Publications by authors named "Charles Safran"

56 Publications

A visual representation of microbiological culture data improves comprehension: a randomized controlled trial.

J Am Med Inform Assoc 2021 Jun 8. Epub 2021 Jun 8.

Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.

Objective: While the judicious use of antibiotics takes past microbiological culture results into consideration, this data's typical format in the electronic health record (EHR) may be unwieldy when incorporated into clinical decision-making. We hypothesize that a visual representation of sensitivities may aid in their comprehension.

Materials And Methods: A prospective parallel unblinded randomized controlled trial was undertaken at an academic urban tertiary care center. Providers managing emergency department (ED) patients receiving antibiotics and having previous culture sensitivity testing were included. Providers were randomly selected to use standard EHR functionality or a visual representation of patients' past culture data as they answered questions about previous sensitivities. Concordance between provider responses and past cultures was assessed using the kappa statistic. Providers were surveyed about their decision-making and the usability of the tool using Likert scales.

Results: 518 ED encounters were screened from 3/5/2018 to 9/30/18, with providers from 144 visits enrolled and analyzed in the intervention arm and 129 in the control arm. Providers using the visualization tool had a kappa of 0.69 (95% CI: 0.65-0.73) when asked about past culture results while the control group had a kappa of 0.16 (95% CI: 0.12-0.20). Providers using the tool expressed improved understanding of previous cultures and found the tool easy to use (P < .001). Secondary outcomes showed no differences in prescribing practices.

Conclusion: A visual representation of culture sensitivities improves comprehension when compared to standard text-based representations.
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http://dx.doi.org/10.1093/jamia/ocab056DOI Listing
June 2021

Assessment of Unintentional Duplicate Orders by Emergency Department Clinicians Before and After Implementation of a Visual Aid in the Electronic Health Record Ordering System.

JAMA Netw Open 2019 12 2;2(12):e1916499. Epub 2019 Dec 2.

Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Importance: Electronic health records allow teams of clinicians to simultaneously care for patients, but an unintended consequence is the potential for duplicate orders of tests and medications.

Objective: To determine whether a simple visual aid is associated with a reduction in duplicate ordering of tests and medications.

Design, Setting, And Participants: This cohort study used an interrupted time series model to analyze 184 694 consecutive patients who visited the emergency department (ED) of an academic hospital with 55 000 ED visits annually. Patient visits occurred 1 year before and after each intervention, as follows: for laboratory orders, from August 13, 2012, to August 13, 2014; for medication orders, from February 3, 2013, to February 3, 2015; and for radiology orders, from December 12, 2013, to December 12, 2015. Data were analyzed from April to September 2019.

Exposure: If an order had previously been placed during the ED visit, a red highlight appeared around the checkbox of that order in the computerized provider order entry system.

Main Outcomes And Measures: Number of unintentional duplicate laboratory, medication, and radiology orders.

Results: A total of 184 694 patients (mean [SD] age, 51.6 [20.8] years; age range, 0-113.0 years; 99 735 [54.0%] women) who visited the ED were analyzed over the 3 overlapping study periods. After deployment of a noninterruptive nudge in electronic health records, there was an associated 49% decrease in the rate of unintentional duplicate orders for laboratory tests (incidence rate ratio, 0.51; 95% CI, 0.45-0.59), from 4485 to 2731 orders, and an associated 40% decrease in unintentional duplicate orders of radiology tests (incidence rate ratio, 0.60; 95% CI, 0.44-0.82), from 956 to 782 orders. There was not a statistically significant change in unintentional duplicate orders of medications (incidence rate ratio, 1.17; 95% CI, 0.52-2.61), which increased from 225 to 287 orders. The nudge eliminated an estimated 17 936 clicks in our electronic health record.

Conclusions And Relevance: In this interrupted time series cohort study, passive visual cues that provided just-in-time decision support were associated with reductions in unintentional duplicate orders for laboratory and radiology tests but not in unintentional duplicate medication orders.
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http://dx.doi.org/10.1001/jamanetworkopen.2019.16499DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6902748PMC
December 2019

InfoSAGE: Usage Pattern of a Family-Centric Care Coordination Online Platform.

