Evaluation of Outcomes Using a Tablet-Based System to Support Glycemic Management Workflow Operations: A Retrospective Observational Study.

The treatment of hospitalized patients with type 2 diabetes requires glycemic management to maintain the patients' blood glucose levels within a normal range. We developed a blood glucose management system (BGM) system in 2015, which is a tablet-based workflow support system. This system enables medical staff to continually confirm the physicians' instructions by measuring the blood glucose levels while using a tablet terminal.In this study, we examined electronic medical records (EMRs) to evaluate the usage frequency of the BGM system and the time required for the glycemic management workflow in comparison to conventional PC terminals in a large hospital setting. The data includes 197,927 blood glucose level measurements that were taken in the general wards of Tottori University Hospital between January 2016 and June 2017. The usage frequency of the glycemic management workflow while using the BGM system was 145,864 times (approximately 74% of the total blood glucose measurements). The mean time until the completion of the glycemic management workflow in the case of hyperglycemia was 16 min 33 s, which is 26% shorter than using a PC terminal for treatment that involves injection or infusion (1454 times). The BGM system is proactively utilized by medical staff, thereby improving the operating efficiency. The results of this study indicate that the BGM system installed on tablet terminals can improve the efficiency in large-scale medical institutions that treat patients with diabetes.

Proposal of diagnostic process model for computer based diagnosis.

We aim at making a diagnosis support system that can be put to practical use. We proposed a diagnostic process model based on simple knowledge which can be gleaned from textbooks. We defined clinical finding (CF) as a general concept for patient's symptom or findings etc., whose value is expressed by Boolean. We call the combination of several CFs a "CF pattern", and a set of CF patterns with concomitant diseases "case base". We consider diagnosis as a process of searching an instance from the case base whose CF pattern is concomitant with that of a patient. The diseases which have the same CF pattern are candidates for diagnosis. Then we select a CF which is present in part of the candidates and check whether it is present or absent in the patient in order to narrow down the candidates. Because the case base does not exist in reality, the probability of CF pattern is calculated by the product of CF occurrence rate assuming that occurrence of CF is independent. Therefore the knowledge required for diagnosis is frequency of disease under sex and age group and CF-disease relation (CF and its occurrence rate in the disease). By processing these two types of knowledge, diagnosis can be made.

Design and Evaluation of a Smartphone Medical Guidance App for Outpatients of Large-Scale Medical Institutions: Retrospective Observational Study.

BACKGROUND: The greatest stressor for outpatients is the waiting time before an examination. If the patient is able to use their smartphone to check in with reception, the patient can wait for their examination at any location, and the burden of waiting can be reduced. OBJECTIVE: This study aimed to report the system design and postintroductory outcomes of the Tori RinRin (TR2) system that was developed to reduce outpatient burden imposed by wait times before examination. METHODS: The TR2 system was introduced at Tottori University Hospital, a large medical facility that accepts a daily average of 1500 outpatients. The system, which links the hospital's electronic medical record database with patients' mobile devices, has the following functions: (1) GPS-based examination check-in processing and (2) sending appointment notification messages via a cloud notification service. In order to evaluate the usefulness of the TR2 system, we surveyed the utilization rate of the TR2 system among outpatients, implemented a user questionnaire, and polled the average time required for patients to respond to call notifications about their turn. RESULTS: The 3-month average of TR2 users 9 months after the TR 2 system introduction was 17.9% (14,536/81,066). In an investigation of 363 subjects, the mean examination call message response time using the TR2 system was 31 seconds (median 14 seconds). Among 166 subjects who responded to a user survey, 86.7% (144/166) said that the system helped reduce the burden of waiting time. CONCLUSIONS: The app allowed 17.9% of outpatients at a large medical facility to check in remotely and wait for examinations anywhere. Hence, it is effective in preventing the spread of infection, especially during pandemics such as that of coronavirus disease. The app reported in this study is beneficial for large medical facilities striving to reduce outpatient burden imposed by wait times.

Range-Measurement Sensor to Improve the Authentication Workflow for Users of a Hospital Information System: A Proof-of-Concept Study.

