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1.
Artigo em Russo | MEDLINE | ID: mdl-32119221

RESUMO

Actually, the opportunity exists to obtain admittance to various data. The article presents the essence of approach to development of decentralized prototype of system managing medical records of patient using blockchain technology. The global analysis of cloud technologies using various experience of their implementation is given. The scientific novelty of study consists in step-by-step application of genuine prototype of patient medical data management system using blockchain technology. It is scientifically justified that applying cloud technologies in medicine permits to improve safety and integrity of medical data of patient and to support linking uncoordinated databases into one whole, making interaction of patients and physicians much more effective and comfortable.


Assuntos
Computação em Nuvem , Registros Eletrônicos de Saúde , Registros Eletrônicos de Saúde/estatística & dados numéricos , Humanos
2.
BMJ ; 368: l6987, 2020 01 22.
Artigo em Inglês | MEDLINE | ID: mdl-31969318

RESUMO

OBJECTIVE: To assess the magnitude and duration of any hypothesised protective effect of household exposure to a child with varicella on the relative incidence of herpes zoster in adults. DESIGN: Self controlled case series. SETTING: UK general practices contributing to Clinical Practice Research Datalink. PARTICIPANTS: 9604 adults (≥18 years) with a diagnosis of herpes zoster (in primary care or hospital records) between 1997 and 2018, who during their observation period lived with a child (<18 years) with a diagnosis of varicella. MAIN OUTCOME MEASURES: Relative incidence of herpes zoster in the 20 years after exposure to a child with varicella in the household compared with baseline time (all other time, excluding the 60 days before exposure). RESULTS: 6584 of the 9604 adults with herpes zoster (68.6%) were women. Median age of exposure to a child with varicella was 38.3 years (interquartile range 32.3-48.8 years) and median observation period was 14.7 (11.1-17.7) years. 4116 adults developed zoster in the baseline period, 433 in the 60 days before exposure and 5055 in the risk period. After adjustment for age, calendar time, and season, strong evidence suggested that in the two years after household exposure to a child with varicella, adults were 33% less likely to develop zoster (incidence ratio 0.67, 95% confidence interval 0.62 to 0.73) compared with baseline time. In the 10-20 years after exposure, adults were 27% less likely to develop herpes zoster (0.73, 0.62 to 0.87) compared with baseline time. A stronger boosting effect was observed among men than among women after exposure to varicella. CONCLUSIONS: The relative incidence of zoster was lower in the periods after exposure to a household contact with varicella, with modest but long lasting protective effects observed. This study suggests that exogenous boosting provides some protection from the risk of herpes zoster, but not complete immunity, as assumed by previous cost effectiveness estimates of varicella immunisation.


Assuntos
Varicela/imunologia , Herpes Zoster/epidemiologia , Herpesvirus Humano 3/imunologia , Adulto , Estudos de Casos e Controles , Varicela/virologia , Pré-Escolar , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Seguimentos , Herpes Zoster/imunologia , Herpes Zoster/virologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Medição de Risco , Reino Unido/epidemiologia
3.
J Surg Res ; 246: 464-475, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31635837

RESUMO

BACKGROUND: Screening patients for frailty is traditionally done at the bedside. However, recent electronic medical record (EMR)-based, comorbidity-focused frailty assessments have been developed. Our objective was to determine how a common bedside frailty assessment, the trauma and emergency surgery (TEGS) frailty index (FI), compares to an EMR-based frailty assessment in predicting geriatric TEGS outcomes. MATERIALS AND METHODS: We retrospectively reviewed our quality improvement project database consisting of TEGS patients ≥ 65 y old. Patients were screened with the TEGS FI, a 15-question bedside assessment, including comorbidities, physical activity, emotional health, and nutrition. Six of 15 items were retrievable from the enterprise data warehouse (EDW), storing all EMR data from Northwestern Memorial Hospital, and use to calculate the EDW frailty score. Patient characteristics and outcomes were compared between different groups. RESULTS: Two hundred thirty-six geriatric TEGS patients were included, of which 75 (31.8%) were TEGS FI frail and 60 (25.4%) were EDW frail. TEGS FI frail patients had increased length of stay (LOS), loss of independence (LOI), and complications compared to TEGS FI nonfrail patients. EDW frail patients had higher LOS and complications than EDW nonfrail patients but similar LOI. TEGS FI and EDW frail patients had similar outcomes except TEGS FI-only patients more often have LOI. CONCLUSIONS: Bedside frailty assessments and EMR-based assessments are both effective in identifying geriatric TEGS patients at risk for increased LOS and complications. However, bedside frailty screening was better at identifying patients who have LOI and may be a more appropriate choice when screening for frailty.


