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Applied Clinical Informatics

Erik Joukes, Nicolette F de Keizer, Martine C de Bruijne, Ameen Abu-Hanna, Ronald Cornet
BACKGROUND:  The implementation of an electronic health record (EHR) with structured and standardized recording of patient data can improve data quality and reusability. Whether and how users perceive these advantages may depend on the preimplementation situation. OBJECTIVE:  To determine whether the influence of implementing a structured and standardized EHR on perceived EHR use, data quality, and data reuse differed for users working with paper-based records versus a legacy EHR before implementation...
March 2019: Applied Clinical Informatics
Justin F Rousseau, Ivan K Ip, Ali S Raja, Vladimir I Valtchinov, Laila Cochon, Jeremiah D Schuur, Ramin Khorasani
BACKGROUND:  When a paucity of clinical information is communicated from ordering physicians to radiologists at the time of radiology order entry, suboptimal imaging interpretations and patient care may result. OBJECTIVES:  Compare documentation of relevant clinical information in electronic health record (EHR) provider note to computed tomography (CT) order requisition, prior to ordering of head CT for emergency department (ED) patients presenting with headache...
March 2019: Applied Clinical Informatics
R Ryanne Wu, Rachel A Myers, Adam H Buchanan, David Dimmock, Kimberly G Fulda, Irina V Haller, Susanne B Haga, Melissa L Harry, Catherine McCarty, Joan Neuner, Teji Rakhra-Burris, Nina Sperber, Corrine I Voils, Geoffrey S Ginsburg, Lori A Orlando
OBJECTIVE:  Investigate sociodemographic differences in the use of a patient-facing family health history (FHH)-based risk assessment platform. METHODS:  In this large multisite trial with a diverse patient population, we evaluated the relationship between sociodemographic factors and FHH health risk assessment uptake using an information technology (IT) platform. The entire study was administered online, including consent, baseline survey, and risk assessment completion...
March 2019: Applied Clinical Informatics
Nabeel Qureshi, Ateev Mehrotra, Robert S Rudin, Shira H Fischer
OBJECTIVES:  More patients are receiving their test results via patient portals. Given test results are written using medical jargon, there has been concern that patients may misinterpret these results. Using sample colonoscopy and Pap smear results, our objective was to assess how frequently people can identify the correct diagnosis and when a patient should follow up with a provider. METHODS:  We used Mechanical Turk-a crowdsourcing tool run by Amazon that enables easy and fast gathering of users to perform tasks like answering questions or identifying objects-to survey individuals who were shown six sample test results (three colonoscopy, three Pap smear) ranging in complexity...
March 2019: Applied Clinical Informatics
Gabrielle Hester, Tom Lang, Laura Madsen, Rabindra Tambyraja, Paul Zenker
BACKGROUND:  Standard methods for obtaining data may delay quality improvement (QI) interventions including for bronchiolitis, a common cause of childhood hospitalization. OBJECTIVE:  To describe the use of a dashboard in the context of a multifaceted QI intervention aimed at reducing the use of chest radiographs, bronchodilators, antibiotics, steroids, and viral testing in patients with bronchiolitis. METHODS:  This QI initiative took place at Children's Minnesota, a large, not-for-profit children's health care organization...
January 2019: Applied Clinical Informatics
Ju Wang, Hongyuan Liang, Hong Kang, Yang Gong
BACKGROUND:  While health information technology (health IT) is able to prevent medication errors in many ways, it may also potentially introduce new paths to errors. To understand the impact of health IT induced medication errors, this study aims to conduct a retrospective analysis of medication safety reports. METHODS:  From the U.S. Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience database, we identified reports in which health IT is a contributing factor to medication errors...
