Use of Health Information Technology among Patient Navigators in Community Health Interventions.

Overview: As chronic disease and comorbidities increase, so does the complexity of patient care.This complexity requires interdisciplinary care teams and multifactor interventions to ensure that patients get the most efficient care. Patient navigators-defined as individuals who help patients move through the complex care continuum-can improve access to care and patient engagement, which can translate into better outcomes. Health information technology (health IT) can support timely communication and information sharing for patient navigators and the providers with whom they interact to better coordinate care. We explored the health IT that patient navigators used, how they used it, and their health IT needs in community-based interventions. Methods: We analyzed three years of qualitative program evaluation data captured though progress reports, site visits, and telephone interviews as part of a larger evaluation of community-based demonstration projects. We used inductive analysis to identify preliminary themes to develop a codebook. Using QSR International's NVivo qualitative analysis software (version 11.0), we then used the preliminary themes in a second round of independent coding. We identified themes relevant to navigators and to barriers and facilitators for health IT. Coders achieved a final kappa of 0.8, suggesting excellent interrater reliability. Results: Navigators used various types of health IT (e.g., health information exchanges, electronic health records, short message service) to capture and share information with the rest of the care team. Navigators used technology to document patient information, track services, and schedule appointments for patients; however, some respondents reported challenges with systems that were not integrated. Navigators must learn to use health IT systems of varying complexity to complete their job duties. Discussion: Health IT can improve workflow by facilitating task organization and communication with the care team. Ultimately, integrating the health IT systems used by navigators with those used by other care team members was most beneficial. Because of the various types of health IT used, patient navigators should receive training to ensure that they have the technical skills to use these systems efficiently and reduce duplication of effort. Conclusion: Managing the care of patients with chronic disease requires comprehensive care teams, which can include patient navigators. Integrating navigators' documentation into other health IT systems can keep providers updated on information while patients are outside of the providers' care. With the growth of health IT use in recent years, technical skills are becoming increasingly important. These findings can help leaders who are planning complex health interventions involving navigators to ensure that technology is used efficiently to support coordination and allow navigators to reach more patients.

Characterization of a unique IgG1 mAb CEX profile by limited Lys-C proteolysis/CEX separation coupled with mass spectrometry and structural analysis.

The unique cation exchange chromatography (CEX) charge variant profile of mAb1 is characterized by a combination of mass spectrometry, limited Lys-C digestion followed by CEX separation and structural analysis. During CEX method development, mAb1 showed several unexpected phenomena, including a unique profile containing two main species (acidic 2 and main) and significant instability during stability studies of the main species. Reduced Lys-C peptide mapping identified a small difference in one of the heavy chain peptides (H4) in acidic 2 and further mass analysis identified this difference as Asn55 deamidation. However, the amount of Asn55 deamidation in acidic 2 could account for only half of the species present in this peak. Lys-C limited digest followed by CEX separated several unique peaks in the acidic peak 2 including two pre Fab peaks (LCC1 and LCC2). Whole protein mass analysis suggested that both LCC1 and LCC2 were potentially deamidated species. Subsequent peptide mapping with MS/MS determined that LCC1 contained isoAsp55 and LCC2 contained Asp55. Combining LCC1 and LCC2 CEX peak areas could account for nearly all of the species present in acidic peak 2. Subsequent detailed sequence analysis combined with molecular modeling identified Asn55 and its surrounding residues are responsible for the different CEX behavior and instability of mAb1 following forced degradation at high pH. Overall, the combinatorial approach used in this study proved to be a powerful tool to understand the unique charge variant and stability profile of a monoclonal antibody.

Effect of electronic charting on the patient-psychiatrist relationship.

The impending implementation of an electronic medical record (EMR) within Behavioral Health facilities at the University of New Mexico (UNM) offers a unique opportunity to study the effects of EMR usage on a psychiatric patient population. A pre-test and post-test design using a satisfaction survey will test for changes to the patient-psychiatrist relationship before and after implementation. To date, 48 subjects have participated in the pre-implementation portion of the study.

Public safety answering point readiness for wireless E-911 in New York State.

OBJECTIVE: To determine the level of wireless enhanced 911 readiness among New York's primary public safety answering points. METHODS: This descriptive study utilized a simple, single-page survey that was distributed in August 2001, with telephone follow-up concluding in January 2002. Surveys were distributed to directors of the primary public safety answering points in each of New York's 62 counties. Information was requested regarding current readiness for providing wireless enhanced 911 service, hardware and software needs for implementing the service, and the estimated costs for obtaining the necessary hardware and software. RESULTS: Two directors did not respond and could not be contacted by telephone; three declined participation; one did not operate an answering point; and seven provided incomplete responses, resulting in usable data from 49 (79%) of the state's public safety answering points. Only 27% of the responding public safety answering points were currently wireless enhanced 911 ready. Specific needs included obtaining or upgrading computer systems (16%), computer-aided dispatch systems (53%), mapping software (71%), telephone systems (27%), and local exchange carrier trunk lines (42%). The total estimated hardware and software costs for achieving wireless enhanced 911 readiness was between 16 million and 20 million dollars. CONCLUSIONS: New York's primary public safety answering points are not currently ready to provide wireless enhanced 911 service, and the cost for achieving readiness could be as high as 20 million dollars.

Development of a clockwork light source to enable cervical inspection by village health workers.

BACKGROUND: Cervical cancer can often be prevented by screening and may be curable if identified and treated in its early stages. However, 80% of new cases occur in less-developed countries where cervical cancer screening programmes are small-scale or non-existent. This is a human tragedy of great proportion, with many of those affected being young mothers. There is some evidence that cancerous or precancerous lesions may be detected by visual inspection with acetic acid (VIA) and field studies indicate that this technique is effective, safe and acceptable to women. However, the provision of a light source for inspection of the cervix presents a major problem in less-developed countries, where candles and torches often provide the only means of illumination. Our objective was to develop a light source based on clockwork technology, that required no batteries or external power source. METHODS: We adapted the design of a commercially available clockwork torch to provide a light source for cervical inspection. The light source was then tested under laboratory conditions in a comparison with other illumination methods typically used in this application. RESULTS: The light source gave illuminance levels greater than those produced by any other method tested, and also had considerable advantages in terms of ease of use and safety. CONCLUSION: This design is small, compact, effective and safe to use and promises a better and more affordable means of visualising the cervix. Further field trials of VIA are now required which incorporate this light source.

EMS Agenda for the Future: Where We Are Where We Want to Be.

During the past 30 years, emergency medical services (EMS) in the United States have experienced explosive growth. The American health care system is now transforming, providing an opportune time to examine what we have learned over the past three decades in order to create a vision for the future of EMS. Over the course of several months, a multidisciplinary steering committee collaborated with hundreds of EMS-interested individuals, organizations, and agencies to develop the "EMS Agenda for the Future." Fourteen EMS attributes were identified as requiring continued development in order to realize the vision established within the Agenda. They are Integration of Health Services, EMS Research, Legislation and Regulation, System Finance, Human Resources, Medical Direction, Education Systems, Public Education, Prevention, Public Access, Communication Systems, Clinical Care, Information Systems, and Evaluation. Discussion of these attributes provides important guidance for achieving a vision for the future of EMS that emphasizes its critical role in American health care. [Delbridge TR, Bailey B, Chew JL Jr, Conn AKT, Krakeel JJ, Manz D, Miller DR, O'Malley PJ, Ryan SD, Spaite DW, Stewart RD, Suter RE, Wilson EM: EMS agenda for the future: Where we are … where we want to be. Ann Emerg Med February 1998;31:251-263.].