Assuntos
Tratamento de Emergência/efeitos adversos , Fragilidade/diagnóstico , Avaliação Geriátrica/métodos , Complicações Pós-Operatórias/epidemiologia , Ferimentos e Lesões/cirurgia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Registros Eletrônicos de Saúde/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Fragilidade/complicações , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco
4.
J Surg Res ; 246: 599-604, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31653413

RESUMO

As more and more health systems have converted to the use of electronic health records, the amount of searchable and analyzable data is exploding. This includes not just provider or laboratory created data but also data collected by instruments, personal devices, and patients themselves, among others. This has led to more attention being paid to the analysis of these data to answer previously unaddressed questions. This is especially important given the number of therapies previously found to be beneficial in clinical trials that are currently being re-scrutinized. Because there are orders of magnitude more information contained in these data sets, a fundamentally different approach needs to be taken to their processing and analysis and the generation of knowledge. Health care and medicine are drivers of this phenomenon and will ultimately be the main beneficiaries. Concurrently, many different types of questions can now be asked using these data sets. Research groups have become increasingly active in mining large data sets, including nationwide health care databases, to learn about associations of medication use and various unrelated diseases such as cancer. Given the recent increase in research activity in this area, its promise to radically change clinical research, and the relative lack of widespread knowledge about its potential and advances, we surveyed the available literature to understand the strengths and limitations of these new tools. We also outline new databases and techniques that are available to researchers worldwide, with special focus on work pertaining to the broad and rapid monitoring of drug safety and secondary effects.


Assuntos
Big Data , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Registros Eletrônicos de Saúde/estatística & dados numéricos , Neoplasias/induzido quimicamente , Mineração de Dados/estatística & dados numéricos , Bases de Dados Factuais/estatística & dados numéricos , Conjuntos de Dados como Assunto , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Humanos , Neoplasias/epidemiologia , Neoplasias/prevenção & controle , Medição de Risco/métodos
5.
Int J Med Inform ; 134: 104042, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31855847

RESUMO

PURPOSE: To investigate whether the installation of electronic patient journey boards in an inpatient adult rehabilitation centre in Victoria, Australia, is associated with shorter lengths of stay for admitted adult rehabilitation patients. METHODS: A retrospective before-after analysis of 3 259 adult inpatient rehabilitation episodes from 2013 to 2018 was performed, analysing case-mix adjusted lengths of stay. RESULTS: A reduction in case-mix adjusted length of stay of 4.1 days per episode (95 % confidence interval: 2.0-6.4 days) was found. The corresponding reduction in hospital costs was estimated to be $3 738 per episode (95 % confidence interval $2 398-$4 983). CONCLUSIONS: Installation of electronic patient journey boards was associated with shorter lengths of stay in an inpatient adult rehabilitation centre. Additional research is needed to 1) provide further evidence of the causal effect of the boards on length of stay, and 2) investigate the mechanisms by which they reduce lengths of stay (e.g., increased currency of information, changes to procedures, remote viewing) in rehabilitation settings.