In this study, we developed an authentication rangefinder (AR) system for hospital information system (HIS) terminals to support the user authentication workflows. The logoff process of the AR system is triggered if no object is placed at least 90 cm in front of the HIS terminal laptop for ≥5 s. We conducted an anonymous survey of medical staff who used the AR system. 33/42(78%) respondents acknowledged an improvement in the logoff process. This study indicates that the AR system improves the user authentication workflow.

A preliminary study on network traffic estimation in using EPR with thin-client computing over wide area network.

With the remarkable advantages of thin-client computing (TCC) on security enhancement and cost reduction, the TCC architecture seemed appropriate for EPR utilization in cross-border e-health systems. The advantage in less consumed network bandwidth, however, still remains quantitatively unidentified at present. This study aimed to estimate the network traffic required in using EPR on WAN environments through the comparison of TCC and server-client (SC) models The results indicated that one of representative TCC applications required much less network bandwidth than the conventional SC model. Further studies will be focused on the verification of the adopted scenarios and a combination of applications that would affect the estimation of the network bandwidth.

Scenario-based stress testing of an electronic patient record system in a thin-client computing implementation.

Implementation of thin-client computing (TCC) generally requires an elaborate process of determining appropriate specifications of the centralized servers (server sizing). This study aimed to assess the usefulness of the server sizing methods with eight scenarios based on practical usage of an electronic patient record. Actual data obtained from a hospital, where TCC was introduced based on the methods of the study, showed that the stress testing of one of server sizing methods contributed to steady operation of the system, while the scenarios should be improved to reflect more practical workflow in real settings to achieve more precise estimation of the centralized server performance in TCC.

Detecting Adverse Drug Events Through the Chronological Relationship Between the Medication Period and the Presence of Adverse Reactions From Electronic Medical Record Systems: Observational Study.

BACKGROUND: Medicines may cause various adverse reactions. An enormous amount of money and effort is spent investigating adverse drug events (ADEs) in clinical trials and postmarketing surveillance. Real-world data from multiple electronic medical records (EMRs) can make it easy to understand the ADEs that occur in actual patients. OBJECTIVE: In this study, we generated a patient medication history database from physician orders recorded in EMRs, which allowed the period of medication to be clearly identified. METHODS: We developed a method for detecting ADEs based on the chronological relationship between the presence of an adverse event and the medication period. To verify our method, we detected ADEs with alanine aminotransferase elevation in patients receiving aspirin, clopidogrel, and ticlopidine. The accuracy of the detection was evaluated with a chart review and by comparison with the Roussel Uclaf Causality Assessment Method (RUCAM), which is a standard method for detecting drug-induced liver injury. RESULTS: The calculated rates of ADE with ALT elevation in patients receiving aspirin, clopidogrel, and ticlopidine were 3.33% (868/26,059 patients), 3.70% (188/5076 patients), and 5.69% (226/3974 patients), respectively, which were in line with the rates of previous reports. We reviewed the medical records of the patients in whom ADEs were detected. Our method accurately predicted ADEs in 90% (27/30patients) treated with aspirin, 100% (9/9 patients) treated with clopidogrel, and 100% (4/4 patients) treated with ticlopidine. Only 3 ADEs that were detected by the RUCAM were not detected by our method. CONCLUSIONS: These findings demonstrate that the present method is effective for detecting ADEs based on EMR data.

Evaluation of response time delay of a pen-tablet system in thin-client computing environments: implications for usability.

Changeover from the traditional paper-based patient records to the computerized patient records has been spreading rapidly in medical facilities. Since ordinary input devices such as a keyboard and mouse are often thought insufficient for the needs of medical workers using electronic patient records (EPR) compared with traditional pens and paper-based patient records, a pen-tablet system (PTS) as a digital pen interface tends to be used instead. On the other hand, with the growing adoption of thin-client computing (TCC) in medical facilities, the usability of PTS with TCC has come to be a concern because of possible reduction of the usability due to delays of response time occurring in TCC environments. To analyze the factors that influence the usability of PTS with TCC, the authors focused on the relationship between length and its scattering of the response time delay. The results indicated that the delay scattering could be a more influencing factor than the delay length itself and that values of the scattering should be within approximately 35 milliseconds for the best usability. This study would provide useful indicators for evaluating the usability of PTS in incorporating it into the EPR system with TCC environments.

Metaboli-Net: online groupware system providing counseling guidance for patients with metabolic syndrome.