Stud Health Technol Inform 2019 Aug;264:1972-1973

Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Globally, there is an expanding elderly population, and families are finding it increasingly challenging to coordinate care for their older family members. This paper reports on the usage patterns of InfoSAGE, an online private social network that has tools for communication and care coordination for elders and their families. This descriptive analysis describes the types of family networks using the platform and types of functionality most used by elders and their family members.
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http://dx.doi.org/10.3233/SHTI190740DOI Listing
August 2019

Alicanto Online Latin American Maternal Informatics Community of Practice.

Stud Health Technol Inform 2019 Aug;264:1676-1677

Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Most cases of maternal deaths could be avoided with timely access to quality healthcare, but a key challenge in addressing quality of care in maternal health is the lack of accurate data and analytics. Implementing online communities of practice is a way to resolve this, but in low-and middle-income countries this is particularly challenging. We discuss the design of the Alicanto Online Latin-American Community of Practice that focuses on both outcomes and process indicators.
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http://dx.doi.org/10.3233/SHTI190592DOI Listing
August 2019

Patient experience with family history tool: analysis of patients' experience sharing their family health history through patient-computer dialogue in a patient portal.

J Am Med Inform Assoc 2019 07;26(7):603-609

Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.

Objective: The collection and use of a family health history are important for assessing the patient's risk of disease, but history taking is often impeded by practical barriers in the office. Provision for patient-computer dialogue, linked with the electronic health record, may enable patients to contribute their history while bypassing these barriers. We sought to assess the patient experience using such a tool.

Materials And Methods: We linked the family history module of a computer-based medical history to the patient portal of a large academic health system. The interview consisted of 39 primary questions with a predetermined high test-retest reliability. Patients' results were structured and summarized, and available within their electronic health record. Patients optionally completed a survey about their experience. We inductively analyzed free-text responses collected between 2014 and 2016.

Results: Among 97 781 patient portal users, 9562 patients accessed and 4223 patients completed the family medical history interview. Of these patients, 1451 completed our survey. Main themes that were identified included (1) patient empowerment, (2) anticipated value, (3) validity concerns, (4) privacy concerns, and (5) reflections on patient-computer dialogue. Patients also provided suggestions for the improvement of future family history tools.

Discussion: Patients providing their family health information is an example of collaborative electronic work with clinicians and was seen as valuable by those who participated. Concerns related to contextual information and uncertainty need to be addressed.

Conclusions: Patient-computer dialogue to collect family medical history empowered patients and added perceived value and efficiency to the patient experience of care.
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http://dx.doi.org/10.1093/jamia/ocz008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7647187PMC
July 2019

InfoSAGE: Supporting Elders and Families through Online Family Networks.

AMIA Annu Symp Proc 2018 5;2018:932-941. Epub 2018 Dec 5.

Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, MA.

With an increasingly elderly population, families are finding it increasingly challenging to coordinate care for their older family members. This paper reports on the findings of InfoSAGE, an online private social network that has tools for communication and care coordination for elders and their families. The InfoSAGE system has 257 registered users; 52 of these opted into an in-depth longitudinal study. A descriptive analysis of these early participants, the online family networks, and barriers to participation that were encountered are presented.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371310PMC
December 2019

Characteristics of the National Applicant Pool for Clinical Informatics Fellowships (2016-2017).

AMIA Annu Symp Proc 2018 5;2018:225-231. Epub 2018 Dec 5.

David Geffen School of Medicine at UCLA, Los Angeles, CA.

We conducted a national study to assess the numbers and diversity of applicants for 2016 and 2017 clinical informatics fellowship positions. In each year, we collected data on the number of applications that programs received from candidates who were ultimately successful vs. unsuccessful. In 2017, we also conducted an anonymous applicant survey. Successful candidates applied to an average of 4.2 and 5.5 programs for 2016 and 2017, respectively. In the survey, unsuccessful candidates reported applying to fewer programs. Assuming unsuccessful candidates submitted between 2-5 applications each, the total applicant pool numbered 42-69 for 2016 (competing for 24 positions) and 52-85 for 2017 (competing for 30 positions). Among survey respondents (n=33), 24% were female, 1 was black and none were Hispanic. We conclude that greater efforts are needed to enhance interest in clinical informatics among medical students and residents, particularly among women and members of underrepresented minority groups.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371309PMC
September 2019

A Usability Evaluation of the InfoSAGE App for Family-Based Medication Management.

