, Monica; Kalus, Robert; Reilly, Dom

    2006-01-01

    The transition to electronic medical records (EMRs) often includes the transition from paper to electronic documentation, a topic less well described in the literature than other aspects of EMR adoption. As part of a broader EMR project, we have participated in the transition to electronic notes on the Medicine service of a teaching hospital affiliated with the University of Washington. During a one year period beginning in February 2005 we adopted the use of semi-structured documentation templates permitting both encoded and narrative text components for admission, progress, and procedure notes, and for some discharge summaries. Currently over 1400 notes are entered each week. Fifty eight percent are entered by residents, 20% by attending physicians, and the remainder by other trainees and staff. The period of greatest change from paper to electronic notes occurred (by design) during the late spring and summer. Leadership, application functionality, speed, note writing time requirements, data availability, training needs, and other factors influenced adoption of this important part of our EMR.

  9. Comparison of the localization of an electron as determined by the two-particle distribution function and by the single-particle sharing index.

    PubMed

    Fulton, Robert L

    2006-11-09

    A comparison of the measure of the delocalization of a particle based on the two-particle distribution function and that based on the single-particle density matrix is made using a simple set of wave functions which span states ranging from single determinant ground and doubly excited states through states mimicking correlated states and which include the singly excited state for electrons and for bosons replacing electrons in H2. The comparison further includes an analysis of the application of the measures to a classical ideal gas and a compressible fluid. It is found that the values of the integrated atom-atom measures agree for a range of wave functions involving combinations of the two single determinant (and equivalent Bose) wave functions but disagree for a different range of these wave functions and for the singly excited wave functions. Aside from the single determinant (and equivalent Bose) wave functions, the two sets of point-point measures that underlie the integrated measures all differ. For the sets of wave functions considered, the values of the measures are identical for electrons and bosons. When applied to a closed classical ideal gas and to a closed compressible fluid, the delocalization measure based on the two-particle distribution has a residual long range term, whereas the sharing index in the classical limit gives a completely localized particle. In general, the two measures describe different aspects of the behavior of the particles. The measures based on the two-particle distribution function give only two-particle properties and the single-particle density, and the sharing quantities give only single-particle properties. The latter includes, however, the quantitative measures of the delocalization of a single particle, the point-point sharing index and the sharing amplitude.

  10. Teaching Vocabulary to Preschoolers with Disabilities Using Adult-Child Shared Bookreading: A Comparison of Traditional and Electronic Books

    ERIC Educational Resources Information Center

    Rhodehouse, Sara Bernice

    2013-01-01

    This study sought to validate adult-child shared storybook reading as a method for teaching target vocabulary words to preschool children with disabilities. The Vocabulary Learning through Books (VLTB) instructional procedure incorporates, adult-child book reading, questioning during reading requiring the child to answer with a target word, and…

  11. Interconnection of electronic medical record with clinical data management system by CDISC ODM.

    PubMed

    Matsumura, Yasushi; Hattori, Atsushi; Manabe, Shiro; Takeda, Toshihiro; Takahashi, Daiyo; Yamamoto, Yuichiro; Murata, Taizo; Mihara, Naoki

    2014-01-01

    EDC system has been used in the field of clinical research. The current EDC system does not connect with electronic medical record system (EMR), thus a medical staff has to transcribe the data in EMR to EDC system manually. This redundant process causes not only inefficiency but also human error. We developed an EDC system cooperating with EMR, in which the data required for a clinical research form (CRF) is transcribed automatically from EMR to electronic CRF (eCRF) and is sent via network. We call this system as "eCRF reporter". The interface module of eCRF reporter can retrieves the data in EMR database including patient biography data, laboratory test data, prescription data and data entered by template in progress notes. The eCRF reporter also enables users to enter data directly to eCRF. The eCRF reporter generates CDISC ODM file and PDF which is a translated form of Clinical data in ODM. After storing eCRF in EMR, it is transferred via VPN to a clinical data management system (CDMS) which can receive the eCRF files and parse ODM. We started some clinical research by using this system. This system is expected to promote clinical research efficiency and strictness.

  12. Managing the quality of health information using electronic medical records: an exploratory study among clinical physicians.

    PubMed

    Smith, Alan D

    2008-01-01

    As technology is advancing in the healthcare field, ways of reducing costs and improving quality are key initiatives in the tedious processes of operations planning. There are several ways of reducing costs and improving quality management. One such way is the implementation of Electronic Health Records (HERs). A personally interviewed sample from a relatively large healthcare facility located in Pittsburgh, Pennsylvania, which is associated with the University of Pittsburgh Medical Center, netted a total of 44 physicians. There were no statistically significant relationships found based on 'clinicians' willingness to accept Electronic Medical Record (EMR)-embedded systems with gender', 'benefits outweigh risks for EMR-embedded implementation', 'EMR-embedded systems should be mandated', 'EMR-embedded systems should be administered by the federal government', 'EMR-embedded systems should be administered by regional systems', 'EMR applications are an invasion of privacy' and 'IT-related technologies pose an added threat to the healthcare environment'. It was only for the independent variable 'improves quality of care by EMR-embedded implementation' that most physicians felt that such a technology does positively impact patient care.

  13. Business process improvement: an electronic system to monitor compliance with medical resident work hours.

    PubMed

    Landesman, Linda Young; Markowitz, Forest; Conde, Nelson

    2010-01-01

    The limitation of medical intern and resident work hours, known as the Bell 405 regulations, was initiated in New York State in 1989 with a modification to the state hospital code. The Bell 405 regulations were strengthened in 2000, and facilities would now be fined for noncompliance. Monitoring systems in place at that time were insufficient to provide an adequate level of review for the New York City Health and Hospitals Corporation (HHC) with more than 7,000 medical residents whose training is based at or who rotate through these public hospitals. A "simple to use," yet comprehensive, method of monitoring compliance needed to be developed to ensure that residents and interns complied with laws regulating working hours. The subsequent development of national accreditation standards increased the stakes for reliable scrutiny. HHC developed and implemented a Web-based Structured Query Language (SQL) application that facilitated easy access to work hour surveys captured through electronic time sheets. The time sheet data automatically entered a database that provided instant analysis of conformance to state law. The development of an electronic on-line application accessible from anywhere allowed HHC to efficiently identify nonconformance and pinpoint corrective action. Since the inception of the application and its expansion allowing access through the intranet, 26,000 individual time sheets have been submitted for evaluation. With the national movement regulating work hours, other hospitals still at the pencil and manual computation stage would greatly benefit by developing a similar application.

  14. Efficient Queries of Stand-off Annotations for Natural Language Processing on Electronic Medical Records

    PubMed Central

    Luo, Yuan; Szolovits, Peter

    2016-01-01

    In natural language processing, stand-off annotation uses the starting and ending positions of an annotation to anchor it to the text and stores the annotation content separately from the text. We address the fundamental problem of efficiently storing stand-off annotations when applying natural language processing on narrative clinical notes in electronic medical records (EMRs) and efficiently retrieving such annotations that satisfy position constraints. Efficient storage and retrieval of stand-off annotations can facilitate tasks such as mapping unstructured text to electronic medical record ontologies. We first formulate this problem into the interval query problem, for which optimal query/update time is in general logarithm. We next perform a tight time complexity analysis on the basic interval tree query algorithm and show its nonoptimality when being applied to a collection of 13 query types from Allen’s interval algebra. We then study two closely related state-of-the-art interval query algorithms, proposed query reformulations, and augmentations to the second algorithm. Our proposed algorithm achieves logarithmic time stabbing-max query time complexity and solves the stabbing-interval query tasks on all of Allen’s relations in logarithmic time, attaining the theoretic lower bound. Updating time is kept logarithmic and the space requirement is kept linear at the same time. We also discuss interval management in external memory models and higher dimensions. PMID:27478379

  15. Efficient Queries of Stand-off Annotations for Natural Language Processing on Electronic Medical Records.

    PubMed

    Luo, Yuan; Szolovits, Peter

    2016-01-01

    In natural language processing, stand-off annotation uses the starting and ending positions of an annotation to anchor it to the text and stores the annotation content separately from the text. We address the fundamental problem of efficiently storing stand-off annotations when applying natural language processing on narrative clinical notes in electronic medical records (EMRs) and efficiently retrieving such annotations that satisfy position constraints. Efficient storage and retrieval of stand-off annotations can facilitate tasks such as mapping unstructured text to electronic medical record ontologies. We first formulate this problem into the interval query problem, for which optimal query/update time is in general logarithm. We next perform a tight time complexity analysis on the basic interval tree query algorithm and show its nonoptimality when being applied to a collection of 13 query types from Allen's interval algebra. We then study two closely related state-of-the-art interval query algorithms, proposed query reformulations, and augmentations to the second algorithm. Our proposed algorithm achieves logarithmic time stabbing-max query time complexity and solves the stabbing-interval query tasks on all of Allen's relations in logarithmic time, attaining the theoretic lower bound. Updating time is kept logarithmic and the space requirement is kept linear at the same time. We also discuss interval management in external memory models and higher dimensions.

  16. Implementation of Electronic Checklists in an Oncology Medical Record: Initial Clinical Experience

    PubMed Central

    Albuquerque, Kevin V.; Miller, Alexis A.; Roeske, John C.

    2011-01-01

    Purpose: The quality of any medical treatment depends on the accurate processing of multiple complex components of information, with proper delivery to the patient. This is true for radiation oncology, in which treatment delivery is as complex as a surgical procedure but more dependent on hardware and software technology. Uncorrected errors, even if small or infrequent, can result in catastrophic consequences for the patient. We developed electronic checklists (ECLs) within the oncology electronic medical record (EMR) and evaluated their use and report on our initial clinical experience. Methods: Using the Mosaiq EMR, we developed checklists within the clinical assessment section. These checklists are based on the process flow of information from one group to another within the clinic and enable the processing, confirmation, and documentation of relevant patient information before the delivery of radiation therapy. The clinical use of the ECL was documented by means of a customized report. Results: Use of ECL has reduced the number of times that physicians were called to the treatment unit. In particular, the ECL has ensured that therapists have a better understanding of the treatment plan before the initiation of treatment. An evaluation of ECL compliance showed that, with additional staff training, > 94% of the records were completed. Conclusion: The ECL can be used to ensure standardization of procedures and documentation that the pretreatment checks have been performed before patient treatment. We believe that the implementation of ECLs will improve patient safety and reduce the likelihood of treatment errors. PMID:22043184

  17. Pre-post evaluation of physicians' satisfaction with a redesigned electronic medical record system.

    PubMed

    Jaspers, Monique W M; Peute, Linda W P; Lauteslager, Arnaud; Bakker, Piet J M

    2008-01-01

    Physicians' acceptance of Electronic Medical Record Systems (EMRs) is closely related to their usability. Knowledge about end-users' opinions on usability of an EMR system may contribute to planning for the next phase of the usability cycle of the system. A demand for integration of new functionalities, such as computerized order entry and an electronic patient status led to redesign of our EMR system, which had been in use for over 8 years at the Academic Medical Center of Amsterdam. The aim of this study was to understand whether the redesigned EMR system was an improvement of the earlier EMR and which system aspects accounted for user satisfaction and which did not. We conducted a formative pre- and post usability evaluation of our former and redesigned EMR system. For the assessment of both system versions' usability, we distributed two standardized usability questionnaires among 150 clinicians who routinely had used the older EMR system and had been working with its newer version for 6 weeks. Though overall user satisfaction was relatively high for both EMR systems, screen layout and interaction structure proved less easy to work with in the newer EMR system. The new EMR system however was more appreciated because of its enhanced functionality, capabilities and likeable user-interface. The results point to a number of actions that might be useful in future usability improvement efforts of our EMR system and other EMRs.

  18. Benchmarking electronic medical records initiatives in the US: a conceptual model.

    PubMed

    Palacio, Carlos; Harrison, Jeffrey P; Garets, David

    2010-06-01

    This article provides a conceptual model for benchmarking the use of clinical information systems within healthcare organizations. Additionally, it addresses the benefits of clinical information systems which include the reduction of errors, improvement in clinical decision-making and real time access to patient information. The literature suggests that clinical information systems provide financial benefits due to cost-savings from improved efficiency and reduction of errors. As a result, healthcare organizations should adopt such clinical information systems to improve quality of care and stay competitive in the marketplace. Our research clearly documents the increased adoption of electronic medical records in U.S. hospitals from 2005 to 2007. This is important because the electronic medical record provides an opportunity for integration of patient information and improvements in efficiency and quality of care across a wide range of patient populations. This was supported by recent federal initiatives such as the establishment of the Office of the National Coordinator of Health Information Technology (ONCHIT) to create an interoperable health information infrastructure. Potential barriers to the implementation of health information technology include cost, a lack of financial incentives for providers, and a need for interoperable systems. As a result, future government involvement and leadership may serve to accelerate widespread adoption of interoperable clinical information systems.

  19. Quality of Co-Prescribing NSAID and Gastroprotective Medications for Elders in The Netherlands and Its Association with the Electronic Medical Record

    PubMed Central

    Opondo, Dedan; Visscher, Stefan; Eslami, Saeid; Verheij, Robert A.; Korevaar, Joke C.; Abu-Hanna, Ameen

    2015-01-01

    Objective To assess guideline adherence of co-prescribing NSAID and gastroprotective medications for elders in general practice over time, and investigate its potential association with the electronic medical record (EMR) system brand used. Methods We included patients 65 years and older who received NSAIDs between 2005 and 2010. Prescription data were extracted from EMR systems of GP practices participating in the Dutch NIVEL Primary Care Database. We calculated the proportion of NSAID prescriptions with co-prescription of gastroprotective medication for each GP practice at intervals of three months. Association between proportion of gastroprotection, brand of electronic medical record (EMR), and type of GP practice were explored. Temporal trends in proportion of gastroprotection between electronic medical records systems were analyzed using a random effects linear regression model. Results We included 91,521 patient visits with NSAID prescriptions from 77 general practices between 2005 and 2010. Overall proportion of NSAID prescriptions to the elderly with co-prescription of gastroprotective medication was 43%. Mean proportion of gastroprotection increased from 27% (CI 25–29%) in the first quarter of 2005 with a rate of 1.2% every 3 months to 55%(CI 52–58%) at the end of 2010. Brand of EMR and type of GP practice were independently associated with co-prescription of gastroprotection. Conclusion Although prescription of gastroprotective medications to elderly patients who receive NSAIDs increased in The Netherlands, they are not co-prescribed in about half of the indicated cases. Brand of EMR system is associated with differences in prescription of gastroprotective medication. Optimal design and utilization of EMRs is a potential area of intervention to improve quality of prescription. PMID:26110650

  20. Use of digital patient photographs and electronic medical record data as diagnostic tools in Japan.

    PubMed

    Kawano, Koichi; Suzuki, Muneoh; Araki, Kenji

    2012-10-01

    An electronic medical record (EMR) system was introduced to the University of Miyazaki Hospital, in Japan, in 2006. This hospital is the only one in Japan to store digital photographs of patients within EMRs. In this paper, we report on the utility of these digital photographs for disease diagnosis. Digital photographs of patients were taken at the time of hospitalization, and have been used for patient identification by medical staff. More than 20,000 digital photographs have been saved, along with examination data and medical history classified by disease, since the introduction of EMR. In the first part of the present study, we analyzed the facial cheek color of patients using photographs taken at the time of hospitalization in relation to diagnoses in six disease categories that were considered to lead to characteristic facial skin characteristics. We verified the presence or absence of a characteristic color for each disease category. Next, we focused on four diseases, Analysis of the facial skin color of 1268 patients found the same patterns of characteristic color. Overall, we found significant differences in complexion according to disease type, based on the analysis of color from digital photos and other EMR information. We propose that color analysis data should become an additional item of information stored in EMRs.

  1. The VA Hypertension Primary Care Longitudinal Cohort: Electronic medical records in the post-genomic era

    PubMed Central

    Salem, Rany M.; Pandey, Braj; Richard, Erin; Fung, Maple M.; Garcia, Erin P.; Brophy, Victoria H.; Schork, Nicholas J.; O'Connor, Daniel T.; Bhatnagar, Vibha

    2011-01-01

    The Veterans Affairs Hypertension Primary Care Longitudinal Cohort (VAHC) was initiated in 2003 as a pilot study designed to link the VA electronic medical record system with individual genetic data. Between June 2003 and December 2004, 1,527 hypertensive participants were recruited. Protected health information (PHI) was extracted from the regional VA data warehouse. Differences between the clinic and mail recruits suggested that clinic recruitment resulted in an over-sampling of African Americans. A review of medical records in a random sample of study participants confirmed that the data warehouse accurately captured most selected diagnoses. Genomic DNA was acquired non-invasively from buccal cells in mouthwash; ~ 96.5 per cent of samples contained DNA suitable for genotyping, with an average DNA yield of 5.02 ± 0.12 micrograms, enough for several thousand genotypes. The coupling of detailed medical databases with genetic information has the potential to facilitate the genetic study of hypertension and other complex diseases. PMID:21216807

  2. [Application Status of Evaluation Methodology of Electronic Medical Record: Evaluation of Bibliometric Analysis].

    PubMed

    Lin, Dan; Liu, Jialin; Zhang, Rui; Li, Yong; Huang, Tingting

    2015-04-01

    In order to provide a reference and theoretical guidance of the evaluation of electronic medical record (EMR) and establishment of evaluation system in China, we applied a bibliometric analysis to assess the application of methodologies used at home and abroad, as well as to summarize the advantages and disadvantages of them. We systematically searched international medical databases of Ovid-MEDLINE, EBSCOhost, EI, EMBASE, PubMed, IEEE, and China's medical databases of CBM and CNKI between Jan. 1997 and Dec. 2012. We also reviewed the reference lists of articles for relevant articles. We selected some qualified papers according to the pre-established inclusion and exclusion criteria, and did information extraction and analysis to the papers. Eventually, 1 736 papers were obtained from online database and other 16 articles from manual retrieval. Thirty-five articles met the inclusion and exclusion criteria and were retrieved and assessed. In the evaluation of EMR, US counted for 54.28% in the leading place, and Canada and Japan stood side by side and ranked second with 8.58%, respectively. For the application of evaluation methodology, Information System Success Model, Technology Acceptance Model (TAM), Innovation Diffusion Model and Cost-Benefit Access Model were widely applied with 25%, 20%, 12.5% and 10%, respectively. In this paper, we summarize our study on the application of methodologies of EMR evaluation, which can provide a reference to EMR evaluation in China.

  3. Use of the Electronic Medical Record to Assess Pancreas Size in Type 1 Diabetes

    PubMed Central

    Virostko, John; Hilmes, Melissa; Eitel, Kelsey; Moore, Daniel J.; Powers, Alvin C.

    2016-01-01

    Aims This study harnessed the electronic medical record to assess pancreas volume in patients with type 1 diabetes (T1D) and matched controls to determine whether pancreas volume is altered in T1D and identify covariates that influence pancreas volume. Methods This study included 25 patients with T1D and 25 age-, sex-, and weight-matched controls from the Vanderbilt University Medical Center enterprise data warehouse. Measurements of pancreas volume were made from medical imaging studies using magnetic resonance imaging (MRI) or computed tomography (CT). Results Patients with T1D had a pancreas volume 47% smaller than matched controls (41.16 ml vs. 77.77 ml, P < 0.0001) as well as pancreas volume normalized by subject body weight, body mass index, or body surface area (all P < 0.0001). Pancreatic volume was smaller with a longer duration of T1D across the patient population (N = 25, P = 0.04). Additionally, four individual patients receiving multiple imaging scans displayed progressive declines in pancreas volume over time (~ 6% of volume/year), whereas five controls scanned a year apart did not exhibit a decline in pancreas size (P = 0.03). The pancreas was uniformly smaller on the right and left side of the abdomen. Conclusions Pancreas volume declines with disease duration in patients with T1D, suggesting a protracted pathological process that may include the exocrine pancreas. PMID:27391588

  4. Leading change: introducing an electronic medical record system to a paramedic service.

    PubMed

    Baird, Shawn; Boak, George

    2016-05-03

    Purpose Leaders in health-care organizations introducing electronic medical records (EMRs) face implementation challenges. The adoption of EMR by the emergency medical and ambulance setting is expected to provide wide-ranging benefits, but there is little research into the processes of adoption in this sector. The purpose of this study is to examine the introduction of EMR in a small emergency care organization and identify factors that aided adoption. Design/methodology/approach Semi-structured interviews with selected paramedics were followed up with a survey issued to all paramedics in the company. Findings The user interfaces with the EMR, and perceived ease of use, were important factors affecting adoption. Individual paramedics were found to have strong and varied preferences about how and when they integrated the EMR into their practice. As company leadership introduced flexibility of use, this enhanced both individual and collective ability to make sense of the change and removed barriers to acceptance. Research limitations/implications This is a case study of one small organization. However, there may be useful lessons for other emergency care organizations adopting EMR. Practical implications Leaders introducing EMR in similar situations may benefit from considering a sense-making perspective and responding promptly to feedback. Originality/value The study contributes to a wider understanding of issues faced by leaders who seek to implement EMRs in emergency medical services, a sector in which there has been to date very little research on this issue.

  5. E-junk is no joke: National lab shares award-winning strategies for electronics lifecycle management

    SciTech Connect

    Lowry, Kami L.; Story, Sean E.; Jagelski, John C.

    2008-06-13

    Nomatter how big or small an enterprise is, electronics represent potentially serious environmental and financial costs if not managed properly. Comprehensive lifecycle management can be a strategic asset to any organization that uses electronics, and the benefits are far-reaching. In addition to the end goal of protecting the environment, lifecycle management offers opportunities for an organization to o demonstrate leadership by taking responsibility for electronic equipment o receive recognition for P2 efforts o save money by implementing smarter purchasing strategies o more effectively track assets. The experience of the Department of Energy’s Pacific Northwest National Laboratory offers an example of how one organization is addressing the electronics challenge. This article offers a brief description of what PNNL is doing to address the issues of electronic waste, plus some practical tips for dealing with electronic waste through responsible lifecycle management.

  6. Numerical Simulation of the Medical Linear Accelerator Electron Beams Absorption by ABS-Plastic doped with Metal

    NASA Astrophysics Data System (ADS)

    Stuchebrov, S. G.; Miloichikova, I. A.; Krasnykh, A. A.

    2016-07-01

    In this paper the numerical simulation results of the dose spatial distribution of the medical electron beams in ABS-plastic doped with different concentrations of lead and zinc are shown. The dependences of the test material density on the lead and zinc mass concentrations are illustrated. The depth dose distributions of the medical electron beams in the modified ABS-plastic for three energies 6 MeV, 12 MeV and 20 MeV are tested. The electron beam shapes in the transverse plane in ABS-plastic doped with different concentrations of lead and zinc are presented.

  7. Prevalence and usage of printed and electronic drug references and patient medication records in community pharmacies in Malaysia.

    PubMed

    Usir, Ezlina; Lua, Pei Lin; Majeed, Abu Bakar Abdul

    2012-06-01

    This study aimed to determine the availability and usage of printed and electronic references and Patient Medication Record in community pharmacy. It was conducted for over 3 months from 15 January to 30 April 2007. Ninety-three pharmacies participated. Structured questionnaires were mailed to community pharmacies. Six weeks later a reminder was sent to all non responders, who were given another six weeks to return the completed questionnaire. Outcomes were analyzed using descriptive statistics and chi-square test of independence. Almost all the pharmacies (96.8%) have at least Monthly Index of Medical Specialties (MIMS) while 78.5% have at least MIMS ANNUAL in their stores. Only about a third (31.2%) of the pharmacies were equipped with online facilities of which the majority referred to medical websites (88.9%) with only a minority (11.1%) referring to electronic journals. More than half (59.1%) of the pharmacists kept Patient Medication Record profiles with 49.1% storing it in paper, 41.8% electronically and 9.1% in both printed and electronic versions. In general, prevalence and usage of electronic references in community pharmacies were rather low. Efforts should be increased to encourage wider usage of electronic references and Patient Medication Records in community pharmacies to facilitate pharmaceutical care.

  8. DICOM image integration into an electronic medical record using thin viewing clients

    NASA Astrophysics Data System (ADS)

    Stewart, Brent K.; Langer, Steven G.; Taira, Ricky K.