This study presented a newly developed online groupware system, Metaboli-Net, to yield counseling guidance on diet and exercise to patients with metabolic syndrome. A distinctive feature adopted in the system to maintain the retention rate of patients was the social network service (SNS) that enables the patients to share their dietary and relevant health information with other participants in the same group on the network. A pilot study was conducted to prove the effectiveness of the system in improving the patient's lifestyle and dietary health awareness. SNS also contributed to the participant's adherence to intervention programs.

Effective solutions in introducing Server-Based Computing into a hospital information system.

Server-Based Computing (SBC) is a technology for terminal administration that achieves higher security at lower expense. Use of SBC in large hospitals, however, is not widespread because methods to effectively implement the technology have not been fully established. We present a system design that uses SBC in a large-scale hospital and then discuss the implementation problems and their solutions. With the exception of network traffic estimates, the server size estimates were validated. Three results from an evaluation of an SBC implementation were: 1) security was re-enforced by applying multiple-policy adaptation to a single client terminal, 2) cost reduction was realized by having fewer PC failures and a lower power consumption, and 3) user-roaming was found to be effective in reducing the number of iterative operations performed by users.

Issues on evaluating the usability of a pen-tablet system using server-based computing.

The purpose of this study is to define the issues in evaluating the usability of pen-tablet systems (PTS) with server-based computing (SBC) in hospital settings. For five subjects with PTS operation, we measured the delay of drawing under SBC environments and compared it with the results of questionnaires from subjects. It was found that the relation of the usability with the drawing velocity and the delay is the crucial issue for a further study.

Evaluation of Treatment Success Rate Among Antihyperuricemic Using Real-World Data.

In this study, treatment and the serum uric acid (UA) level were compared using medication history generated by prescription order records of antihyperuricemic to examine the treatment success rate. We examined the treatment success rate among these patients based on the serum UA level during 120-180 days after the initiation of treatment, which was set as the endpoint. The number of patients whose UA level before the start of treatment was > 8.0 mg/dL but decreased to < 6.0 mg/dL after the treatment, which is the target treatment success, was 92 (success rate of 14.2%), 50 (53.2%), 76 (41.5%), 35 (31.9%), and 45 (37.8%) in the allopurinol 100 mg/day (A1) and 200 mg/day (A2), febuxostat 10 mg/day (F1) and 20 mg/day (F2), and benzbromarone 50 mg/day (B), respectively. Compared with that of the other drugs, the treatment success rate was high with A2 and low with A1. From the generated medication history, the treatment success rate with antihyperuricemic can be extracted mechanically.

Screening of anticancer drugs to detect drug-induced interstitial pneumonia using the accumulated data in the electronic medical record.

Because drug-induced interstitial pneumonia (DIP) is a serious adverse drug reaction, its quantitative risk with individual medications should be taken into due consideration when selecting a medicine. We developed an algorithm to detect DIP using medical record data accumulated in a hospital. Chest computed tomography (CT) is mainly used for the diagnosis of IP, and chest X-ray reports, KL-6, and SP-D values are used to support the diagnosis. The presence of IP in the reports was assessed by a method using natural language-processing, in which IP was estimated according to the product of the likelihood ratio of characteristic keywords in each report. The sensitivity and the specificity of the method for chest CT reports were 0.92 and 0.97, while those for chest X-ray reports were 0.83 and 1, respectively. The occurrence of DIP was estimated by the patterns of presence of IP before, during, and after the administration of the target medicine. The occurrence rate of DIP in cases administered Gefitinib; Methotrexate (MTX); Tegafur, Gimeracil, and Oteracil potassium (TS-1); and Tegafur and Uracil (UTF) was 6.0%, 2.3%, 1.4%, and 0.7%, respectively. The estimated DIP cases were checked by having the medical records independently reviewed by medical doctors. By chart review, the positive predictive values of DIP against Gefitinib, MTX, TS-1, and UFT were 69.2%, 44.4%, 58.6%, and 77.8%, respectively. Although the cases extracted by this method included some that did not have DIP, this method can estimate the relative risk of DIP between medicines.

A Computer-Based Glucose Management System Reduces the Incidence of Forgotten Glucose Measurements: A Retrospective Observational Study.