Stud Health Technol Inform 2019 ;257:352-357

Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, MA.

The design of a mobile medication manager within a broader family and elder-centric collaboration platform faces challenges of usability and wide applicability. To inform the development and use cases of eldercare apps, we present the preliminary results of a usability study of an iOS and Android app intended for both family members and aging adults for the mobile management of medication lists. Seven participants were recorded during the performance of eight typical use-case scenarios of the medication portion of the InfoSAGE app. Audio and video recordings were analyzed for themes and events. The aim of this paper is to help inform future design choices for eldercare mobile apps.
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August 2019

An Informatics Framework for Maternal and Child Health (MCH) Monitoring.

Stud Health Technol Inform 2019 ;257:157-162

Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, MA.

Most cases of maternal deaths could be avoided with timely access to quality healthcare, but a key challenge in addressing quality of care in maternal health, is the lack of accurate data. We present a review of the difficulties of collecting and analyzing maternal health data. We propose a comprehensive informatics monitoring framework to track progress on the achievement of the international targets and priorities toward ending preventable maternal mortality and improving maternal and child health, that at the same time builds capacity at institutional and country level to collect indicators and to generate actionable and comparable knowledge that facilitates analysis, research, and evidence-based decision making.
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August 2019

Information sharing across generations and environments (InfoSAGE): study design and methodology protocol.

BMC Med Inform Decis Mak 2018 11 20;18(1):105. Epub 2018 Nov 20.

Division of Clinical Informatics, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02115, USA.

Background: Longevity creates increasing care needs for healthcare providers and family caregivers. Increasingly, the burden of care falls to one primary caregiver, increasing stress and reducing health outcomes. Additionally, little has been published on adults', over the age of 75, preferences in the development of health information sharing with family members using online platforms. This study aims to assess a novel, Internet based, family-centric communication and collaboration platform created to address the information needs of elders and their informal caregivers in a community setting.

Methods: This study is an internet-based, open prospective cohort study, enrolling dyad pairs of one adult over the age of 75 with one informal caregiver. Dyads will be offered to use the InfoSAGE online platform without prospective assignment. Participants will consent using an online process that enables participation from any location and shares important study and privacy details. The platform will enable the capture of search queries and tracking of functions such as tasks and discussions. Surveys every six months assess health status, health and social needs, and caregiver burden using validated instruments over a two-year period. We will use a mixed methods approach, utilizing qualitative survey data along with website usage analytic data.

Discussion: Analysis of the longitudinal usage and survey data will help to examine the patterns of family communication and health information seeking as the central older adult ages. We will use the study data to inform design recommendations relevant to a complex mixture of users, with special consideration to the needs of older adult users and potential physical limitations.
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http://dx.doi.org/10.1186/s12911-018-0697-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6245635PMC
November 2018

Virtual Care as a Specialty.

JAMA 2018 06;319(24):2559-2560

Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

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http://dx.doi.org/10.1001/jama.2018.5670DOI Listing
June 2018

A Systematic Review on Promoting Adherence to Antiretroviral Therapy in HIV-infected Patients Using Mobile Phone Technology.

Appl Clin Inform 2018 04 20;9(2):450-466. Epub 2018 Jun 20.

Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States.

Objective: Adherence to antiretroviral therapy (ART) is paramount to successful long-term suppression of human immunodeficiency virus (HIV). For poorly adherent patients with HIV, barriers to remaining adherent may be overcome by the implementation of targeted interventions delivered via mobile devices. This systematic review is focused specifically on mobile phone technologies to deliver adherence interventions in HIV/acquired immunodeficiency syndrome (AIDS) populations.