    1998-07-01

    Purpose -- To integrate radiological DICOM images into our currently existing web-browsable Electronic Medical Record (MINDscape). Over the last five years the University of Washington has created a clinical data repository combining in a distributed relational database information from multiple departmental databases (MIND). A text-based view of this data called the Mini Medical Record (MMR) has been available for three years. MINDscape, unlike the text based MMR, provides a platform independent, web browser view of the MIND dataset that can easily be linked to other information resources on the network. We have now added the integration of radiological images into MINDscape through a DICOM webserver. Methods/New Work -- we have integrated a commercial webserver that acts as a DICOM Storage Class Provider to our, computed radiography (CR), computed tomography (CT), digital fluoroscopy (DF), magnetic resonance (MR) and ultrasound (US) scanning devices. These images can be accessed through CGI queries or by linking the image server database using ODBC or SQL gateways. This allows the use of dynamic HTML links to the images on the DICOM webserver from MINDscape, so that the radiology reports already resident in the MIND repository can be married with the associated images through the unique examination accession number generated by our Radiology Information System (RIS). The web browser plug-in used provides a wavelet decompression engine (up to 16-bits per pixel) and performs the following image manipulation functions: window/level, flip, invert, sort, rotate, zoom, cine-loop and save as JPEG. Results -- Radiological DICOM image sets (CR, CT, MR and US) are displayed with associated exam reports for referring physician and clinicians anywhere within the widespread academic medical center on PCs, Macs, X-terminals and Unix computers. This system is also being used for home teleradiology application. Conclusion -- Radiological DICOM images can be made available

  9. Leveraging electronic health records to study pleiotropic effects on bipolar disorder and medical comorbidities

    PubMed Central

    Prieto, M L; Ryu, E; Jenkins, G D; Batzler, A; Nassan, M M; Cuellar-Barboza, A B; Pathak, J; McElroy, S L; Frye, M A; Biernacka, J M

    2016-01-01

    Patients with bipolar disorder (BD) have a high prevalence of comorbid medical illness. However, the mechanisms underlying these comorbidities with BD are not well known. Certain genetic variants may have pleiotropic effects, increasing the risk of BD and other medical illnesses simultaneously. In this study, we evaluated the association of BD-susceptibility genetic variants with various medical conditions that tend to co-exist with BD, using electronic health records (EHR) data linked to genome-wide single-nucleotide polymorphism (SNP) data. Data from 7316 Caucasian subjects were used to test the association of 19 EHR-derived phenotypes with 34 SNPs that were previously reported to be associated with BD. After Bonferroni multiple testing correction, P<7.7 × 10−5 was considered statistically significant. The top association findings suggested that the BD risk alleles at SNP rs4765913 in CACNA1C gene and rs7042161 in SVEP1 may be associated with increased risk of ‘cardiac dysrhythmias' (odds ratio (OR)=1.1, P=3.4 × 10−3) and ‘essential hypertension' (OR=1.1, P=3.5 × 10−3), respectively. Although these associations are not statistically significant after multiple testing correction, both genes have been previously implicated with cardiovascular phenotypes. Moreover, we present additional evidence supporting these associations, particularly the association of the SVEP1 SNP with hypertension. This study shows the potential for EHR-based analyses of large cohorts to discover pleiotropic effects contributing to complex psychiatric traits and commonly co-occurring medical conditions. PMID:27529678

  10. Impact of decision support in electronic medical records on lipid management in primary care.

    PubMed

    Gill, James M; Chen, Ying Xia; Glutting, Joseph J; Diamond, James J; Lieberman, Michael I

    2009-10-01

    Electronic decision-support tools may help to improve management of hyperlipidemia and other chronic diseases. This study examined the impact of lipid management tools integrated into an electronic medical record (EMR) in primary care practices. This randomized controlled trial was conducted in a national network of physicians who use an outpatient EMR. Adult primary care physicians were randomized by office to receive an electronic form that was embedded in the EMR. The form contained prompts regarding suboptimal care based on Adult Treatment Panel-III (ATP-III) guidelines, as well as reporting tools to identify patients outside of office visits whose lipid management was suboptimal. All active patients, ages 20-79 years, whose physicians participated in the study, were categorized as high, moderate, or low cardiovascular risk, and the proportion who were tested for hyperlipidemia, at lipid goal, and on lipid-lowering medications if not at goal were measured according to ATP-III guidelines. A total of 105 physicians from 25 offices and 64,150 patients were included in the study. Outcomes improved for most measures from before to 1 year after the intervention (November 1, 2005 to October 31, 2006). However, after controlling for confounding variables and for clustering in multilevel modeling, only up-to-date lipid testing for high-risk patients was statistically better in the intervention group as compared to the control group (adjusted odds ratio 15.0, P < 0.05). This study showed few differences in quality of lipid management after implementing an EMR-based disease management intervention in primary care settings. Future studies may need to examine more comprehensive interventions that include office staff in a team approach to care.

  11. [The role of electronic health records in medical education of persons with diabetes].

    PubMed

    Mateljić, Marija; Gaćina, Snjezana

    2014-03-01

    Nursing is faced with a requirement to improve the efficacy of health care services, with complete control of the work processes. The need to use work technology, which implies medical informatics knowledge and skills, arises naturally. While high-quality and best possible treatment depend on numerous factors, electronic record keeping can contribute to quality treatment. Data are entered by all health care providers and the patient. Nurses carry out therapeutic education as the basis of diabetes care. They teach patients self-monitoring or treatment adjustment skills, as well as problem coping procedures and skills, using various didactic tools, written and illustrated materials, audio-visual tools or computer simulations, and keeping electronic nursing records. The patient as an active treatment participant carries out blood glucose self-monitoring by means of quick reading device. This is part of the patient's personal electronic health record, which gives an insight into the individual's response to therapy, and is extremely valuable in the entire treatment.

  12. Cost-effectiveness of a shared computerized decision support system for diabetes linked to electronic medical records

    PubMed Central

    Holbrook, Anne; Blackhouse, Gordon; Troyan, Sue; Goeree, Ron

    2011-01-01

    Background Computerized decision support systems (CDSSs) are believed to enhance patient care and reduce healthcare costs; however the current evidence is limited and the cost-effectiveness remains unknown. Objective To estimate the long-term cost-effectiveness of a CDSS linked to evidence-based treatment recommendations for type 2 diabetes. Methods Using the Ontario Diabetes Economic Model, changes in factors (eg, HbA1c) from a randomized controlled trial were used to estimate cost-effectiveness. The cost of implementation, development, and maintenance of the core dataset, and projected diabetes-related complications were included. The base case assumed a 1-year treatment effect, 5% discount rate, and 40-year time horizon. Univariate, one-way sensitivity analyses were carried out by altering different parameter values. The perspective was the Ontario Ministry of Health and costs were in 2010 Canadian dollars. Results The cost of implementing the intervention was $483 699. The one-year intervention reduced HbA1c by 0.2 and systolic blood pressure by 3.95 mm Hg, but increased body mass index by 0.02 kg/m2, resulting in a relative risk reduction of 14% in the occurrence of amputation. The model estimated that the intervention resulted in an additional 0.0117 quality-adjusted life year; the incremental cost-effectiveness ratio was $160 845 per quality-adjusted life-year. Conclusion The web-based prototype decision support system slightly improved short-term risk factors. The model predicted moderate improvements in long-term health outcomes. This disease management program will need to develop considerable efficiencies in terms of costs and processes or improved effectiveness to be considered a cost-effective intervention for treating patients with type 2 diabetes. PMID:22052900

  13. Electronic Health Records: DOD and VA Have Increased Their Sharing of Health Information, but More Work Remains

    DTIC Science & Technology

    2008-07-01

    participating in recent initiatives ed by the Office of the National Coordinator for Health Information echnology (within the Department of Health...veterans, many DOD and VA patients tend to be highly mobile and may have health records residing at multiple medical facilities within

  14. Status report on electron cyclotron resonance ion sources at the Heavy Ion Medical Accelerator in Chiba

    NASA Astrophysics Data System (ADS)

    Kitagawa, A.; Muramatsu, M.; Sekiguchi, M.; Yamada, S.; Jincho, K.; Okada, T.; Yamamoto, M.; Hattori, T.; Biri, S.; Baskaran, R.; Sakata, T.; Sawada, K.; Uno, K.

    2000-02-01

    The Heavy Ion Medical Accelerator in Chiba at the National Institute of Radiological Sciences (NIRS) is not only dedicated to cancer therapy, it is also utilized with various ion species for basic experiments of biomedical science, physics, chemistry, etc. Two electron cyclotron resonance (ECR) ion sources are installed for production of gaseous ions. One of them, the NIRS-ECR, is a 10 GHz ECR ion source, and is mainly operated to produce C4+ ions for daily clinical treatment. This source realizes good reproducibility and reliability and it is easily operated. The other source, the NIRS-HEC, is an 18 GHz ECR ion source that is expected to produce heavier ion species. The output ion currents of the NIRS-ECR and the NIRS-HEC are 430e μA for C4+ and 1.1e mA for Ar8+, respectively.

  15. Electronic Medical Records (EMRs), Epidemiology, and Epistemology: Reflections on EMRs and Future Pediatric Clinical Research

    PubMed Central

    Wasserman, Richard C.

    2011-01-01

    Electronic medical records (EMRs) are increasingly common in pediatric patient care. EMR data represent a relatively novel and rich resource for clinical research. The fact, however, that pediatric EMR data are collected for the purposes of clinical documentation and billing rather than research creates obstacles to their use in scientific investigation. Particular issues include accuracy, completeness, comparability between settings, ease of extraction, and context of recording. Although these problems can be addressed through standard strategies for dealing with partially accurate and incomplete data, a longer term solution will involve work with pediatric clinicians to improve data quality. As research becomes one of the explicit purposes for which pediatricians collect EMR data, the pediatric clinician will play a central role in future pediatric clinical research. PMID:21622040

  16. Despite regulatory changes, hospitals cautious in helping physicians purchase electronic medical records.

    PubMed

    Grossman, Joy M; Cohen, Genna

    2008-09-01

    While hospitals are evaluating strategies to help physicians purchase electronic medical records (EMRs) following recent federal regulatory changes, they are proceeding cautiously, according to findings from the Center for Studying Health System Change's (HSC) 2007 site visits to 12 nationally representative metropolitan communities. Hospital strategies to aid physician EMR adoption include offering direct financial subsidies, extending the hospital's ambulatory EMR vendor discounts and providing technical support. Two key factors driving hospital interest in supporting physician EMR adoption are improving the quality and efficiency of care and aligning physicians more closely with the hospital. A few hospitals have begun small-scale, phased rollouts of subsidized EMRs, but the burden of other hospital information technology projects, budget limitations and lack of physician interest are among the factors impeding hospital action. While it is too early to assess whether the regulatory changes will spur greater physician EMR adoption, the outcome will depend both on hospitals' willingness to provide support and physicians' acceptance of hospital assistance.

  17. Building national electronic medical record systems via the World Wide Web.

    PubMed Central

    Kohane, I S; Greenspun, P; Fackler, J; Cimino, C; Szolovits, P

    1996-01-01

    Electronic medical record systems (EMRSs) currently do not lend themselves easily to cross-institutional clinical care and research. Unique system designs coupled with a lack of standards have led to this difficulty. The authors have designed a preliminary EMRS architecture (W3-EMRS) that exploits the multiplatform, multiprotocol, client-server technology of the World Wide Web. The architecture abstracts the clinical information model and the visual presentation away from the underlying EMRS. As a result, computation upon data elements of the EMRS and their presentation are no longer tied to the underlying EMRS structures. The architecture is intended to enable implementation of programs that provide uniform access to multiple, heterogeneous legacy EMRSs. The authors have implemented an initial prototype of W3-EMRS that accesses the database of the Boston Children's Hospital Clinician's Workstation. PMID:8723610

  18. Java-based framework for the secure distribution of electronic medical records.

    PubMed

    Goh, A

    1999-01-01

    In this paper, we present a Java-based framework for the processing, storage and delivery of Electronic Medical Records (EMR). The choice of Java as a developmental and operational environment ensures operability over a wide-range of client-side platforms, with our on-going work emphasising migration towards Extensible Markup Language (XML) capable Web browser clients. Telemedicine in support of womb-to-tomb healthcare as articulated by the Multimedia Supercorridor (MSC) Telemedicine initiative--which motivated this project--will require high-volume data exchange over an insecure public-access Wide Area Network (WAN), thereby requiring a hybrid cryptosystem with both symmetric and asymmetric components. Our prototype framework features a pre-transaction authentication and key negotiation sequence which can be readily modified for client-side environments ranging from Web browsers without local storage capability to workstations with serial connectivity to a tamper-proof device, and also for point-to-multipoint transaction processes.

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

    PubMed

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

    2016-01-01

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

  20. Investment subsidies and the adoption of electronic medical records in hospitals.

    PubMed

    Dranove, David; Garthwaite, Craig; Li, Bingyang; Ody, Christopher

    2015-12-01

    In February 2009 the U.S. Congress unexpectedly passed the Health Information Technology for Economic and Clinical Health Act (HITECH). HITECH provides up to $27 billion to promote adoption and appropriate use of Electronic Medical Records (EMR) by hospitals. We measure the extent to which HITECH incentive payments spurred EMR adoption by independent hospitals. Adoption rates for all independent hospitals grew from 48 percent in 2008 to 77 percent by 2011. Absent HITECH incentives, we estimate that the adoption rate would have instead been 67 percent in 2011. When we consider that HITECH funds were available for all hospitals and not just marginal adopters, we estimate that the cost of generating an additional adoption was $48 million. We also estimate that in the absence of HITECH incentives, the 77 percent adoption rate would have been realized by 2013, just 2 years after the date achieved due to HITECH.

  1. Electronic medical records (EMRs), epidemiology, and epistemology: reflections on EMRs and future pediatric clinical research.

    PubMed

    Wasserman, Richard C

    2011-01-01

    Electronic medical records (EMRs) are increasingly common in pediatric patient care. EMR data represent a relatively novel and rich resource for clinical research. The fact, however, that pediatric EMR data are collected for the purposes of clinical documentation and billing rather than research creates obstacles to their use in scientific investigation. Particular issues include accuracy, completeness, comparability between settings, ease of extraction, and context of recording. Although these problems can be addressed through standard strategies for dealing with partially accurate and incomplete data, a longer-term solution will involve work with pediatric clinicians to improve data quality. As research becomes one of the explicit purposes for which pediatricians collect EMR data, the pediatric clinician will play a central role in future pediatric clinical research.

  2. Calculation of electron Dose Point Kernel in water with GEANT4 for medical application

    SciTech Connect

    Guimaraes, C. C.; Sene, F. F.; Martinelli, J. R.

    2009-06-03

    The rapid insertion of new technologies in medical physics in the last years, especially in nuclear medicine, has been followed by a great development of faster Monte Carlo algorithms. GEANT4 is a Monte Carlo toolkit that contains the tools to simulate the problems of particle transport through matter. In this work, GEANT4 was used to calculate the dose-point-kernel (DPK) for monoenergetic electrons in water, which is an important reference medium for nuclear medicine. The three different physical models of electromagnetic interactions provided by GEANT4 - Low Energy, Penelope and Standard - were employed. To verify the adequacy of these models, the results were compared with references from the literature. For all energies and physical models, the agreement between calculated DPKs and reported values is satisfactory.

  3. Integrating an enterprise image distribution system into an existing electronic medical record system

    NASA Astrophysics Data System (ADS)

    Witt, Robert M.; Morrow, Robert

    2003-05-01

    The enterprise distribution of radiology images should be integrated into the same application that physicians obtain other clinical information about their patients. Over the past year the Roudebush Veterans Affairs Medical Center has provided enterprise access to radiology images after integrating a commercial web-based image distribution system (Stentor, Brisbane, CA) with the Department of Veterans Affairs internally developed Computerized Patient Record System (CPRS). The application, CPRS, serves as the foundation for the VHA to implement an electronic medical record (EMR). We developed the necessary program communications between the CPRS application and the image distribution application to link the request for a report to a request for the corresponding images. When a physician selects a given radiology report in CPRS the text of the report displays in CPRS and the image application loads the corresponding image study. We found that the requests for film jackets decreased over fifty percent six months after full implementation of the enterprise image distribution system. We have found the integration of the image access and display application into an existing patient information system to be very successful.

  4. Electronic medical records and communication with patients and other clinicians: are we talking less?

    PubMed

    O'Malley, Ann S; Cohen, Genna R; Grossman, Joy M

    2010-04-01

    Commercial electronic medical records (EMRs) both help and hinder physician interpersonal communication--real-time, face-to-face or phone conversations--with patients and other clinicians, according to a new Center for Studying Health System Change (HSC) study based on in-depth interviews with clinicians in 26 physician practices. EMRs assist real-time communication with patients during office visits, primarily through immediate access to patient information, allowing clinicians to talk with patients rather than search for information from paper records. For some clinicians, however, aspects of EMRs pose a distraction during visits. Moreover, some indicated that clinicians may rely on EMRs for information gathering and transfer at the expense of real-time communication with patients and other clinicians. Given time pressures already present in many physician practices, EMR and office-work flow modifications could help ensure that EMRs advance care without compromising interpersonal communication. In particular, policies promoting EMR adoption should consider incorporating communication-skills training for medical trainees and clinicians using EMRs.

  5. Electronic Medical Records and the Technological Imperative: The Retrieval of Dialogue in Community-Based Primary Care.

    PubMed

    Franz, Berkeley; Murphy, John W

    2015-01-01

    Electronic medical records are regarded as an important tool in primary health-care settings. Because these records are thought to standardize medical information, facilitate provider communication, and improve office efficiency, many practices are transitioning to these systems. However, much of the concern with improving the practice of record keeping has related to technological innovations and human-computer interaction. Drawing on the philosophical reflection raised in Jacques Ellul's work, this article questions the technological imperative that may be supporting medical record keeping. Furthermore, given the growing emphasis on community-based care, this article discusses important non-technological aspects of electronic medical records that might bring the use of these records in line with participatory primary-care medicine.

  6. Using technology to teach technology: design and evaluation of bilingual online physician education about electronic medical records.

    PubMed

    Edmonson, Sarah R; Esquivel, Adol; Mokkarala, Pallavi; Johnson, Craig W; Phelps, Cynthia L

    2005-01-01

    The "EMR Tutorial" is designed to be a bilingual online physician education environment about electronic medical records. After iterative assessment and redesign, the tutorial was tested in two groups: U.S. physicians and Mexican medical students. Split-plot ANOVA revealed significantly different pre-test scores in the two groups, significant cognitive gains for the two groups overall, and no significant difference in the gains made by the two groups. Users rated the module positively on a satisfaction questionnaire.

  7. National All Schedules Prescription Electronic Reporting Act (NASPER): balancing substance abuse and medical necessity.

    PubMed

    Manchikanti, Laxmaiah; Brown, Keith R; Singh, Vijay

    2002-07-01

    The National All Schedules Prescription Electronic Reporting Act, or NASPER, is a bill proposed by the American Society of Interventional Pain Physicians to provide and improve patient access with quality care, and protect patients and physicians from deleterious effects of controlled substance misuse, abuse and trafficking. Controlled prescription drugs, including narcotic analgesics, anxiolytics, anti-depressants, stimulants, and sedative-hypnotics play a significant and legitimate role in interventional pain management practices in managing chronic pain and related disorders. Based on the 1997 household survey on drug abuse it is estimated that 76.9 million Americans had used an illicit drug at least once in their life. In 1997, 4.2 million people used analgesics, 2.1 million used tranquillizers, and an additional 2.3 million people used various other drugs, including sedatives, tranquillizers, etc. The non-medical use of prescription drugs exceeds that of all illicit substances except for marijuana and hashish. The report on epidemiology trends in drug abuse, based on community epidemiology work group analysis showed continued increase of abuse of prescription drugs in urban, suburban, and rural areas. The most commonly abused drugs include oxycodone, hydrocodone, hydromorphone, morphine, codeine, clonazepam, alprazolam, lorazepam, diazepam and carisoprodol. The diversion of prescription controlled substances to illicit channels is a public health and safety issue. This review describes the role of controlled substances in chronic pain management, prevalence and economic impact of controlled substance abuse, prescription accountability, effectiveness of prescription monitoring programs, and rationale for national controlled substance electronic reporting system.

  8. The Value of Electronic Medical Record Implementation in Mental Health Care: A Case Study

    PubMed Central

    Fischler, Ilan; Stuckey, Melanie I; Klassen, Philip E; Chen, John

    2017-01-01

    Background Electronic medical records (EMR) have been implemented in many organizations to improve the quality of care. Evidence supporting the value added to a recovery-oriented mental health facility is lacking. Objective The goal of this project was to implement and customize a fully integrated EMR system in a specialized, recovery-oriented mental health care facility. This evaluation examined the outcomes of quality improvement initiatives driven by the EMR to determine the value that the EMR brought to the organization. Methods The setting was a tertiary-level mental health facility in Ontario, Canada. Clinical informatics and decision support worked closely with point-of-care staff to develop workflows and documentation tools in the EMR. The primary initiatives were implementation of modules for closed loop medication administration, collaborative plan of care, clinical practice guidelines for schizophrenia, restraint minimization, the infection prevention and control surveillance status board, drug of abuse screening, and business intelligence. Results Medication and patient scan rates have been greater than 95% since April 2014, mitigating the adverse effects of medication errors. Specifically, between April 2014 and March 2015, only 1 moderately severe and 0 severe adverse drug events occurred. The number of restraint incidents decreased 19.7%, which resulted in cost savings of more than Can $1.4 million (US $1.0 million) over 2 years. Implementation of clinical practice guidelines for schizophrenia increased adherence to evidence-based practices, standardizing care across the facility. Improved infection prevention and control surveillance reduced the number of outbreak days from 47 in the year preceding implementation of the status board to 7 days in the year following. Decision support to encourage preferential use of the cost-effective drug of abuse screen when clinically indicated resulted in organizational cost savings. Conclusions EMR implementation

  9. Identification of a potential fibromyalgia diagnosis using random forest modeling applied to electronic medical records

    PubMed Central

    Emir, Birol; Masters, Elizabeth T; Mardekian, Jack; Clair, Andrew; Kuhn, Max; Silverman, Stuart L

    2015-01-01

    Background Diagnosis of fibromyalgia (FM), a chronic musculoskeletal condition characterized by widespread pain and a constellation of symptoms, remains challenging and is often delayed. Methods Random forest modeling of electronic medical records was used to identify variables that may facilitate earlier FM identification and diagnosis. Subjects aged ≥18 years with two or more listings of the International Classification of Diseases, Ninth Revision, (ICD-9) code for FM (ICD-9 729.1) ≥30 days apart during the 2012 calendar year were defined as cases among subjects associated with an integrated delivery network and who had one or more health care provider encounter in the Humedica database in calendar years 2011 and 2012. Controls were without the FM ICD-9 codes. Seventy-two demographic, clinical, and health care resource utilization variables were entered into a random forest model with downsampling to account for cohort imbalances (<1% subjects had FM). Importance of the top ten variables was ranked based on normalization to 100% for the variable with the largest loss in predicting performance by its omission from the model. Since random forest is a complex prediction method, a set of simple rules was derived to help understand what factors drive individual predictions. Results The ten variables identified by the model were: number of visits where laboratory/non-imaging diagnostic tests were ordered; number of outpatient visits excluding office visits; age; number of office visits; number of opioid prescriptions; number of medications prescribed; number of pain medications excluding opioids; number of medications administered/ordered; number of emergency room visits; and number of musculoskeletal conditions. A receiver operating characteristic curve confirmed the model’s predictive accuracy using an independent test set (area under the curve, 0.810). To enhance interpretability, nine rules were developed that could be used with good predictive probability of

  10. Design and characterization of electron beam focusing for X-ray generation in novel medical imaging architecture

    SciTech Connect

    Bogdan Neculaes, V. Zou, Yun; Zavodszky, Peter; Inzinna, Louis; Zhang, Xi; Conway, Kenneth; Caiafa, Antonio; Frutschy, Kristopher; Waters, William; De Man, Bruno

    2014-05-15

    A novel electron beam focusing scheme for medical X-ray sources is described in this paper. Most vacuum based medical X-ray sources today employ a tungsten filament operated in temperature limited regime, with electrostatic focusing tabs for limited range beam optics. This paper presents the electron beam optics designed for the first distributed X-ray source in the world for Computed Tomography (CT) applications. This distributed source includes 32 electron beamlets in a common vacuum chamber, with 32 circular dispenser cathodes operated in space charge limited regime, where the initial circular beam is transformed into an elliptical beam before being collected at the anode. The electron beam optics designed and validated here are at the heart of the first Inverse Geometry CT system, with potential benefits in terms of improved image quality and dramatic X-ray dose reduction for the patient.

  11. Design and characterization of electron beam focusing for X-ray generation in novel medical imaging architecture.

    PubMed

    Bogdan Neculaes, V; Zou, Yun; Zavodszky, Peter; Inzinna, Louis; Zhang, Xi; Conway, Kenneth; Caiafa, Antonio; Frutschy, Kristopher; Waters, William; De Man, Bruno

    2014-05-01

    A novel electron beam focusing scheme for medical X-ray sources is described in this paper. Most vacuum based medical X-ray sources today employ a tungsten filament operated in temperature limited regime, with electrostatic focusing tabs for limited range beam optics. This paper presents the electron beam optics designed for the first distributed X-ray source in the world for Computed Tomography (CT) applications. This distributed source includes 32 electron beamlets in a common vacuum chamber, with 32 circular dispenser cathodes operated in space charge limited regime, where the initial circular beam is transformed into an elliptical beam before being collected at the anode. The electron beam optics designed and validated here are at the heart of the first Inverse Geometry CT system, with potential benefits in terms of improved image quality and dramatic X-ray dose reduction for the patient.