January 2019: Applied Clinical Informatics
Christopher Pearce, Adam McLeod, Natalie Rinehart, Jon Patrick, Anna Fragkoudi, Jason Ferrigi, Elizabeth Deveny, Robin Whyte, Marianne Shearer
OBJECTIVE:  This project examined and produced a general practice (GP) based decision support tool (DST), namely POLAR Diversion, to predict a patient's risk of emergency department (ED) presentation. The tool was built using both GP/family practice and ED data, but is designed to operate on GP data alone. METHODS:  GP data from 50 practices during a defined time frame were linked with three local EDs. Linked data and data mapping were used to develop a machine learning DST to determine a range of variables that, in combination, led to predictive patient ED presentation risk scores...
January 2019: Applied Clinical Informatics
Xinran Liu, Paul R Sutton, Rory McKenna, Mika N Sinanan, B Jane Fellner, Michael G Leu, Cris Ewell
OBJECTIVE:  The use of text messaging in clinical care has become ubiquitous. Due to security and privacy concerns, many hospital systems are evaluating secure text messaging applications. This paper highlights our evaluation process, and offers an overview of secure messaging functionalities, as well as a framework for how to evaluate such applications. METHODS:  Application functionalities were gathered through literature review, Web sites, speaking with representatives, demonstrations, and use cases...
January 2019: Applied Clinical Informatics
Ann Kutney-Lee, Douglas M Sloane, Kathryn H Bowles, Lawton R Burns, Linda H Aiken
BACKGROUND:  Despite evidence suggesting higher quality and safer care in hospitals with comprehensive electronic health record (EHR) systems, factors related to advanced system usability remain largely unknown, particularly among nurses. Little empirical research has examined sociotechnical factors, such as the work environment, that may shape the relationship between advanced EHR adoption and quality of care. OBJECTIVE:  The objective of this study was to examine the independent and joint effects of comprehensive EHR adoption and the hospital work environment on nurse reports of EHR usability and nurse-reported quality of care and safety...
January 2019: Applied Clinical Informatics
Chenchen Feng, David Le, Allison B McCoy
OBJECTIVE:  We identified the methods used and determined the roles of electronic health records (EHRs) in detecting and assessing adverse drug events (ADEs) in the ambulatory setting. METHODS:  We performed a systematic literature review by searching PubMed and Google Scholar for studies on ADEs detected in the ambulatory setting involving any EHR use published before June 2017. We extracted study characteristics from included studies related to ADE detection methods for analysis...
January 2019: Applied Clinical Informatics
Bat-Zion Hose, Peter L T Hoonakker, Abigail R Wooldridge, Thomas B Brazelton Iii, Shannon M Dean, Ben Eithun, James C Fackler, Ayse P Gurses, Michelle M Kelly, Jonathan E Kohler, Nicolette M McGeorge, Joshua C Ross, Deborah A Rusy, Pascale Carayon
OBJECTIVE:  To describe physician perceptions of the potential goals, characteristics, and content of the electronic problem list (PL) in pediatric trauma. METHODS:  We conducted 12 semistructured interviews with physicians involved in the pediatric trauma care process, including residents, fellows, and attendings from four services: emergency medicine, surgery, anesthesia, and pediatric critical care. Using qualitative content analysis, we identified PL goals, characteristics, and patient-related information from these interviews and the hospital's PL etiquette document of guideline...
January 2019: Applied Clinical Informatics
Ann Scheck McAlearney, Naleef Fareed, Alice Gaughan, Sarah R MacEwan, Jaclyn Volney, Cynthia J Sieck
BACKGROUND:  Patients have demonstrated an eagerness to use portals to access their health information and connect with care providers. While outpatient portals have been extensively studied, there is a recognized need for research that examines inpatient portals. OBJECTIVE:  We conducted this study to improve our understanding about the role of a portal in the context of inpatient care. Our study focused on a large sample of the general adult inpatient population and obtained perspectives from both patients and care team members about inpatient portal use...
January 2019: Applied Clinical Informatics
Raymond Tsai, Elijah J Bell, Hawkin Woo, Kevin Baldwin, Michael A Pfeffer
BACKGROUND:  Given the widespread electronic health record adoption, there is increasing interest to leverage patient portals to improve care. OBJECTIVE:  To determine characteristics of patient portal users and the activities they accessed in the patient portal. METHODS:  We performed a retrospective analysis of patient portal usage at University of California, Los Angeles, Health from July 2014 to May 2015. A total dataset of 505,503 patients was compiled with 396,303 patients who did not register for the patient portal and 109,200 patients who registered for a patient portal account...