INTRODUCTION: Frequent glucose measurements are needed for good blood glucose control in hospitals; however, this requirement means that measurements can be forgotten. We developed a novel glucose management system using an iPod® and electronic health records. METHODS: A time schedule system for glucose measurement was developed using point-of-care testing, an iPod®, and electronic health records. The system contains the glucose measurement schedule and an alarm sounds if a measurement is forgotten. The number of times measurements were forgotten was analyzed. RESULTS: Approximately 7000 glucose measurements were recorded per month. Before implementation of the system, the average number of times measurements were forgotten was 4.8 times per month. This significantly decreased to 2.6 times per month after the system started. We also analyzed the incidence of forgotten glucose measurements as a proportion of the total number of measurements for each period and found a significant difference between the two 9-month periods (43/64,049-24/65,870, P = 0.014, chi-squared test). CONCLUSIONS: This computer-based blood glucose monitoring system is useful for the management of glucose monitoring in hospitals. FUNDING: Johnson & Johnson Japan.

Development of a database and processing method for detecting hematotoxicity adverse drug events.

Adverse events are detected by monitoring the patient's status, including blood test results. However, it is difficult to identify all adverse events based on recognition by individual doctors. We developed a system that can be used to detect hematotoxicity adverse events according to blood test results recorded in an electronic medical record system. The blood test results were graded based on Common Terminology Criteria for Adverse Events (CTCAE) and changes in the blood test results (Up, Down, Flat) were assessed according to the variation in the grade. The changes in the blood test and injection data were stored in a database. By comparing the date of injection and start and end dates of the change in the blood test results, adverse events related to a designated drug were detected. Using this method, we searched for the occurrence of serious adverse events (CTCAE Grades 3 or 4) concerning WBC, ALT and creatinine related to paclitaxel at Osaka University Hospital. The rate of occurrence of a decreased WBC count, increased ALT level and increased creatinine level was 36.0%, 0.6% and 0.4%, respectively. This method is useful for detecting and estimating the rate of occurrence of hematotoxicity adverse drug events.

A template-based computerized instruction entry system helps the comunication between doctors and nurses.

In a hospital, doctors and nurses shares roles in treating admitted patients. Communication between them is necessary and communication errors become the problem in medical safety. In Japan, verbal instruction is prohibited and doctors write their instruction on paper instruction slips. However, because it is difficult to ascertain revision history and the active instructions on instruction slips, human errors can occur. We developed template-based computerized instruction entry system to reduce ward workloads and contribute to medical safety. Templates enable us to input the instructions easily and standardize the descriptions of instructions. By standardizing and combine the instruction into one template for one instruction item, the systems could prevent instructions overlap. We created sets of templates (e.g., admission set, preoperative set), so that doctors could enter their instructions easily. Instructions entered via any of the sets can be subdivided into separate items by the system before being submitted, and can also be changed on a per-item basis. The instructions were displayed as calendar form. Calendar form represents the instruction shift and current active instructions. We prepared 382 standardized instruction templates. In our system, 66% of instructions were entered via templates, and 34% were entered as free-text comments. Our system prevents communication errors between medical staff.

Development of the regional EPR and PACS sharing system on the infrastructure of cloud computing technology controlled by patient identifier cross reference manager.

A Newly developed Oshidori-Net2, providing medical professionals with remote access to electronic patient record systems (EPR) and PACSs of four hospitals, of different venders, using cloud computing technology and patient identifier cross reference manager. The operation was started from April 2012. The patients moved to other hospital were applied. Objective is to show the merit and demerit of the new system.

Usage experience with the document archiving and communication system for the storage and retrieval of medical records.

Standard Japanese electronic medical record (EMR) systems are associated with major shortcomings. For example, they do not assure lifelong readability of records because each document requires its own viewing software program, a system that is difficult to maintain over long periods of time. It can also be difficult for users to comprehend a patient's clinical history because different classes of documents can only be accessed from their own window. To address these problems, we developed a document-based electronic medical record that aggregates all documents for a patient in a PDF or DocuWorks format. We call this system the Document Archiving and Communication System (DACS). There are two types of viewers in the DACS: the Matrix View, which provides a time line of a patient's history, and the Tree View, which stores the documents in hierarchical document classes. We placed 2,734 document classes into 11 categories. A total of 22,3972 documents were entered per month. The frequency of use of the DACS viewer was 268,644 instances per month. The DACS viewer was used to assess a patient's clinical history.