Assuntos
Apresentação de Dados/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Implementação de Plano de Saúde , Hospitalização/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Centros de Reabilitação/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Sistemas de Informação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vitória
6.
Nat Protoc ; 14(12): 3426-3444, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31748751

RESUMO

Phenotypes are the foundation for clinical and genetic studies of disease risk and outcomes. The growth of biobanks linked to electronic medical record (EMR) data has both facilitated and increased the demand for efficient, accurate, and robust approaches for phenotyping millions of patients. Challenges to phenotyping with EMR data include variation in the accuracy of codes, as well as the high level of manual input required to identify features for the algorithm and to obtain gold standard labels. To address these challenges, we developed PheCAP, a high-throughput semi-supervised phenotyping pipeline. PheCAP begins with data from the EMR, including structured data and information extracted from the narrative notes using natural language processing (NLP). The standardized steps integrate automated procedures, which reduce the level of manual input, and machine learning approaches for algorithm training. PheCAP itself can be executed in 1-2 d if all data are available; however, the timing is largely dependent on the chart review stage, which typically requires at least 2 weeks. The final products of PheCAP include a phenotype algorithm, the probability of the phenotype for all patients, and a phenotype classification (yes or no).


Assuntos
Análise de Dados , Registros Eletrônicos de Saúde/estatística & dados numéricos , Ensaios de Triagem em Larga Escala/métodos , Algoritmos , Interpretação Estatística de Dados , Humanos , Aprendizado de Máquina , Processamento de Linguagem Natural , Fenótipo
7.
Int J Med Inform ; 132: 103926, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31605882

RESUMO

BACKGROUND: Diabetic Retinopathy (DR) is considered a pathology of retinal vascular complications, which stays in the top causes of vision impairment and blindness. Therefore, precisely inspecting its progression enables the ophthalmologists to set up appropriate next-visit schedule and cost-effective treatment plans. In the literature, existing work only makes use of numerical attributes in Electronic Medical Records (EMR) for acquiring such kind of DR-oriented knowledge through conventional machine learning techniques, which require an exhaustive job of engineering most impactful risk factors. OBJECTIVE: In this paper, an approach of deep bimodal learning is introduced to leverage the performance of DR risk progression identification. METHODS: In particular, we further involve valuable clinical information of fundus photography in addition to the aforementioned systemic attributes. Accordingly, a Trilogy of Skip-connection Deep Networks, namely Tri-SDN, is proposed to exhaustively exploit underlying relationships between the baseline and follow-up information of the fundus images and EMR-based attributes. Besides that, we adopt Skip-Connection Blocks as basis components of the Tri-SDN for making the end-to-end flow of signals more efficient during feedforward and backpropagation processes. RESULTS: Through a 10-fold cross validation strategy on a private dataset of 96 diabetic mellitus patients, the proposed method attains superior performance over the conventional EMR-modality learning approach in terms of Accuracy (90.6%), Sensitivity (96.5%), Precision (88.7%), Specificity (82.1%), and Area Under Receiver Operating Characteristics (88.8%). CONCLUSIONS: The experimental results show that the proposed Tri-SDN can combine features of different modalities (i.e., fundus images and EMR-based numerical risk factors) smoothly and effectively during training and testing processes, respectively. As a consequence, with impressive performance of DR risk progression recognition, the proposed approach is able to help the ophthalmologists properly decide follow-up schedule and subsequent treatment plans.


Assuntos
Algoritmos , Retinopatia Diabética/diagnóstico , Registros Eletrônicos de Saúde/estatística & dados numéricos , Fundo de Olho , Processamento de Imagem Assistida por Computador/métodos , Aprendizado de Máquina , Retinopatia Diabética/diagnóstico por imagem , Retinopatia Diabética/etiologia , Humanos , Fotografação , Curva ROC , Fatores de Risco
8.
Br J Anaesth ; 123(6): 877-886, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31627890

