615 results match your criteria Applied clinical informatics[Journal]


How to Check the Reliability of Artificial Intelligence Solutions-Ensuring Client Expectations are Met.

Authors:
Jon Patrick

Appl Clin Inform 2019 Mar 17;10(2):269-271. Epub 2019 Apr 17.

Health Language Analytics Global, Eveleigh, Australia.

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http://dx.doi.org/10.1055/s-0039-1685220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469981PMC

Evaluating the Effect of Monitoring through Telephone (Tele-Monitoring) on Self-Care Behaviors and Readmission of Patients with Heart Failure after Discharge.

Appl Clin Inform 2019 Mar 17;10(2):261-268. Epub 2019 Apr 17.

Department of Nursing & Emergency Medicine, Dezful University of Medical Sciences, Dezful, Iran.

Background:  Heart failure is one of the serious cardiovascular diseases, which poses a global pandemic and places a heavy burden on health care systems worldwide. The incidence of this disease in Iran is higher than in other Asian countries. To reduce patients' complications, readmission rates, and health care expenditures, it is necessary to design interventions, which are culturally appropriate and based on community needs. Read More

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http://www.thieme-connect.de/DOI/DOI?10.1055/s-0039-1685167
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http://dx.doi.org/10.1055/s-0039-1685167DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469982PMC
March 2019
2 Reads

Early Adopters of Patient-Generated Health Data Upload in an Electronic Patient Portal.

Appl Clin Inform 2019 Mar 10;10(2):254-260. Epub 2019 Apr 10.

Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York, United States.

Background And Objective:  Patient-generated health data (PGHD) may help providers monitor patient status between clinical visits. Our objective was to describe our medical center's early experience with an electronic flowsheet allowing patients to upload self-monitored blood glucose to their provider's electronic health record (EHR).

Methods:  An academic multispecialty practice enabled the portal-linked PGHD tool in 2012. Read More

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http://dx.doi.org/10.1055/s-0039-1683987DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6458021PMC

Electronic Health Record Documentation Patterns of Recorded Primary Care Visits Focused on Complex Communication: A Qualitative Study.

Appl Clin Inform 2019 Mar 10;10(2):247-253. Epub 2019 Apr 10.

Division of General Internal Medicine, The Ohio State University Wexner Medical Center, Grandview, Ohio, United States.

Background:  In a time-constrained clinical environment, physicians cannot feasibly document all aspects of an office visit in the electronic health record (EHR). This is especially true for patients with multiple chronic conditions requiring complex clinical reasoning. It is unclear how physicians prioritize the documentation of health information in the EHR. Read More

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http://dx.doi.org/10.1055/s-0039-1683986DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6458018PMC

Assessing the Safety of Custom Web-Based Clinical Decision Support Systems in Electronic Health Records: A Case Study.

Appl Clin Inform 2019 Mar 3;10(2):237-246. Epub 2019 Apr 3.

Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.

Background:  With the widespread adoption of vendor-supplied electronic health record (EHR) systems, clinical decision support (CDS) customization efforts beyond those anticipated by the vendor may require the use of technologies external to the EHR such as web services. Pursuing such customizations, however, is not without risk. Validating the expected behavior of a customized CDS system in the high-volume, complex environment of the live EHR is a challenging problem. Read More

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http://dx.doi.org/10.1055/s-0039-1683985DOI Listing

Comparison of Antibiotic Dosing Before and After Implementation of an Electronic Order Set.

Appl Clin Inform 2019 Mar 3;10(2):229-236. Epub 2019 Apr 3.

Pharmacy Practice Department, Butler University College of Pharmacy and Health Sciences, Indianapolis, Indiana, United States.

Background:  To maximize resources, the antimicrobial stewardship program at a pediatric tertiary care hospital made pediatric dosing specific guidance within the electronic health record available to all hospitals within the health system.

Objective:  The objective of this study was to compare the appropriateness of antibiotic dosing before and after the implementation of an electronic intravenous (IV) antibiotic order set.

Methods:  This was a retrospective cohort study evaluating orders from patients younger than 18 years who received cefepime, piperacillin-tazobactam, tobramycin, or gentamicin at 12 health-system hospitals. Read More

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http://dx.doi.org/10.1055/s-0039-1683877DOI Listing

An openEHR Approach to Detailed Clinical Model Development: Tobacco Smoking Summary Archetype as a Case Study.