  12. Design and characterization of electron beam focusing for X-ray generation in novel medical imaging architecturea

    PubMed Central

    Bogdan Neculaes, V.; Zou, Yun; Zavodszky, Peter; Inzinna, Louis; Zhang, Xi; Conway, Kenneth; Caiafa, Antonio; Frutschy, Kristopher; Waters, William; De Man, Bruno

    2014-01-01

    A novel electron beam focusing scheme for medical X-ray sources is described in this paper. Most vacuum based medical X-ray sources today employ a tungsten filament operated in temperature limited regime, with electrostatic focusing tabs for limited range beam optics. This paper presents the electron beam optics designed for the first distributed X-ray source in the world for Computed Tomography (CT) applications. This distributed source includes 32 electron beamlets in a common vacuum chamber, with 32 circular dispenser cathodes operated in space charge limited regime, where the initial circular beam is transformed into an elliptical beam before being collected at the anode. The electron beam optics designed and validated here are at the heart of the first Inverse Geometry CT system, with potential benefits in terms of improved image quality and dramatic X-ray dose reduction for the patient. PMID:24826066

  13. Challenges of Self-Reported Medical Conditions and Electronic Medical Records Among Members of a Large Military Cohort

    DTIC Science & Technology

    2008-06-05

    29.7 99.6 Manic - depressive disorder 0.9 (0.8, 0.9) 2.1 (2.0, 2.3) 1.9 11.8 98.7 Hepatitis C 0.8 (0.7, 0.9) 0.2 (0.2, 0.3) 0.1 25.4 99.6 Coronary...relatively common acute or transient medical conditions were migraine headaches and depression . Relatively common chronic medical conditions were...recorded data was consistently lower than prevalence based on self- report for most conditions, with the exception of chronic bronchitis, manic

  14. A Simple and Portable Algorithm for Identifying Atrial Fibrillation in the Electronic Medical Record.

    PubMed

    Khurshid, Shaan; Keaney, John; Ellinor, Patrick T; Lubitz, Steven A

    2016-01-15

    Atrial fibrillation (AF) is common and increases stroke risk and mortality. Many knowledge gaps remain with respect to practice patterns and outcomes. Electronic medical records (EMRs) may serve as powerful research tools if AF status can be properly ascertained. We sought to develop an algorithm for identifying subjects with and without AF in the EMR and compare it to previous methods. Using a hospital network EMR (n = 5,737,846), we randomly selected 8,200 subjects seen at a large academic medical center in January 2014 to derive and validate 7 AF classification schemas (4 cases and 3 controls) to construct a composite AF algorithm. In an independent sample of 172,138 subjects, we compared this algorithm against published AF classification methods. In total, we performed manual adjudication of AF in 700 subjects. Three AF schemas (AF1, AF2, and AF4) achieved positive predictive value (PPV) >0.9. Two control schemas achieved PPV >0.9 (control 1 and control 3). A combination algorithm AF1, AF2, and AF4 (PPV 88%; 8.2% classified) outperformed published classification methods including >1 outpatient International Statistical Classification of Diseases, Ninth Revision code or 1 outpatient code with an electrocardiogram demonstrating AF (PPV 82%; 5.9% classified), ≥ 1 inpatient International Statistical Classification of Diseases, Ninth Revision code or electrocardiogram demonstrating AF (PPV 88%; 6.1% classified), or the intersection of these (PPV 84%; 7.4% classified). When applied simultaneously, the case and control algorithms classified 98.4% of the cohort with zero disagreement. In conclusion, we derived a parsimonious and portable algorithm to identify subjects with and without AF with high sensitivity. If broadly applied, this algorithm can provide optimal power for EMR-based AF research.

  15. Novel open-source electronic medical records system for palliative care in low-resource settings

    PubMed Central

    2013-01-01

    Background The need for palliative care in sub-Saharan Africa is staggering: this region shoulders over 67% of the global burden of HIV/AIDS and cancer. However, provisions for these essential services remain limited and poorly integrated with national health systems in most nations. Moreover, the evidence base for palliative care in the region remains scarce. This study chronicles the development and evaluation of DataPall, an open-source electronic medical records system that can be used to track patients, manage data, and generate reports for palliative care providers in these settings. DataPall was developed using design criteria encompassing both functional and technical objectives articulated by hospital leaders and palliative care staff at a leading palliative care center in Malawi. The database can be used with computers that run Windows XP SP 2 or newer, and does not require an internet connection for use. Subsequent to its development and implementation in two hospitals, DataPall was tested among both trained and untrained hospital staff populations on the basis of its usability with comparison to existing paper records systems as well as on the speed at which users could perform basic database functions. Additionally, all participants evaluated this program on a standard system usability scale. Results In a study of health professionals in a Malawian hospital, DataPall enabled palliative care providers to find patients’ appointments, on average, in less than half the time required to locate the same record in current paper records. Moreover, participants generated customizable reports documenting patient records and comprehensive reports on providers’ activities with little training necessary. Participants affirmed this ease of use on the system usability scale. Conclusions DataPall is a simple, effective electronic medical records system that can assist in developing an evidence base of clinical data for palliative care in low resource settings. The

  16. The Study of Electronic Medical Record Adoption in a Medicare Certified Home Health Agency Using a Grounded Theory Approach

    ERIC Educational Resources Information Center

    May, Joy L.

    2013-01-01

    The purpose of this qualitative grounded theory study was to examine the experiences of clinicians in the adoption of Electronic Medical Records in a Medicare certified Home Health Agency. An additional goal for this study was to triangulate qualitative research between describing, explaining, and exploring technology acceptance. The experiences…

  17. Examining the Role of Electronic Medical Record Generated Provider Reminders on Provider Offering of Breast Cancer Screening Services

    ERIC Educational Resources Information Center

    Beverley, Charles St. Clare, Jr.

    2013-01-01

    Introduction: Breast cancer affects the lives of millions of women each year in the United States. Early detection by mammography screening can reduce the risk for advanced stages of breast cancer and improve the probability of long-term survival in women. Electronic medical records (EMRs) have been identified as a successful approach for…

  18. Electronic Medical Records (EMR): An Empirical Testing of Factors Contributing to Healthcare Professionals' Resistance to Use EMR Systems

    ERIC Educational Resources Information Center

    Bazile, Emmanuel Patrick

    2016-01-01

    The benefits of using electronic medical records (EMRs) have been well documented; however, despite numerous financial benefits and cost reductions being offered by the federal government, some healthcare professionals have been reluctant to implement EMR systems. In fact, prior research provides evidence of failed EMR implementations due to…

  19. A Qualitative Study to Evaluate the Effectiveness of Simulation as a Training Method in Implementation of Electronic Medical Records

    ERIC Educational Resources Information Center

    Chelton, Barbara S.

    2009-01-01

    Background: Adoption of electronic medical records has been gradual in part due to physician concerns that its use in the exam room will interfere with the physician-patient relationship. Studies demonstrate their concern to be loss of eye contact with the patient and that entering information into the computer in the presence of the patient will…

  20. Is there any legal and scientific basis for classifying electronic cigarettes as medications?

    PubMed

    Farsalinos, Konstantinos E; Stimson, Gerry V

    2014-05-01

    The rapid growth in the use of electronic cigarettes has been accompanied by substantial discussions by governments, international organisations, consumers and public health experts about how they might be regulated. In the European Union they are currently regulated under consumer legislation but new legislation will regulate them under the Tobacco Products Directive. However, several countries have sought to regulate them under medicines regulations. These claims have been successfully challenged in 6 court cases in European states. Under European legislation a product may be deemed to be a medicine by function if it is used in or administered to human beings either with a view to restoring, correcting or modifying physiological functions by exerting a pharmacological, immunological or metabolic action, or to making a medical diagnosis. It is a medicine by presentation if it is presented (e.g. by a manufacturer or distributor) as having properties for treating or preventing disease in human beings. We assess the legal and scientific basis for the claim that electronic cigarettes should be regulated as medicines. We conclude that they are neither medicine by function nor necessarily by presentation The main reason for their existence is as a harm reduction product in which the liking for and/or dependence on nicotine is maintained, and adoption of use is as a substitute for smoking and not as a smoking cessation product. In reality, they are used as consumer products providing pleasure to the user. They are not used to treat nicotine addiction or other disease, but to enable continued use of nicotine. Their use is adjusted individually by each consumer according to his or her perceived pleasure and satisfaction. Gaps in current regulation regarding safety and quality can be met by tailored regulations.

  1. From papyrus to the electronic tablet: a brief history of the clinical medical record with lessons for the digital age.

    PubMed

    Gillum, Richard F

    2013-10-01

    A major transition is underway in documentation of patient-related data in clinical settings with rapidly accelerating adoption of the electronic health record and electronic medical record. This article examines the history of the development of medical records in the West in order to suggest lessons applicable to the current transition. The first documented major transition in the evolution of the clinical medical record occurred in antiquity, with the development of written case history reports for didactic purposes. Benefiting from Classical and Hellenistic models earlier than physicians in the West, medieval Islamic physicians continued the development of case histories for didactic use. A forerunner of modern medical records first appeared in Paris and Berlin by the early 19th century. Development of the clinical record in America was pioneered in the 19th century in major teaching hospitals. However, a clinical medical record useful for direct patient care in hospital and ambulatory settings was not developed until the 20th century. Several lessons are drawn from the 4000-year history of the medical record that may help physicians improve patient care in the digital age.

  2. Automated physician order recommendations and outcome predictions by data-mining electronic medical records.

    PubMed

    Chen, Jonathan H; Altman, Russ B

    2014-01-01

    The meaningful use of electronic medical records (EMR) will come from effective clinical decision support (CDS) applied to physician orders, the concrete manifestation of clinical decision making. CDS development is currently limited by a top-down approach, requiring manual production and limited end-user awareness. A statistical data-mining alternative automatically extracts expertise as association statistics from structured EMR data (>5.4M data elements from >19K inpatient encounters). This powers an order recommendation system analogous to commercial systems (e.g., Amazon.com's "Customers who bought this…"). Compared to a standard benchmark, the association method improves order prediction precision from 26% to 37% (p<0.01). Introducing an inverse frequency weighted recall metric demonstrates a quantifiable improvement from 3% to 17% (p<0.01) in recommending more specifically relevant orders. The system also predicts clinical outcomes, such as 30 day mortality and 1 week ICU intervention, with ROC AUC of 0.88 and 0.78 respectively, comparable to state-of-the-art prognosis scores.

  3. Discovering knowledge on pediatric fluid therapy and dysnatremias from quantitative data found in electronic medical records.

    PubMed

    Pham, Steve L; Bickel, Jonathan P; Moritz, Michael L; Levin, James E

    2010-11-13

    It is accepted that intravenous fluid (IVF) therapy can result in hospital-acquired dysnatremias in pediatric patients, with associated morbidity and mortality. There is interest in improving IVF therapy to prevent dysnatremias, but the optimal approach is controversial. In this study, we develop Natremia Deviation and Intravenous Renderer (NaDIR), a tool that preprocesses large volumes of electronic medical record data obtained from an academic pediatric hospital in order to analyze (1) IVF therapy, (2) the epidemiology of dysnatremias, and (3) the impact of IVFs on changes in serum sodium (ΔS(Na)). We then applied NaDIR to 3,256 inpatient records over a 3 month period, which revealed (1) a 19.9% incidence of dysnatremias, (2) a significant increase in lengths of stay associated with dysnatremias, and (3) a novel linear relationship between ΔS(Na) and IVF tonicity. This demonstrates that EMR data that can be readily analyzed to discover epidemiologic and predictive knowledge.

  4. Building a diabetes screening population data repository using electronic medical records.

    PubMed

    Tuan, Wen-Jan; Sheehy, Ann M; Smith, Maureen A

    2011-05-01

    There has been a rapid advancement of information technology in the area of clinical and population health data management since 2000. However, with the fast growth of electronic medical records (EMRs) and the increasing complexity of information systems, it has become challenging for researchers to effectively access, locate, extract, and analyze information critical to their research. This article introduces an outpatient encounter data framework designed to construct an EMR-based population data repository for diabetes screening research. The outpatient encounter data framework is developed on a hybrid data structure of entity-attribute-value models, dimensional models, and relational models. This design preserves a small number of subject-specific tables essential to key clinical constructs in the data repository. It enables atomic information to be maintained in a transparent and meaningful way to researchers and health care practitioners who need to access data and still achieve the same performance level as conventional data warehouse models. A six-layer information processing strategy is developed to extract and transform EMRs to the research data repository. The data structure also complies with both Health Insurance Portability and Accountability Act regulations and the institutional review board's requirements. Although developed for diabetes screening research, the design of the outpatient encounter data framework is suitable for other types of health service research. It may also provide organizations a tool to improve health care quality and efficiency, consistent with the "meaningful use" objectives of the Health Information Technology for Economic and Clinical Health Act.

  5. Comparison of medical students’ learning approaches between electronic and hard copy team-based learning

    PubMed Central

    Sharaf, Fawzy; Alnohair, Sultan

    2017-01-01

    Aim: To compare the students’ perception of team-based learning (TBL): The paper (hard copy) compared with the e-copy (electronic copy) in the family medicine course of the fifth year medical students, Qassim University College of Medicine. Methods: A cross-sectional study was conducted during the family medicine course in 2015-2016 to compare the hard copy and the e-copy TBL sessions. We used Google drive to distribute, collect and analyze the questionnaire. The results of the e-copy TBL are shown and displayed directly with each session to the students, which was not the same as practiced with hard copy. We used also SPSS (version 17 for Windows) for more statistical analysis. Results: The total number of respondents of students in each was 96; a phase of TBL phase 1 (hard copy) and phase 2 (e-copy). Male were 64 (66.7%) and females 32 (33.3%). The first three knowledge questions showed no difference between the mean score between paper and e-copy TBL, but of the perception questions showed a significant difference between the paper and e-copy TBL. Conclusions: The results of the survey showed that the students prefer e-copy TBL as a course format, as it was an attraction for most of the students and making them even more successful in the key exam and e-copy TBL develop the skills needed to work productively in task-groups. PMID:28293158

  6. Tissue Banking, Bioinformatics, and Electronic Medical Records: The Front-End Requirements for Personalized Medicine

    PubMed Central

    Suh, K. Stephen; Sarojini, Sreeja; Youssif, Maher; Nalley, Kip; Milinovikj, Natasha; Elloumi, Fathi; Russell, Steven; Pecora, Andrew; Schecter, Elyssa; Goy, Andre

    2013-01-01

    Personalized medicine promises patient-tailored treatments that enhance patient care and decrease overall treatment costs by focusing on genetics and “-omics” data obtained from patient biospecimens and records to guide therapy choices that generate good clinical outcomes. The approach relies on diagnostic and prognostic use of novel biomarkers discovered through combinations of tissue banking, bioinformatics, and electronic medical records (EMRs). The analytical power of bioinformatic platforms combined with patient clinical data from EMRs can reveal potential biomarkers and clinical phenotypes that allow researchers to develop experimental strategies using selected patient biospecimens stored in tissue banks. For cancer, high-quality biospecimens collected at diagnosis, first relapse, and various treatment stages provide crucial resources for study designs. To enlarge biospecimen collections, patient education regarding the value of specimen donation is vital. One approach for increasing consent is to offer publically available illustrations and game-like engagements demonstrating how wider sample availability facilitates development of novel therapies. The critical value of tissue bank samples, bioinformatics, and EMR in the early stages of the biomarker discovery process for personalized medicine is often overlooked. The data obtained also require cross-disciplinary collaborations to translate experimental results into clinical practice and diagnostic and prognostic use in personalized medicine. PMID:23818899

  7. Automated Detection of Sepsis Using Electronic Medical Record Data: A Systematic Review.

    PubMed

    Despins, Laurel A

    2016-09-13

    Severe sepsis and septic shock are global issues with high mortality rates. Early recognition and intervention are essential to optimize patient outcomes. Automated detection using electronic medical record (EMR) data can assist this process. This review describes automated sepsis detection using EMR data. PubMed retrieved publications between January 1, 2005 and January 31, 2015. Thirteen studies met study criteria: described an automated detection approach with the potential to detect sepsis or sepsis-related deterioration in real or near-real time; focused on emergency department and hospitalized neonatal, pediatric, or adult patients; and provided performance measures or results indicating the impact of automated sepsis detection. Detection algorithms incorporated systemic inflammatory response and organ dysfunction criteria. Systems in nine studies generated study or care team alerts. Care team alerts did not consistently lead to earlier interventions. Earlier interventions did not consistently translate to improved patient outcomes. Performance measures were inconsistent. Automated sepsis detection is potentially a means to enable early sepsis-related therapy but current performance variability highlights the need for further research.

  8. Development of a validated algorithm for the diagnosis of paediatric asthma in electronic medical records

    PubMed Central

    Cave, Andrew J; Davey, Christina; Ahmadi, Elaheh; Drummond, Neil; Fuentes, Sonia; Kazemi-Bajestani, Seyyed Mohammad Reza; Sharpe, Heather; Taylor, Matt

    2016-01-01

    An accurate estimation of the prevalence of paediatric asthma in Alberta and elsewhere is hampered by uncertainty regarding disease definition and diagnosis. Electronic medical records (EMRs) provide a rich source of clinical data from primary-care practices that can be used in better understanding the occurrence of the disease. The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) database includes cleaned data extracted from the EMRs of primary-care practitioners. The purpose of the study was to develop and validate a case definition of asthma in children 1–17 who consult family physicians, in order to provide primary-care estimates of childhood asthma in Alberta as accurately as possible. The validation involved the comparison of the application of a theoretical algorithm (to identify patients with asthma) to a physician review of records included in the CPCSSN database (to confirm an accurate diagnosis). The comparison yielded 87.4% sensitivity, 98.6% specificity and a positive and negative predictive value of 91.2% and 97.9%, respectively, in the age group 1–17 years. The algorithm was also run for ages 3–17 and 6–17 years, and was found to have comparable statistical values. Overall, the case definition and algorithm yielded strong sensitivity and specificity metrics and was found valid for use in research in CPCSSN primary-care practices. The use of the validated asthma algorithm may improve insight into the prevalence, diagnosis, and management of paediatric asthma in Alberta and Canada. PMID:27882997

  9. Spin electronic magnetic sensor based on functional oxides for medical imaging

    NASA Astrophysics Data System (ADS)

    Solignac, A.; Kurij, G.; Guerrero, R.; Agnus, G.; Maroutian, T.; Fermon, C.; Pannetier-Lecoeur, M.; Lecoeur, Ph.

    2015-09-01

    To detect magnetic signals coming from the body, in particular those produced by the electrical activity of the heart or of the brain, the development of ultrasensitive sensors is required. In this regard, magnetoresistive sensors, stemming from spin electronics, are very promising devices. For example, tunnel magnetoresistance (TMR) junctions based on MgO tunnel barrier have a high sensitivity. Nevertheless, TMR also often have high level of noise. Full spin polarized materials like manganite La0.67Sr0.33MnO3 (LSMO) are attractive alternative candidates to develop such sensors because LSMO exhibits a very low 1/f noise when grown on single crystals, and a TMR response has been observed with values up to 2000%. This kind of tunnel junctions, when combined with a high Tc superconductor loop, opens up possibilities to develop full oxide structures working at liquid nitrogen temperature and suitable for medical imaging. In this work, we investigated on LSMO-based tunnel junctions the parameters controlling the overall system performances, including not only the TMR ratio, but also the pinning of the reference layer and the noise floor. We especially focused on studying the effects of the quality of the barrier, the interface and the electrode, by playing with materials and growth conditions.

  10. Improving gestational weight gain counseling through meaningful use of an electronic medical record.

    PubMed

    Lindberg, Sara M; Anderson, Cynthie K

    2014-11-01

    The purpose of this study was to test the effectiveness of an intervention to improve the consistency and accuracy of antenatal gestational weight gain counseling through introduction of a "best practice alert" into an electronic medical record (EMR) system. A best practice alert was designed and implemented in the EMR. Based on each patient's pre-gravid body mass index (BMI), fetal number, and 2009 Institute of Medicine (IOM) guidelines, the alert provides an individualized total gestational weight gain goal, the weight gain goal per week of gestation, a template for scripted provider counseling and documentation, and a patient handout containing personalized gestational weight gain information. Retrospective chart reviews of 388 pre-intervention patients and 345 post-intervention patients were used to evaluate effectiveness. Introduction of a gestational weight gain best practice alert into the EMR improved the rate of antenatal gestational weight gain counseling that was consistent with current IOM guidelines (p < 0.001). Improvement in IOM-consistent gestational weight gain counseling was seen across all provider types, including obstetricians, family practice physicians, and certified nurse midwives. The intervention also resulted in significant improvement in documentation of pre-gravid weights and BMIs within the EMR. The EMR is an effective tool for improving the consistency and accuracy of antenatal gestational weight gain counseling in accord with 2009 IOM guidelines.

  11. Meeting the security requirements of electronic medical records in the ERA of high-speed computing.

    PubMed

    Alanazi, H O; Zaidan, A A; Zaidan, B B; Kiah, M L Mat; Al-Bakri, S H

    2015-01-01

    This study has two objectives. First, it aims to develop a system with a highly secured approach to transmitting electronic medical records (EMRs), and second, it aims to identify entities that transmit private patient information without permission. The NTRU and the Advanced Encryption Standard (AES) cryptosystems are secured encryption methods. The AES is a tested technology that has already been utilized in several systems to secure sensitive data. The United States government has been using AES since June 2003 to protect sensitive and essential information. Meanwhile, NTRU protects sensitive data against attacks through the use of quantum computers, which can break the RSA cryptosystem and elliptic curve cryptography algorithms. A hybrid of AES and NTRU is developed in this work to improve EMR security. The proposed hybrid cryptography technique is implemented to secure the data transmission process of EMRs. The proposed security solution can provide protection for over 40 years and is resistant to quantum computers. Moreover, the technique provides the necessary evidence required by law to identify disclosure or misuse of patient records. The proposed solution can effectively secure EMR transmission and protect patient rights. It also identifies the source responsible for disclosing confidential patient records. The proposed hybrid technique for securing data managed by institutional websites must be improved in the future.

  12. Evaluation of use of electronic patient controlled analgesia pumps to improve patient safety in an academic medical center.

    PubMed

    Ohashi, Kumiko; Dykes, Patricia; Mcintosh, Kathleen; Buckley, Elizabeth; Yoon, Catherine; Luppi, Carol; Bane, Anne; Bates, David W

    2014-01-01

    Patient controlled analgesia (PCA) and Patient-controlled epidural analgesia (PCEA) pumps are methods of pain control with complex smart infusion devices and are widely used in hospitals. Smart PCA/PCEA pumps can be programmed with the dose and rate of medications within pre-set ranges. However, adverse effects have been reported associated with these pumps' use. In this paper, we describe a prevalence observational study where observers used an electronic data collection tool to record pump settings and medications with PCA pumps, corresponding medication orders to identify errors. The results showed that there were many labeling and tubing change tag errors, which were a violation of hospital policy. A few potential harmful medication errors were identified but no critical errors. Study results suggest the importance of a standard process of PCA pump use. Next steps include implementing a safety bundle for improving PCA practice to support safe and effective pain management.

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

    PubMed Central

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

    2013-01-01

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

  14. Annotation methods to develop and evaluate an expert system based on natural language processing in electronic medical records.

    PubMed

    Gicquel, Quentin; Tvardik, Nastassia; Bouvry, Côme; Kergourlay, Ivan; Bittar, André; Segond, Frédérique; Darmoni, Stefan; Metzger, Marie-Hélène

    2015-01-01

    The objective of the SYNODOS collaborative project was to develop a generic IT solution, combining a medical terminology server, a semantic analyser and a knowledge base. The goal of the project was to generate meaningful epidemiological data for various medical domains from the textual content of French medical records. In the context of this project, we built a care pathway oriented conceptual model and corresponding annotation method to develop and evaluate an expert system's knowledge base. The annotation method is based on a semi-automatic process, using a software application (MedIndex). This application exchanges with a cross-lingual multi-termino-ontology portal. The annotator selects the most appropriate medical code proposed for the medical concept in question by the multi-termino-ontology portal and temporally labels the medical concept according to the course of the medical event. This choice of conceptual model and annotation method aims to create a generic database of facts for the secondary use of electronic health records data.

  15. Sharing code.

    PubMed

    Kubilius, Jonas

    2014-01-01

    Sharing code is becoming increasingly important in the wake of Open Science. In this review I describe and compare two popular code-sharing utilities, GitHub and Open Science Framework (OSF). GitHub is a mature, industry-standard tool but lacks focus towards researchers. In comparison, OSF offers a one-stop solution for researchers but a lot of functionality is still under development. I conclude by listing alternative lesser-known tools for code and materials sharing.