RESUMO

BACKGROUND: Rapid, preoperative identification of patients with the highest risk for medical complications is necessary to ensure that limited infrastructure and human resources are directed towards those most likely to benefit. Existing risk scores either lack specificity at the patient level or utilise the American Society of Anesthesiologists (ASA) physical status classification, which requires a clinician to review the chart. METHODS: We report on the use of machine learning algorithms, specifically random forests, to create a fully automated score that predicts postoperative in-hospital mortality based solely on structured data available at the time of surgery. Electronic health record data from 53 097 surgical patients (2.01% mortality rate) who underwent general anaesthesia between April 1, 2013 and December 10, 2018 in a large US academic medical centre were used to extract 58 preoperative features. RESULTS: Using a random forest classifier we found that automatically obtained preoperative features (area under the curve [AUC] of 0.932, 95% confidence interval [CI] 0.910-0.951) outperforms Preoperative Score to Predict Postoperative Mortality (POSPOM) scores (AUC of 0.660, 95% CI 0.598-0.722), Charlson comorbidity scores (AUC of 0.742, 95% CI 0.658-0.812), and ASA physical status (AUC of 0.866, 95% CI 0.829-0.897). Including the ASA physical status with the preoperative features achieves an AUC of 0.936 (95% CI 0.917-0.955). CONCLUSIONS: This automated score outperforms the ASA physical status score, the Charlson comorbidity score, and the POSPOM score for predicting in-hospital mortality. Additionally, we integrate this score with a previously published postoperative score to demonstrate the extent to which patient risk changes during the perioperative period.


Assuntos
Registros Eletrônicos de Saúde/estatística & dados numéricos , Nível de Saúde , Mortalidade Hospitalar , Aprendizado de Máquina , Complicações Pós-Operatórias/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , California , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Medição de Risco , Fatores de Risco , Adulto Jovem
9.
Int J Med Inform ; 132: 103986, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31629312

RESUMO

BACKGROUND AND PURPOSE: Pneumonia is a common complication after stroke, causing an increased length of hospital stay and death. Therefore, the timely and accurate prediction of post-stroke pneumonia would be highly valuable in clinical practice. Previous pneumonia risk score models were often built on simple statistical methods such as logistic regression. This study aims to investigate post-stroke pneumonia prediction models using more advanced machine learning algorithms, specifically deep learning approaches. METHODS: Using a hospital's electronic health record(EHR) data from 2007-2017, 13,930 eligible patients with acute ischaemic stroke (AIS) were identified to build and evaluate the models (85% of the patients were used for training, and 15% were used for testing). In total, 1012 patients (7.23%) contracted pneumonia during hospitalization. A number of machine learning methods were developed and compared to predict pneumonia in the stroke population in China. In addition to the classic methods (i.e., logistic regression (LR), support vector machines (SVMs), extreme gradient boosting (XGBoost)), methods based on multiple layer perceptron (MLP) neural networks and recurrent neural network (RNNs) (i.e., attention-augmented gated recurrent unit (GRU)) are also implemented to make use of the temporal sequence information in electronic health record (EHR) systems. Prediction models for pneumonia were built for two time windows, i.e., within 7 days and within 14 days after stroke onset. In particular, pneumonia occurring within the 7-day window is considered highly associated with stroke (stroke-associated pneumonia, SAP). MAIN FINDINGS: The attention-augmented GRU model achieved the best performance based on an area under the receiver operating characteristic curve (AUC) of 0.928 for pneumonia prediction within 7 days and an AUC of 0.905 for pneumonia prediction within 14 days. This method outperformed the other machine learning-based methods and previously published pneumonia risk score models. Considering that pneumonia prediction after stroke requires a high sensitivity to facilitate its prevention at a relatively low cost (i.e., increasing the nursing level), we also compared the prediction performance using other evaluation criteria by setting the sensitivity to 0.90. The attention-augmented GRU achieved the optimal performance, with a specificity of 0.85, a positive predictive value (PPV) of 0.32 and a negative predictive value (NPV) of 0.99 for pneumonia within 7 days and a specificity of 0.82, a PPV of 0.29 and an NPV of 0.99 for pneumonia within 14 days. CONCLUSIONS: The deep learning-based predictive model is feasible for stroke patient management and achieves the optimal performance compared to many classic machine learning methods.