Methods: This review (PROSPERO #CRD42017065131) systematically extracted data from published literature from five databases on mobile phone interventions to improve adherence to ART for HIV. The reported studies had been conducted between 2007 and 2017. Risk of bias was assessed using the Cochrane method ranking each criterion as low, high, or unclear risk of bias.

Results: Of the 835 articles returned, we identified 26 randomized controlled trials (RCTs), retrospective and prospective cohort trials, or mixed method studies with a comparison group that fit criteria for inclusion. No standard measure of adherence was consistent throughout the examined studies, and assessments by self-report, pill counting, and medication event monitoring system (MEMS) were utilized. The studies reported mixed results, with 17 reporting significant improvements to adherence, 3 reporting improvements without supplying -values, and 6 reporting no significant change or a reduction in adherence.

Conclusion: The mixed nature of the results exemplifies the need for more comprehensive approaches and larger scale trials to confirm results observed in limited cohort sizes. To better retain satisfactory adherence within the HIV population, and especially in low-resource settings, we recommend that future interventions incorporate multiple strategies: mobile-based reminders, social support structures, and personalized content.
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http://dx.doi.org/10.1055/s-0038-1660516DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6010354PMC
April 2018

Rethinking the outpatient medication list: increasing patient activation and education while architecting for centralization and improved medication reconciliation.

J Am Med Inform Assoc 2018 08;25(8):1047-1053

Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, MA 02446, USA.

Objective: Identify barriers impacting the time consuming and error fraught process of medication reconciliation. Design and implement an electronic medication management system where patient and trusted healthcare proxies can participate in establishing and maintaining an inclusive and up-to-date list of medications.

Methods: A patient-facing electronic medication manager was deployed within an existing research project focused on elder care management funded by the AHRQ, InfoSAGE, allowing patients and patients' proxies the ability to build and maintain an accurate and up-to-date medication list. Free and open-source tools available from the U.S. government were used to embed the tenets of centralization, interoperability, data federation, and patient activation into the design.

Results: Using patient-centered design and free, open-source tools, we implemented a web and mobile enabled patient-facing medication manager for complex medication management.

Conclusions: Patient and caregiver participation are essential to improve medication safety. Our medication manager is an early step towards a patient-facing medication manager that has been designed with data federation and interoperability in mind.
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http://dx.doi.org/10.1093/jamia/ocy047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6915822PMC
August 2018

Accessing Reliable Health Information on the Web: A Review of the HON Approach.

Stud Health Technol Inform 2017 ;245:1004-1008

Health On The Net Foundation, Geneva, Switzerland.

Accessing online health content of high quality and reliability presents challenges. Laypersons cannot easily differentiate trustworthy content from misinformed or manipulated content. This article describes complementary approaches for members of the general public and health professionals to find trustworthy content with as little bias as possible. These include the Khresmoi health search engine (K4E), the Health On the Net Code of Conduct (HONcode) and health trust indicator Web browser extensions.
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June 2018

Medication Harmony: A Framework to Save Time, Improve Accuracy and Increase Patient Activation.

AMIA Annu Symp Proc 2016 10;2016:1959-1966. Epub 2017 Feb 10.

Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA.

Incompletely reconciled medication lists contribute to prescribing errors and adverse drug events. Providers expend time and effort at every point of patient contact attempting to curate a best possible medication list, and yet often the list is incomplete or inaccurate. We propose a framework that builds upon the existing infrastructure of a health information exchange (HIE), centralizes data and encourages patient activation. The solution is a constantly accessible, singular, patient-adjudicated medication list that incorporates useful information and features into the list itself. We aim to decrease medication errors across transitions of care, increase awareness of potential drug-drug interactions, improve patient knowledge and self-efficacy regarding medications, decrease polypharmacy, improve prescribing safety and ultimately decrease cost to the health-care system.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5333345PMC
September 2017

InfoSAGE: Use of Online Technologies for Communication and Elder Care.

Stud Health Technol Inform 2017 ;234:280-285

Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, MA.