  16. Integration of multiple DICOM Web servers into an enterprise-wide Web-based electronic medical record

    NASA Astrophysics Data System (ADS)

    Stewart, Brent K.; Langer, Steven G.; Martin, Kelly P.

    1999-07-01

    The purpose of this paper is to integrate multiple DICOM image webservers into the currently existing enterprises- wide web-browsable electronic medical record. Over the last six years the University of Washington has created a clinical data repository combining in a distributed relational database information from multiple departmental databases (MIND). A character cell-based view of this data called the Mini Medical Record (MMR) has been available for four years, MINDscape, unlike the text-based MMR. provides a platform independent, dynamic, web browser view of the MIND database that can be easily linked with medical knowledge resources on the network, like PubMed and the Federated Drug Reference. There are over 10,000 MINDscape user accounts at the University of Washington Academic Medical Centers. The weekday average number of hits to MINDscape is 35,302 and weekday average number of individual users is 1252. DICOM images from multiple webservers are now being viewed through the MINDscape electronic medical record.

  17. Study of the cost-benefit analysis of electronic medical record systems in general hospital in China.

    PubMed

    Li, Kai; Naganawa, Shinji; Wang, Kai; Li, Ping; Kato, Ken; Li, Xiu; Zhang, Jie; Yamauchi, Kazunobu

    2012-10-01

    Electronic medical record (EMR) systems have been proposed as technology to improve the quality of patient care, decrease medical errors, control and reduce medical expenditure, however the financial effects have not yet been as well documented in China. We presented a net financial cost-benefit analysis of implementing electronic medical record systems in general hospital in China. The data, which were obtained from studies of the general hospital and the published literature, collected from 15 consecutive fiscal months from May 1, 2009 to August 30, 2010. We performed a perspective cost-benefit study to analyze the financial effects of EMR system implementing. The reference strategy for comparisons was the traditional paper-based medical record. The net financial benefits or costs for a 6-year period were calculated. All data were adjusted for inflation. The totally assessed net benefit from implementing an EMR system for a 6-year period was $559,025 in the general hospital. Benefits accrue primarily from savings in new medical record creation, decreased full-time-equivalent (FTE) employees, saving of adverse drug events (ADEs) and dose errors, improved charge capture and decreased billing errors. In this model, the time of return on investment is 3.00 years. In one-way sensitivity analysis, the model was most sensitive in new medical record creation; the net benefit varied from $398,057 to $719,992. The five-way sensitivity analysis with the most pessimistic and optimistic assumptions showed results ranging from a $76,970 net cost to a $1,062,122 net benefit; the pessimistic time of return on investment is 5.38 years. An EMR system cost-benefit analysis can rapidly demonstrate a positive return on investment when implemented in hospitals. The magnitude of the return is sensitive to several key factors.

  18. Impact of a Cost Visibility Tool in the Electronic Medical Record on Antibiotic Prescribing in an Academic Medical Center

    PubMed Central

    Fargo, Kelly L.; Johnston, Jessica; Stevenson, Kurt B.; Deutscher, Meredith

    2015-01-01

    Background: Studies evaluating the impact of passive cost visibility tools on antibiotic prescribing are lacking. Objective: The objective of this study was to evaluate whether the implementation of a passive antibiotic cost visibility tool would impact antibiotic prescribing and decrease antibiotic spending. Methods: An efficiency and effectiveness initiative (EEI) was implemented in October 2012. To support the EEI, an antibiotic cost visibility tool was created in June 2013 displaying the relative cost of antibiotics. Using an observational study of interrupted time series design, 3 time frames were studied: pre EEI, post EEI, and post cost visibility tool implementation. The primary outcome was antibiotic cost per 1,000 patient days. Secondary outcomes included case mix index (CMI)–adjusted antibiotic cost per 1,000 patient days and utilization of the cost visibility tool. Results: Initiation of the EEI was associated with a $4,675 decrease in antibiotic cost per 1,000 patient days (P = .003), and costs continued to decrease in the months following EEI (P = .009). After implementation of the cost visibility tool, costs remained stable (P = .844). Despite CMI increasing over time, adjustment for CMI had no impact on the directionality or statistical significance of the results. Conclusion: Our study demonstrated a significant and sustained decrease in antibiotic cost per 1,000 patient days when focused medication cost reduction efforts were implemented, but passive cost visibility tool implementation was not associated with additional cost reduction. Antibiotic cost visibility tools may be of most benefit when prior medication cost reduction efforts are lacking or when an active intervention is incorporated. PMID:26405341

  19. A Novel Method for Estimating Transgender Status Using Electronic Medical Records

    PubMed Central

    Roblin, Douglas; Barzilay, Joshua; Tolsma, Dennis; Robinson, Brandi; Schild, Laura; Cromwell, Lee; Braun, Hayley; Nash, Rebecca; Gerth, Joseph; Hunkeler, Enid; Quinn, Virginia P.; Tangpricha, Vin; Goodman, Michael

    2016-01-01

    Background We describe a novel algorithm for identifying transgender people and determining their male-to-female (MTF) or female-to-male (FTM) identity in electronic medical records (EMR) of an integrated health system. Methods A SAS program scanned Kaiser Permanente Georgia EMR from January 2006 through December 2014 for relevant diagnostic codes, and presence of specific keywords (e.g., “transgender” or “transsexual”) in clinical notes. Eligibility was verified by review of de-identified text strings containing targeted keywords, and if needed, by an additional in-depth review of records. Once transgender status was confirmed, FTM or MTF identity was assessed using a second SAS program and another round of text string reviews. Results Of 813,737 members, 271 were identified as possibly transgender: 137 through keywords only, 25 through diagnostic codes only, and 109 through both codes and keywords. Of these individuals, 185 (68%, 95% confidence interval [CI]: 62-74%) were confirmed as definitely transgender. The proportions (95% CIs) of definite transgender status among persons identified via keywords, diagnostic codes, and both were 45% (37-54%), 56% (35-75%), and 100% (96-100%), respectively. Of the 185 definitely transgender people, 99 (54%, 95% CI: 46-61%) were MTF, 84 (45%, 95% CI: 38-53%) were FTM. For two persons, gender identity remained unknown. Prevalence of transgender people (per 100,000 members) was 4.4 (95% CI: 2.6-7.4) in 2006 and 38.7 (95% CI: 32.4-46.2) in 2014. Conclusions The proposed method of identifying candidates for transgender health studies is low cost and relatively efficient. It can be applied in other similar health care systems. PMID:26907539

  20. Understanding Electronic Medical Record Adoption in the United States: Communication and Sociocultural Perspectives

    PubMed Central

    Kreps, Gary L; Polit, Stan

    2013-01-01

    Background This paper adopts a communication and sociocultural perspective to analyze the factors behind the lag in electronic medical record (EMR) adoption in the United States. Much of the extant research on this topic has emphasized economic factors, particularly, lack of economic incentives, as the primary cause of the delay in EMR adoption. This prompted the Health Information Technology on Economic and Clinical Health Act that allow financial incentives through the Centers of Medicare and Medicaid Services for many health care organizations planning to adopt EMR. However, financial incentives alone have not solved the problem; many new innovations do not diffuse even when offered for free. Thus, this paper underlines the need to consider communication and sociocultural factors to develop a better understanding of the impediments of EMR adoption. Objective The objective of this paper was to develop a holistic understanding of EMR adoption by identifying and analyzing the impact of communication and sociocultural factors that operate at 3 levels: macro (environmental), meso (organizational), and micro (individual). Methods We use the systems approach to focus on the 3 levels (macro, meso, and micro) and developed propositions at each level drawing on the communication and sociocultural perspectives. Results Our analysis resulted in 10 propositions that connect communication and sociocultural aspects with EMR adoption. Conclusions This paper brings perspectives from the social sciences that have largely been missing in the extant literature of health information technology (HIT) adoption. In doing so, it implies how communication and sociocultural factors may complement (and in some instances, reinforce) the impact of economic factors on HIT adoption. PMID:23612390

  1. Predicting Risk of Suicide Attempt Using History of Physical Illnesses From Electronic Medical Records

    PubMed Central

    Luo, Wei; Tran, Truyen; Berk, Michael; Venkatesh, Svetha

    2016-01-01

    Background Although physical illnesses, routinely documented in electronic medical records (EMR), have been found to be a contributing factor to suicides, no automated systems use this information to predict suicide risk. Objective The aim of this study is to quantify the impact of physical illnesses on suicide risk, and develop a predictive model that captures this relationship using EMR data. Methods We used history of physical illnesses (except chapter V: Mental and behavioral disorders) from EMR data over different time-periods to build a lookup table that contains the probability of suicide risk for each chapter of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes. The lookup table was then used to predict the probability of suicide risk for any new assessment. Based on the different lengths of history of physical illnesses, we developed six different models to predict suicide risk. We tested the performance of developed models to predict 90-day risk using historical data over differing time-periods ranging from 3 to 48 months. A total of 16,858 assessments from 7399 mental health patients with at least one risk assessment was used for the validation of the developed model. The performance was measured using area under the receiver operating characteristic curve (AUC). Results The best predictive results were derived (AUC=0.71) using combined data across all time-periods, which significantly outperformed the clinical baseline derived from routine risk assessment (AUC=0.56). The proposed approach thus shows potential to be incorporated in the broader risk assessment processes used by clinicians. Conclusions This study provides a novel approach to exploit the history of physical illnesses extracted from EMR (ICD-10 codes without chapter V-mental and behavioral disorders) to predict suicide risk, and this model outperforms existing clinical assessments of suicide risk. PMID:27400764

  2. Electronic medical records and physician stress in primary care: results from the MEMO Study

    PubMed Central

    Babbott, Stewart; Manwell, Linda Baier; Brown, Roger; Montague, Enid; Williams, Eric; Schwartz, Mark; Hess, Erik; Linzer, Mark

    2014-01-01

    Background Little has been written about physician stress that may be associated with electronic medical records (EMR). Objective We assessed relationships between the number of EMR functions, primary care work conditions, and physician satisfaction, stress and burnout. Design and participants 379 primary care physicians and 92 managers at 92 clinics from New York City and the upper Midwest participating in the 2001–5 Minimizing Error, Maximizing Outcome (MEMO) Study. A latent class analysis identified clusters of physicians within clinics with low, medium and high EMR functions. Main measures We assessed physician-reported stress, burnout, satisfaction, and intent to leave the practice, and predictors including time pressure during visits. We used a two-level regression model to estimate the mean response for each physician cluster to each outcome, adjusting for physician age, sex, specialty, work hours and years using the EMR. Effect sizes (ES) of these relationships were considered small (0.14), moderate (0.39), and large (0.61). Key results Compared to the low EMR cluster, physicians in the moderate EMR cluster reported more stress (ES 0.35, p=0.03) and lower satisfaction (ES −0.45, p=0.006). Physicians in the high EMR cluster indicated lower satisfaction than low EMR cluster physicians (ES −0.39, p=0.01). Time pressure was associated with significantly more burnout, dissatisfaction and intent to leave only within the high EMR cluster. Conclusions Stress may rise for physicians with a moderate number of EMR functions. Time pressure was associated with poor physician outcomes mainly in the high EMR cluster. Work redesign may address these stressors. PMID:24005796

  3. Progress in the Enhanced Use of Electronic Medical Records: Data From the Ontario Experience

    PubMed Central

    Koziel, Chad; Larsen, Darren; Berry, Plumaletta; Kubatka-Willms, Elena

    2017-01-01

    Background This paper describes a change management strategy, including a self-assessment survey tool and electronic medical record (EMR) maturity model (EMM), developed to support the adoption and implementation of EMRs among community-based physicians in the province of Ontario, Canada. Objective The aim of our study was to present an analysis of progress in EMR use in the province of Ontario based on data from surveys completed by over 4000 EMR users. Methods The EMM and the EMR progress report (EPR) survey tool clarify levels of capability and expected benefits of improved use. Maturity is assessed on a 6-point scale (0-5) for 25 functions, across 7 functional areas, ranging from basic to more advanced. A total of 4214 clinicians completed EPR surveys between April 2013 and March 2016. Univariate and multivariate descriptive statistics were calculated to describe the survey results. Results Physicians reported continual improvement over years of use, perceiving that the longer they used their EMR, the better patient care they provided. Those with at least two years of experience reported the greatest progress. Conclusions From our analyses at this stage we identified: (1) a direct correlation between years of EMR use and EMR maturity as measured in our model, (2) a similar positive correlation between years of EMR use and the perception that these systems improve clinical care in at least four patient-centered areas, and (3) evidence of ongoing improvement even in advanced years of use. Future analyses will be supplemented by qualitative and quantitative data collected from field staff engagements as part of the new EMR practice enhancement program (EPEP). PMID:28228372

  4. Distinguishing incident and prevalent diabetes in an electronic medical records database

    PubMed Central

    Mamtani, Ronac; Haynes, Kevin; Finkelman, Brian S; Scott, Frank I; Lewis, James D

    2014-01-01

    Purpose To develop a method to identify incident diabetes mellitus (DM) using an Electronic Medical Records (EMR) database, and test this classification by comparing incident and prevalent DM with common outcomes related to DM duration. Methods Incidence rates (IRs) of DM (defined as a first diagnosis or prescription) were measured in 3-month intervals through 36 months after registration in The Health Improvement Network, a primary care database, from 1994 to 2012. We used Joinpoint regression to identify the point where a statistically significant change in the trend of IRs occurred. Further analyses used this point to distinguish those likely to have incident (n=50,315) versus prevalent (n=28,337) DM. Incident and prevalent cohorts were compared using Cox regression for all-cause mortality, cardiovascular disease, diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. Analyses were adjusted for age, sex, smoking, obesity, hyperlipidemia, hypertension, and calendar year. Results Trends in DM incidence rates plateaued 9 months after registration (p=0.04). All cause-mortality was increased (HR 1.62, 95% CI 1.53–1.70) among patients diagnosed with DM prior to 9 months following registration (prevalent DM) compared to those diagnosed after 9 months (incident DM). Similarly, the risk of DM-related complications was higher in prevalent vs. incident DM patients [cardiovascular disease, HR 2.24 (2.08–2.40); diabetic retinopathy, HR 1.31 (1.24–1.38); diabetic nephropathy, HR 2.30 (1.95–2.72); diabetic neuropathy, HR 1.28 (1.16–1.41)]. Conclusion Joinpoint regression can be used to identify patients with newly diagnosed diabetes within EMR data. Failure to exclude patients with prevalent DM can lead to exaggerated associations of DM-related outcomes. PMID:24375925

  5. Antimicrobial Stewardship in a Long-Term Acute Care Hospital Using Offsite Electronic Medical Record Audit.

    PubMed

    Beaulac, Kirthana; Corcione, Silvia; Epstein, Lauren; Davidson, Lisa E; Doron, Shira

    2016-04-01

    OBJECTIVE To offer antimicrobial stewardship to a long-term acute care hospital using telemedicine. METHODS We conducted an uninterrupted time-series analysis to measure the impact of antimicrobial stewardship on hospital-acquired Clostridium difficile infection (CDI) rates and antimicrobial use. Simple linear regression was used to analyze changes in antimicrobial use; Poisson regression was used to estimate the incidence rate ratio in CDI rates. The preimplementation period was April 1, 2010-March 31, 2011; the postimplementation period was April 1, 2011-March 31, 2014. RESULTS During the preimplementation period, total antimicrobial usage was 266 defined daily doses (DDD)/1,000 patient-days (PD); it rose 4.54 (95% CI, -0.19 to 9.28) per month then significantly decreased from preimplementation to postimplementation (-6.58 DDD/1,000 PD [95% CI, -11.48 to -1.67]; P=.01). The same trend was observed for antibiotics against methicillin-resistant Staphylococcus aureus (-2.97 DDD/1,000 PD per month [95% CI, -5.65 to -0.30]; P=.03). There was a decrease in usage of anti-CDI antibiotics by 50.4 DDD/1,000 PD per month (95% CI, -71.4 to -29.2; P<.001) at program implementation that was maintained afterwards. Anti-Pseudomonas antibiotics increased after implementation (30.6 DDD/1,000 PD per month [95% CI, 4.9-56.3]; P=.02) but with ongoing education this trend reversed. Intervention was associated with a decrease in hospital-acquired CDI (incidence rate ratio, 0.57 [95% CI, 0.35-0.92]; P=.02). CONCLUSION Antimicrobial stewardship using an electronic medical record via remote access led to a significant decrease in antibacterial usage and a decrease in CDI rates.

  6. Ascertaining Problems with Medication Histories

    PubMed Central

    Halapy, Henry; Kertland, Heather

    2012-01-01

    Background: Accurate and complete medication histories are not always obtained in clinical practice. Objective: This qualitative research study was undertaken to explore the barriers to and facilitators of obtaining accurate medication histories. Methods: Individual interviews, based on a structured interview guide, were conducted with 25 patients from both inpatient and ambulatory care clinic settings. Focus groups, based on a semistructured interview guide, were conducted with pharmacists, medical residents, and nurses. Transcribed data were analyzed by forming coded units and assessing these units for emerging themes. Results: Major themes that emerged from the patient interviews included patient ownership of health and medication knowledge (with knowledge of medications and their side effects and how to take medications being seen as important), patient-specific strategies to improve medication histories (e.g., use of regularly updated medication lists), and suggestions for system-level facilitators to improve medication histories (e.g., centralized databases of medication histories, increased patient education regarding the use and purpose of medications). Major themes also emerged from focus groups with health care professionals, including shared responsibility for medication history-taking among all 3 health care professions, perceptions about the barriers to medication history-taking (including patients not knowing their medications and not bringing their medication lists), and suggestions to improve medication histories (e.g., educating patients to bring medication vials to hospital admissions and appointments, using a centralized computer database for medication histories). Conclusions: Key recommendations resulting from this study include using standardized documentation techniques for medication histories, recording of medication history information in centralized electronic databases, educating patients to bring medications to every health care visit

  7. Developing a sustainable electronic portfolio (ePortfolio) program that fosters reflective practice and incorporates CanMEDS competencies into the undergraduate medical curriculum.

    PubMed

    Hall, Pippa; Byszewski, Anna; Sutherland, Stephanie; Stodel, Emma J

    2012-06-01

    The University of Ottawa (uOttawa) Faculty of Medicine in 2008 launched a revised undergraduate medical education (UGME) curriculum that was based on the seven CanMEDS roles (medical expert, communicator, collaborator, health advocate, manager, scholar, and professional) and added an eighth role of person to incorporate the dimension of mindfulness and personal well-being. In this article, the authors describe the development of an electronic Portfolio (ePortfolio) program that enables uOttawa medical students to document their activities and to demonstrate their development of competence in each of the eight roles. The ePortfolio program supports reflective practice, an important component of professional competence, and provides a means for addressing the "hidden curriculum." It is bilingual, mandatory, and spans the four years of UGME. It includes both an online component for students to document their personal development and for student-coach dialogue, as well as twice-yearly, small-group meetings in which students engage in reflective discussions and learn to give and receive feedback.The authors reflect on the challenges they faced in the development and implementation of the ePortfolio program and share the lessons they have learned along the way to a successful and sustainable program. These lessons include switching from a complex information technology system to a user-friendly, Web-based blog platform; rethinking orientation sessions to ensure that faculty and students understand the value of the ePortfolio program; soliciting student input to improve the program and increase student buy-in; and providing faculty development opportunities and recognition.

  8. Shared care (comanagement).

    PubMed

    Montero Ruiz, E

    2016-01-01

    Surgical departments have increasing difficulties in caring for their hospitalised patients due to the patients' advanced age and comorbidity, the growing specialisation in medical training and the strong political-healthcare pressure that a healthcare organisation places on them, where surgical acts take precedence over other activities. The pressure exerted by these departments on the medical area and the deficient response by the interconsultation system have led to the development of a different healthcare organisation model: Shared care, which includes perioperative medicine. In this model, 2 different specialists share the responsibility and authority in caring for hospitalised surgical patients. Internal Medicine is the most appropriate specialty for shared care. Internists who exercise this responsibility should have certain characteristics and must overcome a number of concerns from the surgeon and anaesthesiologist.

  9. Cancer patients' attitudes and experiences of online access to their electronic medical records: A qualitative study.

    PubMed

    Rexhepi, Hanife; Åhlfeldt, Rose-Mharie; Cajander, Åsa; Huvila, Isto

    2016-07-19

    Patients' access to their online medical records serves as one of the cornerstones in the efforts to increase patient engagement and improve healthcare outcomes. The aim of this article is to provide in-depth understanding of cancer patients' attitudes and experiences of online medical records, as well as an increased understanding of the complexities of developing and launching e-Health services. The study result confirms that online access can help patients prepare for doctor visits and to understand their medical issues. In contrast to the fears of many physicians, the study shows that online access to medical records did not generate substantial anxiety, concerns or increased phone calls to the hospital.

  10. MEDICAL "DEPRIVATION."

    ERIC Educational Resources Information Center

    SUCHMAN, EDWARD A.

    THE SOCIAL AND MEDICAL PROBLEM TODAY HAS SHIFTED FROM PROVIDING FOR THE EMERGENCY MEDICAL NEEDS OF THE INDIGENT SICK TO RAISING THE LEVEL OF LOWER CLASS PARTICIPATION IN THE BENEFITS OF MODERN MEDICINE. GREATER ATTENTION IS BEING FOCUSED ON MEDICAL DEPRIVATION SUFFERED BY LARGE SEGMENTS OF THE POPULATION WHO DO NOT SHARE EQUALLY IN MEDICAL…

  11. A simulated hospital pharmacy module using an electronic medical record in a pharmaceutical care skills laboratory course.

    PubMed

    Kirwin, Jennifer L; DiVall, Margarita V; Guerra, Christina; Brown, Todd

    2013-04-12

    OBJECTIVES. To implement and evaluate the effects of a simulated hospital pharmacy module using an electronic medical record on student confidence and abilities to perform hospital pharmacist duties. DESIGN. A module was developed that simulated typical hospital pharmacist tasks. Learning activities were modified based upon student feedback and instructor assessment. ASSESSMENTS. Ninety-seven percent of respondents reported full-time hospital internship experience and 72% had electronic medical record experience prior to completing the module. Mean scores on confidence with performing typical hospital pharmacist tasks significantly increased from the pre-module survey to the post-module survey from 1.5-2.9 (low comfort/confidence) to 2.0-3.4 (moderate comfort/confidence). Course assessments confirmed student achievement of covered competencies. CONCLUSIONS. A simulated hospital pharmacy module improved pharmacy students' hospital practice skills and their perceived comfort and confidence in completing the typical duties of a hospital pharmacist.

  12. Electronic medical records and the transgender patient: recommendations from the World Professional Association for Transgender Health EMR Working Group.

    PubMed

    Deutsch, Madeline B; Green, Jamison; Keatley, JoAnne; Mayer, Gal; Hastings, Jennifer; Hall, Alexandra M

    2013-01-01

    Transgender patients have particular needs with respect to demographic information and health records; specifically, transgender patients may have a chosen name and gender identity that differs from their current legally designated name and sex. Additionally, sex-specific health information, for example, a man with a cervix or a woman with a prostate, requires special attention in electronic health record (EHR) systems. The World Professional Association for Transgender Health (WPATH) is an international multidisciplinary professional association that publishes recognized standards for the care of transgender and gender variant persons. In September 2011, the WPATH Executive Committee convened an Electronic Medical Records Working Group comprised of both expert clinicians and medical information technology specialists, to make recommendations for developers, vendors, and users of EHR systems with respect to transgender patients. These recommendations and supporting rationale are presented here.

  13. The right mix to support electronic medical record training: classroom computer-based training and blended learning.

    PubMed

    McCain, Christina L

    2008-01-01

    Staff development plays a crucial role in supporting clinicians to adapt to the ever changing technological advances in the healthcare setting. The quest to support staff in the implementation and ongoing optimization of an electronic medical record (EMR) led these staff development educators to computer based training and a blended learning approach building upon the traditional anchor of classroom learning and the advantages of computer-based training.

  14. Shared Attention.

    PubMed

    Shteynberg, Garriy

    2015-09-01

    Shared attention is extremely common. In stadiums, public squares, and private living rooms, people attend to the world with others. Humans do so across all sensory modalities-sharing the sights, sounds, tastes, smells, and textures of everyday life with one another. The potential for attending with others has grown considerably with the emergence of mass media technologies, which allow for the sharing of attention in the absence of physical co-presence. In the last several years, studies have begun to outline the conditions under which attending together is consequential for human memory, motivation, judgment, emotion, and behavior. Here, I advance a psychological theory of shared attention, defining its properties as a mental state and outlining its cognitive, affective, and behavioral consequences. I review empirical findings that are uniquely predicted by shared-attention theory and discuss the possibility of integrating shared-attention, social-facilitation, and social-loafing perspectives. Finally, I reflect on what shared-attention theory implies for living in the digital world.

  15. Medical terminology coding systems and medicolegal death investigation data: searching for a standardized method of electronic coding at a statewide medical examiner's office.