Assuntos
Algoritmos , Isquemia Encefálica/complicações , Registros Eletrônicos de Saúde/estatística & dados numéricos , Aprendizado de Máquina , Pneumonia/diagnóstico , Acidente Vascular Cerebral/complicações , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/epidemiologia , Pneumonia/etiologia , Valor Preditivo dos Testes , Curva ROC
10.
World J Gastroenterol ; 25(37): 5619-5629, 2019 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-31602162

RESUMO

BACKGROUND: Korean National Health Insurance (NHI) claims database provides large-cohort. However, studies regarding accuracy of administrative database for pancreatic cancer (PC) have not been reported. We aimed to identify accuracy of NHI database regarding PC classified by international classification of disease (ICD)-10 codes. AIM: To identify the accuracy and usefulness of administrative database in PC and the accurate ICD codes for PC with location. METHODS: Study and control groups were collected from 2003 to 2016 at Seoul National University Bundang Hospital. Cases of PC were identified in NHI database by international classification of diseases, 10th revision edition (ICD-10 codes) supported with V codes. V code is issued by medical doctors for covering 95% of medical cost by Korean government. According to pathologic reports, definite or possible diagnoses were defined using medical records, images, and pathology. RESULTS: A total of 1846 cases with PC and controls were collected. Among PC, only 410 (22.2%) cases were identified as specific cancer sites including head in 234 (12.7%) cases, tail in 104 (5.6%) cases and body in 72 (3.9%) cases. Among PC, 910 (49.3%) cases were diagnosed by definite criteria. Most of these were adenocarcinoma (98.0%). The rates of definite diagnosis of PC were highest in head (70.1%) followed by body (47.2%) and tail (43.3%). False-positive cases were pancreatic cystic neoplasm and metastasis to the pancreas. In terms of the overall diagnosis of PC, sensitivity, specificity, positive predictive value, and negative predictive value were 99.95%, 98.72%, 98.70%, and 99.95%, respectively. Diagnostic accuracy was similar both in terms of diagnostic criteria and tumor locations. CONCLUSION: Korean NHI claims database collected according to ICD-10 code with V code for PC showed good accuracy.


Assuntos
Coleta de Dados/métodos , Bases de Dados Factuais/estatística & dados numéricos , Neoplasias Pancreáticas/diagnóstico , Idoso , Coleta de Dados/estatística & dados numéricos , Sistemas de Gerenciamento de Base de Dados/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Pâncreas/patologia , Neoplasias Pancreáticas/epidemiologia , Neoplasias Pancreáticas/patologia , República da Coreia/epidemiologia , Estudos Retrospectivos , Sensibilidade e Especificidade
11.
Health Serv Res ; 54(6): 1335-1345, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31602639

RESUMO

OBJECTIVE: To assess whether an electronic health record (EHR) portal to enable health information exchange (HIE) between a hospital and three skilled nursing facilities (SNFs) reduced likelihood of patient readmission. SETTING/DATA: Secondary data; all discharges from a large academic medical center to SNFs between July 2013 and March 2017, combined with portal usage records from SNFs with HIE access. DESIGN: We use difference-in-differences to determine whether portal implementation reduced likelihood of readmission over time for patients discharged to HIE-enabled SNFs, relative to those discharged to nonenabled facilities. Additional descriptive analyses of audit log data characterize portal use within enabled facilities. DATA COLLECTION: Encounter-level clinical EHR data were merged with EHR audit log data that captured portal usage in the timeframe associated with a patient transition from hospital to SNF. PRINCIPAL FINDINGS: Declines in likelihood of 30-day readmission were not significantly different for patients in HIE-enabled vs control SNFs (diff-in-diff = 0.022; P = .431). We observe similar null effects with shorter readmission windows. The portal was used for 46 percent of discharges, with significant usage pattern variation within/across facilities. CONCLUSIONS: Implementation of a hospital-SNF EHR portal did not reduce readmissions from enabled SNFs. Emergent HIE use cases need to be better defined and leveraged for design and implementation that generates value in the context of postacute transitions.


