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1.
Stud Health Technol Inform ; 267: 118-125, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31483263

RESUMO

Computerized guidelines have been utilized for several decades by now. Systems based on computerized-guidelines often intertwine (1) medical knowledge representation, (2) guideline procedures and (3) hospital workflows. This induces several drawbacks. Most prominent problems include non-shareability of the computerized guideline between hospitals, limited accessibility of the computerized guideline for humans, and an unclear, often confusing combination of hospital-specific workflow and guideline-induced control flows. This article proposes a 3-layer modelling approach strictly distinguishing the aforementioned three aspects to overcome the respective problems. We applied the 3-layer approach to the implementation of a guideline-interpreting software module in the context of the Medical Informatics Initiative Germany (here: SMITH Project) and comment on the resulting implications for the software design of that module.


Assuntos
Informática Médica , Alemanha , Guias de Prática Clínica como Assunto , Software , Desenho de Programas de Computador , Fluxo de Trabalho
2.
J Biol Regul Homeost Agents ; 33(3 Suppl. 1): 43-50, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31538449

RESUMO

Customization of post-and-cores using computer-aided-design and computer-aided-manufacturing (CAD-CAM) requires the scanning of a pattern and the subsequent digital design. This case report describes the production of a CAD-CAM customized post-and-core designed from an intraoral scan and milled from a metal block. The use of an intraoral scanner (IOS) for post-endodontic rehabilitation could lead to a faster and more efficient CAD-CAM customized post-and-core realization. The use of a high resistance material such as metal is paramount in cases with high loss of coronal structure. The patient has been treated with bisphosphonate (BP) for years. The risk of osteonecrosis of the jaw after extraction was high.


Assuntos
Projeto Auxiliado por Computador , Implantes Dentários , Fluxo de Trabalho , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Implantação Dentária Endo-Óssea Endodôntica , Difosfonatos/efeitos adversos , Difosfonatos/uso terapêutico , Humanos , Metais
3.
Stud Health Technol Inform ; 264: 1318-1322, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438139

RESUMO

In 2017, a US academic medical center switched to a commercial EHR system using the "specialist training the specialist" model, which combines peer-to-peer training, classroom based training, and web-based training. We conducted semi-structured interviews with physicians at multiple training levels to investigate the impact of this EHR switch and to explore the training experience of physicians and their perception of the training quality pre and post Go-Live. Our team used Grounded Theory methodology to classify the interview information. Themes that emerged from the interviews included stress and anxiety, the desire for more realistic training environments tailored to specialty needs, and concerns about the duration of time between training and implementation. In future implementations, we recommend more data-rich test patients and the demonstration of real-world workflows during training.


Assuntos
Medicina , Médicos , Centros Médicos Acadêmicos , Registros Eletrônicos de Saúde , Humanos , Fluxo de Trabalho
4.
Stud Health Technol Inform ; 264: 403-407, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437954

RESUMO

In trauma care and trauma care research there exists an implementation gap regarding a consistent controlled vocabulary to describe organizational aspects of trauma centers and trauma systems. This paper describes the development and evaluation of a controlled vocabulary for trauma care organizations. We give a detailed description of the involvement of domain experts in the domain analysis workflow and the authoring of definitions and additional term descriptions. Finally, the paper details the evaluation methodology to assess the initial version of the controlled vocabulary. The results of the evaluation show that our development process yields terms most of which find approval from domain experts not involved in the development. In addition, our evaluation tools resulted in valuable domain expert input to optimize the controlled vocabulary.


Assuntos
Centros de Traumatologia , Vocabulário Controlado , Fluxo de Trabalho
5.
Stud Health Technol Inform ; 264: 1652-1653, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438276

RESUMO

Under-reporting of adverse drug events (ADEs) is a common issue across healthcare systems, and lack of integration with clinical workflow and systems are among the leading causes of this problem. We sought to describe the development of an ADEs reporting system within an EHR that represents user needs and captures relevant data. We compared periods before and after the implementation, and describe the corresponding reporting rates.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Sistemas de Notificação de Reações Adversas a Medicamentos , Humanos , Farmacovigilância , Fluxo de Trabalho
6.
Adv Exp Med Biol ; 1158: 83-100, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31452137