Appl Clin Inform 2019 Mar 27;10(2):219-228. Epub 2019 Mar 27.

School of Population Health, The University of Auckland, New Zealand, Auckland, New Zealand.

Background:  Data modeling for electronic health records (EHRs) is complex, requiring technological and cognitive sophistication. The EHR approach leverages the tacit knowledge of domain experts made explicit in a model development process aiming at interoperability and data reuse.

Objective:  The purpose of our research was to explore the process that enabled the aggregation of the tacit knowledge of domain experts in an explicit form using the Clinical Knowledge Manager (CKM) platform and associated assets. Read More

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http://www.thieme-connect.de/DOI/DOI?10.1055/s-0039-1681074
Publisher Site
http://dx.doi.org/10.1055/s-0039-1681074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6436962PMC
March 2019
4 Reads

Safeuristics! Do Heuristic Evaluation Violation Severity Ratings Correlate with Patient Safety Severity Ratings for a Native Electronic Health Record Mobile Application?

Appl Clin Inform 2019 Mar 27;10(2):210-218. Epub 2019 Mar 27.

Human Factors Collaborative, Children's Mercy Hospital, Kansas City, Missouri, United States.

Objective:  Usability of electronic health records (EHRs) remains challenging, and poor EHR design has patient safety implications. Heuristic evaluation detects usability issues that can be classified by severity. The National Institute of Standards and Technology provides a safety scale for EHR usability. Read More

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http://dx.doi.org/10.1055/s-0039-1681073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6436963PMC

Impact of Electronic versus Paper-Based Recording before EHR Implementation on Health Care Professionals' Perceptions of EHR Use, Data Quality, and Data Reuse.

Appl Clin Inform 2019 Mar 20;10(2):199-209. Epub 2019 Mar 20.

Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

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. Read More

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http://dx.doi.org/10.1055/s-0039-1681054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426723PMC

Can Automated Retrieval of Data from Emergency Department Physician Notes Enhance the Imaging Order Entry Process?

Appl Clin Inform 2019 Mar 20;10(2):189-198. Epub 2019 Mar 20.

Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States.

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.

Methods:  In this institutional review board-approved retrospective observational study performed between April 1, 2013 and September 30, 2014 at an adult quaternary academic hospital, we reviewed data from 666 consecutive ED encounters for patients with headaches who received head CT. Read More

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http://dx.doi.org/10.1055/s-0039-1679927DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426724PMC

Effect of Sociodemographic Factors on Uptake of a Patient-Facing Information Technology Family Health History Risk Assessment Platform.

Appl Clin Inform 2019 Mar 13;10(2):180-188. Epub 2019 Mar 13.

Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States.

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. Read More

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http://dx.doi.org/10.1055/s-0039-1679926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6415985PMC
March 2019
1 Read

Common Laboratory Results Frequently Misunderstood by a Sample of Mechanical Turk Users.

Appl Clin Inform 2019 Mar 13;10(2):175-179. Epub 2019 Mar 13.

RAND Corporation, Boston, Massachusetts, United States.

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. Read More

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http://dx.doi.org/10.1055/s-0039-1679960DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6415984PMC
March 2019
4 Reads

Timely Data for Targeted Quality Improvement Interventions: Use of a Visual Analytics Dashboard for Bronchiolitis.

Appl Clin Inform 2019 Jan 6;10(1):168-174. Epub 2019 Mar 6.

Emergency Department, Children's Minnesota, Minneapolis, Minnesota, United States.

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. Read More

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http://dx.doi.org/10.1055/s-0039-1679868DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402943PMC
January 2019
1 Read

Understanding Health Information Technology Induced Medication Safety Events by Two Conceptual Frameworks.

Appl Clin Inform 2019 Jan 6;10(1):158-167. Epub 2019 Mar 6.

School of Biomedical Informatics, University of Texas Health Science Center, Houston, Texas, United States.

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. Read More

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http://dx.doi.org/10.1055/s-0039-1678693DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402944PMC
January 2019
1 Read

POLAR Diversion: Using General Practice Data to Calculate Risk of Emergency Department Presentation at the Time of Consultation.