Assuntos
Continuidade da Assistência ao Paciente/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Troca de Informação em Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
12.
Int J Med Inform ; 132: 103942, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31627031

RESUMO

BACKGROUND: Health Information Systems (HIS), and especially Electronic Health Records (EHR), offer great promise. However, the true benefits of HIS and EHR are more elusive as research shows they have obtained mixed results across countries. To increase the success of these systems while creating value for healthcare professionals, research emphasizes the importance of involving clinical users in the design of HIS. OBJECTIVE: Following calls for interdisciplinary research and increased end-user participation in HIS development, this paper shows how a service design approach can support the successful development and implementation of national EHRs. Service design brings a human-centered, participatory, holistic, creative and visual approach to HIS development, through an iterative process of exploration, ideation, reflection and implementation, fostering stakeholder participation and co-creation of the solution. METHOD: This paper presents an in-depth case study of the Portuguese National EHR development and implementation following a service design approach. The study involved individual and group interviews, as well as participatory design workshops with more than 170 participants along the different stages of exploration, ideation, reflection and implementation. RESULTS: The service design approach, including the visual models and tools used across the different design stages, was instrumental to envision new EHR concepts and design the system to enhance healthcare users experience. A qualitative study performed after implementation showed that the EHR was considered useful and easy to use, and these results are backed by widespread usage of the system. DISCUSSION AND CONCLUSION: This paper shows how a service design approach can address key challenges in EHR development. By adopting a holistic perspective, service design broadens the scope of EHR development to understand its broader service system and position it to enable value creation with users. The human-centered, participatory, creative, visual and holistic approach supports the understanding of user needs and context, and their active involvement in the design and co-creation effort. This service design approach fosters user adoption at the implementation stage. Service design can thus contribute to the successful development and implementation of EHRs.


Assuntos
Assistência à Saúde/normas , Registros Eletrônicos de Saúde/organização & administração , Sistemas de Informação em Saúde/organização & administração , Pessoal de Saúde/normas , Serviços de Saúde/normas , Administração dos Cuidados ao Paciente/organização & administração , Qualidade da Assistência à Saúde/normas , Atitude do Pessoal de Saúde , Registros Eletrônicos de Saúde/normas , Registros Eletrônicos de Saúde/estatística & dados numéricos , Sistemas de Informação em Saúde/normas , Sistemas de Informação em Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde , Humanos , Portugal , Pesquisa Qualitativa , Qualidade da Assistência à Saúde/organização & administração
13.
J Pediatr Orthop ; 39(9): e722-e728, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503236

RESUMO

INTRODUCTION: Electronic medical record (EMR) use among pediatric orthopaedic surgeons has evolved substantially within the past decade. In response to the Patient Protection and Affordable Care Act, large hospitals and tertiary pediatric medical centers rapidly acquired and implemented EMRs with uncertainty as to the potential impact on patient care and operational efficiency of subspecialists. This study reviews the background and regulatory framework for Meaningful Use of EMR and assesses the current landscape of EMR utilization by pediatric orthopaedic surgeons. METHODS: In 2015, the Practice Management Committee distributed a survey regarding EMR use and satisfaction to members of the Pediatric Orthopaedic Society of North America. Survey responses from 324 members were used to analyze levels of satisfaction by EMR platform and practice type and to consider drivers of satisfaction or dissatisfaction of end users. RESULTS: Although there were no differences in overall satisfaction based on vendor or practice type, significant differences were noted for 5 specific parameters of satisfaction, including: usefulness of templates, efficiency of practice workflow, information services support, number of logon events, and speed of the system. A user/vendor map is provided to facilitate networking among providers and groups utilizing common EMR platforms to help bring about rational improvements in EMR functionality for the future. CONCLUSIONS: Substantial effort needs to be made to improve subspecialty-specific EMR documentation, order entry, research tools, and clinical workflows to enhance the processes of care for children with orthopaedic conditions in the era of EMR. LEVEL OF EVIDENCE: Level IV.