    PubMed

    Lathrop, Sarah L; Davis, Wayland L; Nolte, Kurt B

    2009-01-01

    Medical examiner and coroner reports are a rich source of data for epidemiologic research. To maximize the utility of this information, medicolegal death investigation data need to be electronically coded. In order to determine the best option for coding, we evaluated four different options (Current Procedural Terminology [CPT], International Classification of Disease [ICD] coding, Systematized Nomenclature of Medicine Clinical Terms [SNOMED CT], and an in-house system), then conducted internal and external needs assessments to determine which system best met the needs of a centralized, statewide medical examiner's office. Although all four systems offer distinct advantages and disadvantages, SNOMED CT is the most accurate for coding pathologic diagnoses, with ICD-10 the best option for classifying the cause of death. For New Mexico's Office of the Medical Investigator, the most feasible coding option is an upgrade of an in-house coding system, followed by linkage to ICD codes for cause of death from the New Mexico Bureau of Vital Records and Health Statistics, and ideally, SNOMED classification of pathologic diagnoses.

  16. Sharing code

    PubMed Central

    Kubilius, Jonas

    2014-01-01

    Sharing code is becoming increasingly important in the wake of Open Science. In this review I describe and compare two popular code-sharing utilities, GitHub and Open Science Framework (OSF). GitHub is a mature, industry-standard tool but lacks focus towards researchers. In comparison, OSF offers a one-stop solution for researchers but a lot of functionality is still under development. I conclude by listing alternative lesser-known tools for code and materials sharing. PMID:25165519

  17. ePhenotyping for Abdominal Aortic Aneurysm in the Electronic Medical Records and Genomics (eMERGE) Network: Algorithm Development and Konstanz Information Miner Workflow

    PubMed Central

    Borthwick, Kenneth M; Smelser, Diane T; Bock, Jonathan A; Elmore, James R; Ryer, Evan J; Ye, Zi; Pacheco, Jennifer A.; Carrell, David S.; Michalkiewicz, Michael; Thompson, William K; Pathak, Jyotishman; Bielinski, Suzette J; Denny, Joshua C; Linneman, James G; Peissig, Peggy L; Kho, Abel N; Gottesman, Omri; Parmar, Harpreet; Kullo, Iftikhar J; McCarty, Catherine A; Böttinger, Erwin P; Larson, Eric B; Jarvik, Gail P; Harley, John B; Bajwa, Tanvir; Franklin, David P; Carey, David J; Kuivaniemi, Helena; Tromp, Gerard

    2015-01-01

    Background and objective We designed an algorithm to identify abdominal aortic aneurysm cases and controls from electronic health records to be shared and executed within the “electronic Medical Records and Genomics” (eMERGE) Network. Materials and methods Structured Query Language, was used to script the algorithm utilizing “Current Procedural Terminology” and “International Classification of Diseases” codes, with demographic and encounter data to classify individuals as case, control, or excluded. The algorithm was validated using blinded manual chart review at three eMERGE Network sites and one non-eMERGE Network site. Validation comprised evaluation of an equal number of predicted cases and controls selected at random from the algorithm predictions. After validation at the three eMERGE Network sites, the remaining eMERGE Network sites performed verification only. Finally, the algorithm was implemented as a workflow in the Konstanz Information Miner, which represented the logic graphically while retaining intermediate data for inspection at each node. The algorithm was configured to be independent of specific access to data and was exportable (without data) to other sites. Results The algorithm demonstrated positive predictive values (PPV) of 92.8% (CI: 86.8-96.7) and 100% (CI: 97.0-100) for cases and controls, respectively. It performed well also outside the eMERGE Network. Implementation of the transportable executable algorithm as a Konstanz Information Miner workflow required much less effort than implementation from pseudo code, and ensured that the logic was as intended. Discussion and conclusion This ePhenotyping algorithm identifies abdominal aortic aneurysm cases and controls from the electronic health record with high case and control PPV necessary for research purposes, can be disseminated easily, and applied to high-throughput genetic and other studies. PMID:27054044

  18. Mobile Electronic Medical Records Promote Workflow: Physicians’ Perspective From a Survey

    PubMed Central

    Schmidt, Sein; Hupperts, Hagen; Brandt, Stephan A

    2016-01-01

    Background As a result of demographic changes, physicians are required to deliver needed services with limited resources. Research suggests that tablet PCs with access to patient data may streamline clinical workflow. A recent study found tablets with mobile electronic medical records (EMRs) can facilitate data retrieval and produce time savings across the clinical routine within hospital settings. However, the reasons for these time savings, including details on how tablets were being used, remain unclear. The same applies to physicians’ perceptions of this tool within an inpatient setting. Objective This study examined physicians’ perception of tablets with EMRs in an inpatient setting. The rationale was to identify both subjective and objective factors that impacted the successful implementation and use of tablets running an EMR. Methods We developed a 57-item survey questionnaire designed to examine users’ perception of and attitude toward tablets, which was administered to 14 participating physicians following 7 weeks of tablet use. Five participants volunteered to participate in a second study that investigated physicians’ patterns of tablet use within the EMR environment by digitally tracking and storing usage behavior. Statistical analyses of questionnaire results included mean values with their bootstrapped 95% confidence intervals and multivariate analysis of variance to identify predictors of tablet use. Results Physicians reported high degrees of satisfaction with the tablets. There was a general consensus among physicians that tablet use streamlined clinical workflow through optimized data retrieval (rated 0.69, 0.23-1.15 points better than control) and improved communication with patients and other physicians (rated 0.85, 0.54-1.15 and 0.77, 0.38-1.15 points better than control, respectively). Age (F3,11=3.54, P=.04), occupational group (F1,11=7.17, P=.04), and attitude toward novel technologies (F1,11=10.54, P=.02) predicted physicians

  19. Risk stratification using data from electronic medical records better predicts suicide risks than clinician assessments

    PubMed Central

    2014-01-01

    Background To date, our ability to accurately identify patients at high risk from suicidal behaviour, and thus to target interventions, has been fairly limited. This study examined a large pool of factors that are potentially associated with suicide risk from the comprehensive electronic medical record (EMR) and to derive a predictive model for 1–6 month risk. Methods 7,399 patients undergoing suicide risk assessment were followed up for 180 days. The dataset was divided into a derivation and validation cohorts of 4,911 and 2,488 respectively. Clinicians used an 18-point checklist of known risk factors to divide patients into low, medium, or high risk. Their predictive ability was compared with a risk stratification model derived from the EMR data. The model was based on the continuation-ratio ordinal regression method coupled with lasso (which stands for least absolute shrinkage and selection operator). Results In the year prior to suicide assessment, 66.8% of patients attended the emergency department (ED) and 41.8% had at least one hospital admission. Administrative and demographic data, along with information on prior self-harm episodes, as well as mental and physical health diagnoses were predictive of high-risk suicidal behaviour. Clinicians using the 18-point checklist were relatively poor in predicting patients at high-risk in 3 months (AUC 0.58, 95% CIs: 0.50 – 0.66). The model derived EMR was superior (AUC 0.79, 95% CIs: 0.72 – 0.84). At specificity of 0.72 (95% CIs: 0.70-0.73) the EMR model had sensitivity of 0.70 (95% CIs: 0.56-0.83). Conclusion Predictive models applied to data from the EMR could improve risk stratification of patients presenting with potential suicidal behaviour. The predictive factors include known risks for suicide, but also other information relating to general health and health service utilisation. PMID:24628849

  20. Maternity patients' access to their electronic medical records: use and perspectives of a patient portal.

    PubMed

    Megan Forster, Megan; Dennison, Kerrie; Callen, Joanne; Andrew, Andrew; Westbrook, Johanna I

    2015-01-01

    Patients have been able to access clinical information from their paper-based health records for a number of years. With the advent of Electronic Medical Records (EMRs) access to this information can now be achieved online using a secure electronic patient portal. The purpose of this study was to investigate maternity patients' use and perceptions of a patient portal developed at the Mater Mothers' Hospital in Brisbane, Australia. A web-based patient portal, one of the first developed and deployed in Australia, was introduced on 26 June 2012. The portal was designed for maternity patients booked at Mater Mothers' Hospital, as an alternative to the paper-based Pregnancy Health Record. Through the portal, maternity patients are able to complete their hospital registration form online and obtain current health information about their pregnancy (via their EMR), as well as access a variety of support tools to use during their pregnancy such as tailored public health advice. A retrospective cross-sectional study design was employed. Usage statistics were extracted from the system for a one year period (1 July 2012 to 30 June 2013). Patients' perceptions of the portal were obtained using an online survey, accessible by maternity patients for two weeks in February 2013 (n=80). Descriptive statistics were employed to analyse the data. Between July 2012 and June 2013, 10,892 maternity patients were offered a patient portal account and access to their EMR. Of those 6,518 created one (60%; 6,518/10,892) and 3,104 went on to request access to their EMR (48%; 3,104/6,518). Of these, 1,751 had their access application granted by 30 June 2013. The majority of maternity patients submitted registration forms online via the patient portal (56.7%). Patients could view their EMR multiple times: there were 671 views of the EMR, 2,781 views of appointment schedules and 135 birth preferences submitted via the EMR. Eighty survey responses were received from EMR account holders, (response

  1. Effectiveness of Electronic Reminders to Improve Medication Adherence in Tuberculosis Patients: A Cluster-Randomised Trial

    PubMed Central

    Liu, Xiaoqiu; Lewis, James J.; Zhang, Hui; Lu, Wei; Zhang, Shun; Zheng, Guilan; Bai, Liqiong; Li, Jun; Li, Xue; Chen, Hongguang; Liu, Mingming; Chen, Rong; Chi, Junying; Lu, Jian; Huan, Shitong; Cheng, Shiming; Wang, Lixia; Jiang, Shiwen; Chin, Daniel P.; Fielding, Katherine L.

    2015-01-01

    Background Mobile text messaging and medication monitors (medication monitor boxes) have the potential to improve adherence to tuberculosis (TB) treatment and reduce the need for directly observed treatment (DOT), but to our knowledge they have not been properly evaluated in TB patients. We assessed the effectiveness of text messaging and medication monitors to improve medication adherence in TB patients. Methods and Findings In a pragmatic cluster-randomised trial, 36 districts/counties (each with at least 300 active pulmonary TB patients registered in 2009) within the provinces of Heilongjiang, Jiangsu, Hunan, and Chongqing, China, were randomised using stratification and restriction to one of four case-management approaches in which patients received reminders via text messages, a medication monitor, combined, or neither (control). Patients in the intervention arms received reminders to take their drugs and reminders for monthly follow-up visits, and the managing doctor was recommended to switch patients with adherence problems to more intensive management or DOT. In all arms, patients took medications out of a medication monitor box, which recorded when the box was opened, but the box gave reminders only in the medication monitor and combined arms. Patients were followed up for 6 mo. The primary endpoint was the percentage of patient-months on TB treatment where at least 20% of doses were missed as measured by pill count and failure to open the medication monitor box. Secondary endpoints included additional adherence and standard treatment outcome measures. Interventions were not masked to study staff and patients. From 1 June 2011 to 7 March 2012, 4,292 new pulmonary TB patients were enrolled across the 36 clusters. A total of 119 patients (by arm: 33 control, 33 text messaging, 23 medication monitor, 30 combined) withdrew from the study in the first month because they were reassessed as not having TB by their managing doctor (61 patients) or were switched to

  2. FRR: fair remote retrieval of outsourced private medical records in electronic health networks.

    PubMed

    Wang, Huaqun; Wu, Qianhong; Qin, Bo; Domingo-Ferrer, Josep

    2014-08-01

    Cloud computing is emerging as the next-generation IT architecture. However, cloud computing also raises security and privacy concerns since the users have no physical control over the outsourced data. This paper focuses on fairly retrieving encrypted private medical records outsourced to remote untrusted cloud servers in the case of medical accidents and disputes. Our goal is to enable an independent committee to fairly recover the original private medical records so that medical investigation can be carried out in a convincing way. We achieve this goal with a fair remote retrieval (FRR) model in which either t investigation committee members cooperatively retrieve the original medical data or none of them can get any information on the medical records. We realize the first FRR scheme by exploiting fair multi-member key exchange and homomorphic privately verifiable tags. Based on the standard computational Diffie-Hellman (CDH) assumption, our scheme is provably secure in the random oracle model (ROM). A detailed performance analysis and experimental results show that our scheme is efficient in terms of communication and computation.

  3. The effectiveness of interventions using electronic reminders to improve adherence to chronic medication: a systematic review of the literature

    PubMed Central

    Linn, Annemiek J; van Weert, Julia C M; de Bakker, Dinny H; Bouvy, Marcel L; van Dijk, Liset

    2012-01-01

    Background Many patients experience difficulties in adhering to long-term treatment. Although patients' reasons for not being adherent are diverse, one of the most commonly reported barriers is forgetfulness. Reminding patients to take their medication may provide a solution. Electronic reminders (automatically sent reminders without personal contact between the healthcare provider and patient) are now increasingly being used in the effort to improve adherence. Objective To examine the effectiveness of interventions using electronic reminders in improving patients' adherence to chronic medication. Methods A comprehensive literature search was conducted in PubMed, Embase, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials. Electronic searches were supplemented by manual searching of reference lists and reviews. Two reviewers independently screened all citations. Full text was obtained from selected citations and screened for final inclusion. The methodological quality of studies was assessed. Results Thirteen studies met the inclusion criteria. Four studies evaluated short message service (SMS) reminders, seven audiovisual reminders from electronic reminder devices (ERD), and two pager messages. Best evidence synthesis revealed evidence for the effectiveness of electronic reminders, provided by eight (four high, four low quality) studies showing significant effects on patients' adherence, seven of which measured short-term effects (follow-up period <6 months). Improved adherence was found in all but one study using SMS reminders, four studies using ERD and one pager intervention. In addition, one high quality study using an ERD found subgroup effects. Conclusion This review provides evidence for the short-term effectiveness of electronic reminders, especially SMS reminders. However, long-term effects remain unclear. PMID:22534082

  4. Salicylate 5-Hydroxylase from Ralstonia sp. Strain U2: a Monooxygenase with Close Relationships to and Shared Electron Transport Proteins with Naphthalene Dioxygenase

    PubMed Central

    Zhou, Ning-Yi; Al-Dulayymi, Jumáa; Baird, Mark S.; Williams, Peter A.

    2002-01-01

    The genes from the oxygenase cluster nagAaGHAbAcAd of naphthalene-degrading Ralstonia sp. strain U2 were cloned and overexpressed. Salicylate 5-hydroxylase (S5H) activity, converting salicylate to gentisate, was present in vitro only in the single extract of cells with overexpressed nagAaGHAb or in a mixture of three cell extracts containing, respectively, NagGH (the oxygenase components), NagAa (ferredoxin reductase), and NagAb (ferredoxin). Each of the three extracts required for S5H activity was rate limiting in the presence of excess of the others but, when in excess, did not affect the rate of catalysis. S5H catalyzed the 5-hydroxylation of the aromatic rings of 3- and 4-substituted salicylates. However, the methyl group of 5-methylsalicylate was hydroxylated to produce the 5-hydroxymethyl derivative and the 6-position on the ring of 5-chlorosalicylate was hydroxylated, producing 5-chloro-2,6-dihydroxybenzoate. In an assay for the nag naphthalene dioxygenase (NDO) based on the indole-linked oxidation of NADH, three extracts were essential for activity (NagAcAd, NagAa, and NagAb). NDO and S5H were assayed in the presence of all possible combinations of the nag proteins and the corresponding nah NDO proteins from the “classical” naphthalene degrader P. putida NCIMB9816. All three oxygenase components functioned with mixed combinations of the electron transport proteins from either strain. The S5H from strain U2 is a unique monooxygenase which shares sequence similarity with dioxygenases such as NDO but is also sufficiently similar in structure to interact with the same electron transport chain and probably does so in vivo during naphthalene catabolism in strain U2. PMID:11872705

  5. Can't get no satisfaction? Will pay for performance help?: toward an economic framework for understanding performance-based risk-sharing agreements for innovative medical products.

    PubMed

    Towse, Adrian; Garrison, Louis P

    2010-01-01

    This article examines performance-based risk-sharing agreements for pharmaceuticals from a theoretical economic perspective. We position these agreements as a form of coverage with evidence development. New performance-based risk sharing could produce a more efficient market equilibrium, achieved by adjustment of the price post-launch to reflect outcomes combined with a new approach to the post-launch costs of evidence collection. For this to happen, the party best able to manage or to bear specific risks must do so. Willingness to bear risk will depend not only on ability to manage it, but on the degree of risk aversion. We identify three related frameworks that provide relevant insights: value of information, real option theory and money-back guarantees. We identify four categories of risk sharing: budget impact, price discounting, outcomes uncertainty and subgroup uncertainty. We conclude that a value of information/real option framework is likely to be the most helpful approach for understanding the costs and benefits of risk sharing. There are a number of factors that are likely to be crucial in determining if performance-based or risk-sharing agreements are efficient and likely to become more important in the future: (i) the cost and practicality of post-launch evidence collection relative to pre-launch; (ii) the feasibility of coverage with evidence development without a pre-agreed contract as to how the evidence will be used to adjust price, revenues or use, in which uncertainty around the pay-off to additional research will reduce the incentive for the manufacturer to collect the information; (iii) the difficulty of writing and policing risk-sharing agreements; (iv) the degree of risk aversion (and therefore opportunity to trade) on the part of payers and manufacturers; and (v) the extent of transferability of data from one country setting to another to support coverage with evidence development in a risk-sharing framework. There is no doubt that

  6. Electron linac for medical isotope production with improved energy efficiency and isotope recovery

    DOEpatents

    Noonan, John; Walters, Dean; Virgo, Matt; Lewellen, John

    2015-09-08

    A method and isotope linac system are provided for producing radio-isotopes and for recovering isotopes. The isotope linac is an energy recovery linac (ERL) with an electron beam being transmitted through an isotope-producing target. The electron beam energy is recollected and re-injected into an accelerating structure. The ERL provides improved efficiency with reduced power requirements and provides improved thermal management of an isotope target and an electron-to-x-ray converter.

  7. Medication Use during Pregnancy

    MedlinePlus

    ... What's this? Submit Button Past Emails CDC Features Medication Use During Pregnancy Recommend on Facebook Tweet Share ... are taking only medications that are necessary. What Medications Can Cause Birth Defects? We know that taking ...

  8. Dwight D. Eisenhower Army Medical Center (DDEAMC) Staff Preferences: Electronic Journals versus Print Journals

    DTIC Science & Technology

    2003-04-01

    Biomedical Library Journal Preferences 26 investigated the impact of electronic journals on research processes. The results of this research indicated... Library Journal Preferences 28 reported that health science researchers valued the convenience and time-saving features of electronic journals including 24...Health Science Library (2001). Health Science Library Journal List [Brochure]. Fort Gordon, Georgia: Author. Department of Defense (2002). Department

  9. Use of single scatter electron monte carlo transport for medical radiation sciences

    DOEpatents

    Svatos, Michelle M.

    2001-01-01

    The single scatter Monte Carlo code CREEP models precise microscopic interactions of electrons with matter to enhance physical understanding of radiation sciences. It is designed to simulate electrons in any medium, including materials important for biological studies. It simulates each interaction individually by sampling from a library which contains accurate information over a broad range of energies.

  10. Tablet computers with mobile electronic medical records enhance clinical routine and promote bedside time: a controlled prospective crossover study.

    PubMed

    Fleischmann, Robert; Duhm, Julian; Hupperts, Hagen; Brandt, Stephan A

    2015-03-01

    Demographic changes require physicians to deliver needed services with fewer resources. Neurology as an interdisciplinary domain involves complex diagnostic procedures and time-consuming data handling. Tablet PCs might streamline clinical workflow through mobile access to patient data. This study examined the impact of tablets running an electronic medical record on ward round performance. We hypothesised that tablet use should reduce ward round time and decrease the time needed to check medical records thereby increasing physicians' bedside availability. Nine resident neurologists participated in a controlled prospective crossover trial over 14 weeks. In the experimental condition, tablets were used in addition to the established medical record. In the control condition, physicians used established systems only. The combined primary outcome measure included changes in total ward round time and relative time shifts between associated work processes. The secondary outcome measure was physicians' time required to check a medical record vs. physicians' bedside time. There was a significant main effect on the primary outcome measure (p = 0.01). Tablet use accelerated preparing (p = 0.004) and post-processing (p < 0.001) of ward rounds. Time for conducting ward rounds was unaffected (p = 0.19). Checking medical records was faster with tablets (p = 0.001) increasing physicians' bedside time (p < 0.001). Tablet use led to significant time savings during preparing and post-processing of ward rounds. It was further associated with time savings during checking medical data and an increase in physicians' bedside time. Tablets may facilitate clinical data handling and promote workflow.

  11. Assessment of risks of EMI for personal medical electronic devices (PMEDs) from emissions of millimeter-wave security screening systems

    NASA Astrophysics Data System (ADS)

    Witters, Donald; Bassen, Howard; Guag, Joshua; Addissie, Bisrat; LaSorte, Nickolas; Rafai, Hazem

    2013-06-01

    This paper describes research and testing of a representative group of high priority body worn and implantable personal medical electronic devices (PMEDs) for exposure to millimeter wave (MMW) advanced imaging technology (AIT) security systems used at airports. The sample PMEDs included in this study were implantable cardiac pacemakers, ICDs, neurostimulators and insulin pumps. These PMEDs are designed and tested for susceptibility to electromagnetic interference (EMI) under the present standards for medical device electromagnetic compatibility (EMC). However, the present standards for medical equipment do not address exposure to the much higher frequency fields that are emitted by MMW security systems. Initial AIT emissions measurements were performed to assess the PMED and passenger exposures. Testing protocols were developed and testing methods were tailored to the type of PMED. In addition, a novel exposure simulation system was developed to allow controlled EMC testing without the need of the MMW AIT system. Methodology, test results, and analysis are presented, along with an assessment of the human exposure and risks for PMED users. The results on this study reveal no effects on the medical devices from the exposure to the MMW security system. Furthermore, the human exposure measurements and analysis showed levels well below applicable standard, and the risks for PMED users and others we assessed to be very low. These findings apply to the types of PMEDs used in the study though these findings might suggest that the risks for other, similar PMEDs would likely be similar.

  12. Predictive modeling of colorectal cancer using a dedicated pre-processing pipeline on routine electronic medical records.

    PubMed

    Kop, Reinier; Hoogendoorn, Mark; Teije, Annette Ten; Büchner, Frederike L; Slottje, Pauline; Moons, Leon M G; Numans, Mattijs E

    2016-09-01

    Over the past years, research utilizing routine care data extracted from Electronic Medical Records (EMRs) has increased tremendously. Yet there are no straightforward, standardized strategies for pre-processing these data. We propose a dedicated medical pre-processing pipeline aimed at taking on many problems and opportunities contained within EMR data, such as their temporal, inaccurate and incomplete nature. The pipeline is demonstrated on a dataset of routinely recorded data in general practice EMRs of over 260,000 patients, in which the occurrence of colorectal cancer (CRC) is predicted using various machine learning techniques (i.e., CART, LR, RF) and subsets of the data. CRC is a common type of cancer, of which early detection has proven to be important yet challenging. The results are threefold. First, the predictive models generated using our pipeline reconfirmed known predictors and identified new, medically plausible, predictors derived from the cardiovascular and metabolic disease domain, validating the pipeline's effectiveness. Second, the difference between the best model generated by the data-driven subset (AUC 0.891) and the best model generated by the current state of the art hypothesis-driven subset (AUC 0.864) is statistically significant at the 95% confidence interval level. Third, the pipeline itself is highly generic and independent of the specific disease targeted and the EMR used. In conclusion, the application of established machine learning techniques in combination with the proposed pipeline on EMRs has great potential to enhance disease prediction, and hence early detection and intervention in medical practice.

  13. Cognitive performance-altering effects of electronic medical records: An application of the human factors paradigm for patient safety

    PubMed Central

    Holden, Richard J.