Aging creates new information and communication needs for families who are helping to coordinate care for frail parents. To identify how information and communication needs evolve with the aging process, we created a living laboratory of families, supported by an online private social network with tools for care coordination. Site registrants are invite to participate in a more in-depth survey-based longitudinal study. In year one, we assessed the feasibility of an online living laboratory. During this first year, 155 individuals registered on InfoSAGE, and 26% opted into the more in-depth longitudinal study. The survey response rate for those in the study was 61%. We present here a descriptive analysis of our early participants and networks, as well as barriers to participation that the study team encountered.
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June 2018

Time for Transitions.

Authors:
Charles Safran

Int J Med Inform 2016 Aug;92

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http://dx.doi.org/10.1016/j.ijmedinf.2016.06.002DOI Listing
August 2016

Addressing the Challenges of Aging: How Elders and Their Care Partners Seek Information.

Gerontologist 2017 10;57(5):955-962

Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Brookline, Massachusetts.

Purpose: Elders in retirement communities face many challenges concerning information and communication. We know little about whether or how online technologies help meet their medical and social needs. The objective of this study was to gain insights into how these elders and their families manage health information and communication.

Design And Methods: Qualitative analysis of 10 focus groups with elders and family members. Participants were 30 elders at least 75 years of age residing in 5 senior living communities in and near Boston, MA, and 23 family members.

Results: Elders and families turned first to their personal networks when they needed information or help. They stayed informed about elders' health primarily by talking directly with providers. They used online resources infrequently, including portal access to medical records. They wanted online access to medication lists and visit notes, up-to-date information about local services and social activities, and a way to avoid the overwhelming nature of Internet searches.

Implications: Elders in senior living communities and their families piece together information primarily from word of mouth communication. In the future, electronic social and collaborative technologies may make information gathering easier.
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http://dx.doi.org/10.1093/geront/gnw060DOI Listing
October 2017

Improving health care proxy documentation using a web-based interview through a patient portal.

J Am Med Inform Assoc 2016 05 13;23(3):580-7. Epub 2015 Nov 13.

Division of Clinical Informatics, Beth Israel Deaconess Medical Center, 1330 Beacon St., Suite 400, Brookline, MA 02446, USA.

Objective: Health care proxy (HCP) documentation is suboptimal. To improve rates of proxy selection and documentation, we sought to develop and evaluate a web-based interview to guide patients in their selection, and to capture their choices in their electronic health record (EHR).

Methods: We developed and implemented a HCP interview within the patient portal of a large academic health system. We analyzed the experience, together with demographic and clinical factors, of the first 200 patients who used the portal to complete the interview. We invited users to comment about their experience and analyzed their comments using established qualitative methods.

Results: From January 20, 2015 to March 13, 2015, 139 of the 200 patients who completed the interview submitted their HCP information for their clinician to review in the EHR. These patients had a median age of 57 years (Inter Quartile Range (IQR) 45-67) and most were healthy. The 99 patients who did not previously have HCP information in their EHR were more likely to complete and then submit their information than the 101 patients who previously had a proxy in their health record (odds ratio 2.4, P = .005). Qualitative analysis identified several ways in which the portal-based interview reminded, encouraged, and facilitated patients to complete their HCP.

Conclusions: Patients found our online interview convenient and helpful in facilitating selection and documentation of an HCP. Our study demonstrates that a web-based interview to collect and share a patient's HCP information is both feasible and useful.
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http://dx.doi.org/10.1093/jamia/ocv133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4901371PMC
May 2016

Global Challenges in People-Centered E-Health.

Stud Health Technol Inform 2015 ;216:977

Division of Clinical Informatics, Beth Israel Deaconess Medical Center and Harvard Medical School.

People-centered health care seeks an active role for the patient while empowering all other members of the health care team. By promoting greater patient responsibility and optimal usage, patient-centered health care leads to improved health outcomes, quality of life and optimal value for health care investment. This paper reviews some definitions of people-centered health care and various e-health approaches around the world used to implement this vision. The barriers and enablers to implementation this type of approach are explored. This paper provides a proposed research agenda for future implementations of people-centered e-health.
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April 2016

Clinical Informatics Board Specialty Certification for Physicians: A Global View.

