User Experience of Mobile Personal Health Records for the Emergency Department: Mixed Methods Study.

BACKGROUND: Personal health records (PHRs) can be useful in the emergency department, as they provide patient information in an accurate and timely manner and enable it to be used actively. This has an effect on patients' health outcomes and patient experience. Despite the importance of PHRs in emergencies, there are only a few studies related to PHRs in emergencies that evaluate patient experience. OBJECTIVE: This study aims to introduce the novel mobile PHR (mPHR) platform to emergency environments and assess user experience. METHODS: The study was conducted from October 2019 to November 2019. In total, 1000 patients or carers in the emergency departments of 3 hospitals were provided an application-based service called FirstER, which was developed to collect and utilize medical information for patients in the emergency department. This study was performed as a mixed methods study. After using FirstER, we investigated its usability and conducted a survey on the experience of obtaining medical information with a legacy system and with FirstER. Additionally, we interviewed 24 patients to gain insight into their experiences regarding medical information using FirstER. For the quantitative analysis, the survey results were analyzed using descriptive statistics (mean and standard deviation). For the qualitative analysis, we determined the keywords and their frequencies from each survey question and interview question. RESULTS: In total, 1000 participants, consisting of both patients and carers, were recruited in this study. Their mean age was 41.4 (SD 13.3) years. We ascertained participants' satisfaction with FirstER and their mPHR needs through a survey and an in-depth interview. With the current system, participants were not well aware of their health conditions and medical information, and they were passive in the use of their medical information and treatment. However, they wanted their medical information for several reasons, such as information sharing and managing their health conditions. FirstER provided participants with their needed information and an easy way to access it. The mean System Usability Scale (SUS) value was 67.1 (SD 13.8), which was considered very near to acceptable. CONCLUSIONS: This study is the first to implement mPHRs in the emergency department of large tertiary hospitals in the Republic of Korea. FirstER was found to enhance user experience in emergencies, as it provided necessary medical information and proper user experience. Moreover, the average SUS was 67.1, which means that participants found FirstER to be very near to acceptable. This is very encouraging in that FirstER was developed within a very short time, and it was a pilot study. TRIAL REGISTRATION: Clinicaltrials.gov NCT04180618; https://clinicaltrials.gov/ct2/show/NCT04180618.

Automated Annotation of Sphingolipids Including Accurate Identification of Hydroxylation Sites Using MSn Data.

Sphingolipids constitute a heterogeneous lipid category that is involved in many key cellular functions. For high-throughput analyses of sphingolipids, tandem mass spectrometry (MS/MS) is the method of choice, offering sufficient sensitivity, structural information, and quantitative precision for detecting hundreds to thousands of species simultaneously. While glycerolipids and phospholipids are predominantly non-hydroxylated, sphingolipids are typically dihydroxylated. However, species containing one or three hydroxylation sites can be detected frequently. This variability in the number of hydroxylation sites on the sphingolipid long-chain base and the fatty acyl moiety produces many more isobaric species and fragments than for other lipid categories. Due to this complexity, the automated annotation of sphingolipid species is challenging, and incorrect annotations are common. In this study, we present an extension of the Lipid Data Analyzer (LDA) "decision rule set" concept that considers the structural characteristics that are specific for this lipid category. To address the challenges inherent to automated annotation of sphingolipid structures from MS/MS data, we first developed decision rule sets using spectra from authentic standards and then tested the applicability on biological samples including murine brain and human plasma. A benchmark test based on the murine brain samples revealed a highly improved annotation quality as measured by sensitivity and reliability. The results of this benchmark test combined with the easy extensibility of the software to other (sphingo)lipid classes and the capability to detect and correctly annotate novel sphingolipid species make LDA broadly applicable to automated sphingolipid analysis, especially in high-throughput settings.

Anesthesia Information Management Systems: Evolution of the Paper Anesthetic Record to a Multisystem Electronic Medical Record Network That Streamlines Perioperative Care.