    2010-01-01

    According to the human factors paradigm for patient safety, health care work systems and innovations such as electronic medical records do not have direct effects on patient safety. Instead, their effects are contingent on how the clinical work system, whether computerized or not, shapes health care providers' performance of cognitive work processes. An application of the human factors paradigm to interview data from two hospitals in the Midwest United States yielded numerous examples of the performance-altering effects of electronic medical records, electronic clinical documentation, and computerized provider order entry. Findings describe both improvements and decrements in the ease and quality of cognitive performance, both for interviewed clinicians and for their colleagues and patients. Changes in cognitive performance appear to have desirable and undesirable implications for patient safety as well as for quality of care and other important outcomes. Cognitive performance can also be traced to interactions between work system elements, including new technology, allowing for the discovery of problems with “fit” to be addressed through design interventions. PMID:21479125

  14. Photo-induced regeneration of hormones by electron transfer processes: Potential biological and medical consequences

    NASA Astrophysics Data System (ADS)

    Getoff, Nikola; Hartmann, Johannes; Schittl, Heike; Gerschpacher, Marion; Quint, Ruth Maria

    2011-08-01

    Based on the previous results concerning electron transfer processes in biological substances, it was of interest to investigate if hormone transients resulting by e.g. electron emission can be regenerated. The presented results prove for the first time that the hormone transients originating by the electron emission process can be successfully regenerated by the transfer of electrons from a potent electron donor, such as vitamin C (VitC). Investigations were performed using progesterone (PRG), testosterone (TES) and estrone (E1) as representatives of hormones. By irradiation with monochromatic UV light (λ=254 nm) in a media of 40% water and 60% ethanol, the degradation as well as the regeneration of the hormones was studied with each hormone individually and in the mixture with VitC as a function of the absorbed UV dose, using HPLC. Calculated from the obtained initial yields, the determined regeneration of PRG amounted to 52.7%, for TES to 58.6% and for E1 to 90.9%. The consumption of VitC was determined in the same way. The reported results concerning the regeneration of hormones by the transfer of electrons from an electron donor offer a new, promising method for the therapy with hormones. As a consequence of the regeneration of hormones, a decreased formation of carcinogenic metabolites is expected.

  15. Use of personal computers, electronic medical records and availability of Internet among office based GPs and internists in Austrian province of Styria.

    PubMed

    Rakovac, Ivo; Seereiner, Sabine; Ratz, Birgit; Habacher, Wolfgang; Pieber, Thomas R; Beck, Peter

    2008-11-06

    We conducted a survey of personal computer (PC), electronic medical record (EMR) usage, and Internet accessibility among Austrian office based general practitioners and internists. PCs were available to 97% of responders, and among PC users, 91% used EMRs.

  16. CliniViewer: a tool for viewing electronic medical records based on natural language processing and XML.

    PubMed

    Liu, Hongfang; Friedman, Carol

    2004-01-01

    With the evolving use of computers in healthcare, the electronic medical record (EMR) is becoming more and more popular. A tool is needed that would enable physicians to accurately and efficiently access clinical information in multiple medical records associated with a particular patient. Both natural language processing (NLP) and the eXtensible Markup Language (XML) have been used in the clinical domain for capturing, representing, and utilizing clinical information and both have shown great potential. In this paper, we demonstrate another use of XML and NLP through CliniViewer, a tool that organizes and presents the clinical information in multiple records. We also describe the flexibility and capability provided when combining XML and NLP to summarize, navigate, and conceptualize structured information. The tool has been fully implemented and tested using patients with multiple discharge summaries.

  17. Evaluating the impact and costs of deploying an electronic medical record system to support TB treatment in Peru

    PubMed Central

    Fraser, Hamish SF; Blaya, Joaquin; Choi, Sharon S; Bonilla, Cesar; Jazayeri, Darius

    2006-01-01

    The PIH-EMR is a Web based electronic medical record that has been in operation for over four years in Peru supporting the treatment of drug resistant TB. We describe here the types of evaluations that have been performed on the EMR to assess its impact on patient care, reporting, logistics and observational research. Formal studies have been performed on components for drug order entry, drug requirements prediction tools and the use of PDAs to collect bacteriology data. In addition less formal data on the use of the EMR for reporting and research are reviewed. Experience and insights from porting the PIH-EMR to the Philippines, and modifying it to support HIV treatment in Haiti and Rwanda are discussed. We propose that additional data of this sort is valuable in assessing medical information systems especially in resource poor areas. PMID:17238344

  18. A quality improvement study using fishbone analysis and an electronic medical records intervention to improve care for children with asthma.

    PubMed

    Gold, Jonathan; Reyes-Gastelum, David; Turner, Jane; Davies, H Dele

    2014-01-01

    Despite expert guidelines, gaps persist in quality of care for children with asthma. This study sought to identify barriers and potential interventions to improve compliance to national asthma prevention guidelines at a single academic pediatric primary care clinic. Using the plan-do-check-act (PDCA) quality improvement framework and fishbone analysis, several barriers to consistent asthma processes and possible interventions were identified by a group of key stakeholders. Two interventions were implemented using the electronic medical record (EMR). Physician documentation of asthma quality measures were analyzed before intervention and during 2 subsequent time points over 16 months. Documentation of asthma action plans (core group P < .001, noncore group P = .004) and medication counseling (core group P < .001, noncore group P < .001) improved substantially by the third time point. A systematic approach to quality improvement using PDCA and fishbone analysis in conjunction with embedded EMR tools can improve asthma care in a pediatric primary care setting.

  19. Development and Evaluation of an Interactive Electronic Laboratory Manual for Cooperative Learning of Medical Histology

    ERIC Educational Resources Information Center

    Khalil, Mohammed K.; Kirkley, Debbie L.; Kibble, Jonathan D.

    2013-01-01

    This article describes the development of an interactive computer-based laboratory manual, created to facilitate the teaching and learning of medical histology. The overarching goal of developing the manual is to facilitate self-directed group interactivities that actively engage students during laboratory sessions. The design of the manual…

  20. Architectural Choices and Challenges of Integrating Electronic Patient Questionnaires into the Electronic Medical Record to Support Patient-Centered Care

    PubMed Central

    Moore, Barbara J; Gaehde, Stephan; Curtis, Clayton

    2008-01-01

    Strategies to deliver guideline-concordant, patient-centered care during office visits sometimes impose conflicting demands on clinicians. One way to help relieve time-constrained visits and to improve the patient-centeredness of care may be through patients electronically self-reporting data that flow automatically into an EMR note for clinician confirmation or editing, relieving physicians of some data entry and rote history-gathering tasks, thus freeing up time to allow clinicians to focus on significant issues and patient concerns while also increasing the likelihood that necessary data are gathered and available for decision-making. We developed a prototype to enable such data gathering and integration into the EMR. The lack of consistent provision of interfaces by vendors for sending data into EMRs and the idiosyncrasies of any particular EMR in the context of a particular organization’s IT infrastructure and policies pose architectural choices and challenges that healthcare organizations embarking on such IT projects may need to consider. PMID:18999024

  1. Linking electronic medical records to large-scale simulation models: can we put rapid learning on turbo?

    PubMed

    Eddy, David M

    2007-01-01

    One method for rapid learning is to use data from electronic medical records (EMRs) to help build and validate large-scale, physiology-based simulation models. These models can than be used to help answer questions that cannot be addressed directly from the EMR data. Their potential uses include analyses of physiological pathways; simulation and design of clinical trials; and analyses of clinical management tools such as guidelines, performance measures, priority setting, and cost-effectiveness. Linking the models to EMR data also facilitates tailoring analyses to specific populations. The models' power and accuracy can be improved by linkage to comprehensive, person-specific, longitudinal data from EMRs.

  2. Technology Mediated Information Sharing (Monitor Sharing) in Primary Care Encounters

    ERIC Educational Resources Information Center

    Asan, Onur

    2013-01-01

    The aim of this dissertation study was to identify and describe the use of electronic health records (EHRs) for information sharing between patients and clinicians in primary-care encounters and to understand work system factors influencing information sharing. Ultimately, this will promote better design of EHR technologies and effective training…

  3. Radioactive isotope production for medical applications using Kharkov electron driven subcritical assembly facility.

    SciTech Connect

    Talamo, A.; Gohar, Y.; Nuclear Engineering Division

    2007-05-15

    Kharkov Institute of Physics and Technology (KIPT) of Ukraine has a plan to construct an accelerator driven subcritical assembly. The main functions of the subcritical assembly are the medical isotope production, neutron thereby, and the support of the Ukraine nuclear industry. Reactor physics experiments and material research will be carried out using the capabilities of this facility. The United States of America and Ukraine have started collaboration activity for developing a conceptual design for this facility with low enrichment uranium (LEU) fuel. Different conceptual designs are being developed based on the facility mission and the engineering requirements including nuclear physics, neutronics, heat transfer, thermal hydraulics, structure, and material issues. Different fuel designs with LEU and reflector materials are considered in the design process. Safety, reliability, and environmental considerations are included in the facility conceptual design. The facility is configured to accommodate future design improvements and upgrades. This report is a part of the Argonne National Laboratory Activity within this collaboration for developing and characterizing the subcritical assembly conceptual design. In this study, the medical isotope production function of the Kharkov facility is defined. First, a review was carried out to identify the medical isotopes and its medical use. Then a preliminary assessment was performed without including the self-shielding effect of the irradiated samples. Finally, more detailed investigation was carried out including the self-shielding effect, which defined the sample size and irradiation location for producing each medical isotope. In the first part, the reaction rates were calculated as the multiplication of the cross section with the unperturbed neutron flux of the facility. Over fifty isotopes were considered and all transmutation channels are used including (n,{gamma}), (n,2n), (n,p), and ({gamma},n). In the second part

  4. Electronic medical records and genomics (eMERGE) network exploration in cataract: Several new potential susceptibility loci

    PubMed Central

    Verma, Shefali S.; Hall, Molly A.; Goodloe, Robert J.; Berg, Richard L.; Carrell, Dave S.; Carlson, Christopher S.; Chen, Lin; Crosslin, David R.; Denny, Joshua C.; Jarvik, Gail; Li, Rongling; Linneman, James G.; Pathak, Jyoti; Peissig, Peggy; Rasmussen, Luke V.; Ramirez, Andrea H.; Wang, Xiaoming; Wilke, Russell A.; Wolf, Wendy A.; Torstenson, Eric S.; Turner, Stephen D.; McCarty, Catherine A.

    2014-01-01

    Purpose Cataract is the leading cause of blindness in the world, and in the United States accounts for approximately 60% of Medicare costs related to vision. The purpose of this study was to identify genetic markers for age-related cataract through a genome-wide association study (GWAS). Methods In the electronic medical records and genomics (eMERGE) network, we ran an electronic phenotyping algorithm on individuals in each of five sites with electronic medical records linked to DNA biobanks. We performed a GWAS using 530,101 SNPs from the Illumina 660W-Quad in a total of 7,397 individuals (5,503 cases and 1,894 controls). We also performed an age-at-diagnosis case-only analysis. Results We identified several statistically significant associations with age-related cataract (45 SNPs) as well as age at diagnosis (44 SNPs). The 45 SNPs associated with cataract at p<1×10−5 are in several interesting genes, including ALDOB, MAP3K1, and MEF2C. All have potential biologic relationships with cataracts. Conclusions This is the first genome-wide association study of age-related cataract, and several regions of interest have been identified. The eMERGE network has pioneered the exploration of genomic associations in biobanks linked to electronic health records, and this study is another example of the utility of such resources. Explorations of age-related cataract including validation and replication of the association results identified herein are needed in future studies. PMID:25352737

  5. Accessing to electronic medical history using a mobility intra hospital system.

    PubMed

    Guillén, Sergio; Traver, Vicente; Monton, Eduardo; Castellano, Elena; Valdivieso, Bernardo; Valero, Manuel Regaña

    2011-01-01

    The aim of this paper is to describe the solution that has been developed in Valencia Region (Spain) to provide health professionals (physicians and nurses) access to all the functionalities of a Hospital Information System (HIS) already available at fixed clients workstations. These functionalities are adapted to the care process carried out at patient bedside. In this way, professionals will have access to treatment and administration, recording of vital signs, nursing assessment, scales, care plan, extractions, medical records, progress notes so that they have all necessary information at the bedside, and record swiftly changes that occur in-situ. In addition, clinical safety is reinforced, including RFID patient identification mechanisms and barcode readers for blood samples or unidosis medication.

  6. BION microstimulators: a case study in the engineering of an electronic implantable medical device.

    PubMed

    Kane, Michael J; Breen, Paul P; Quondamatteo, Fabio; ÓLaighin, Gearóid

    2011-01-01

    The BION (Bionic Neuron) is a single channel implantable neurostimulator of unique design that can be delivered by injection. The development of the BION injectable neurostimulators exemplifies a challenging, but well posed medical design problem addressed with a successful strategy for prioritizing and resolving the biomedical and technological challenges. Though some performance requirements required post-evaluation revision, all fundamental goals were realized. A small number of significant design corrections occurred because the device requirements did not include the full scope of environmental demands. The design has spawned a number of variants optimized for diverse biomedical applications, and its clinical applications continue to evolve. The BION development history demonstrates design successes worth emulating and design pitfalls that may be avoidable for future medical device development teams. This paper serves as an introduction to the BION microstimulator technology and as an analysis of the design process used to develop the early clinical devices.

  7. Knowledge and use of electronic information resources by medical sciences faculty at The University of the West Indies

    PubMed Central

    Renwick, Shamin

    2005-01-01

    Objective: The objective was to determine faculty's knowledge of electronic resources, access to a computer, use of electronic resources (both number and frequency) available at the Medical Sciences Library (MSL), and the areas of training needed and to identify areas for further research. Methods: A survey was administered to faculty in medicine, pharmacy, dentistry, and veterinary sciences at The University of the West Indies. The questions covered computer literacy, computer access and location, knowledge and use of electronic resources, and training needs. Results: The response rate was 70%, of whom 97% were computer users. Seventy-three percent used computers daily, and 82% felt that their computer literacy level was average or beyond. Overall, it was found that faculty had high awareness of the electronic resources made available by the MSL but low use of MSL-specific resources supporting the suggested problem of underutilization. Many respondents felt that e-resources were important, and, though many felt that they were competent users, 83% were self-taught and many still expressed a need for training. Over 60% felt that a workshop with a hands-on component was the preferred format for training. It was recommended that there be greater promotion of the library's e-resources. PMID:15685270

  8. Improving sensitivity of machine learning methods for automated case identification from free-text electronic medical records

    PubMed Central

    2013-01-01

    Background Distinguishing cases from non-cases in free-text electronic medical records is an important initial step in observational epidemiological studies, but manual record validation is time-consuming and cumbersome. We compared different approaches to develop an automatic case identification system with high sensitivity to assist manual annotators. Methods We used four different machine-learning algorithms to build case identification systems for two data sets, one comprising hepatobiliary disease patients, the other acute renal failure patients. To improve the sensitivity of the systems, we varied the imbalance ratio between positive cases and negative cases using under- and over-sampling techniques, and applied cost-sensitive learning with various misclassification costs. Results For the hepatobiliary data set, we obtained a high sensitivity of 0.95 (on a par with manual annotators, as compared to 0.91 for a baseline classifier) with specificity 0.56. For the acute renal failure data set, sensitivity increased from 0.69 to 0.89, with specificity 0.59. Performance differences between the various machine-learning algorithms were not large. Classifiers performed best when trained on data sets with imbalance ratio below 10. Conclusions We were able to achieve high sensitivity with moderate specificity for automatic case identification on two data sets of electronic medical records. Such a high-sensitive case identification system can be used as a pre-filter to significantly reduce the burden of manual record validation. PMID:23452306

  9. [Knowledge, attitudes and opinions about conventional and electronic cigarette smoking among University of Pavia medical students (Italy)].

    PubMed

    Tettamanti, Glenda; Varetta, Alessia; Macchi, Marcello; Gallotti, Cristina; Laddomada, Maria Stella

    2016-01-01

    The aim of this study was to investigate attitudes and awareness about conventional and electronic cigarettes in a sample of students attending the Faculty of Medicine of Pavia University (Italy). An anonymous and self-reported questionnaire was administered to 226 students attending either the first or third years of medical school during the 2013 to 2014 school year. Participation was voluntary and required signing an informed consent form. The prevalence of smokers was 12%. Sixty-seven percent of smokers reported smoking less than 5 cigarettes/day, and 15% more than 10 cigarettes/day. Most smokers (63%) prefer packaged cigarettes and 33% handmade cigarettes; 86% began to smoke between the ages of 15 and 20 years and 45% were influenced by friends. Almost all the students are aware of electronic cigarettes but only one reported regularly using them. Prevalence of smokers and average number of cigarettes smoked per day were both found to be lower than that of the Italian population. Preference of packaged versus handmade cigarettes is the same as national data. E-cigarette use is lower than that reported in the Italian population. This study highlights the need for health education interventions aimed at medical students and family physicians.

  10. Characterization of a medical X-ray machine for testing the response of electronic dosimeters in pulsed radiation fields

    NASA Astrophysics Data System (ADS)

    Guimarães, Margarete C.; Da Silva, Teógenes A.

    2014-11-01

    Electronic personal dosimeters (EPD) based on solid state detectors have been used for personnel monitoring for radiation protection purpose; their use has been extended to practices with pulsed radiation beams although their performance is not well known. Deficiencies in the EPD response in pulsed radiation fields have been reported; they were not detected before since type tests and calibrations of EPDs were established in terms of continuous X and gamma reference radiations. An ISO working group was formed to elaborate a standard for test conditions and performance requirements of EPDs in pulsed beams; the PTB/Germany implemented a special X-ray facility for generating the reference pulsed radiation beams. In this work, an 800 Plus VMI medical X-ray machine of the Dosimeter Calibration Laboratory of CDTN/CNEN was characterized to verify its feasibility to perform EPD tests. Characterization of the x-ray beam was done in terms of practical peak voltage, half-value layer, mean energy and air kerma rate. Reference dosimeters used for air kerma measurements were verified as far their metrological coherence and a procedure for testing EDPs was established. Electronic personal dosimeters (EPD) have been used for personnel monitoring. EPD use has been extended to pulsed radiation beams. Deficiencies in the EPD response in pulsed beams have been reported. The feasibility of using a medical X-ray machine to perform EPD tests was studied. Reference dosimeters were verified and EPD testing procedure was established.

  11. Giving rheumatology patients online home access to their electronic medical record (EMR): advantages, drawbacks and preconditions according to care providers.

    PubMed

    van der Vaart, Rosalie; Drossaert, Constance H C; Taal, Erik; van de Laar, Mart A F J

    2013-09-01

    Technology enables patients home access to their electronic medical record (EMR), via a patient portal. This study aims to analyse (dis)advantages, preconditions and suitable content for this service, according to rheumatology health professionals. A two-phase policy Delphi study was conducted. First, interviews were performed with nurses/nurse practitioners (n = 9) and rheumatologists (n = 13). Subsequently, collected responses were quantified, using a questionnaire among the interviewees. The following advantages of patient home access to the EMR were reported: (1) enhancement of patient participation in treatment, (2) increased knowledge and self-management, (3) improved patient-provider interaction, (4) increased patient safety, and (5) better communication with others. Foreseen disadvantages of the service included: (1) problems with interpretation of data, (2) extra workload, (3) a change in consultation content, and (4) disturbing the patient-provider interaction. Also, the following preconditions emerged from the data: (1) optimal security, (2) no extra record, but a patient-accessible section, (3) no access to clinical notes, and (4) a lag time on the release of lab data. Most respondents reported that data on diagnosis, medication, treatment plan and consultations could be released to patients. On releasing more complex data, such as bodily examinations, lab results and radiological images the opinions differed considerably. Providing patients home access to their medical record might be a valuable next step into patient empowerment and in service towards the patient, provided that security is optimal and content and presentation of data are carefully considered.

  12. Development of a data-mining algorithm to identify ages at reproductive milestones in electronic medical records.

    PubMed

    Malinowski, Jennifer; Farber-Eger, Eric; Crawford, Dana C

    2014-01-01

    Electronic medical records (EMRs) are becoming more widely implemented following directives from the federal government and incentives for supplemental reimbursements for Medicare and Medicaid claims. Replete with rich phenotypic data, EMRs offer a unique opportunity for clinicians and researchers to identify potential research cohorts and perform epidemiologic studies. Notable limitations to the traditional epidemiologic study include cost, time to complete the study, and limited ancestral diversity; EMR-based epidemiologic studies offer an alternative. The Epidemiologic Architecture for Genes Linked to Environment (EAGLE) Study, as part of the Population Architecture using Genomics and Epidemiology (PAGE) I Study, has genotyped more than 15,000 patients of diverse ancestry in BioVU, the Vanderbilt University Medical Center's biorepository linked to the EMR (EAGLE BioVU). We report here the development and performance of data-mining techniques used to identify the age at menarche (AM) and age at menopause (AAM), important milestones in the reproductive lifespan, in women from EAGLE BioVU for genetic association studies. In addition, we demonstrate the ability to discriminate age at naturally-occurring menopause (ANM) from medically-induced menopause. Unusual timing of these events may indicate underlying pathologies and increased risk for some complex diseases and cancer; however, they are not consistently recorded in the EMR. Our algorithm offers a mechanism by which to extract these data for clinical and research goals.

  13. Relative electron density determination using a physics based parameterization of photon interactions in medical DECT

    NASA Astrophysics Data System (ADS)

    van Abbema, Joanne K.; van Goethem, Marc-Jan; Greuter, Marcel J. W.; van der Schaaf, Arjen; Brandenburg, Sytze; van der Graaf, Emiel R.

    2015-05-01

    Radiotherapy and particle therapy treatment planning require accurate knowledge of the electron density and elemental composition of the tissues in the beam path to predict the local dose deposition. We describe a method for the analysis of dual energy computed tomography (DECT) images that provides the electron densities and effective atomic numbers of tissues. The CT measurement process is modelled by system weighting functions, which apply an energy dependent weighting to the parameterization of the total cross section for photon interactions with matter. This detailed parameterization is based on the theoretical analysis of Jackson and Hawkes and deviates, at most, 0.3% from the tabulated NIST values for the elements H to Zn. To account for beam hardening in the object as present in the CT image we implemented an iterative process employing a local weighting function, derived from the method proposed by Heismann and Balda. With this method effective atomic numbers between 1 and 30 can be determined. The method has been experimentally validated on a commercially available tissue characterization phantom with 16 inserts made of tissue substitutes and aluminium that has been scanned on a dual source CT system with tube potentials of 100 kV and 140 kV using a clinical scan protocol. Relative electron densities of all tissue substitutes have been determined with accuracy better than 1%. The presented DECT analysis method thus provides high accuracy electron densities and effective atomic numbers for radiotherapy and especially particle therapy treatment planning.

  14. Relative electron density determination using a physics based parameterization of photon interactions in medical DECT.

    PubMed

    van Abbema, Joanne K; van Goethem, Marc-Jan; Greuter, Marcel J W; van der Schaaf, Arjen; Brandenburg, Sytze; van der Graaf, Emiel R

    2015-05-07

    Radiotherapy and particle therapy treatment planning require accurate knowledge of the electron density and elemental composition of the tissues in the beam path to predict the local dose deposition. We describe a method for the analysis of dual energy computed tomography (DECT) images that provides the electron densities and effective atomic numbers of tissues. The CT measurement process is modelled by system weighting functions, which apply an energy dependent weighting to the parameterization of the total cross section for photon interactions with matter. This detailed parameterization is based on the theoretical analysis of Jackson and Hawkes and deviates, at most, 0.3% from the tabulated NIST values for the elements H to Zn. To account for beam hardening in the object as present in the CT image we implemented an iterative process employing a local weighting function, derived from the method proposed by Heismann and Balda. With this method effective atomic numbers between 1 and 30 can be determined. The method has been experimentally validated on a commercially available tissue characterization phantom with 16 inserts made of tissue substitutes and aluminium that has been scanned on a dual source CT system with tube potentials of 100 kV and 140 kV using a clinical scan protocol. Relative electron densities of all tissue substitutes have been determined with accuracy better than 1%. The presented DECT analysis method thus provides high accuracy electron densities and effective atomic numbers for radiotherapy and especially particle therapy treatment planning.

  15. Acceptance and Usage of Electronic Health Record Systems in Small Medical Practices

    ERIC Educational Resources Information Center

    Tannan, Ritu

    2012-01-01

    One of the objectives of the U.S. government has been the development of a nationwide health information infrastructure, including adoption and use of an electronic health records (EHR) system. However, a 2008 survey conducted by the National Center for Health Statistics indicated a 41.5% usage of the EHR system by physicians in office-based…

  16. Validation of Autism Spectrum Disorder Diagnoses in Large Healthcare Systems with Electronic Medical Records

    ERIC Educational Resources Information Center

    Coleman, Karen J.; Lutsky, Marta A.; Yau, Vincent; Qian, Yinge; Pomichowski, Magdalena E.; Crawford, Phillip M.; Lynch, Frances L.; Madden, Jeanne M.; Owen-Smith, Ashli; Pearson, John A.; Pearson, Kathryn A.; Rusinak, Donna; Quinn, Virginia P.; Croen, Lisa A.

    2015-01-01

    To identify factors associated with valid Autism Spectrum Disorder (ASD) diagnoses from electronic sources in large healthcare systems. We examined 1,272 charts from ASD diagnosed youth <18 years old. Expert reviewers classified diagnoses as confirmed, probable, possible, ruled out, or not enough information. A total of 845 were classified with…

  17. How accurate are electronic monitoring devices? A laboratory study testing two devices to measure medication adherence.