Assuntos
Atitude do Pessoal de Saúde , Comportamento do Consumidor , Registros Eletrônicos de Saúde/estatística & dados numéricos , Ortopedia/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Registros Eletrônicos de Saúde/legislação & jurisprudência , Registros Eletrônicos de Saúde/normas , Humanos , Uso Significativo/legislação & jurisprudência , Patient Protection and Affordable Care Act , Software/normas , Inquéritos e Questionários , Estados Unidos , Fluxo de Trabalho
14.
Health Serv Res ; 54(5): 971-980, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31506956

RESUMO

OBJECTIVE: To estimate the relationship between breach remediation efforts and hospital care quality. DATA SOURCES: Department of Health and Human Services' (HHS) public database on hospital data breaches and Medicare Compare's public data on hospital quality measures for 2012-2016. MATERIALS AND METHODS: Data breach data were merged with the Medicare Compare data for years 2012-2016, yielding a panel of 3025 hospitals with 14 297 unique hospital-year observations. STUDY DESIGN: The relationship between breach remediation and hospital quality was estimated using a difference-in-differences regression. Hospital quality was measured by 30-day acute myocardial infarction mortality rate and time from door to electrocardiogram. PRINCIPAL FINDINGS: Hospital time-to-electrocardiogram increased as much as 2.7 minutes and 30-day acute myocardial infarction mortality increased as much as 0.36 percentage points during the 3-year window following a breach. CONCLUSION: Breach remediation efforts were associated with deterioration in timeliness of care and patient outcomes. Thus, breached hospitals and HHS oversight should carefully evaluate remedial security initiatives to achieve better data security without negatively affecting patient outcomes.


Assuntos
Segurança Computacional/estatística & dados numéricos , Segurança Computacional/normas , Confidencialidade/normas , Registros Eletrônicos de Saúde/normas , Hospitais/normas , Medicare/normas , Qualidade da Assistência à Saúde/normas , Registros Eletrônicos de Saúde/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Medicare/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estados Unidos
15.
Int J Med Inform ; 131: 103952, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31557699

RESUMO

BACKGROUND: While aiming for the same goal of building a national eHealth Infrastructure, Germany and the United States pursued different strategic approaches - particularly regarding the role of promoting the adoption and usage of hospital Electronic Health Records (EHR). OBJECTIVE: To measure and model the diffusion dynamics of EHRs in German hospital care and to contrast the results with the developments in the US. MATERIALS AND METHODS: All acute care hospitals that were members of the German statutory health system were surveyed during the period 2007-2017 for EHR adoption. Bass models were computed based on the German data and the corresponding data of the American Hospital Association (AHA) from non-federal hospitals in order to model and explain the diffusion of innovation. RESULTS: While the diffusion dynamics observed in the US resembled the typical s-shaped curve with high imitation effects (q = 0.583) but with a relatively low innovation effect (p = 0.025), EHR diffusion in Germany stagnated with adoption rates of approx. 50% (imitation effect q = -0.544) despite a higher innovation effect (p = 0.303). DISCUSSION: These findings correlate with different governmental strategies in the US and Germany of financially supporting EHR adoption. Imitation only seems to work if there are financial incentives, e.g. those of the HITECH Act in the US. They are lacking in Germany, where the government left health IT adoption strategies solely to the free market and the consensus among all of the stakeholders. CONCLUSION: Bass diffusion models proved to be useful for distinguishing the diffusion dynamics in German and US non-federal hospitals. When applying the Bass model, the imitation parameter needs a broader interpretation beyond the network effects, including driving forces such as incentives and regulations, as was demonstrated by this study.