Initially devised in the 1890s, the traditional anesthetic record comprises physiological changes, crucial anesthetic or surgical events, and medications administered during the perioperative period. The timely collection of quality data facilitates situational awareness and point-of-care clinical decision making. The burgeoning volume and complexity of data in conjunction with financial incentives and the push for improved clinical documentation by regulatory bodies have prompted the transition away from paper records. Anesthesia Information Management Systems (AIMS) are specialized electronic health record networks that allow the anesthesia record to interface with hospital clinical data repositories, resulting in improvements in quality of care, patient safety, operations management, reimbursement, and translational research. Like most new technological advances, adoption was slow at first due to the challenges of integrating complex systems into daily clinical practice, questions about return on investment, and medicolegal liability. Recent technological advances, coupled with government incentives, have allowed AIMS adoption to reach an acceleration phase among US academic medical centers; widespread utilization of AIMS by 84% of US academic medical centers is expected by 2018-2020. Adoption among nonacademic US and European medical centers still remains low; information concerning Asian countries is limited to literature describing only single-hospital center experiences.

Adherence to growth hormone (GH) therapy in naïve to treatment GH-deficient children: data of the Italian Cohort from the Easypod Connect Observational Study (ECOS).

BACKGROUND: With the use of non-objective measurement, adherence to growth hormone (GH) therapy has been reported suboptimal in a large proportion of patients, and poor adherence has been shown to affect short-term growth response in patients receiving GH treatment. OBJECTIVE: The Easypod™ electronic device allows objective measurement of adherence. In this study, we report 3-year prospective adherence data of the Italian cohort of naïve GH deficient (GHD) children extrapolated from the Easypod Connect Observational Study (ECOS) database. PATIENTS AND METHODS: Seventy-three GHD children naïve to GH treatment were included in the analysis. 22 Italian centers participated in the study. RESULTS: Mean adherence rate was consistently above 85% across the 3-year observation period. Particularly, mean adherence was 88.5%, 86.6%, and 85.7% after 1, 2 and 3 years, respectively. Mean (± SD) height-SDS increase after the first year was 0.41 (± 0.38). CONCLUSIONS: The majority of naïve GHD children starting GH treatment with Easypod maintained an adherence rate > 85% up to 3 years. Easypod is a useful tool to follow-up patients' adherence allowing timely intervention to improve optimal treatment for these patients.

Desenvolvimento e implementação de um modelo de data warehouse para integração de sistemas electrónicos de seguimento de pacientes hiv+: um estudo de caso da província da zambézia, moçambique / Development and implementation of a data warehouse model for integration of electronic monitoring systems hiv+ patients: a case study from the province of zambézia, mozambique

Desde 2007, o Sector de Saúde em Moçambique, incluindo a Província da Zambézia, está a implementar diferentes Sistemas Electrónicos para Seguimento de Pacientes (SESP) HIV+ em diversas Unidades Sanitárias (US). Estes sistemas estão sendo implementados de forma isolada em cada Distrito/US, sem, contudo, nenhuma comunicação em tempo real, nem intercâmbio electrónico de informações. Por outro lado, não existe um repositório provincial que agrega os dados dos sistemas em implementação, tornando complexos os processos de análise centralizada de dados e extracção dos mesmos para pesquisas em saúde. Para superar os problemas ora mencionados, neste estudo criamos e implementamos um modelo de Data Warehousing (DWH), utilizando como referência o SESP Open Medical Record System (OpenMRS) em uso na Província da Zambézia e realizamos um estudo exploratório com abordagem mista, a qualitativa e a quantitativa, visando o desenvolvimento e aperfeiçoamento efectivo do mesmo. Através das entrevistas semi-estruturadas e observação directa foi possível documentar os desafios e perspectivas para a implementação de SESP e a centralização de dados no contexto da Província da Zambézia. A centralização das bases de dados do Centro de Saúde (CS) 4 de Dezembro, em Quelimane, e CS de Gilé permitiu a validação da funcionalidade do modelo criado (DWH), razão pela qual propõe-se a sua implementação efectiva envolvendo todos interessados, desde os decisores até os utilizadores finais. Apesar de se revelar eficaz e eficiente, a implementação de SESP e DWH na província da Zambézia enfrenta barreiras de várias ordens tais como: falta de capacidade técnica dos profissionais afectos ao Sector de Saúde, a diversidade dos sistemas no início de implementação e escassez de recursos financeiros.

