Integrating Patient-generated Digital Health Data into Electronic Health Records (EHRs) in Ambulatory Care Settings: EHR Vendor Survey and Interviews.

Data traditionally collected in a clinic or hospital setting is now collected electronically in everyday environments from patients, known as patient-generated health data (PGHD). We conducted informal interviews and collected survey data from major ambulatory care EHR vendors that serve the majority of the U.S. market to collect information on how their clients are integrating PGHD into EHRs. Of the 9 EHR vendors contacted, 6 completed the survey and 5 participated in a 45-minute interview. Feedback from the vendors included how PGHD use has steadily risen over the past decade and how the COVID-19 pandemic accelerated PGHD use. Pathways for data from devices or surveys to be brought securely into the EHR are increasing. While promising, adoption of health IT systems has its challenges. There are disparities in EHRs, devices, and applications. We concluded that more supportive policies are needed to advance PGHD integration.

Suitability of capillary blood glucose analysis in patients receiving vasopressors.

BACKGROUND: Glycemic control in critically ill patients decreases infection and mortality. Patients receiving vasopressors have altered peripheral perfusion, which may affect accuracy of capillary blood glucose values measured with point-of-care devices. OBJECTIVES: To compare capillary and arterial glucose values measured via point-of-care testing (POCT) with arterial glucose values measured via clinical chemistry laboratory testing (CCLT) in patients after cardiothoracic surgery. To determine if vasopressors or diminished peripheral perfusion influence the accuracy of POCT values. METHODS: In a prospective, convenience sample of 50 adult postoperative cardiothoracic patients receiving insulin and vasopressors, 162 samples were obtained simultaneously from capillary and arterial sites during insulin infusion and tested via both POCT and CCLT. Clarke error grid analysis and ISO 15197 were used to analyze level of agreement. Two-way analysis of variance was used to analyze differences in glucose values with respect to vasopressor use and peripheral perfusion. RESULTS: An unacceptable level of agreement was found between the capillary POCT results and arterial CCLT results (only 88.3% of values fell in zone A, or within the ISO 15197 tolerance bands). Arterial POCT results showed acceptable (94.4%) agreement with CCLT results. Vasopressor use had a significant effect on the accuracy of arterial blood glucose values (F=15.01; P<.001). CONCLUSIONS: Even when the more accurate POCT with arterial blood is used, blood glucose values are significantly less accurate in patients receiving more than 2 vasopressors than in patients receiving fewer vasopressors. CCLT may be safer for titrating insulin doses in these patients.

Stagnant perceptions of nursing among high school students: results of a shadowing intervention study.

To gain insight into high school students' perceptions of the role of the nurse and to explore students' impressions of nursing following a nurse-shadowing intervention. Often nurses abandon staffing positions in the first 1-2 years, reporting a "poor fit" with nursing. Few studies have examined expectations and perceptions of nursing among high school students; a population of potential nurses in whom a more accurate view of nursing opportunities and professionalism may be fostered. High school students from two North Carolina counties participated in a nurse-shadowing intervention. Constant comparison and thematic coding were used for analysis of post-intervention in-depth interviews. Sixteen of 24 students completed the study. Misperception of nursing was the dominant theme. Five sub-themes were professional role responsibility, teamwork, caring relationships, tools and technology, and medication management. Experiential knowledge of nursing was a core need for students interested in nursing careers. These data suggest that a nurse shadowing program may positively influence perceptions of nursing, and may result in improved recruitment and retention in the workplace.