Stud Health Technol Inform 2015 ;216:501-5

Vanderbilt University, Nashville, TN, USA.

Clinical informatics workforce development is a high priority for medicine. Professional board certification for physicians is an important tool to demonstrating excellence. The recent recognition of clinical informatics as a subspecialty board in the U.S. has generated interest and excitement among the U.S. informatics community. To determine the extent of similar programs in countries around the world, we performed literature searches with relevant keywords and internet searches of websites of informatics societies around the world for mentions or descriptions of certifications and reviewed publicly available sources. The U.S. certification was prominent in the recent published literature. Germany and Belgium have long-standing certifications with South Korea and Sri Lanka considering similar programs. This is the first global view of clinical informatics board certification for physicians. Training and certification for non-physician informatics professionals in allied areas are widespread. Official recognition and certification for physicians and all informatics professionals represents a key component of capacity building and a means of addressing the shortage of a skilled informatics workforce. Wider adoption of certification programs may further attracting talent and accelerate growth of the field.
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December 2016

Information Sharing Preferences of Older Patients and Their Families.

JAMA Intern Med 2015 Sep;175(9):1492-7

Division of Clinical Informatics, Beth Israel Deaconess Medical Center, Boston, Massachusetts3Harvard Medical School, Boston, Massachusetts.

Importance: Elderly patients often share control of their personal health information and decision making with family and friends when needed. Patient portals can help with information sharing, but concerns about privacy and autonomy of elderly patients remain. Health systems that implement patient portals would benefit from guidance about how best to implement access to portals for caregivers of elderly patients.

Objective: To identify how patients older than 75 years (hereinafter, elders) and family caregivers of such patients approach sharing of health information, with the hope of applying the results to collaborative patient portals.

Design, Setting, And Participants: A qualitative study was conducted from October 20, 2013, to February 16, 2014, inviting participants older than 75 years (n = 30) and participants who assist a family member older than 75 years (n = 23) to 1 of 10 discussion groups. Participants were drawn from the Information Sharing Across Generations (InfoSAGE) Living Laboratory, an ongoing study of information needs of elders and families based within an academically affiliated network of senior housing in metropolitan Boston, Massachusetts. Groups were separated into elders and caregivers to allow for more detailed discussion. A professional moderator led groups using a discussion guide. Group discussions were audiotaped, transcribed, and analyzed inductively using immersion/crystallization methods for central themes.

Main Outcomes And Measures: Central themes regarding sharing of health information between elderly patients and family caregivers.

Results: Seven lessons emerged from 2 main themes. First, sharing information has consequences: (1) elders and caregivers have different perspectives on what is seen as the "burden" of information, (2) access to medical information by families can have unintended consequences, and (3) elders do not want to feel "spied on" by family. Second, control of information sharing is dynamic: (4) elders wish to retain control of decision making as long as possible, (5) transfer of control occurs gradually depending on elders' health and functional status, (6) control of information sharing and decision making should be fluid to maximize elders' autonomy, and (7) no "one-size-fits-all" approach can satisfy individuals' different preferences.

Conclusions And Relevance: Information sharing and control are complex issues even under the most well-meaning circumstances. While elders may delegate control and share information with family, they want to retain granular control of their information. When using patient portals, simple proxy access may not adequately address the needs and concerns of aging patients.
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http://dx.doi.org/10.1001/jamainternmed.2015.2903DOI Listing
September 2015

Patient-to-physician messaging: volume nearly tripled as more patients joined system, but per capita rate plateaued.

Health Aff (Millwood) 2014 Oct;33(10):1817-22

Bruce E. Landon is a professor of health care policy at Harvard Medical School.