Since 2007, the health sector in Mozambique, in particular the province of Zambézia, is implementing different Electronic Patient Tracking System (EPTS) for HIV+ patients in various health units. These systems are being implemented in isolation in each district / health unit without real-time communication or electronic exchange of information. There is no provincial repository that aggregates the data of the systems in implementation, making complex the processes of centralized data analysis and data extraction for health research. To support the centralized data analysis, in this study we created and implemented a data warehousing (DWH) model, using as reference the EPTS Open Medical Record System (OpenMRS) in use in Zambézia Province. For the effective development of the model, we carried out an exploratory study with a mixed approach, being qualitative and quantitative. Through semi-structured interviews and direct observation, it was possible to document the challenges and perspectives of the implementation of EPTS and data centralization in the Zambézia Province context and for the validation of the model created, the databases of the 4 Dezembro Health Facility (HF) and Gilé HF were successfully centralized. The lack of technical capacity of Zambézia health sector, the diversity of the systems at the beginning of implementation and the difficulties associated with financial order constitute barriers to the implementation of EPTS and DWH. The proposed DWH model proved its functionality since it was possible to centralize the databases 4 de Dezembro HF and Gilé HF. For successful implementation of a EPTS and DWH it should be a process with initial involvement of all stakeholders from decision makers to end users.

Self-administered structured food record for measuring individual energy and nutrient intake in large cohorts: Design and validation / Registro alimentario estructurado y autoadministrado para estimar la ingesta individual de energía y nutrientes en grandes cohortes: diseño y validación

Introduction: Several instruments developed to assess dietary intake of groups or populations have strengths and weaknesses that affect their specific application. No self-administered, closed-ended dietary survey was previously used in Argentina to assess current food and nutrient intake on a daily basis. Objective: To design and validate a self-administered, structured food record (NutriQuid, NQ) representative of the adult Argentine population's food consumption pattern to measure individual energy and nutrient intake. Materials and methods: Records were loaded onto a database using software that checks a regional nutrition information system (SARA program), automatically quantifying energy and nutrient intake. NQ validation included two phases: (1) NQ construct validity comparing records kept simultaneously by healthy volunteers (45-75 years) and a nutritionist who provided meals (reference), and (2) verification of whether NQ reflected target population consumption (calories and nutrients), week consumption differences, respondent acceptability, and ease of data entry/analysis. Data analysis included descriptive statistics, repeated measures ANOVA, intraclass correlation coefficient, nonparametric regression, and cross-classification into quintiles. Results: The first validation (study group vs. reference) showed an underestimation (10%) of carbohydrate, fat, and energy intake. Second validation: 109 volunteers (91% response) completed the NQ for seven consecutive days. Record completion took about 9min/day, and data entry 3-6min. Mean calorie intake was 2240±119kcal/day (42% carbohydrates, 17% protein, and 41% fat). Intake significantly increased in the weekend. Conclusion: NQ is a simple and efficient tool to assess dietary intake in large samples

Introducción: Diferentes instrumentos para evaluar la ingesta alimentaria grupal o poblacional tienen fortalezas y debilidades que afectan a su aplicación. No existe experiencia nacional con un registro dietético auto-administrado cerrado para evaluar la ingesta actual de alimentos y nutrientes diaria de alimentos. Objetivo: Diseñar y validar un registro de alimentos estructurado, auto-administrado (NutriQuid [NQ]), representativo del patrón de consumo alimentario de la población argentina adulta para medir la ingesta individual de energía y nutrientes. Materiales y métodos: Desarrollamos un software para incorporar registros en una base de datos y verificar información nutricional (programa SARA), cuantificando automáticamente la ingesta de energía y nutrientes. La validación de NQ incluyó 2 fases: 1) comparación simultánea de registros del NQ completado por voluntarios sanos (45-75 años) y de una nutricionista que preparó las comidas ofrecidas (referencia), y 2) verificación si el NQ reflejó el consumo diferencial de población objetivo (calorías y nutrientes) durante la semana, aceptabilidad por los encuestados y facilidad de ingreso/análisis de datos. Análisis estadístico: incluyó estadística descriptiva, ANOVA de medidas repetidas, coeficiente de correlación intraclase, regresión no paramétrica y clasificación cruzada en quintilos. Resultados: La primera validación (voluntarios vs. referencia): mostró una subestimación del 10% de la ingesta de carbohidratos, grasas y energía. Segunda validación: 109 voluntarios (91% de respuesta) completaron el NQ durante 7 días consecutivos. Completar los registros requirió 9min/día y la carga de datos 3-6min. La ingesta calórica promedio fue de 2.240±119kcal/día (42% carbohidratos, 17% proteína y 41% grasa) y aumentó significativamente durante el fin de semana. Conclusión: El NQ es una herramienta simple y eficiente para evaluar la ingesta alimentaria en grandes grupos

ODMSummary: A Tool for Automatic Structured Comparison of Multiple Medical Forms Based on Semantic Annotation with the Unified Medical Language System.