Appl Clin Inform 2019 Jan 27;10(1):151-157. Epub 2019 Feb 27.

Gippsland Primary Health Network, Moe, Victoria, Australia.

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. Read More

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http://dx.doi.org/10.1055/s-0039-1678608DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6393160PMC
January 2019
1 Read

Evaluation of Secure Messaging Applications for a Health Care System: A Case Study.

Appl Clin Inform 2019 Jan 27;10(1):140-150. Epub 2019 Feb 27.

University of Washington Information Technology Services, Seattle, Washington, United States.

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. Read More

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http://dx.doi.org/10.1055/s-0039-1678607DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6393161PMC
January 2019
1 Read

Electronic Health Record Adoption and Nurse Reports of Usability and Quality of Care: The Role of Work Environment.

Appl Clin Inform 2019 Jan 20;10(1):129-139. Epub 2019 Feb 20.

Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States.

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. Read More

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http://dx.doi.org/10.1055/s-0039-1678551DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382496PMC
January 2019
1 Read
0.386 Impact Factor

Using Electronic Health Records to Identify Adverse Drug Events in Ambulatory Care: A Systematic Review.

Appl Clin Inform 2019 Jan 20;10(1):123-128. Epub 2019 Feb 20.

Department of Global Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States.

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. Read More

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http://dx.doi.org/10.1055/s-0039-1677738DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382497PMC
January 2019

Physician Perceptions of the Electronic Problem List in Pediatric Trauma Care.

Appl Clin Inform 2019 Jan 13;10(1):113-122. Epub 2019 Feb 13.

Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States.

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. Read More

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http://dx.doi.org/10.1055/s-0039-1677737DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6374147PMC
January 2019

Empowering Patients during Hospitalization: Perspectives on Inpatient Portal Use.

Appl Clin Inform 2019 Jan 13;10(1):103-112. Epub 2019 Feb 13.

Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States.

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. Read More

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http://dx.doi.org/10.1055/s-0039-1677722DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6374145PMC
January 2019
3 Reads

How Patients Use a Patient Portal: An Institutional Case Study of Demographics and Usage Patterns.

Appl Clin Inform 2019 Jan 6;10(1):96-102. Epub 2019 Feb 6.

Department of Health Information Technology, University of California, Los Angeles, California, United States.

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. Read More

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http://dx.doi.org/10.1055/s-0038-1677528DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365289PMC
January 2019
1 Read

Lessons Learned in Creating Interoperable Fast Healthcare Interoperability Resources Profiles for Large-Scale Public Health Programs.

Appl Clin Inform 2019 Jan 6;10(1):87-95. Epub 2019 Feb 6.

Department of Biomedical Informatics, Intermountain Healthcare, Murray, Utah, United States.

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. Read More

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http://dx.doi.org/10.1055/s-0038-1677527DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365290PMC
January 2019
8 Reads

Rebuilding the Standing Prescription Renewal Orders.

Appl Clin Inform 2019 Jan 30;10(1):77-86. Epub 2019 Jan 30.

Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States.

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. Read More

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http://dx.doi.org/10.1055/s-0038-1675813DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353649PMC
January 2019
7 Reads
0.386 Impact Factor

Reduced Verification of Medication Alerts Increases Prescribing Errors.

Appl Clin Inform 2019 Jan 30;10(1):66-76. Epub 2019 Jan 30.

Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.

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. Read More

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http://dx.doi.org/10.1055/s-0038-1677009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353646PMC
January 2019
1 Read

Automated Generation of CONSORT Diagrams Using Relational Database Software.

Appl Clin Inform 2019 Jan 23;10(1):60-65. Epub 2019 Jan 23.

Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.

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. Read More

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http://dx.doi.org/10.1055/s-0038-1677043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6344335PMC
January 2019
4 Reads

Integration of Postcoordination Content into a Clinical Interface Terminology to Support Administrative Coding.

Appl Clin Inform 2019 Jan 23;10(1):51-59. Epub 2019 Jan 23.

Intelligent Medical Objects, Northbrook, Illinois, United States.

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.

