The Effect of Information Technology on the Information Exchange between Laboratories and Ambulatory Care Centers: A Systematic Review.

Laboratory services form an integral part of medical care in the decision-making of physicians, including those working at ambulatory care centers. Information exchange is essential between ambulatory care centers and laboratories. Inevitable errors have always existed in the exchange of such information on paper, which can be to some extent avoided by developing appropriate computer-based interfaces. Therefore, this review aimed to examine studies conducted to determine the effect of electronic communication between ambulatory care centers and laboratories. This systematic review was conducted on the basis of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were searched in the PubMed, Embase, Cochrane, and Web of Science, and those written in English and published between 2000 and February 2019 with full texts available were selected. From a total of 3898 papers retrieved from the studied databases, 24 papers were eligible for entering this study after removing similar and nonrelated studies. Electronic exchanges between ambulatory care centers and laboratories can have numerous benefits in terms of financial, organizational, and quality. This evidence for the value of electronic communications is an important factor contributing to its local investment and adoption.

Patients' beliefs about generic medicines in Malaysia / Creencias de los pacientes sobre los medicamentos genéricos en Malasia

Background: Acceptance of generic medicines by patients is an essential factor given that they are the end users of these medicines. In fact, adequate knowledge and positive perceptions are prerequisite to patients’ acceptance and use of generic medicines. Objective: To assess the current belief and views of patients about generic medicines in Malaysia. Method: This was a self-administered questionnairebased study. The study was conducted with patients visiting outpatient pharmacy department at a tertiary care hospital in Malaysia. The Malaysian version of Generic Medicines Scale (GMS) was used. The GMS consists of two subscales: efficacy and similarity of generic medicines to original brand medicines. The efficacy subscale consists of 10 items while the similarity subscale consists of 6 items. The responses to the items were framed as a fivepoint Likert scale (1=strongly disagree to 5=strongly agree). Results: A total of 202 out of 300 patients participated in the study, giving a response rate of 67.3%. In this study, only 49% of them (n=99) knew the term ‘generic medicine’. Moreover, only 53.5% of the respondents (n=108) believed that the efficacy of generic medicines was the same as original brand medicines. In terms of quality, only 44% of the respondents (n=89) disagreed that generic medicines were of a lower quality. About one third (n=65, 32.2%) believed that generic medicines were cheaper because they were less efficacious. In terms of side effects, 44.5% of the respondents (n=90) believed that generic medicines had the same side effect profile as original brand medicines. Conclusions: The study finding showed that almost half of the respondents had negative belief in generic medicines. Similarly, many patients were not aware of the similarities and differences between generic and original brand medicines. Therefore, there is a need to provide patients with adequate information about generic medicines (AU)

Antecedentes: La aceptación de los genéricos por los pacientes es un factor esencial dado que son los utilizadores finales de estos medicamentos. De hecho, el conocimiento adecuado y las percepciones positivas son requisitos para la aceptación y el uso de genéricos por los pacientes. Objetivo: Evaluar las creencias y la visión actuales de los pacientes sobre medicamentos genéricos en Malasia. Método: Este fue un estudio basado en un cuestionario auto-administrado. El estudio se realizó con pacientes que visitaron un departamento de farmacia ambulatoria de un hospital terciario en Malasia. Se usó la versión malaya del Generic Medicines Scale (GMS). El GMS consiste en dos escalas: eficacia y semejanza del genérico con el original de marca. La sub-escala de eficacia consiste en 10 ítems, mientras que la de semejanza consiste en 6 ítems. Las respuestas de los ítems se estipularon en una escala de Likert de 5 puntos: (1=desacuerdo fuerte a 5=acuerdo fuerte). Resultados: Un total de 202 de los 300 pacientes participaron en el estudio, lo que da una tasa de respuesta del 67,3%. En este estudio, solo el 49% de ellos (n=99) conocían el término ‘medicamento genérico’. Sólo el 53,5% de los respondentes (n=108) creían que la eficacia de los genéricos era la misma que la de los originales de marca. En términos de calidad, solo el 44% de los respondentes (n=89) estaba en desacuerdo que los genéricos eran de menor calidad. Cerca de un tercio (n=65, 32,2%) creía que los genéricos eran más baratos porque eran menos eficaces. En términos de efectos adversos, el 44,5% de los respondentes (n=90) creía que los genéricos tenían el mismo perfil de efectos adversos que los medicamentos de marca. Conclusiones: Los hallazgos del estudio demostraron que casi la mitad de los respondentes tenían creencias negativas sobre los genéricos. Del mismo modo, muchos pacientes no conocían las semejanzas y similitudes de los genéricos y los de marca. Por tanto, se necesita proporcionar a los pacientes información adecuada sobre medicamentos genéricos (AU)

Evidence-based management of ambulatory electronic health record system implementation: an assessment of conceptual support and qualitative evidence.