    PubMed

    De Bleser, Leentje; De Geest, Sabina; Vandenbroeck, Sofie; Vanhaecke, Johan; Dobbels, Fabienne

    2010-01-01

    In a prospective descriptive laboratory study, 25 Helping Hand(™) (HH) (10 without and 15 with reminder system) and 50 Medication Event Monitoring Systems (MEMS) (25 with 18-month and 25 with 2-year battery life) were manipulated twice daily following a predefined protocol during 3 consecutive weeks. Accuracy was determined using the fixed manipulation scheme as the reference. Perfect functioning (i.e., total absence of missing registrations and/or overregistrations) was observed in 70% of the HH without, 87% of the HH with reminder, 20% MEMS with 18 months, and 100% with 2-year battery life respectively.

  18. Evaluating the state of the art in coreference resolution for electronic medical records

    PubMed Central

    Bodnari, Andreea; Shen, Shuying; Forbush, Tyler; Pestian, John; South, Brett R

    2012-01-01

    Background The fifth i2b2/VA Workshop on Natural Language Processing Challenges for Clinical Records conducted a systematic review on resolution of noun phrase coreference in medical records. Informatics for Integrating Biology and the Bedside (i2b2) and the Veterans Affair (VA) Consortium for Healthcare Informatics Research (CHIR) partnered to organize the coreference challenge. They provided the research community with two corpora of medical records for the development and evaluation of the coreference resolution systems. These corpora contained various record types (ie, discharge summaries, pathology reports) from multiple institutions. Methods The coreference challenge provided the community with two annotated ground truth corpora and evaluated systems on coreference resolution in two ways: first, it evaluated systems for their ability to identify mentions of concepts and to link together those mentions. Second, it evaluated the ability of the systems to link together ground truth mentions that refer to the same entity. Twenty teams representing 29 organizations and nine countries participated in the coreference challenge. Results The teams' system submissions showed that machine-learning and rule-based approaches worked best when augmented with external knowledge sources and coreference clues extracted from document structure. The systems performed better in coreference resolution when provided with ground truth mentions. Overall, the systems struggled in solving coreference resolution for cases that required domain knowledge. PMID:22366294

  19. ILU industrial electron accelerators for medical-product sterilization and food treatment

    NASA Astrophysics Data System (ADS)

    Bezuglov, V. V.; Bryazgin, A. A.; Vlasov, A. Yu.; Voronin, L. A.; Panfilov, A. D.; Radchenko, V. M.; Tkachenko, V. O.; Shtarklev, E. A.

    2016-12-01

    Pulse linear electron accelerators of the ILU type have been developed and produced by the Institute of Nuclear Physics, Siberian Branch, Russian Academy of Sciences, for more than 30 years. Their distinctive features are simplicity of design, convenience in operation, and reliability during long work under conditions of industrial production. ILU accelerators have a range of energy of 0.7-10 MeV at a power of accelerated beam of up to 100 kW and they are optimally suitable for use as universal sterilizing complexes. The scientific novelty of these accelerators consists of their capability to work both in the electron-treatment mode of production and in the bremsstrahlung generation mode, which has high penetrating power.

  20. Adopting electronic medical records: what do the new federal incentives mean to your individual physician practice?

    PubMed

    Neclerio, John M; Cheney, Kathleen; Goldman, C Mitchell; Clark, Lisa W

    2009-01-01

    Under President Obama's American Recovery and Reinvestment Act of 2009, the federal government is offering incentives to physicians to adopt electronic health records. The goal is to improve quality of care and constrain costs. Higher incentive payments are available for those physicians who act quickly to meet the government's standards. Physicians who practice in "health professional shortage areas" and who serve mainly Medicaid recipients may qualify for additional incentives. Although compliance is "voluntary, "physicians who have not met the standards by 2015 will face reductions in their Medicare reimbursements unless they can show a significant hardship. Physicians can get started by contacting hospitals with which they are affiliated and professional associations to find out what vendors are being used in their service area. Agreements for electronic health records should be reviewed carefully to ensure that physicians' interests are protected.

  1. Different experimental protocols for decontamination affect the cleaning of medical devices. A preliminary electron microscopy analysis.

    PubMed

    Tessarolo, F; Caola, I; Fedel, M; Stacchiotti, A; Caciagli, P; Guarrera, G M; Motta, A; Nollo, G

    2007-04-01

    The aim of the present study was to examine the efficiency of different decontamination-cleaning protocols on blood-soiled catheters used for interventional cardiology. Electrophysiology and cardiac ablation disposable devices were contaminated with bacteria-spiked human blood and underwent four different pre-sterilization protocols, including a chlorine-releasing agent, a polyphenolic emulsion, and an enzymatic detergent. Treated samples were examined by optical microscopy, scanning electron microscopy and transmission electron microscopy to identify and characterize biological and inorganic residuals. The use of chlorine as a first treatment caused denaturation of serum proteins and adherence of blood components to the surface of the device, thus hindering the cleaning efficiency of subsequent treatments with enzymatic detergents. An enzymatic/chlorine protocol was more efficient, but was considered to be a greater risk to healthcare staff. Polyphenolic-based treatments had the highest level of efficiency in bioburden removal, but interaction and adsorption of this class of chemicals onto biopolymers might lead to serious concerns about toxicity on subsequent reuse. Adequate pre-sterilization cleaning is fundamental for sterilization success and high-resolution electron microscopy can provide significant and detailed information about the efficiency of chemicals used for cleaning a blood-soiled device.

  2. EMRlog method for computer security for electronic medical records with logic and data mining.

    PubMed

    Martínez Monterrubio, Sergio Mauricio; Frausto Solis, Juan; Monroy Borja, Raúl

    2015-01-01

    The proper functioning of a hospital computer system is an arduous work for managers and staff. However, inconsistent policies are frequent and can produce enormous problems, such as stolen information, frequent failures, and loss of the entire or part of the hospital data. This paper presents a new method named EMRlog for computer security systems in hospitals. EMRlog is focused on two kinds of security policies: directive and implemented policies. Security policies are applied to computer systems that handle huge amounts of information such as databases, applications, and medical records. Firstly, a syntactic verification step is applied by using predicate logic. Then data mining techniques are used to detect which security policies have really been implemented by the computer systems staff. Subsequently, consistency is verified in both kinds of policies; in addition these subsets are contrasted and validated. This is performed by an automatic theorem prover. Thus, many kinds of vulnerabilities can be removed for achieving a safer computer system.

  3. EMRlog Method for Computer Security for Electronic Medical Records with Logic and Data Mining

    PubMed Central

    Martínez Monterrubio, Sergio Mauricio; Frausto Solis, Juan; Monroy Borja, Raúl

    2015-01-01

    The proper functioning of a hospital computer system is an arduous work for managers and staff. However, inconsistent policies are frequent and can produce enormous problems, such as stolen information, frequent failures, and loss of the entire or part of the hospital data. This paper presents a new method named EMRlog for computer security systems in hospitals. EMRlog is focused on two kinds of security policies: directive and implemented policies. Security policies are applied to computer systems that handle huge amounts of information such as databases, applications, and medical records. Firstly, a syntactic verification step is applied by using predicate logic. Then data mining techniques are used to detect which security policies have really been implemented by the computer systems staff. Subsequently, consistency is verified in both kinds of policies; in addition these subsets are contrasted and validated. This is performed by an automatic theorem prover. Thus, many kinds of vulnerabilities can be removed for achieving a safer computer system. PMID:26495300

  4. Evaluation of a Prediction Model for the Development of Atrial Fibrillation in a Repository of Electronic Medical Records

    PubMed Central

    Kolek, Matthew J.; Graves, Amy J.; Xu, Meng; Bian, Aihua; Teixeira, Pedro Luis; Shoemaker, M. Benjamin; Parvez, Babar; Xu, Hua; Heckbert, Susan R.; Ellinor, Patrick T.; Benjamin, Emelia J.; Alonso, Alvaro; Denny, Joshua C.; Moons, Karel G.M.; Shintani, Ayumi K.; Harrell, Frank E.; Roden, Dan M.; Darbar, Dawood

    2017-01-01

    Importance Atrial fibrillation contributes to substantial morbidity, mortality, and healthcare expenditures. Accurate prediction of incident atrial fibrillation would enhance patient management and potentially improve outcomes. Objective We aimed to validate the atrial fibrillation risk prediction model originally developed by the CHARGE-AF investigators utilizing a large repository of electronic medical records. Design Using a database of de-identified medical records, we conducted a retrospective electronic medical record study of subjects without atrial fibrillation followed in Internal Medicine outpatient clinics at our institution. Individuals were followed for incident atrial fibrillation from 2005 until 2010. Adjusting for differences in baseline hazard, we applied the CHARGE-AF Cox proportional hazards model regression coefficients to our cohort. A simple version of the model, with no ECG variables was also evaluated. Setting Outpatient clinics at a large academic medical center. Participants 33,494 subjects of age ≥40 years, white or African American, and no previous history of atrial fibrillation. Predictors Predictors in the model included age, race, height, weight, systolic and diastolic blood pressure, treatment for hypertension, smoking status, diabetes, heart failure, history of myocardial infarction, left ventricular hypertrophy, and PR interval. Main outcome Incident atrial fibrillation. Results The median age was 57 years (25th to 75th percentile: 49 to 67), 57% of patients were women, 85.7% were white, 14.3% were African American. During the mean follow-up period of 4.8 ± 0.85 years, 2455 (7.3%) subjects developed atrial fibrillation. Both models had poor calibration in our cohort, with under-prediction of AF among low-risk subjects and over-prediction of AF among high-risk subjects. The full CHARGE-AF model had a C-index of 0.71 (95% confidence interval [CI]: 0.70 to 0.72) in our cohort. The simple model had similar discrimination (C-index: 0

  5. Design and implementation of decision support for tobacco dependence treatment in an inpatient electronic medical record: a randomized trial.

    PubMed

    Bernstein, Steven L; Rosner, June; DeWitt, Michelle; Tetrault, Jeanette; Hsiao, Allen L; Dziura, James; Sussman, Scott; O'Connor, Patrick; Toll, Benjamin

    2017-02-13

    Tobacco dependence treatment for hospitalized smokers results in long-term cessation if treatment continues at least 30 days post-discharge. Health information technology may facilitate ongoing tobacco dependence treatment after hospital discharge. To describe the use and impact of a new decision support tool and order set for inpatient physicians, addressing tobacco dependence treatment for hospitalized smokers, embedded in an electronic health record (EHR). In a cluster-randomized trial, 254 physicians were randomized (1:1) to either receive or not receive the decision support tool and order set, which were embedded in the Epic (Madison, WI) EHR used at 2 hospitals in a single city. When an adult patient was admitted to a medical service, an electronic alert appeared if the patient was coded in the EHR as a smoker. For physicians randomized to the intervention, the alert linked to an order set to prescribe tobacco treatment medications and refer the patient to the state tobacco quitline. Additionally, "tobacco use disorder" was added to the patient's problem list, and an e-mail was sent to the patient's primary care provider (PCP). In the control arm, an alert fired with no screen visibility. Generalized estimating equations were used to model the data. Since August 2013, the alert has appeared for 10,939 patients (5391 intervention, 5548 control). Compared to control physicians, intervention physicians were more likely to order tobacco treatment medication (35 vs. 29%, P < 0.0001), populate the problem list with tobacco use disorder (41 vs. 2%, P < 0.0001), and make a referral to the state smokers' quitline (30 vs. 0%, P < 0.0001). In addition, intervention physicians sent an e-mail to the patient's PCP 4152 (99%) times. Designing and implementing an order set and alert for tobacco treatment in an EHR is feasible and helps physicians place more orders for tobacco treatment medication, referrals to the state smokers' quitline, and e-mails to patients' PCPs

  6. From medical record to patient record through electronic data interchange (EDI).

    PubMed

    Kinkhorst, O M; Lalleman, A W; Hasman, A

    1996-07-01

    In this contribution the role of Electronic Data Interchange (EDI) for patient records is discussed. It is our opinion that unlimited access to patient records of different care provides is not a wise thing to do and may even not be acceptable legally. The exchange of EDI messages may be a solution in that the relevant information is exchanged on a need to know basis under the responsibility of the care provider that generated the information. The state of the art with respect to the availability of EDI messages in Europe is presented.

  7. Electronic prescribing in pediatrics: toward safer and more effective medication management.

    PubMed

    2013-04-01

    This policy statement identifies the potential value of electronic prescribing (e-prescribing) systems in improving quality and reducing harm in pediatric health care. On the basis of limited but positive pediatric data and on the basis of federal statutes that provide incentives for the use of e-prescribing systems, the American Academy of Pediatrics recommends the adoption of e-prescribing systems with pediatric functionality. The American Academy of Pediatrics also recommends a set of functions that technology vendors should provide when e-prescribing systems are used in environments in which children receive care.

  8. The Evolving Use of a Clinical Data Repository: Facilitating Data Access Within an Electronic Medical Record

    PubMed Central

    Wilcox, Adam B.; Vawdrey, David K.; Chen, Yueh-Hsia; Forman, Bruce; Hripcsak, George

    2009-01-01

    We demonstrate the integration of a longitudinal, internally-developed legacy clinical information system with a vendor-based electronic health record application. The expense of developing the interface across systems was minimal, and it was successfully incorporated within the vendor EHR. Users consistently used the legacy data view while using the EHR; usage reached up to 50% of accessed data. Data showing concurrent increases in the use of the legacy data view and adoption of the new EHR suggests the method may improve adoption of the new system. PMID:20351944

  9. [Cooperation with the electronic medical record and accounting system of an actual dose of drug given by a radiology information system].

    PubMed

    Yamamoto, Hideo; Yoneda, Tarou; Satou, Shuji; Ishikawa, Toru; Hara, Misako

    2009-12-20

    By input of the actual dose of a drug given into a radiology information system, the system converting with an accounting system into a cost of the drug from the actual dose in the electronic medical record was built. In the drug master, the first unit was set as the cost of the drug, and we set the second unit as the actual dose. The second unit in the radiology information system was received by the accounting system through electronic medical record. In the accounting system, the actual dose was changed into the cost of the drug using the dose of conversion to the first unit. The actual dose was recorded on a radiology information system and electronic medical record. The actual dose was indicated on the accounting system, and the cost for the drug was calculated. About the actual dose of drug, cooperation of the information in a radiology information system and electronic medical record were completed. It was possible to decide the volume of drug from the correct dose of drug at the previous inspection. If it is necessary for the patient to have another treatment of medicine, it is important to know the actual dose of drug given. Moreover, authenticity of electronic medical record based on a statute has also improved.

  10. 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.

  11. Establishment of electronic chart-based stroke registry system in a medical system in Taiwan.

    PubMed

    Lee, Tsong-Hai; Chang, Chien-Hung; Chang, Yeu-Jhy; Chang, Ku-Chou; Chung, Jacky

    2011-08-01

    To establish a prospective, real-time, self-sustainable stroke registry system, we incorporated a registry with an electronic chart to create an electronic chart-based stroke registry system in November 2006. The International Classification of Diseases Ninth Revision code (430-437) was used to auto-enroll stroke patients admitted to neurology departments. Clinical information was written by doctors, nursing information was recorded by nurses, and basic patient information was entered by administrative departments. Numerical data and the date and time of any studies were auto-downloaded from the hospital computer. In total, 212 items were auto-downloaded, including basic patient information, laboratory blood test and examination results, and the date and time of imaging and special intervention. The stroke scales (121 items, National Institutes of Health Stroke Scale, Barthel index, and modified Rankin scale) were designed to be auto-adjusted to reduce incompatibility. The 95 items with pull-down options were used to specify the contents. This registry system can be time-, labor- and money-saving with secured data accuracy.

  12. Assessing the impact of cognitive impairment on the usability of an electronic medication delivery unit in an assisted living population

    PubMed Central

    Ligons, Frank M.; Mello-Thoms, Claudia; Handler, Steven M.; Romagnoli, Katrina M.; Hochheiser, Harry

    2014-01-01

    Purpose To examine the relationship between cognitive status and the usability of an integrated medication delivery unit (MDU) in older adults who reside in an Assisted Living Facility (ALF). Methods Subjects were recruited from a single ALF in Pittsburgh, PA. Usability testing sessions required subjects to execute tasks essential to using EMMA® (Electronic Medication Management Assistant), a Class II Federal Drug Administration (FDA) approved integrated MDU. Video coding allowed for quantification of usability errors observed during the testing sessions. Each subject's cognitive status was assessed using the Mini Mental State Exam (MMSE®) with scores <24 indicating cognitive impairment. Functional status was assessed using the Lawton Instrumental Activities of Daily Living (IADL) questionnaire, and a global assessment of subjective usability was assessed by completing the System Usability Scale (SUS). Non-parametric statistics and correlation analysis were used to determine whether significant differences existed between cognitively impaired and non-impaired subjects. Results Nineteen subjects were recruited and completed the protocol. The subject pool was primarily white, female, 80+ and in possession of above average education. There was a significant relationship between MMSE® scores and the percentage of task success (z = −2.03, p = 0.04). Subjects with MMSE® scores of 24+ (no cognitive impairment) successfully completed an average of 69.0% of tasks vs. the 34.7% performance for those in the cognitively impaired group (<24). Six of the unimpaired group also succeeded at meeting the 85% (6 out of 7 correct) threshold, while none of the impaired group was able to. No subject with cognitive impairments (<24 MMSE®) completed more than 5/7 (71.4%) of their tasks. Two of the impaired subjects failed all of the tasks. Three of the MMSE®'s subsections (Date, Location and Spell ‘world’ backwards) were found to be significantly related (p < 0.05) to the

  13. Validation of self-reported post-treatment mammography surveillance among breast cancer survivors by electronic medical record extraction method

    PubMed Central

    Sanders, Joanne M.; Shay, L. Aubree; Murphy, Caitlin C.; Hamann, Heidi A.; Bartholomew, L. Kay; Savas, Lara S.; Vernon, Sally W.

    2016-01-01

    Little is known about validity of self-reported mammography surveillance among breast cancer survivors. Most studies have focused on accuracy among healthy, average-risk populations and none have assessed validity by electronic medical record (EMR) extraction method. To assess validity of survivor-reported mammography post-active treatment care, we surveyed all survivors diagnosed 2004–2009 in an academic hospital cancer registry (n = 1441). We used electronic query and manual review to extract EMR data. Concordance, sensitivity, specificity, positive predictive value, and report-to-records ratio were calculated by comparing survivors' self-reports to data from each extraction method. We also assessed average difference in months between mammography dates by source and correlates of concordance. Agreement between the two EMR extraction methods was high (concordance 0.90; kappa 0.70), with electronic query identifying more mammograms. Sensitivity was excellent (0.99) regardless of extraction method; concordance and positive predictive value were good; however, specificity was poor (manual review 0.20, electronic query 0.31). Report-to-records ratios were both over 1 suggesting over-reporting. We observed slight forward telescoping for survivors reporting mammograms 7–12 months prior to survey date. Higher educational attainment and less time since mammogram receipt were associated with greater concordance. Accuracy of survivors' self-reported mammograms was generally high with slight forward telescoping among those recalling their mammograms between 7 and 12 months prior to the survey date. Results are encouraging for clinicians and practitioners relying on survivor reports for surveillance care delivery and as a screening tool for inclusion in interventions promoting adherence to surveillance guidelines. PMID:25922083

  14. Rapid application design of an electronic clinical skills portfolio for undergraduate medical students.

    PubMed

    Dornan, Tim; Lee, Catherine; Stopford, Adam; Hosie, Liam; Maredia, Neil; Rector, Alan

    2005-04-01

    The aim was to find how to use information and communication technology to present the clinical skills content of an undergraduate medical curriculum. Rapid application design was used to develop the product, and technical action research was used to evaluate the development process. A clinician-educator, two medical students, two computing science masters students, two other project workers, and a hospital education informatics lead, formed a design team. A sample of stakeholders took part in requirements planning workshops and continued to advise the team throughout the project. A university hospital had many features that favoured fast, inexpensive, and successful system development: a clearly defined and readily accessible user group; location of the development process close to end-users; fast, informal communication; leadership by highly motivated and senior end-users; devolved authority and lack of any rigidly imposed management structure; cooperation of clinicians because the project drew on their clinical expertise to achieve scholastic goals; a culture of learning and involvement of highly motivated students. A detailed specification was developed through storyboarding, use case diagramming, and evolutionary prototyping. A very usable working product was developed within weeks. "SkillsBase" is a database web application using Microsoft Active Server Pages, served from a Microsoft Windows 2000 Server operating system running Internet Information Server 5.0. Graphing functionality is provided by the KavaChart applet. It presents the skills curriculum, provides a password-protected portfolio function, and offers training materials. The curriculum can be presented in several different ways to help students reflect on their objectives and progress towards achieving them. The reflective portfolio function is entirely private to each student user and allows them to document their progress in attaining skills, as judged by self, peer and tutor assessment, and

  15. Electronic Monitoring of Medication Adherence in Early Maintenance Phase Treatment for Pediatric Leukemia and Lymphoma: Identifying Patterns of Nonadherence

    PubMed Central

    Drotar, Dennis; Alderfer, Melissa; Donewar, Crista Wetherington; Ewing, Linda; Katz, Ernest R.; Muriel, Anna

    2015-01-01

    Objective To describe patterns of treatment adherence to early maintenance phase therapy for acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL). Methods Using an objective observational method (electronic monitoring), adherence was examined for 139 patients aged 7–19 years diagnosed with ALL or LBL across 6 centers. Results The mean adherence percentage was 86.2%. Adherence rates declined over the 1-month of follow-up to 83%. 3 linear trajectories of 6-mercaptopurine adherence were identified: (1) exemplary adherence (n = 99): Averaging nearly 100%; (2) deteriorating (n = 23): Adherence decreased from 100 to 60%; and (3) chronically poor adherence (n = 9): Averaging 40%. Conclusions Adherence promotion interventions might be tailored to subgroups of patients who demonstrated problematic patterns of treatment adherence that could place them at risk for relapse. This research demonstrates the importance of using objective real-time measures of medication adherence for measuring and documenting adherence patterns. PMID:24365698

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

    PubMed

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

    2015-12-01

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

  17. In situ degradation of antibiotic residues in medical intravenous infusion bottles using high energy electron beam irradiation

    NASA Astrophysics Data System (ADS)

    Wang, Min; Zhang, Lele; Zhang, Guilong; Pang, Tao; Zhang, Xin; Cai, Dongqing; Wu, Zhengyan

    2017-01-01

    This study reported an immediate approach for the degradation of three antibiotic (amoxicillin, ofloxacin, and cefradine) residues in medical intravenous infusion bottles (MIIBs) using high energy electron beam (HEEB) irradiation. The effects of irradiation doses, initial concentrations, initial pH, and scavengers of active radicals on the degradation of three antibiotic residues (ARs) were investigated, and the results displayed that 97.02%, 97.61% and 96.87% of amoxicillin, ofloxacin, and cefradine residues could be degraded in situ through HEEB irradiation respectively. Fourier transform infrared spectroscopy (FTIR) and high performance liquid chromatography-mass spectrometry (HPLC-MS) analysis demonstrated that ARs were mainly decomposed into inorganic ions and alkanes. Typically, the detailed degradation mechanism of ARs was also investigated, and the dominant active particle inducing the degradation of antibiotics during the HEEB irradiation process was demonstrated to be hydroxyl radical.

  18. In situ degradation of antibiotic residues in medical intravenous infusion bottles using high energy electron beam irradiation

    PubMed Central

    Wang, Min; Zhang, Lele; Zhang, Guilong; Pang, Tao; Zhang, Xin; Cai, Dongqing; Wu, Zhengyan

    2017-01-01

    This study reported an immediate approach for the degradation of three antibiotic (amoxicillin, ofloxacin, and cefradine) residues in medical intravenous infusion bottles (MIIBs) using high energy electron beam (HEEB) irradiation. The effects of irradiation doses, initial concentrations, initial pH, and scavengers of active radicals on the degradation of three antibiotic residues (ARs) were investigated, and the results displayed that 97.02%, 97.61% and 96.87% of amoxicillin, ofloxacin, and cefradine residues could be degraded in situ through HEEB irradiation respectively. Fourier transform infrared spectroscopy (FTIR) and high performance liquid chromatography-mass spectrometry (HPLC-MS) analysis demonstrated that ARs were mainly decomposed into inorganic ions and alkanes. Typically, the detailed degradation mechanism of ARs was also investigated, and the dominant active particle inducing the degradation of antibiotics during the HEEB irradiation process was demonstrated to be hydroxyl radical. PMID:28045097

  19. An evaluation of the time for nursing activity in a hospital using a full Electronic Medical Record System (EMR).

    PubMed

    Chung, Eun-Ja; Kim, Hyun-Ja; Park, Kwang-Hee; Song, Young-Ae; Lee, Boek-Nam; Lee, Mi-Jeong; Lee, Jeong-Hee; Lee, Hye-A; Lim, Yeon-Sook; Choi, Eun-Young; Hwang, Hye-Young; Lee, Hyun-Sook

    2006-01-01

    This study was designed to analyze the time for direct and indirect nursing activity to evaluate the workload of nurses using a full Electronic Medical Record (EMR) system on practice. The result is that the mean time for nursing activity per nurse was 499.56 minutes, the mean time for direct nursing activity per nurse was 251.1 minutes (50.3%), and the mean time for indirect nursing activity per nurse was 248.42 minutes(49.7%). The time for direct nursing activity was more than the time for indirect nursing activity. There was a significant difference in the time for nursing activity according to workplace (p < 0.00*), but no difference according to nursing career. Regarding 3 duty-shifts, the time for direct nursing activity was highest in the evening shift and the time for indirect nursing activity was highest in the night shift.