RESUMO

Mitochondria (mt) are double-membraned, dynamic organelles that play an essential role in a large number of cellular processes, and impairments in mt function have emerged as a causative factor for a growing number of human disorders. Given that most biological functions are driven by physical associations between proteins, the first step towards understanding mt dysfunction is to map its protein-protein interaction (PPI) network in a comprehensive and systematic fashion. While mass-spectrometry (MS) based approaches possess the high sensitivity ideal for such an endeavor, it also requires stringent biochemical purification of bait proteins to avoid detecting spurious, non-specific PPIs. Here, we outline a tagging-based affinity purification coupled with mass spectrometry (AP-MS) workflow for discovering new mt protein associations and providing novel insights into their role in mt biology and human physiology/pathology. Because AP-MS relies on the creation of proteins fused with affinity tags, we employ a versatile-affinity (VA) tag, consisting of 3× FLAG, 6 × His, and Strep III epitopes. For efficient delivery of affinity-tagged open reading frames (ORF) into mammalian cells, the VA-tag is cloned onto a specific ORF using Gateway recombinant cloning, and the resulting expression vector is stably introduced in target cells using lentiviral transduction. In this chapter, we show a functional workflow for mapping the mt interactome that includes tagging, stable transduction, selection and expansion of mammalian cell lines, mt extraction, identification of interacting protein partners by AP-MS, and lastly, computational assessment of protein complexes/PPI networks.


Assuntos
Cromatografia de Afinidade , Espectrometria de Massas , Proteínas Mitocondriais , Mapeamento de Interação de Proteínas/métodos , Fluxo de Trabalho , Animais , Humanos , Mitocôndrias/metabolismo , Proteínas Mitocondriais/isolamento & purificação
7.
Stud Health Technol Inform ; 266: 162-167, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31397318

RESUMO

Digital health is widely believed to have vast potential in improving patient care. MyHealthRecord (MyHR) is a digital health information system which enables Australian citizens to access their health information centrally, making it available anywhere, at anytime. The aim of this study is to explore the adoption of MyHR in general practices in Victoria and understand its impacts. A qualitative case study research method was used to underpin this investigation. Ten general practices were engaged where MyHR was implemented/used. Detailed interviews with MyHR implementers were held and GPs were engaged in short interviews. Twenty observations were made during GP/patient consultations for health summary uploads. Findings indicate that the practice incentive payment (PIP) funding policy change encouraged the use of MyHR, but the adoption was limited to satisfy funding criteria. Change management was often extemporised. Health summary upload was a quick and easy process but was influenced by clinical system data quality and GP familiarity with the system. Community awareness and GP interest in MyHR was lacking. The conclusion is that MyHR was not well integrated in general practices nor the community. As a result, an improved engagement approach between healthcare organisations, the MyHR system operator and Australians is required.


Assuntos
Medicina Geral , Fluxo de Trabalho , Austrália , Assistência à Saúde , Humanos
8.
Stud Health Technol Inform ; 264: 133-137, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437900

RESUMO

Laboratory data collected in the electronic health record as part of routine care can be used in secondary research. For example, the US Department of Veterans Affairs maintains a data warehouse covering over 20 million individuals and 6.6 billion lab tests. However, data aggregation in such a data warehouse can be difficult. In order to retrieve all or nearly all of one type of lab result with a high degree of precision, we perform clinical concept adjudication, which is the process of an expert determining which database records correspond to a target clinical concept. In this work, we develop an interactive machine learning tool to "extend the reach" of expert laboratory test adjudicators. Our tool provides access to automatic laboratory classification in a user-facing front end that covers all steps in an adjudication workflow, in order to lower barriers to collaboration, increase transparency of adjudication, and to promote efficiencies and data reuse.


Assuntos
Aprendizado de Máquina , Treinamento por Simulação , Bases de Dados Factuais , Registros Eletrônicos de Saúde , Humanos , Fluxo de Trabalho
9.
Stud Health Technol Inform ; 264: 950-953, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438064

RESUMO

With the novel approach of molecularly stratified therapies based on genetic characteristics of individual tumors, the need for databases providing information on molecular alterations and targeted treatment options is increasing rapidly. In Molecular Tumor Boards (MTB) professionals discuss molecular alterations and provide biological context for therapeutic options using external knowledge databases. The identification of informative databases and the information on their specific contents can greatly facilitate and standardize the functioning of a MTB. In this work we present a list of databases which have been deemed useful and relevant for MTB in a clinical setting. We describe workflows to recommend the use of specific databases at different steps in the clinical curation process. Information obtained from these databases is a necessary prerequisite to evaluate molecular alterations and devise rational targeted therapies in MTB.


Assuntos
Neoplasias , Medicina de Precisão , Humanos , Oncologia , Padrão de Cuidado , Fluxo de Trabalho
10.
Stud Health Technol Inform ; 264: 1070-1074, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438089

RESUMO

The increased use of eHealth services has shifted focus towards quality and interoperability. This study quantifies the technical quality of the ePrescription in Belgium by validating the construction of the Kind Messages for Electronic Health Records (KMEHR) used for communicating between prescriber and pharmacist, and by validating the digital signature within the ePrescription. A two-way cluster randomized subset of prescriptions of the tarification service Koninklijk Limburgs Apothekers Verbond (KLAV) is used (n = 82,952). Here, 38,032 prescriptions (45.85%) were handled electronically, but 180 prescriptions (0.22%) contained an empty KMEHR message at tarification. All 37,852 ePrescriptions (100%) passed the XSD Schema validation, but only 29,428 ePrescriptions (77.74%) passed the Software Development Kit (SDK) XPath validation rule set of the national Recip-e project. 37,622 ePrescriptions (99.39%) passed the validity test for having a correct digital signature. Improvement towards the construction and the digital signature is required in order to fully dematerialize the ePrescription workflow.