OBJECTIVES: While electronic health record (EHR) systems have potential to drive improvements in healthcare, a majority of EHR implementations fall short of expectations. Shortcomings in implementations are often due to organizational issues around the implementation process rather than technological problems. Evidence from both the information technology and healthcare management literature can be applied to improve the likelihood of implementation success, but the translation of this evidence into practice has not been widespread. Our objective was to comprehensively study and synthesize best practices for managing ambulatory EHR system implementation in healthcare organizations, highlighting applicable management theories and successful strategies. METHODS: We held 45 interviews with key informants in six U.S. healthcare organizations purposively selected based on reported success with ambulatory EHR implementation. We also conducted six focus groups comprised of 37 physicians. Interview and focus group transcripts were analyzed using both deductive and inductive methods to answer research questions and explore emergent themes. RESULTS: We suggest that successful management of ambulatory EHR implementation can be guided by the Plan-Do-Study-Act (PDSA) quality improvement (QI) model. While participants did not acknowledge nor emphasize use of this model, we found evidence that successful implementation practices could be framed using the PDSA model. Additionally, successful sites had three strategies in common: 1) use of evidence from published health information technology (HIT) literature emphasizing implementation facilitators; 2) focusing on workflow; and 3) incorporating critical management factors that facilitate implementation. CONCLUSIONS: Organizations seeking to improve ambulatory EHR implementation processes can use frameworks such as the PDSA QI model to guide efforts and provide a means to formally accommodate new evidence over time. Implementing formal management strategies and incorporating new evidence through the PDSA model is a key element of evidence-based management and a crucial way for organizations to position themselves to proactively address implementation and use challenges before they are exacerbated.

Smartphone-assisted prehospital medical information system for analyzing data on prehospital stroke care.

BACKGROUND AND PURPOSE: Optimizing prehospital stroke care is important because effective treatments for acute stroke require a narrow therapeutic time window. We developed a smartphone-assisted prehospital medical information system (SPMIS) to facilitate research on prehospital stroke care. METHODS: Prehospital medical information was input into the SPMIS application installed on smartphones by emergency medical staff, sent to a server through the Internet, and connected with in-hospital information. Using SPMIS, we analyzed data on 914 patients transferred to our institution by ambulance between April 2012 and March 2013. RESULTS: The data analyzed were the sensitivity and specificity of the prehospital diagnosis and prehospital stroke scale and the relationship between prehospital vital signs and forms of stroke. These analyses could be performed semiautomatically in a few hours. CONCLUSIONS: SPMIS enabled us to analyze the prehospital information of patients with stroke in a short time with little effort. More large-scale studies on prehospital stroke care will become feasible using SPMIS, which may lead to advances in stroke treatment.

An assessment of the accuracy and availability of data in electronic patient tracking systems for patients receiving HIV treatment in central Mozambique.

BACKGROUND: Since the rapid scale-up of antiretroviral therapy (ART) programs in sub-Saharan Africa, electronic patient tracking systems (EPTS) have been deployed to respond to the growing demand for program monitoring, evaluation and reporting to governments and donors. These routinely collected data are often used in epidemiologic and operations research studies intended to improve programs. To ensure accurate reporting and good quality for research, the reliability and completeness of data systems need to be assessed and reported. We assessed the completeness and reliability of EPTS used in 16 HIV care and treatment clinics in Manica and Sofala provinces of Mozambique. METHODS: We conducted a cross-sectional study to assess the completeness and reliability of key variables in the electronic data system for patients enrolling in 16 public sector HIV treatment clinics between 1 July 2004 and 30 June 2008. Data from the electronic database was compared with data abstracted from a stratified random sample of 520 patient charts. Percent agreement, kappa scores and concordance correlation coefficients were calculated for specified variables. Percentile bootstrap confidence intervals were calculated to account for the stratified nature of our sampling. RESULTS: A total of 16,149 patients with a median age of 33 years and a median CD4 count of 151 enrolled in these 16 clinics between 1 July 2004 and 30 June 2008. The level of completeness was high for most variables with height (18.6%) and weight (11.5%) having the highest amount of missing data. The level of agreement for available data was also high with reliability statistics of 0.95 (95% CI: 0.92-0.98) for gender, 0.91 (95% CI: 0.80-1.00) for pre-ART CD4 value and 0.97 (95% CI: 0.95-0.99) for patient retention. CONCLUSIONS: Electronic patient tracking systems have been deployed to respond to the growing monitoring, evaluation and reporting requirements. In our cross-sectional study of clinics in Manica and Sofala provinces of Mozambique, we found high levels of completeness and reliability for key variables indicating that these electronic databases provided adequate data not only for monitoring and evaluation but also for research. Routine evaluations of the completeness and reliability of these databases need to occur to ensure high quality data are being used for reporting and research.