  20. Study of the factors that promoted the implementation of Electronic Medical Record on iPads at Two Emergency Departments

    PubMed Central

    Rao, Akhil Sanjay; Adam, Terrence J.; Gensinger, Raymond; Westra, Bonnie L.

    2012-01-01

    The purpose of this study was to understand the factors which promoted the demand for iPads by physicians in two Emergency departments (ED) prior to a system wide implementation of an electronic medical record (EMR). A grounded theory design was employed and 14 semi-structured interviews conducted with ED physicians. Analysis of the interview transcripts was completed using Atlas.ti qualitative software, which revealed that physicians’ perceptions of iPad use in the ED stemmed from their personal use of iPads along with three perceived ease of use factors. Physicians perceived that improved patient physician interaction, improved workflow and structural iPad benefits promoted their demand. Physicians perceived the structural benefits of iPads would improve patient physician interaction and improve workflow in the ED. As interest in handheld devices such as iPads increases, these findings could direct and encourage other iPad implementations at other hospital EDs’. PMID:23304348

  1. User satisfaction survey and usage of an electronic desktop document delivery service at an academic medical library.

    PubMed

    Sayed, Ellen N; Murray, Sarah D

    2003-01-01

    In June 2000, the Biomedical Library at the University of South Alabama introduced Prospero, an electronic desktop document delivery service. From June 2000 to November 2002, Prospero delivered 28% of interlibrary loan requests and 72% of document delivery requests. In November 2002, the library conducted a user satisfaction survey of the Prospero service. Forty-two surveys were used. Fifteen responses were received from affiliated faculty, staff, and students, who generally expressed satisfaction with the service. Twenty-seven responses were received from unaffiliated users, comprised of medical libraries, individual users, and businesses. Based on the survey results, the library deemed the Prospero service a success. To better support users, the library's Web page was updated to include hardware and software requirements for successful use of the Prospero service, as well as screen shots of the Prospero process.

  2. Development and evaluation of an interactive electronic laboratory manual for cooperative learning of medical histology.

    PubMed

    Khalil, Mohammed K; Kirkley, Debbie L; Kibble, Jonathan D

    2013-01-01

    This article describes the development of an interactive computer-based laboratory manual, created to facilitate the teaching and learning of medical histology. The overarching goal of developing the manual is to facilitate self-directed group interactivities that actively engage students during laboratory sessions. The design of the manual includes guided instruction for students to navigate virtual slides, exercises for students to monitor learning, and cases to provide clinical relevance. At the end of the laboratory activities, student groups can generate a laboratory report that may be used to provide formative feedback. The instructional value of the manual was evaluated by a questionnaire containing both closed-ended and open-ended items. Closed-ended items using a five-point Likert-scale assessed the format and navigation, instructional contents, group process, and learning process. Open-ended items assessed student's perception on the effectiveness of the manual in facilitating their learning. After implementation for two consecutive years, student evaluation of the manual was highly positive and indicated that it facilitated their learning by reinforcing and clarifying classroom sessions, improved their understanding, facilitated active and cooperative learning, and supported self-monitoring of their learning.

  3. Data sharing in neuroimaging research

    PubMed Central

    Poline, Jean-Baptiste; Breeze, Janis L.; Ghosh, Satrajit; Gorgolewski, Krzysztof; Halchenko, Yaroslav O.; Hanke, Michael; Haselgrove, Christian; Helmer, Karl G.; Keator, David B.; Marcus, Daniel S.; Poldrack, Russell A.; Schwartz, Yannick; Ashburner, John; Kennedy, David N.

    2012-01-01

    Significant resources around the world have been invested in neuroimaging studies of brain function and disease. Easier access to this large body of work should have profound impact on research in cognitive neuroscience and psychiatry, leading to advances in the diagnosis and treatment of psychiatric and neurological disease. A trend toward increased sharing of neuroimaging data has emerged in recent years. Nevertheless, a number of barriers continue to impede momentum. Many researchers and institutions remain uncertain about how to share data or lack the tools and expertise to participate in data sharing. The use of electronic data capture (EDC) methods for neuroimaging greatly simplifies the task of data collection and has the potential to help standardize many aspects of data sharing. We review here the motivations for sharing neuroimaging data, the current data sharing landscape, and the sociological or technical barriers that still need to be addressed. The INCF Task Force on Neuroimaging Datasharing, in conjunction with several collaborative groups around the world, has started work on several tools to ease and eventually automate the practice of data sharing. It is hoped that such tools will allow researchers to easily share raw, processed, and derived neuroimaging data, with appropriate metadata and provenance records, and will improve the reproducibility of neuroimaging studies. By providing seamless integration of data sharing and analysis tools within a commodity research environment, the Task Force seeks to identify and minimize barriers to data sharing in the field of neuroimaging. PMID:22493576

  4. Prevalence of toddler, child and adolescent overweight and obesity derived from primary care electronic medical records: an observational study

    PubMed Central

    Biro, Suzanne; Barber, Dave; Williamson, Tyler; Morkem, Rachael; Khan, Shahriar; Janssen, Ian

    2016-01-01

    Background: Population monitoring and surveillance of objectively measured child weight data in Canada is limited to national surveys with poor regional applicability, and no healthy weight data are available for children less than 2 years of age. We aimed to determine the prevalence of childhood overweight and obesity using objective measures derived from primary care electronic medical records. Methods: Observational data included all height and weight records for children less than 20 years of age, between 2004 and 2013, from 3 Ontario primary care research networks. We calculated body mass index (BMI)-for-age and weight-for-length using the World Health Organization Growth Standards and Reference to assign growth status indicator categories by age group. Descriptive data and prevalence estimates were generated for 2013. We also compared weight-for-length for children less than 2 years of age with a corresponding billing code for known well-child visits. Results: Our study included 8261 children with a corresponding growth status indicator, a sample close to 4 times larger than the national survey sample. In 2013, 28.4% of children aged 5-19 years, and 6% of children aged 0-5 years, were categorized as overweight or obese. Between 2008 and 2013, the total number of 18-month well baby visit billing codes was 1152; 6.9% of this group were categorized as overweight or obese; 19.2% were categorized as having risk of overweight. Interpretation: Primary care electronic medical records show good potential for ongoing population monitoring of overweight and obesity, particularly for very young children for whom early intervention is likely to show the greatest positive health impact. PMID:27730118

  5. Using Human Factors Methods to Design a New Interface for an Electronic Medical Record

    PubMed Central

    Saleem, Jason J.; Patterson, Emily S.; Militello, Laura; Asch, Steven M.; Doebbeling, Bradley N.; Render, Marta L.

    2007-01-01

    The Veterans Health Administration (VHA) is a leader in development and use of electronic patient records and clinical decision support. The VHA is currently reengineering a somewhat dated platform for its Computerized Patient Record System (CPRS). This process affords a unique opportunity to implement major changes to the current design and function of the system. We report on two human factors studies designed to provide input and guidance during this reengineering process. One study involved a card sort to better understand how providers tend to cognitively organize clinical data, and how that understanding can help guide interface design. The other involved a simulation to assess the impact of redesign modifications on computerized clinical reminders, a form of clinical decision support in the CPRS, on the learnability of the system for first-time users. PMID:18693914

  6. Electron miscroscopy and histochemical studies on four Egyptian helminthes eggs of medical importance.

    PubMed

    Mahmoud, Lily H; el-Alfy, Nadia M

    2003-04-01

    By SEM the Fasciola gigantica egg is ovoid with a small knob like operculum, while the egg of Heterophyes heterophytes is broad oval with the operculum more tapering. The egg shell of fertilized Ascaris lumbricoides has interconnected ridges and peak-like projections, while the egg of Enterobius vermicularis is flattened with a thicker margin at the curved side. By TEM, Fasciola egg shell consists of fine reticulum fibrils of three layers. The outer lipoprotein of perivitelline membrane beneath which 2 membranes separated by inclusions, middle of protein globules and inner lipoprotein layer with minute electron-dense granules of melanin or polymer origin, in some parts of the shell giving the egg its brown coloration. The Heterophyes egg shell is more or less similar to that of Fasciola but lacking the minute electron-dense granules. The egg shell of Ascaris has outer ulterine layer with three consecutive layers, basal lipoprotein layer and the inner lipid or ascaroside layer which is the most resistant layer. The Enterobius egg shell consists of five layers, external uterine, internal uterine, vitelline, chitinous and lipid layer. Histochemically, Fasciola egg shell consists of nine amino-acids, and that of Heterophyes consists of ten amino acids. In Ascaris, the lipid layer characteristically consists 25% protein and 75% lipid. The histochemical examination of Enterobius as a detailed example, showed different degrees of reactions with mercuric bromophenol blue, diazotization coupling, Sakaguchi reaction, Sudan black and Mallory's triple stain. Temperature showed marked effect on eggs survival. Eggs of Fasciola and Heterophyes withstand more low temperatures but those of Ascaris and Enterobius withstand more high ones. There are marked correlations between the egg shell constitution, histochemical compositions on one hand and water permeability and egg dryness on the other hand. The results were photographed and discussed.

  7. Implementation of Indigenous Electronic Medical Record System to Facilitate Care of Sickle Cell Disease Patients in Chhattisgarh

    PubMed Central

    Choubey, Mona; Mishra, Hrishikesh; Soni, Khushboo

    2016-01-01

    Introduction Sickle cell disease (SCD) is prevalent in central India including Chhattisgarh. Screening for SCD is being carried out by Government of Chhattisgarh. Electronic Medical Record (EMR) system was developed and implemented in two phases. Aim Aim was to use informatics techniques and indigenously develop EMR system to improve the care of SCD patients in Chhattisgarh. EMR systems had to be developed to store and manage: i) huge data generated through state wide screening for SCD; ii) clinical data for SCD patients attending the outpatient department (OPD) of institute. Materials and Methods ‘State Wide Screening Data Interface’ (SWSDI) was designed and implemented for storing and managing data generated through screening program. Further, ‘Sickle Cell Patients Temporal Data Management System’ (SCPTDMS) was developed and implemented for storing, managing and analysing sickle cell disease patients’ data at OPD. Both systems were developed using VB.Net and MS SQL Server 2012. Results Till April 2015, SWSDI has data of 1294558 persons, out of which 121819 and 4087 persons are carriers and patients of sickle cell disease respectively. Similarly till June 2015, SCPTDMS has data of 3760 persons, of which 923 are sickle cell disease patients (SS) and 1355 are sickle cell carriers (AS). Conclusion Both systems are proving to be useful in efficient storage, management and analysis of data for clinical and research purposes. The systems are an example of beneficial usage of medical informatics solutions for managing large data at community level. PMID:27042486

  8. Data-Mining Electronic Medical Records for Clinical Order Recommendations: Wisdom of the Crowd or Tyranny of the Mob?

    PubMed Central

    Chen, Jonathan H.; Altman, Russ B.

    2015-01-01

    Uncertainty and variability is pervasive in medical decision making with insufficient evidence-based medicine and inconsistent implementation where established knowledge exists. Clinical decision support constructs like order sets help distribute expertise, but are constrained by knowledge-based development. We previously produced a data-driven order recommender system to automatically generate clinical decision support content from structured electronic medical record data on >19K hospital patients. We now present the first structured validation of such automatically generated content against an objective external standard by assessing how well the generated recommendations correspond to orders referenced as appropriate in clinical practice guidelines. For example scenarios of chest pain, gastrointestinal hemorrhage, and pneumonia in hospital patients, the automated method identifies guideline reference orders with ROC AUCs (c-statistics) (0.89, 0.95, 0.83) that improve upon statistical prevalence benchmarks (0.76, 0.74, 0.73) and pre-existing human-expert authored order sets (0.81, 0.77, 0.73) (P<10−30 in all cases). We demonstrate that data-driven, automatically generated clinical decision support content can reproduce and optimize top-down constructs like order sets while largely avoiding inappropriate and irrelevant recommendations. This will be even more important when extrapolating to more typical clinical scenarios where well-defined external standards and decision support do not exist. PMID:26306281

  9. An enhanced security solution for electronic medical records based on AES hybrid technique with SOAP/XML and SHA-1.

    PubMed

    Kiah, M L Mat; Nabi, Mohamed S; Zaidan, B B; Zaidan, A A

    2013-10-01

    This study aims to provide security solutions for implementing electronic medical records (EMRs). E-Health organizations could utilize the proposed method and implement recommended solutions in medical/health systems. Majority of the required security features of EMRs were noted. The methods used were tested against each of these security features. In implementing the system, the combination that satisfied all of the security features of EMRs was selected. Secure implementation and management of EMRs facilitate the safeguarding of the confidentiality, integrity, and availability of e-health organization systems. Health practitioners, patients, and visitors can use the information system facilities safely and with confidence anytime and anywhere. After critically reviewing security and data transmission methods, a new hybrid method was proposed to be implemented on EMR systems. This method will enhance the robustness, security, and integration of EMR systems. The hybrid of simple object access protocol/extensible markup language (XML) with advanced encryption standard and secure hash algorithm version 1 has achieved the security requirements of an EMR system with the capability of integrating with other systems through the design of XML messages.

  10. Implementation of an innovative, integrated electronic medical record (EMR) and public health information exchange for HIV/AIDS.

    PubMed

    Herwehe, Jane; Wilbright, Wayne; Abrams, Amir; Bergson, Susan; Foxhood, Joseph; Kaiser, Michael; Smith, Luis; Xiao, Ke; Zapata, Amy; Magnus, Manya

    2012-01-01

    Louisiana is severely affected by HIV/AIDS, ranking fifth in AIDS rates in the USA. The Louisiana Public Health Information Exchange (LaPHIE) is a novel, secure bi-directional public health information exchange, linking statewide public health surveillance data with electronic medical record data. LaPHIE alerts medical providers when individuals with HIV/AIDS who have not received HIV care for >12 months are seen at any ambulatory or inpatient facility in an integrated delivery network. Between 2/1/2009 and 1/31/2011, 488 alerts identified 345 HIV positive patients. Of those identified, 82% had at least one CD4 or HIV viral load test over the study follow-up period. LaPHIE is an innovative use of health information exchange based on surveillance data and real time clinical messaging, facilitating rapid provider notification of those in need of treatment. LaPHIE successfully reduces critical missed opportunities to intervene with individuals not in care, leveraging information historically collected solely for public health purposes, not health care delivery, to improve public health.

  11. Implementation of an innovative, integrated electronic medical record (EMR) and public health information exchange for HIV/AIDS

    PubMed Central

    Wilbright, Wayne; Abrams, Amir; Bergson, Susan; Foxhood, Joseph; Kaiser, Michael; Smith, Luis; Xiao, Ke; Zapata, Amy; Magnus, Manya

    2011-01-01

    Louisiana is severely affected by HIV/AIDS, ranking fifth in AIDS rates in the USA. The Louisiana Public Health Information Exchange (LaPHIE) is a novel, secure bi-directional public health information exchange, linking statewide public health surveillance data with electronic medical record data. LaPHIE alerts medical providers when individuals with HIV/AIDS who have not received HIV care for >12 months are seen at any ambulatory or inpatient facility in an integrated delivery network. Between 2/1/2009 and 1/31/2011, 488 alerts identified 345 HIV positive patients. Of those identified, 82% had at least one CD4 or HIV viral load test over the study follow-up period. LaPHIE is an innovative use of health information exchange based on surveillance data and real time clinical messaging, facilitating rapid provider notification of those in need of treatment. LaPHIE successfully reduces critical missed opportunities to intervene with individuals not in care, leveraging information historically collected solely for public health purposes, not health care delivery, to improve public health. PMID:22037891

  12. How we developed eForms: an electronic form and data capture tool to support assessment in mobile medical education.

    PubMed

    Mooney, Jane S; Cappelli, Tim; Byrne-Davis, Lucie; Lumsden, Colin J

    2014-12-01

    Mobile learning technologies are being introduced and adopted by an increasing number of medical schools. Following the implementation of these devices, institutions are tasked with the challenge of their integration into curriculum delivery and presented with the opportunity to facilitate data collection from large student cohorts. Since 2011, Manchester Medical School (MMS) has undertaken the largest deployment of iPads within UK Higher Education. Working towards the more efficient collation of students' compulsory workplace-based assessment data led us to evaluate how existing information management software could replace previously paper-based systems. Following an evaluation of six, and a trial of one, commercially available packages, the existing software solutions were found to be inflexible and unfit for purpose. This resulted in the development of a new digital solution that addressed the limitations of the previous system. "University of Manchester (UoM) eForms" consists of an app and a web-based administration system that respectively permit high volume data collection and management. UoM eForms has now replaced the preceding paper-based and electronic systems within MMS for workplace-based assessment administration, due to the improved usability and dynamicity built into its interface and infrastructure. This new system has found many further useful applications, including research data collection, feedback, placement evaluations, quality assurance and interview marking.

  13. Quality assessment of Isfahan Medical Faculty web site electronic services and prioritizing solutions using analytic hierarchy process approach

    PubMed Central

    Hajrahimi, Nafiseh; Dehaghani, Sayed Mehdi Hejazi; Hajrahimi, Nargess; Sarmadi, Sima

    2014-01-01

    Context: Implementing information technology in the best possible way can bring many advantages such as applying electronic services and facilitating tasks. Therefore, assessment of service providing systems is a way to improve the quality and elevate these systems including e-commerce, e-government, e-banking, and e-learning. Aims: This study was aimed to evaluate the electronic services in the website of Isfahan University of Medical Sciences in order to propose solutions to improve them. Furthermore, we aim to rank the solutions based on the factors that enhance the quality of electronic services by using analytic hierarchy process (AHP) method. Materials and Methods: Non-parametric test was used to assess the quality of electronic services. The assessment of propositions was based on Aqual model and they were prioritized using AHP approach. The AHP approach was used because it directly applies experts’ deductions in the model, and lead to more objective results in the analysis and prioritizing the risks. After evaluating the quality of the electronic services, a multi-criteria decision making frame-work was used to prioritize the proposed solutions. Statistical Analysis Used: Non-parametric tests and AHP approach using Expert Choice software. Results: The results showed that students were satisfied in most of the indicators. Only a few indicators received low satisfaction from students including, design attractiveness, the amount of explanation and details of information, honesty and responsiveness of authorities, and the role of e-services in the user's relationship with university. After interviewing with Information and Communications Technology (ICT) experts at the university, measurement criteria, and solutions to improve the quality were collected. The best solutions were selected by EC software. According to the results, the solution “controlling and improving the process in handling users complaints” is of the utmost importance and authorities

  14. Medical revolution in Argentina.

    PubMed

    Ballarin, V L; Isoardi, R A

    2010-01-01

    The paper discusses the major Argentineans contributors, medical physicists and scientists, in medical imaging and the development of medical imaging in Argentina. The following are presented: history of medical imaging in Argentina: the pioneers; medical imaging and medical revolution; nuclear medicine imaging; ultrasound imaging; and mathematics, physics, and electronics in medical image research: a multidisciplinary endeavor.

  15. Automation and integration of components for generalized semantic markup of electronic medical texts.

    PubMed

    Dugan, J M; Berrios, D C; Liu, X; Kim, D K; Kaizer, H; Fagan, L M

    1999-01-01

    Our group has built an information retrieval system based on a complex semantic markup of medical textbooks. We describe the construction of a set of web-based knowledge-acquisition tools that expedites the collection and maintenance of the concepts required for text markup and the search interface required for information retrieval from the marked text. In the text markup system, domain experts (DEs) identify sections of text that contain one or more elements from a finite set of concepts. End users can then query the text using a predefined set of questions, each of which identifies a subset of complementary concepts. The search process matches that subset of concepts to relevant points in the text. The current process requires that the DE invest significant time to generate the required concepts and questions. We propose a new system--called ACQUIRE (Acquisition of Concepts and Queries in an Integrated Retrieval Environment)--that assists a DE in two essential tasks in the text-markup process. First, it helps her to develop, edit, and maintain the concept model: the set of concepts with which she marks the text. Second, ACQUIRE helps her to develop a query model: the set of specific questions that end users can later use to search the marked text. The DE incorporates concepts from the concept model when she creates the questions in the query model. The major benefit of the ACQUIRE system is a reduction in the time and effort required for the text-markup process. We compared the process of concept- and query-model creation using ACQUIRE to the process used in previous work by rebuilding two existing models that we previously constructed manually. We observed a significant decrease in the time required to build and maintain the concept and query models.

  16. Ultralight Cut-Paper-Based Self-Charging Power Unit for Self-Powered Portable Electronic and Medical Systems.

    PubMed

    Guo, Hengyu; Yeh, Min-Hsin; Zi, Yunlong; Wen, Zhen; Chen, Jie; Liu, Guanlin; Hu, Chenguo; Wang, Zhong Lin

    2017-04-12

    The development of lightweight, superportable, and sustainable power sources has become an urgent need for most modern personal electronics. Here, we report a cut-paper-based self-charging power unit (PC-SCPU) that is capable of simultaneously harvesting and storing energy from body movement by combining a paper-based triboelectric nanogenerator (TENG) and a supercapacitor (SC), respectively. Utilizing the paper as the substrate with an assembled cut-paper architecture, an ultralight rhombic-shaped TENG is achieved with highly specific mass/volume charge output (82 nC g(-1)/75 nC cm(-3)) compared with the traditional acrylic-based TENG (5.7 nC g(-1)/5.8 nC cm(-3)), which can effectively charge the SC (∼1 mF) to ∼1 V in minutes. This wallet-contained PC-SCPU is then demonstrated as a sustainable power source for driving wearable and portable electronic devices such as a wireless remote control, electric watch, or temperature sensor. This study presents a potential paper-based portable SCPU for practical and medical applications.

  17. Sharing values, sharing a vision

    SciTech Connect

    Not Available

    1993-12-31

    Teamwork, partnership and shared values emerged as recurring themes at the Third Technology Transfer/Communications Conference. The program drew about 100 participants who sat through a packed two days to find ways for their laboratories and facilities to better help American business and the economy. Co-hosts were the Lawrence Livermore National Laboratory and the Lawrence Berkeley Laboratory, where most meetings took place. The conference followed traditions established at the First Technology Transfer/Communications Conference, conceived of and hosted by the Pacific Northwest Laboratory in May 1992 in Richmond, Washington, and the second conference, hosted by the National Renewable Energy Laboratory in January 1993 in Golden, Colorado. As at the other conferences, participants at the third session represented the fields of technology transfer, public affairs and communications. They came from Department of Energy headquarters and DOE offices, laboratories and production facilities. Continued in this report are keynote address; panel discussion; workshops; and presentations in technology transfer.

  18. Medical Treatments for Fibroids

    MedlinePlus

    ... NICHD Research Information Clinical Trials Resources and Publications Medical Treatments for Fibroids Skip sharing on social media ... Page Content Your health care provider may suggest medical treatments to reduce the symptoms of fibroids or ...

  19. A mobile agent approach for secure integrated medical information systems.

    PubMed

    Liu, Chia-Hui; Chung, Yu-Fang; Chiang, Te-Wei; Chen, Tzer-Shyong; Wang, Sheng-De

    2012-10-01

    Different patient-related information in medical organizations is the primary reference for medical personnel diagnosing, treating, and caring patients. With the rapid development of information technology, paper-based medical records have gradually been changed to electronic forms. However, different medical organizations present individual system specifications and data-saving formats so that the medical information of the same patient cannot be exchanged, shared, and securely accessed. In order not to largely change the present medical information systems as well as not to increase abundant costs, Virtual Integrated Medical-information Systems (VIMS) is proposed to assist various hospitals in information exchange. Furthermore, with Mobile Agent, the dispersed medical information can be securely integrated. It presents confidentiality, non-repudiation, source authentication, and integrity in network transmission. Virtual Integrated Medical-information Systems (VIMS) is a virtual electronic integration system combined with Mobile Agent technology. With the features of independence, adaptability, mobility, objectives, and autonomy, Mobile Agent is applied to overcome the problems from heterogeneous systems. With the features, the over-dispersed medical records can be integrated. Moreover, Mobile Agent can ensure the instantaneity and usability of medical records from which doctors can make the most appropriate evaluation and diagnoses. It will avoid the waste of medical resources, such as repetition medication, as well as become the reference of further consultation or health check. Not only can it improve the medical care quality, but it can be provided for medical research.

  20. Medications for High Blood Pressure

    MedlinePlus

    ... Products For Consumers Home For Consumers Consumer Updates Medications for High Blood Pressure Share Tweet Linkedin Pin ... all their lives. back to top Types of Medications FDA has approved many medications to treat high ...