INTRODUCTION: Medical documentation is applied in various settings including patient care and clinical research. Since procedures of medical documentation are heterogeneous and developed further, secondary use of medical data is complicated. Development of medical forms, merging of data from different sources and meta-analyses of different data sets are currently a predominantly manual process and therefore difficult and cumbersome. Available applications to automate these processes are limited. In particular, tools to compare multiple documentation forms are missing. The objective of this work is to design, implement and evaluate the new system ODMSummary for comparison of multiple forms with a high number of semantically annotated data elements and a high level of usability. METHODS: System requirements are the capability to summarize and compare a set of forms, enable to estimate the documentation effort, track changes in different versions of forms and find comparable items in different forms. Forms are provided in Operational Data Model format with semantic annotations from the Unified Medical Language System. 12 medical experts were invited to participate in a 3-phase evaluation of the tool regarding usability. RESULTS: ODMSummary (available at https://odmtoolbox.uni-muenster.de/summary/summary.html) provides a structured overview of multiple forms and their documentation fields. This comparison enables medical experts to assess multiple forms or whole datasets for secondary use. System usability was optimized based on expert feedback. DISCUSSION: The evaluation demonstrates that feedback from domain experts is needed to identify usability issues. In conclusion, this work shows that automatic comparison of multiple forms is feasible and the results are usable for medical experts.

Análisis modal de fallos y efectos en las prescripciones farmacológicas informatizadas / Failure mode and effects analysis on computerized drug prescriptions

Objetivo. Determinar y analizar los errores en las prescripciones farmacológicas de pacientes asistidos en un hospital de alta resolución mediante la aplicación de un análisis modal de fallos y efectos (AMFE). Material y métodos. Un grupo multidisciplinar de distintas especialidades médicas y de enfermería analizó historias clínicas, en las que las prescripciones farmacológicas se realizaban en formato de texto libre. Se desarrolló un AMFE en el que el índice de prioridad de riesgos (IPR) se obtuvo a partir de un estudio observacional transversal, mediante una auditoría de historias clínicas realizada en 2 fases: 1) verificación previa a la intervención y 2) evaluación de las acciones de mejora después del primer análisis. El tamaño muestral auditable, calculado con técnica de muestreo estratificado y selección aleatoria de episodios clínicos, fue de 679 historias clínicas. Resultados. Se incluyó a 2.096 pacientes. Los errores de prescripción respecto del total de prescripciones descendieron en la segunda fase un 22,2%. En las variables con IPR mayor («vía de administración no especificada» y «dosificación no especificada») no se observaron descensos significativos en la segunda fase, durante la cual no se detectó «pauta horaria incorrecta», «contraindicación del fármaco por alergia», «paciente incorrecto» ni «duplicidad de prescripción», lo que redundó en la mejora de las prescripciones. Conclusiones. Se han determinado y analizado errores de prescripciones farmacológicas mediante la metodología AMFE, mejorando la seguridad clínica de dichas prescripciones. La herramienta permite monitorizar actualizaciones del sistema de prescripción electrónica. Para evitar dichos errores se requeriría que todos los apartados de una prescripción fueran de registro obligado (AU)