Objectives:  The transition from ICD-9-CM to ICD-10-CM posed a challenge to CIT users due to the substantially increased details in ICD-10-CM. Read More

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http://dx.doi.org/10.1055/s-0038-1676972DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6344336PMC
January 2019

Technology Access, Technical Assistance, and Disparities in Inpatient Portal Use.

Appl Clin Inform 2019 Jan 16;10(1):40-50. Epub 2019 Jan 16.

Department of Biomedical Informatics, Columbia University, New York, New York, United States.

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. Read More

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http://dx.doi.org/10.1055/s-0038-1676971DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6335107PMC
January 2019
4 Reads

Active Participation and Engagement of Residents in Clinical Informatics.

Appl Clin Inform 2019 Jan 16;10(1):38-39. Epub 2019 Jan 16.

Information Technology Department, UNIMED Health Insurance, Sao Paulo, Brazil.

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http://dx.doi.org/10.1055/s-0038-1676970DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6335106PMC
January 2019

Automatic Detection of Front-Line Clinician Hospital Shifts: A Novel Use of Electronic Health Record Timestamp Data.

Appl Clin Inform 2019 Jan 9;10(1):28-37. Epub 2019 Jan 9.

Division of General Pediatrics, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States.

Objective:  Excess physician work hours contribute to burnout and medical errors. Self-report of work hours is burdensome and often inaccurate. We aimed to validate a method that automatically determines provider shift duration based on electronic health record (EHR) timestamps across multiple inpatient settings within a single institution. Read More

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http://www.thieme-connect.de/DOI/DOI?10.1055/s-0038-1676819
Publisher Site
http://dx.doi.org/10.1055/s-0038-1676819DOI Listing
January 2019
1 Read

The Reach and Feasibility of an Interactive Lung Cancer Screening Decision Aid Delivered by Patient Portal.

Appl Clin Inform 2019 Jan 9;10(1):19-27. Epub 2019 Jan 9.

Department of Internal Medicine, Section on General Internal Medicine, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina, United States.

Objective:  Health systems could adopt population-level approaches to screening by identifying potential screening candidates from the electronic health record and reaching out to them via the patient portal. However, whether patients would read or act on sent information is unknown. We examined the feasibility of this digital health outreach strategy. Read More

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http://dx.doi.org/10.1055/s-0038-1676807DOI Listing
January 2019
13 Reads

Qualitative and Quantitative Analysis of Patients' Perceptions of the Patient Portal Experience with OpenNotes.

Appl Clin Inform 2019 Jan 2;10(1):10-18. Epub 2019 Jan 2.

Division of Hospital Medicine, Virginia Commonwealth University Health System, Richmond, Virginia, United States.

Background:  Access to medical encounter notes (OpenNotes) is believed to empower patients and improve the quality and safety of care. The impact of such access is not well understood beyond select health care systems and notes from primary care providers.

Objectives:  This article analyzes patients' perceptions about the patient portal experience with access to primary care and specialist's notes and evaluates free-text comments as an improvement opportunity. Read More

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http://dx.doi.org/10.1055/s-0038-1676588DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327733PMC
January 2019

CDS in a Learning Health Care System: Identifying Physicians' Reasons for Rejection of Best-Practice Recommendations in Pneumonia through Computerized Clinical Decision Support.

Appl Clin Inform 2019 Jan 2;10(1):1-9. Epub 2019 Jan 2.

Division of Pulmonary and Critical Care Medicine, Intermountain Healthcare and University of Utah, Murray, Utah, United States.

Background:  Local implementation of guidelines for pneumonia care is strongly recommended, but the context of care that affects implementation is poorly understood. In a learning health care system, computerized clinical decision support (CDS) provides an opportunity to both improve and track practice, providing insights into the implementation process.

Objectives:  This article examines physician interactions with a CDS to identify reasons for rejection of guideline recommendations. Read More

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http://dx.doi.org/10.1055/s-0038-1676587DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327742PMC
January 2019
3 Reads

Comparing Real-Time Self-Tracking and Device-Recorded Exercise Data in Subjects with Type 1 Diabetes.

Appl Clin Inform 2018 Oct 26;9(4):919-926. Epub 2018 Dec 26.

Division of Endocrinology, Mayo Clinic Arizona, Scottsdale, Arizona, United States.