Patients want to be able to communicate with their physicians by e-mail. However, physicians are often concerned about the impact that such communications will have on their time, productivity, and reimbursement. Typically, physicians are not reimbursed for time spent communicating with patients electronically. But under federal meaningful-use criteria for information technology, physicians can receive a modest incentive for such communications. Little is known about trends in secure e-mail messaging between physicians and patients. To understand these trends, we analyzed the volume of messages in a large academic health system's patient portal in the period 2001-10. At the end of 2010, 49,778 patients (22.7 percent of all patients seen within the system) had enrolled in the portal, and 36.9 percent of enrolled patients (8.4 percent of all patients) had sent at least one message to a physician. Physicians in the aggregate saw a near tripling of e-mail messages during the study period. However, the number of messages per hundred patients per month stabilized between 2005 and 2010, at an average of 18.9 messages. As physician reimbursement moves toward global payments, physicians' and patients' participation in secure messaging will likely increase, and electronic communication should be considered part of physicians' job descriptions.
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http://dx.doi.org/10.1377/hlthaff.2013.1145DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4418542PMC
October 2014

Acceptance and use of health information technology by community-dwelling elders.

Int J Med Inform 2014 Sep 16;83(9):624-35. Epub 2014 Jun 16.

Division of Clinical Informatics, Beth Israel Deaconess Medical Center, 1330 Beacon St., Suite 400, Brookline, MA 02446, United States.

Objectives: With the worldwide population growing in age, information technology may help meet important needs to prepare and support patients and families for aging. We sought to explore the use and acceptance of information technology for health among the elderly by reviewing the existing literature.

Methods: Review of literature using PubMed and Google Scholar, references from relevant papers, and consultation with experts.

Results: Elderly people approach the Internet and health information technology differently than younger people, but have growing rates of adoption. Assistive technology, such as sensors or home monitors, may help 'aging in place', but these have not been thoroughly evaluated. Elders face many barriers in using technology for healthcare decision-making, including issues with familiarity, willingness to ask for help, trust of the technology, privacy, and design challenges.

Conclusions: Barriers must be addressed for these tools to be available to this growing population. Design, education, research, and policy all play roles in addressing these barriers to acceptance and use.
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http://dx.doi.org/10.1016/j.ijmedinf.2014.06.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4144164PMC
September 2014

Hospital information system survey in qatar.

Stud Health Technol Inform 2013 ;192:959

Sidra Medical and Research Center, Qatar.

Unlabelled: Healthcare can be enhanced by the effective use of information technology to improve the quality and safety of care and many healthcare providers are adopting advanced health information technology to improve their healthcare delivery process. Qatar is a relatively young Middle Eastern country with an ambitious and progressive national strategy to develop its healthcare system, including an advanced e-health infrastructure delivering the right medical information at the right time to clinicians and patients. To assess the effectiveness of such programs, it is important to have a pre-intervention baseline from which comparisons, performance against target measures and forward thinking strategic planning can be grounded. This study presents the first published campus wide survey of Hospital Information Systems in large public and private hospitals in Qatar.

Objective: To qualitatively assess and describe the current state of Hospital Information Systems in large hospitals in Qatar, and to establish a baseline or reference point for Qatar's readiness for, and adoption of Hospital Information Systems.
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April 2015

Medicine based upon data.

Authors:
Charles Safran

J Gen Intern Med 2013 Dec;28(12):1545-6

Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 1330 Beacon Street Suite 400, Brookline, MA, 02446, USA,

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http://dx.doi.org/10.1007/s11606-013-2549-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832715PMC
December 2013

Identifying gender-preferred communication styles within online cancer communities: a retrospective, longitudinal analysis.

PLoS One 2012 14;7(11):e49169. Epub 2012 Nov 14.

Silverlink Communications, Boston, Massachusetts, United States of America.

Background: The goal of this research is to determine if different gender-preferred social styles can be observed within the user interactions at an online cancer community. To achieve this goal, we identify and measure variables that pertain to each gender-specific social style.

Methods And Findings: We perform social network and statistical analysis on the communication flow of 8,388 members at six different cancer forums over eight years. Kruskal-Wallis tests were conducted to measure the difference between the number of intimate (and highly intimate) dyads, relationship length, and number of communications. We determine that two patients are more likely to form an intimate bond on a gender-specific cancer forum (ovarian P = <0.0001, breast P = 0.0089, prostate P = 0.0021). Two female patients are more likely to form a highly intimate bond on a female-specific cancer forum (Ovarian P<0.0001, Breast P<0.01). Typically a male patient communicates with more members than a female patient (Ovarian forum P = 0.0406, Breast forum P = 0.0013). A relationship between two patients is longer on the gender-specific cancer forums than a connection between two members not identified as patients (ovarian forum P = 0.00406, breast forum P = 0.00013, prostate forum P = .0.0003).