Objective. To identify and analyze errors in drug prescriptions of patients treated in a «high resolution» hospital by applying a Failure mode and effects analysis (FMEA).Material and methods A multidisciplinary group of medical specialties and nursing analyzed medical records where drug prescriptions were held in free text format. An FMEA was developed in which the risk priority index (RPI) was obtained from a cross-sectional observational study using an audit of the medical records, carried out in 2 phases: 1) Pre-intervention testing, and (2) evaluation of improvement actions after the first analysis. An audit sample size of 679 medical records from a total of 2,096 patients was calculated using stratified sampling and random selection of clinical events. Results. Prescription errors decreased by 22.2% in the second phase. FMEA showed a greater RPI in «unspecified route of administration» and «dosage unspecified», with no significant decreases observed in the second phase, although it did detect, «incorrect dosing time», «contraindication due to drug allergy», «wrong patient» or «duplicate prescription», which resulted in the improvement of prescriptions. Conclusions. Drug prescription errors have been identified and analyzed by FMEA methodology, improving the clinical safety of these prescriptions. This tool allows updates of electronic prescribing to be monitored. To avoid such errors would require the mandatory completion of all sections of a prescription (AU)

Toward Successful Implementation of Speech Recognition Technology: A Survey of SRT Utilization Issues in Healthcare Settings.

PURPOSE: To evaluate physician utilization of speech recognition technology (SRT) for medical documentation in two hospitals. METHODS: A quantitative survey was used to collect data in the areas of practice, electronic equipment used for documentation, documentation created after providing care, and overall thoughts about and satisfaction with the SRT. The survey sample was from one rural and one urban facility in central Missouri. In addition, qualitative interviews were conducted with a chief medical officer and a physician champion regarding implementation issues, training, choice of SRT, and outcomes from their perspective. RESULTS: Seventy-one (60%) of the anticipated 125 surveys were returned. A total of 16 (23%) participants were practicing in internal medicine and 9 (13%) were practicing in family medicine. Fifty-six (79%) participants used a desktop and 14 (20%) used a laptop (2%) computer. SRT products from Nuance were the dominant SRT used by 59 participants (83%). Windows operating systems (Microsoft, Redmond, WA) was used by more than 58 (82%) of the survey respondents. With regard to user experience, 42 (59%) participants experienced spelling and grammatical errors, 15 (21%) encountered clinical inaccuracy, 9 (13%) experienced word substitution, and 4 (6%) experienced misleading medical information. CONCLUSIONS: This study shows critical issues of inconsistency, unreliability, and dissatisfaction in the functionality and usability of SRT. This merits further attention to improve the functionality and usability of SRT for better adoption within varying healthcare settings.

Cardiac resuscitation events: one eyewitness is not enough.

OBJECTIVE: To determine the accuracy of paper cardiopulmonary resuscitation records. DESIGN: Case series. SETTING: Twenty-six-bed video-monitored pediatric cardiac ICU. PATIENTS: All patients who had a resuscitation event with available video and electronically stored vital sign and waveform data from May 2012 to February 2013. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: There were 41 cardiopulmonary resuscitation events during the study period. Fifteen had complete and valid data from the paper cardiopulmonary resuscitation forms, the retrieved monitor data, and the continuous bedside video monitoring. These 15 events occurred in 12 individual patients, and there was 100% agreement of data in the documentation of interventions in place (ventilation, arterial catheter, pulse oximetry, and vascular access) and in the presence of a witness at the onset of the arrest. All events were witnessed. Of the 15 events, video and monitor review revealed that 14 used waveform and numeric capnometry to confirm endotracheal tube/tracheostomy placement, but this section was only completed on the paper cardiopulmonary resuscitation record in three of the 14 cases. All records showed no discrepancies in the time of return of spontaneous circulation. The video and monitor review revealed delay in initiating cardiopulmonary resuscitation (mode, 2 min; two cases ≥ 7 min) and shockable rhythms (ventricular arrhythmia) in two cases. A sign of pulseless state was discovered in seven cases classified on the paper record as "always with a pulse." Those include sudden loss of consciousness, flat arterial line tracing, and abrupt drop in the partial pressure of exhaled carbon dioxide tracing (< 10 mm Hg). CONCLUSIONS: Eyewitness accounts of cardiopulmonary resuscitation are often inaccurate and incomplete. Review of information from video and electronically stored vital sign and waveform data provides more accurate information than review of paper-based cardiopulmonary resuscitation records and may provide the insight necessary to improving cardiopulmonary resuscitation.

Protecting privacy in a clinical data warehouse.