Same organization, same electronic health records (EHRs) system, different use: exploring the linkage between practice member communication patterns and EHR use patterns in an ambulatory care setting.

OBJECTIVE: Despite efforts made by ambulatory care organizations to standardize the use of electronic health records (EHRs), practices often incorporate these systems into their work differently from each other. One potential factor contributing to these differences is within-practice communication patterns. The authors explore the linkage between within-practice communication patterns and practice-level EHR use patterns. DESIGN: Qualitative study of six practices operating within the same multi-specialty ambulatory care organization using the same EHR system. Semistructured interviews and direct observation were conducted with all physicians, nurses, medical assistants, practice managers, and non-clinical staff from each practice. MEASUREMENTS: An existing model of practice relationships was used to analyze communication patterns within the practices. Practice-level EHR use was defined and analyzed as the ways in which a practice uses an EHR as a collective or a group-including the degree of feature use, level of EHR-enabled communication, and frequency that EHR use changes in a practice. Interview and observation data were analyzed for themes. Based on these themes, within-practice communication patterns were categorized as fragmented or cohesive, and practice-level EHR use patterns were categorized as heterogeneous or homogeneous. Practices where EHR use was uniformly high across all users were further categorized as having standardized EHR use. Communication patterns and EHR use patterns were compared across the six practices. RESULTS: Within-practice communication patterns were associated with practice-level EHR use patterns. In practices where communication patterns were fragmented, EHR use was heterogeneous. In practices where communication patterns were cohesive, EHR use was homogeneous. Additional analysis revealed that practices that had achieved standardized EHR use (uniformly high EHR use across all users) exhibited high levels of mindfulness and respectful interaction, whereas practices that were furthest from achieving standardized EHR use exhibited low levels of mindfulness and respectful interaction. CONCLUSION: Within-practice communication patterns provide a unique perspective for exploring the issue of standardization in EHR use. A major fallacy of setting homogeneous EHR use as the goal for practice-level EHR use is that practices with uniformly low EHR use could be considered successful. Achieving uniformly high EHR use across all users in a practice is more consistent with the goals of current EHR adoption and use efforts. It was found that some communication patterns among practice members may enable more standardized EHR use than others. Understanding the linkage between communication patterns and EHR use can inform understanding of the human element in EHR use and may provide key lessons for the implementation of EHRs and other health information technologies.

Estudio de la epidemia de gripe A nH1N1 de 2009-2010. Síntomas guía en Atención Primaria. Comparación clínica con los casos hospitalarios / Study of pandemic A nH1N1 influenza (2009-2010). Guiding signs in primary care and comparison with hospitalized cases

Objetivos: analizar la capacidad de predicción clínica respecto al diagnóstico de gripe A nH1N1 de los síntomas que presentan los pacientes ambulatorios registrados en la base de datos de la Red Centinela de Aragón (RCA). Comparar la casuística ambulatoria con los pacientes ingresados durante la epidemia de gripe A nH1N1 (2009-2010). Pacientes y métodos: estudio descriptivo retrospectivo de los pacientes que cumplían los criterios epidemiológicos de definición de caso, en los que de manera aleatoria se les realizó reacción en cadena de la polimerasa en tiempo real (PCR-RT) de gripe A nH1N1, así como de los pacientes ingresados en el hospital de tercer nivel de referencia. Comparación de las características epidemiológicas y clínicas entre los pacientes ambulatorios y hospitalarios. Resultados: de los pacientes registrados por la RCA no se encontraron diferencias clínicas entre los niños con frotis (PCR-RT) positivo o negativo para el virus gripal nH1N1, por lo que no se ha podido encontrar un conjunto de síntomas que sean predictores de tener un frotis positivo con la PCR-RT. Los pacientes hospitalizados tenían menor edad que los de la RCA, así como mayor porcentaje de patología de base y comorbilidad asociada. Conclusión: según los datos analizados, la epidemia de gripe A se comportó como una enfermedad benigna, de sintomatología similar a la gripe estacional. Tan solo el hecho de encontrar clínica gripal en una semana epidemiológica de alta incidencia (semanas 43-48) resultaron moderadamente predictores de infección por gripe A(AU)