January 2019: Applied Clinical Informatics
Susan A Matney, Bret Heale, Steve Hasley, Emily Decker, Brittni Frederiksen, Nathan Davis, Patrick Langford, Nadia Ramey, Stanley M Huff
OBJECTIVE:  This article describes lessons learned from the collaborative creation of logical models and standard Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR) profiles for family planning and reproductive health. The National Health Service delivery program will use the FHIR profiles to improve federal reporting, program monitoring, and quality improvement efforts. MATERIALS AND METHODS:  Organizational frameworks, work processes, and artifact testing to create FHIR profiles are described...
January 2019: Applied Clinical Informatics
Scott D Nelson, Hayley H Rector, Daniel Brashear, Janos L Mathe, Haomin Wen, Stacey Lynn English, William Hedges, Christoph U Lehmann, Asli Ozdas-Weitkamp, Shane P Stenner
BACKGROUND:  Managing prescription renewal requests is a labor-intensive challenge in ambulatory care. In 2009, Vanderbilt University Medical Center developed clinic-specific standing prescription renewal orders that allowed nurses, under specific conditions, to authorize renewal requests. Formulary and authorization changes made maintaining these documents very challenging. OBJECTIVE:  This article aims to review, standardize, and restructure legacy standing prescription renewal orders into a modular, scalable, and easier to manage format for conversion and use in a new electronic health record (EHR)...
January 2019: Applied Clinical Informatics
David Lyell, Farah Magrabi, Enrico Coiera
OBJECTIVE:  Clinicians using clinical decision support (CDS) to prescribe medications have an obligation to ensure that prescriptions are safe. One option is to verify the safety of prescriptions if there is uncertainty, for example, by using drug references. Supervisory control experiments in aviation and process control have associated errors, with reduced verification arising from overreliance on decision support. However, it is unknown whether this relationship extends to clinical decision-making...
January 2019: Applied Clinical Informatics
Teresa O'Leary, June Weiss, Benjamin Toll, Cynthia Brandt, Steven L Bernstein
BACKGROUND:  Investigators conducting prospective clinical trials must report patient flow using the Consolidated Standards of Reporting Trials (CONSORT) statement. Depending on how data are collected, this can be a laborious, time-intensive process. However, because many trials enter data electronically, CONSORT diagrams may be generated in an automated fashion. OBJECTIVE:  Our objective was to use an off-the-shelf software to develop a technique to generate CONSORT diagrams automatically...
January 2019: Applied Clinical Informatics
Eric Rose, Steven Rube, Andrew S Kanter, Matthew Cardwell, Frank Naeymi-Rad
BACKGROUND:  Clinical interface terminologies (CITs) consist of terms designed for clinical documentation and, through mappings to standardized vocabularies, to support secondary uses of patient data, including clinical decision support, quality measurement, and billing for health care services. The latter purpose requires maps to administrative coding systems, such as the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), for diagnoses in the United States...
January 2019: Applied Clinical Informatics
Lisa V Grossman, Ruth M Masterson Creber, Jessica S Ancker, Beatriz Ryan, Fernanda Polubriaginof, Min Qian, Irma Alarcon, Susan Restaino, Suzanne Bakken, George Hripcsak, David K Vawdrey
BACKGROUND:  Disadvantaged populations, including minorities and the elderly, use patient portals less often than relatively more advantaged populations. Limited access to and experience with technology contribute to these disparities. Free access to devices, the Internet, and technical assistance may eliminate disparities in portal use. OBJECTIVE:  To examine predictors of frequent versus infrequent portal use among hospitalized patients who received free access to an iPad, the Internet, and technical assistance...
January 2019: Applied Clinical Informatics
Fernán Gonzalez Bernaldo de Quirós, Analía Baum, Antonio Lira
No abstract text is available yet for this article.
January 2019: Applied Clinical Informatics
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