Assuntos
Prescrição Eletrônica , Bélgica , Estudos Transversais , Humanos , Farmacêuticos , Fluxo de Trabalho
11.
Stud Health Technol Inform ; 264: 1700-1701, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438300

RESUMO

We developed a prototype CDSS that 1) provides tailored recommendations by combining a fall-risk prediction model, patients data, and evidence from CPGs, and 2) helps nurses to plan nursing care and document their activities for fall prevention. The accuracy of rules in knowledge base and inference engine was verified using ten scenarios and heuristics of user interface evaluated by four experts. We are currently evaluating the effects of the system on nurses' workflow and patient outcomes.


Assuntos
Acidentes por Quedas , Sistemas de Apoio a Decisões Clínicas , Acidentes por Quedas/prevenção & controle , Humanos , Bases de Conhecimento , Fluxo de Trabalho
12.
Stud Health Technol Inform ; 264: 1702-1703, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438301

RESUMO

Medication processes are consisted with multiple steps by professionals and consumers. Physicians prescribe drugs to patient with conformance, but sometimes they were changed to other drugs. We designed concept models to capture medication workflow process records by openEHR archetype models, and four templates were determined with each step of the medication process. We will show the detail of clinical modeling about medication workflow in this article.


Assuntos
Registros Eletrônicos de Saúde , Fluxo de Trabalho , Assistência à Saúde , Tratamento Farmacológico , Humanos
13.
Stud Health Technol Inform ; 265: 48-53, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31431576

RESUMO

Community Health Workers (CHW) perform important healthcare and health promotion in many low and middle income countries. They are increasingly supported in their work by the use of mHealth. This study aims to explore how mHealth services can support the everyday work for CHWs when delivering home care in rural areas in South Africa. A single case study was performed, mapping CHWs workflow and investigating where and when CHW can be supported by mHealth services. Despite the very positive feedback from the CHWs and the fact that the studied mHealth solutions appears to support the majority of the important activities in the CHWs work process, the application is no longer in use. Financial and strategic decisions are behind the discontinuation of the project, further stressing the importance of taking all socio-technical dimensions into account when evaluating success or failure of implementation projects.


Assuntos
Telemedicina , Fluxo de Trabalho , Agentes Comunitários de Saúde , Assistência à Saúde , Humanos , África do Sul
14.
Stud Health Technol Inform ; 265: 54-59, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31431577

RESUMO

With an ageing population and limited resources in healthcare, many high-income countries such as Sweden see an increase in homecare and mobile work for healthcare professionals. In this case study, we explore how mHealth services can support the everyday work for healthcare professionals when delivering home care in rural areas in Sweden. The studied mHealth application had failed to be adopted among district nurses, despite a great expressed need for mobile tools. The results indicate that the mHealth solution did not live up the healthcare professionals' expectations in terms of providing the same functions as the regular electronic health record systems, and with poor integration into the existing eco-system of eHealth applications. In conclusion, in order for a mHealth application to be successfully implemented in a context where many digital services are already in use, it is not enough to support important activities in the current workflow. The mHealth application will need to be carefully integrated into the existing eco-system of healthcare applications to increase the chances of adoption.


Assuntos
Serviços de Assistência Domiciliar , Telemedicina , Assistência à Saúde , Humanos , Suécia , Fluxo de Trabalho
15.
Stud Health Technol Inform ; 265: 121-127, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31431587

RESUMO

Health care is in dramatic transformation due to the rapid development and massive implementation of (high- and low-tech) technologies. But not all transformations are as intended. Research in health transformation has disclosed new sources of risk and unpredictability, which require more research and organizational adjustment, i.e. learning. However, unintended consequences and effects occur at different levels of interaction and collaboration, requiring corresponding adjustment and learning strategies. - On the background of an ethnographic study of support-work in surgery in different Danish hospitals, this paper analyses cognitive-socio-technical health care practices as learning ecologies, giving special attention to the intentional and unintentional roles of technologies herein and their context dependency. The paper argues for an increased awareness of support at different contextual levels of use, presenting three examples from the study as learning cases. The three cases exemplify instances of disruption of the workflow and the collaboration among clinicians. They display how these instances are taken as challenges requiring learning at different levels in order to live up to the overall purpose, which is to reestablish safety - in the team and for the patient.