Background:  Insulin therapy, medical nutrition therapy, and physical activity are required for the treatment of type 1 diabetes (T1D). There is a lack of studies in real-life environments that characterize patient-reported data from logs, activity trackers, and medical devices (e.g. Read More

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http://dx.doi.org/10.1055/s-0038-1676458DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6306279PMC
October 2018

CMS Payment Policy, E&M Guideline Reform, and the Prospect of Electronic Health Record Optimization.

Appl Clin Inform 2018 Oct 26;9(4):914-918. Epub 2018 Dec 26.

American Medical Informatics Association, Bethesda, Maryland, United States.

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http://www.thieme-connect.de/DOI/DOI?10.1055/s-0038-1676337
Publisher Site
http://dx.doi.org/10.1055/s-0038-1676337DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6306276PMC
October 2018
1 Read

Identifying, Analyzing, and Visualizing Diagnostic Paths for Patients with Nonspecific Abdominal Pain.

Appl Clin Inform 2018 Oct 19;9(4):905-913. Epub 2018 Dec 19.

Ambulatory Primary Care Innovations Group, NorthShore University HealthSystem, Evanston, Illinois, United States.

Background:  Diagnosis is complex, uncertain, and error-prone. Symptoms such as nonspecific abdominal pain are especially challenging. A diagnostic path consists of diagnostic steps taken from initial presentation until a diagnosis is obtained or the evaluation ends for other reasons. Read More

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http://dx.doi.org/10.1055/s-0038-1676338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6301880PMC
October 2018

Sharing of ADHD Information between Parents and Teachers Using an EHR-Linked Application.

Appl Clin Inform 2018 Oct 19;9(4):892-904. Epub 2018 Dec 19.

Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States.

Background:  Appropriate management of attention-deficit/hyperactivity disorder (ADHD) involves parents, clinicians, and teachers. Fragmentation of interventions between different settings can lead to suboptimal care and outcomes. Electronic systems can bridge gaps across settings. Read More

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http://dx.doi.org/10.1055/s-0038-1676087DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6300414PMC
October 2018
1 Read

Health Information Exchange in Emergency Medical Services.

Appl Clin Inform 2018 Oct 12;9(4):884-891. Epub 2018 Dec 12.

The Warren Alpert Medical School, Brown University, Providence, Rhode Island, United States.

Background:  The Office of the National Coordinator for Health Information Technology has outlined the benefits of health information exchange in emergency medical services (EMSs) according to the model-, , , -developed in collaboration with the California Emergency Medical Services Authority.

Objective:  This scoping review aims to identify and characterize progress toward the adoption of prehospital health information exchange, as reported in the peer-reviewed literature.

Methods:  A structured review of literature in MEDLINE-indexed journals was conducted using the "Electronic Health Records" topic-specific query, the "Emergency Medical Services" Medical Subject Headings descriptor, and a prehospital identifier. Read More

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http://www.thieme-connect.de/DOI/DOI?10.1055/s-0038-1676041
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http://dx.doi.org/10.1055/s-0038-1676041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6291398PMC
October 2018
27 Reads

Communicating with Vulnerable Patient Populations: A Randomized Intervention to Teach Inpatients to Use the Electronic Patient Portal.

Appl Clin Inform 2018 Oct 12;9(4):875-883. Epub 2018 Dec 12.

University of California, Los Angeles, California, United States.

Background:  Patient portals are expanding as a means to engage patients and have evidence for benefit in the outpatient setting. However, few studies have evaluated their use in the inpatient setting, or with vulnerable patient populations.

Objective:  This article assesses an intervention to teach hospitalized vulnerable patients to access their discharge summaries using electronic patient portals. Read More

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http://dx.doi.org/10.1055/s-0038-1676333DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6291377PMC
October 2018
8 Reads

Impact of Electronic Physician Order-Set on Antibiotic Ordering Time in Septic Patients in the Emergency Department.

Appl Clin Inform 2018 Oct 5;9(4):869-874. Epub 2018 Dec 5.

UPMC St. Margaret, Pittsburgh, Pennsylvania, United States.