Conclusion: The high level of interconnectedness among the prostate patients supports the hypothesis that men prefer to socialize in large, interconnected, less-intimate groups. A female patient is more likely to form a highly intimate connection with another female patient; this finding is consistent with the hypothesis that woman prefer fewer, more intimate connections. The relationships of same-gender cancer patients last longer than other relationships; this finding demonstrates homophily within these online communities. Our findings regarding online communication preferences are in agreement with research findings from person-to-person communication preference studies. These findings should be considered when designing online communities as well as designing and evaluating psychosocial and educational interventions for cancer patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0049169PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498295PMC
May 2013

Evaluation of computer-based medical histories taken by patients at home.

J Am Med Inform Assoc 2012 Jul-Aug;19(4):545-8. Epub 2012 Jan 11.

Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.

The authors developed a computer-based general medical history to be taken by patients in their homes over the internet before their first visit with their primary care doctor, and asked six doctors and their participating patients to assess this history and its effect on their subsequent visit. Forty patients began the history; 32 completed the history and post-history assessment questionnaire and were for the most part positive in their assessment; and 23 continued on to complete their post-visit assessment questionnaire and were for the most part positive about the helpfulness of the history and its summary at the time of their visit with the doctor. The doctors in turn strongly favored the immediate, routine use of two modules of the history--the family and social histories--for all their new patients. The doctors suggested further that the summaries of the other modules of the history be revised and shortened to make it easier for them to focus on clinical issues in the order of their preference.
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http://dx.doi.org/10.1136/amiajnl-2011-000580DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384115PMC
December 2012

Using Digital Crumbs from an Electronic Health Record to identify, study and improve health care teams.

AMIA Annu Symp Proc 2011 22;2011:491-500. Epub 2011 Oct 22.

Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.

We have developed a novel approach, the Digital Crumb Investigator, for using data collected as a byproduct of Electonic Health Record (EHR) use to help define care teams and care processes. We are developing tools and methods to utilize these routinely collected data to visualize and quantify care networks across acute care and ambulatory settings We have chosen a clinical care domain where clinicians use EHRs in their offices, on the maternity wards and in the neonatal intensive care units as a test paradigm for this technology. The tools and methods we deliver should readily translate to other health care settings that collect behind-the-scenes electronic metadata such as audit trails. We believe that by applying the methods of social networking to define clinical relationships around a patient's care we will enable new areas of research into the usage of EHRs to promote patient safety and other improvements in care.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3243159PMC
February 2013

Identifying Temporal Changes and Topics that Promote Growth Within Online Communities: A Prospective Study of Six Online Cancer Forums.

Int J Comput Models Algorithms Med 2011 Apr;2(2):1-22

Silverlink Communications, USA.

In this paper the authors have extended the methodology for temporal analysis of online forums and applied the methodology to six online cancer forums (melanoma, prostate cancer, testicular cancer, ovarian cancer and breast cancer). The goal was to develop, apply and improve methods that quantify the responsiveness of the interactions in online forums in order to identify the users and topics that promote use and usefulness of these online medical communities. The evolutional stages that gauge when a forum is expanding, contracting, or in a state of equilibrium were considered. The response function was thought to be an approximation of a discussion group's utility to its members. By applying the evolutionary phase algorithm, it was determined that two out of six of the forums are in contracting phases, while four are in their largest growth phase. By analyzing the topics of the influential threads, the authors conclude that cancer treatment discussions as well as stage IV cancer discussions promote growth in the forums. It is observed that the discussion of treatment rather than diagnosis is important to help a cancer forum thrive.
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http://dx.doi.org/10.4018/jcmam.2011040101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3183581PMC
April 2011