Assuntos
Assistência à Saúde , Fluxo de Trabalho , Antropologia Cultural , Humanos
16.
Stud Health Technol Inform ; 264: 1823-1824, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438362

RESUMO

Compared to other laboratory data, microbiology data are a complex mix of quantitative and qualitative results that return iteratively over time. Commercial electronic health records (EHR) frequently have limitations in the manner in which they manage microbiology data, not attempting to codify data but rather displaying it as text. This contributes to time-consuming and error-prone clinical workflows. We developed a microbiology viewer application to aggregate results and implemented it in our EHR.


Assuntos
Registros Eletrônicos de Saúde , Atitude do Pessoal de Saúde , Microbiologia , Fluxo de Trabalho
17.
Stud Health Technol Inform ; 264: 1835-1836, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438367

RESUMO

Patients with olfactory disorders are often encountered with a complex workflow and unsatisfied results. This article explores an informatics application to manage olfactory disorders with clinical decision support. Evidence from PubMed was used to analyze and extract the workflow, according to the "five rights" CDS framework. Five focus points and corresponding tips were identified. This work provides disease analysis and life guidance for prediction of the occurrence of more serious diseases.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Idoso , Humanos , Transtornos do Olfato , Fluxo de Trabalho
18.
Stud Health Technol Inform ; 264: 1735-1736, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438318

RESUMO

Accurate and rapid differential diagnosis are required for personalized cancer treatment. However, owing to the numerous molecular tests used for establishing a diagnosis, pathologists need time to investigate and confirm necessary test items. We present a guideline-based decision support system for effective workflow with regards to the molecular tests for pathological differential diagnosis.


Assuntos
Patologistas , Fluxo de Trabalho , Diagnóstico Diferencial , Sistemas Especialistas , Humanos , Software
19.
Stud Health Technol Inform ; 264: 1763-1764, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438332

RESUMO

Clinical decision support systems (CDSS) are widely used to improve patient care and guide workflow. End users can be valuable contributors to monitoring for CDSS malfunctions. However, they often have little means of providing direct feedback on the design and build of such systems. In this study, we describe an electronic survey tool deployed from within the electronic health record and coupled with a conversation with Clinical Informaticians as a method to manage CDSS design and lifecycle.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Registros Eletrônicos de Saúde , Inquéritos e Questionários , Fluxo de Trabalho
20.
J Stroke Cerebrovasc Dis ; 28(9): 2530-2536, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31307897

RESUMO

BACKGROUND: UCHealth's Mobile Stroke Unit (MSU) at University of Colorado Hospital is an ambulance equipped with a computed tomography (CT) scanner and tele-stroke capabilities that began clinical operation in Aurora, Colorado January 2016. As one of the first MSU's in the United States, it was necessary to design unique and dynamic information technology infrastructure. This includes high-speed cellular connectivity, Health Insurance Portability and Accountability Act compliance, cloud-based and remote access to electronic medical records (EMR), and reliable and rapid image transfer. Here we describe novel technologies incorporated into the MSU. Technological data-handling aspects of the MSU were reviewed. Functions evaluated include wireless connectivity while in transit, EMR access and manipulation in the field, CT with image transfer from the MSU to the hospital's Picture Archiving Communication System (PACS), and video and audio communication for neurological assessment. METHODS/RESULTS: The MSU wireless system was designed with redundancy to avoid dropped signals during data transfer. Two separate Internet Protocol destinations with split-tunnel architecture are assigned, for videoconferencing and for EMR data transfer. Brain images acquired in the ambulance CT scanner are transferred initially to an onboard laptop, then via Citrix Receiver to the hospital-based PACS server where they can be viewed in PACS or EMR by the stroke neurologist, neuroradiologist, and other providers. PACS and Radiology Information System are 2 of the XenApps utilized by CT technologists on board the MSU. DISCUSSION/CONCLUSIONS: These technologies will serve as a blueprint for development of similar units elsewhere, and as a framework for improvement in this technology.


Assuntos
Ambulâncias/organização & administração , Diagnóstico por Computador , Registros Eletrônicos de Saúde/organização & administração , Unidades Móveis de Saúde/organização & administração , Acidente Vascular Cerebral/diagnóstico por imagem , Integração de Sistemas , Telerradiologia/organização & administração , Tomografia Computadorizada por Raios X , Tecnologia sem Fio/organização & administração , Colorado , Prestação Integrada de Cuidados de Saúde/organização & administração , Diagnóstico por Computador/instrumentação , Humanos , Valor Preditivo dos Testes , Prognóstico , Avaliação de Programas e Projetos de Saúde , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Telerradiologia/instrumentação , Fatores de Tempo , Tempo para o Tratamento , Tomografia Computadorizada por Raios X/instrumentação , Tecnologia sem Fio/instrumentação , Fluxo de Trabalho
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