Background:  Sepsis is a serious medical condition that can lead to organ dysfunction and death. Research shows that each hour delay in antibiotic administration increases mortality. The Surviving Sepsis Campaign Bundles created standards to assist in the timely treatment of patients with suspected sepsis to improve outcomes and reduce mortality. Read More

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http://dx.doi.org/10.1055/s-0038-1676040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281440PMC
October 2018
16 Reads

Understanding Secure Messaging in the Inpatient Environment: A New Avenue for Communication and Patient Engagement.

Appl Clin Inform 2018 Oct 5;9(4):860-868. Epub 2018 Dec 5.

Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States.

Background:  Patient portals, and the secure messaging feature in particular, have been studied in the outpatient setting, but research in the inpatient setting is relatively less mature.

Objective:  To understand the topics discussed in secure messaging in the inpatient environment, we analyzed and categorized messages sent within an inpatient portal.

Materials And Methods:  This observational study examined the content of all secure messages sent from December 2013 to June 2017 within an inpatient portal at a large Midwestern academic medical center (AMC). Read More

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http://dx.doi.org/10.1055/s-0038-1675814DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6281442PMC
October 2018
2 Reads

Social Media in Health Care: Time for Transparent Privacy Policies and Consent for Data Use and Disclosure.

Appl Clin Inform 2018 Oct 28;9(4):856-859. Epub 2018 Nov 28.

Departments of Biomedical Informatics and Pediatrics, Vanderbilt University, Nashville, Tennessee, United States.

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http://dx.doi.org/10.1055/s-0038-1676332DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6261737PMC
October 2018
0.386 Impact Factor

Evaluation of Clinical Relevance of Drug-Drug Interaction Alerts Prior to Implementation.

Appl Clin Inform 2018 Oct 28;9(4):849-855. Epub 2018 Nov 28.

St Vincent's Clinical School, UNSW Medicine, University of New South Wales, Sydney, New South Wales, Australia.

Introduction:  Drug-drug interaction (DDI) alerts are often implemented in the hospital computerized provider order entry (CPOE) systems with limited evaluation. This increases the risk of prescribers experiencing too many irrelevant alerts, resulting in alert fatigue. In this study, we aimed to evaluate clinical relevance of alerts prior to implementation in CPOE using two common approaches: compendia and expert panel review. Read More

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http://www.thieme-connect.de/DOI/DOI?10.1055/s-0038-1676039
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http://dx.doi.org/10.1055/s-0038-1676039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6261735PMC
October 2018
1 Read

The Impact of a Location-Sensing Electronic Health Record on Clinician Efficiency and Accuracy: A Pilot Simulation Study.

Appl Clin Inform 2018 Oct 21;9(4):841-848. Epub 2018 Nov 21.

Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, Texas, United States.

Background:  Through the Health Information Technology for Economic and Clinical Health Act of 2009, the federal government invested $26 billion in electronic health records (EHRs) to improve physician performance and patient safety; however, these systems have not met expectations. One of the cited issues with EHRs is the human-computer interaction, as exhibited by the excessive number of interactions with the interface, which reduces clinician efficiency. In contrast, real-time location systems (RTLS)-technologies that can track the location of people and objects-have been shown to increase clinician efficiency. Read More

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http://dx.doi.org/10.1055/s-0038-1675812DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6249134PMC
October 2018
12 Reads

Self-Care Support for Patients with Gastrointestinal Cancer: iCancerHealth.

Appl Clin Inform 2018 Oct 21;9(4):833-840. Epub 2018 Nov 21.

Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, United States.

Background:  Patient-centered symptom assessment and management tools allow patients to perform self-assessments and engage in self-symptom management. Efficacious tools exist for reducing symptom distress; however, little is known about feature-specific use.

Objectives:  This article evaluates the feasibility of the iCancerHealth app as an adjunct to usual patient education regarding cancer symptoms and medication management. Read More

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http://dx.doi.org/10.1055/s-0038-1675810DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6249135PMC
October 2018
7 Reads

Response to: An Evidence-Based Tool for Safe Configuration of Electronic Health Records: The eSafety Checklist.

Authors:
Ross Koppel

Appl Clin Inform 2018 Oct 14;9(4):831-832. Epub 2018 Nov 14.

Sociology Department, University of Pennsylvania, Philadelphia, Pennsylvania, United States.