Peking University has several prestigious teaching hospitals in China. To make secondary use of massive medical data for research purposes, construction of a clinical data warehouse is imperative in Peking University. However, a big concern for clinical data warehouse construction is how to protect patient privacy. In this project, we propose to use a combination of symmetric block ciphers, asymmetric ciphers, and cryptographic hashing algorithms to protect patient privacy information. The novelty of our privacy protection approach lies in message-level data encryption, the key caching system, and the cryptographic key management system. The proposed privacy protection approach is scalable to clinical data warehouse construction with any size of medical data. With the composite privacy protection approach, the clinical data warehouse can be secure enough to keep the confidential data from leaking to the outside world.

Monitorización de eventos adversos en un servicio de cirugía general mediante una base de datos interrelacionada / Monitoring of adverse events in a general surgery department by applying an interrelated database

Introducción: La monitorización de los eventos adversos (EA) permite detectar precozmente desviaciones de la práctica clínica, analizar sus causas y proponer medidas para evitarlos. En el servicio de Cirugía General de un hospital universitario de tercer nivel se desarrolló una base de datos interrelacionada (BDI) basada en registros hospitalarios para monitorizar los principales EA observados en las intervenciones quirúrgicas programadas (IQ). Material y métodos: El EA se definió como el registro en la BDI de una o más de las siguientes situaciones: exitus, reintervenciones, reingresos y diversas complicaciones (hemorragia, dehiscencia, evisceración, fístula, peritonitis, absceso, sepsis y otras). No siendo excluyentes. También se registró el grado de complejidad del procedimiento. Se describió la monitorización de los EA en acumulados mensuales. Se calcularon los porcentajes acumulados de EA y exitus respecto del acumulado de IQ consecutivas. Los cálculos se hicieron para todas las IQ y para las más complejas. Resultados: De las 4.572 IQ, 415 presentaron EA (9,08%), con 74 exitus (1,62%). En las 1.819 IQ complejas hubo 311 EA (17,1%), con 60 exitus (3,3%). Todos los EA aumentaron según lo hacía la complejidad quirúrgica (p<0,001). Se elaboraron gráficas de monitorización de la frecuencia acumulada de EA y exitus tanto en las IQ acumuladas cada mes como en las IQ totales desde el inicio de la cohorte. Conclusiones: La monitorización no sólo muestra el número de EA ocurrido durante un periodo de tiempo, sino que permite a los clínicos monitorizar resultados, detectar rápidamente desviaciones e investigar factores desencadenantes para su corrección

Introduction: The monitoring of adverse events (EA) allows early detection of deviations of clinical practice, analyzing their causes and proposing measures for improvement. In the General Surgery Department of a university hospital we developed an interrelated database (BDI) on hospital records to monitor the main EA that resulted from elective surgery (IQ). Material and Methods: The EA was defined as the registering of one or more of the following issues in the BDI: exitus, reoperation, readmission and various complications (bleeding, dehiscence, evisceration, fistula, peritonitis, abscess, sepsis and others). They were not exclusive. The complexity degree of the procedure was also recorded. The EA monitoring of monthly cumulatives was described. The cumulative percentages of EA and exitus regarding consecutive cumulative IQ were calculated. Calculations were made for all IQ and for the most complex ones. Results: EA and exitus were registered in 415 (9,8%) and 64 (1,6%) respectively out of a total of 4,572 IQ. Among 1,819 complex IQ there were 311 EA (17.1%), with 60 exitus (3.3%). The frequency of EA increased as did surgical complexity (p<0.001). We developed graphic monitoring of the accumulated frequency of EA and exitus, both IQ accumulated monthly and total IQ from the start of the cohort. Conclusions: Monitoring not only shows the number of EA that occurred over a period of time, but also allows clinicians to monitor results, to detect deviations early and to investigate triggering factors for their correction

Mapping query terms to data and schema using content based similarity search in clinical information systems.

This paper reports on the issues in mapping the terms of a query to the field names of the schema of an Entity Relationship (ER) model or to the data part of the Entity Attribute Value (EAV) model using similarity based Top-K algorithm in clinical information system together with an extension of EAV mapping for medication names. In addition, the details of the mapping algorithm and the required pre-processing including NLP (Natural Language Processing) tasks to prepare resources for mapping are explained. The experimental results on an example clinical information system demonstrate more than 84 per cent of accuracy in mapping. The results will be integrated into our proposed Clinical Data Analytics Language (CliniDAL) to automate mapping process in CliniDAL.