Objectives: to analyze the prediction's capacity of clinical symptoms to diagnose nH1N1 Influenza in outpatients who were chosen by Aragon's Sentinel surveillance Network. To compare outpatients with hospitalized cases during influenza A virus pandemic (2009-2010). Methods: retrospective study of a randomized group of patients with symptoms of influenza who had laboratory-confirmation by PCR-RT and of all patients admitted to the reference hospital of Aragon. Comparison of epidemiological and clinical characteristics in outpatients and between outpatients and hospital cases. Results: there were no clinical differences between the laboratory-confirmed by PCR-RT cases and the other outpatients, so it was not possible to find defining symptoms of infection. Hospitalized patients were younger, with higher percentage of underlying disease and comorbidity. Conclusions: the epidemic of influenza A behaved as a benign disease, symptoms were similar to seasonal influenza. The clinical finding of having influenza symptoms in a high incidence week (weeks 43-48) was moderately predictive of influenza A infection(AU)

The development of a highly constrained health level 7 implementation guide to facilitate electronic laboratory reporting to ambulatory electronic health record systems.

Electronic laboratory interfaces can significantly increase the value of ambulatory electronic health record (EHR) systems by providing laboratory result data automatically and in a computable form. However, many ambulatory EHRs cannot implement electronic laboratory interfaces despite the existence of messaging standards, such as Health Level 7, version 2 (HL7). Among several barriers to implementing laboratory interfaces is the extensive optionality within the HL7 message standard. This paper describes the rationale for and development of an HL7 implementation guide that seeks to eliminate most of the optionality inherent in HL7, but retain the information content required for reporting outpatient laboratory results. A work group of heterogeneous stakeholders developed the implementation guide based on a set of design principles that emphasized parsimony, practical requirements, and near-term adoption. The resulting implementation guide contains 93% fewer optional data elements than HL7. This guide was successfully implemented by 15 organizations during an initial testing phase and has been approved by the HL7 standards body as an implementation guide for outpatient laboratory reporting. Further testing is required to determine whether widespread adoption of the implementation guide by laboratories and EHR systems can facilitate the implementation of electronic laboratory interfaces.

Mobile health requires mobile security: challenges, solutions, and standardization.

Extended communication and advanced cooperation in a permanently growing healthcare and welfare domain require a well-defined set of security services provided by an interoperable security infrastructure based on international and European standards. Any communication and collaboration procedure requires a purpose. But such legal purpose-binding is definitely not the only aspect to carefully be observed and investigated. More and more, aspects of security, safety, privacy, ethics, and quality reach importance while discussing about future-proof health information systems and health networks - regardless whether local, regional or even pan-European networks. During the course of the current paradigm change from an organization-centered to a process-related and to a person-centered health system, different new technologies including mobile solutions need to be applied in order to meet challenges arising from both legal and technical circumstances. Beside the typical Information and Communication Technology systems and applications, the extended use of modern technologies includes large medical devices like, e.g., MRI and CT but also small devices like sensors worn by a person or included in clothing. Security and safety are on top of the priority list. The paper addresses the identification of some specific aspects like mobile technology and safety when moving both IT and people towards mobile health aiming at increasing citizens and patients awareness, confidence, and acceptance in future mobile care - a world often still beyond the horizon.

Making the electronic medical record work for the orthopedic surgeon.

This article explores the current reasons why orthopedic surgeons might consider the adoption of an electronic medical record system in their practices today. The costs and benefits as well as the barriers to implementation are discussed.

Self assessment for practices considering electronic medical record systems.

Medical practices are increasingly adopting electronic medical record (EMR) systems to help manage documentation and clinical work flow. With literally thousands of vendors and system offerings and considering the investment required for an EMR system, carefully planning for an EMR system is critical. Too often, practices transition to EMRs without an internal assessment and are then disappointed with the post-implementation results of their new system. This article outlines key questions practices should consider before purchasing a system to pave the way for optimal results.