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http://www.thieme-connect.de/DOI/DOI?10.1055/s-0038-1675811
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http://dx.doi.org/10.1055/s-0038-1675811DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6235671PMC
October 2018
10 Reads

An Evidence-Based Tool for Safe Configuration of Electronic Health Records: The eSafety Checklist.

Appl Clin Inform 2018 Oct 14;9(4):817-830. Epub 2018 Nov 14.

School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada.

Background:  Electronic health records (EHRs) are transforming the way health care is delivered. They are central to improving the quality of patient care and have been attributed to making health care more accessible, reliable, and safe. However, in recent years, evidence suggests that specific features and functions of EHRs can introduce new, unanticipated patient safety concerns that can be mitigated by safe configuration practices. Read More

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http://www.thieme-connect.de/DOI/DOI?10.1055/s-0038-1675210
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http://dx.doi.org/10.1055/s-0038-1675210DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6247819PMC
October 2018
11 Reads

An Electronic Medical Record in Pediatric Medical Education: Survey of Medical Students' Expectations and Experiences.

Appl Clin Inform 2018 Oct 7;9(4):809-816. Epub 2018 Nov 7.

EMR Team, The Royal Children's Hospital Melbourne, Parkville, Australia.

Objective:  This study sought to quantitatively characterize medical students' expectations and experiences of an electronic health record (EHR) system in a hospital setting, and to examine perceived and actual impacts on learning.

Methods:  Medical students from July to December 2016 at a tertiary pediatric institution completed pre- and postrotation surveys evaluating their expectations and experience of using an EHR during a pediatric medicine rotation. Survey data included past technology experience, EHR accessibility, use of learning resources, and effect on learning outcomes and patient-clinician communication. Read More

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http://dx.doi.org/10.1055/s-0038-1675371DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221827PMC
October 2018

Automating a Manual Sepsis Screening Tool in a Pediatric Emergency Department.

Appl Clin Inform 2018 Oct 31;9(4):803-808. Epub 2018 Oct 31.

Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio, United States.

Objective:  This article describes the method of integrating a manual pediatric emergency department sepsis screening process into the electronic health record that leverages existing clinical documentation and keeps providers in their current, routine clinical workflows.

Methods:  Criteria in the manual pediatric emergency department sepsis screening tool were mapped to standard documentation routinely entered in the electronic health record. Data elements were extracted and scored from the medical history, medication record, vital signs, and physical assessments. Read More

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http://dx.doi.org/10.1055/s-0038-1675211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6209517PMC
October 2018

User Testing an Information Foraging Tool for Ambulatory Surgical Site Infection Surveillance.

Appl Clin Inform 2018 Oct 24;9(4):791-802. Epub 2018 Oct 24.

Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.

Background:  Surveillance for surgical site infections (SSIs) after ambulatory surgery in children requires a detailed manual chart review to assess criteria defined by the National Health and Safety Network (NHSN). Electronic health records (EHRs) impose an inefficient search process where infection preventionists must manually review every postsurgical encounter (< 30 days). Using text mining and business intelligence software, we developed an information foraging application, the SSI Workbench, to visually present which postsurgical encounters included SSI-related terms and synonyms, antibiotic, and culture orders. Read More

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http://www.thieme-connect.de/DOI/DOI?10.1055/s-0038-1675179
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http://dx.doi.org/10.1055/s-0038-1675179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6200553PMC
October 2018
12 Reads

Asynchronous Speech Recognition Affects Physician Editing of Notes.

Appl Clin Inform 2018 Oct 17;9(4):782-790. Epub 2018 Oct 17.

Department of Biomedical & Health Informatics, University of Washington, Seattle, Washington, United States.

Objective:  Clinician progress notes are an important record for care and communication, but there is a perception that electronic notes take too long to write and may not accurately reflect the patient encounter, threatening quality of care. Automatic speech recognition (ASR) has the potential to improve clinical documentation process; however, ASR inaccuracy and editing time are barriers to wider use. We hypothesized that automatic text processing technologies could decrease editing time and improve note quality. Read More

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http://www.thieme-connect.de/DOI/DOI?10.1055/s-0038-1673417
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http://dx.doi.org/10.1055/s-0038-1673417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6192791PMC
October 2018
6 Reads