Assuntos
Difusão de Inovações , Registros Eletrônicos de Saúde/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Uso Significativo , Registros Eletrônicos de Saúde/legislação & jurisprudência , Alemanha , Humanos , Estudos Longitudinais , Estados Unidos
16.
Int J Med Inform ; 130: 103943, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31476655

RESUMO

INTRODUCTION: Previous biomedical studies identified many lifestyle exposures that could possibly represent risk factors for dementia in general or dementia due to Alzheimer's disease (AD). These lifestyle exposures are mainly mentioned in free-text electronic health records (EHRs). However, automatic extraction and assessment of these exposures using EHRs remains understudied. METHODS: A natural language processing (NLP) approach was adopted to extract lifestyle exposures and intervention strategies from the clinical notes of 260 patients with clinical diagnoses of AD dementia and 260 age-matched cognitively unimpaired persons. Statistics of lifestyle exposures were compared between these two groups. The mapping results of the NLP extraction were evaluated by comparing the results with data captured independently by clinicians. RESULTS: Thirty out of fifty-five potentially relevant lifestyle exposures were mentioned in our clinical note dataset. Twenty-two dietary factors and three substance abuses that were potentially relevant were not found in clinical notes. Patients with AD dementia were significantly exposed to more of the potential risk factors compared to the cognitively unimpaired subjects (χ2 = 120.31, p-value < 0.001). The average accuracy of the automated extraction was 74.0% in comparison with the manual review of randomly selected 50 sample documents. DISCUSSION AND CONCLUSION: We illustrated the feasibility of NLP techniques for the automated evaluation of a large number lifestyle habits using free-text EHR data. We found that AD dementia patients were exposed to more of the potential risk factors than the comparison group. Our results also demonstrated the feasibility and accuracy of investigating putative risk factors using NLP techniques.


Assuntos
Doença de Alzheimer/etiologia , Registros Eletrônicos de Saúde/estatística & dados numéricos , Estilo de Vida , Processamento de Linguagem Natural , Humanos , Projetos de Pesquisa , Fatores de Risco
17.
Rhinology ; 57(6): 420-429, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31490466

RESUMO

BACKGROUND: The aim of this study was to analyse rates of antibiotic usage in chronic rhinosinusitis (CRS) in primary care in England and Wales and to identify trends in the choice of antibiotics prescribed. METHODS: We used linked data from primary care EHRs, with diagnoses coded using the Read terminology (Clinical Practice Research Datalink) from consenting general practices, with (2) hospital care administrative records (Hospital Episode Statistics, HES recorded using ICD-10). RESULTS: From the total of 88,317 cases of CRS identified, 40,462 (46%) had an antibiotic prescription within 5 days of their first CRS diagnosis. Of patients receiving a first line antibiotic within 5 days of CRS diagnosis, over 80%, in each CRS group, received a subsequent prescription for an antibiotic. Within 5 years of diagnosis, 9% are estimated to have had 5 or more antibiotics within 5 days of a CRS-related consultation. With data spanning almost 20 years, it was possible to discern trends in antibiotics prescriptions, with a clear increasing trend towards macrolide and tetracycline prescribing evident. CONCLUSIONS: While antibiotics may have been prescribed for acute exacerbations, we have found high rates of repeated antibiotic prescription in some patients with CRS in primary care. There is a need for stronger evidence on the role of antibiotics in CRS management.


Assuntos
Antibacterianos/uso terapêutico , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Doença Crônica , Registros Eletrônicos de Saúde/estatística & dados numéricos , Inglaterra/epidemiologia , Humanos , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Rinite/epidemiologia , Sinusite/epidemiologia , País de Gales/epidemiologia
18.
BMC Res Notes ; 12(1): 558, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31484585

RESUMO

OBJECTIVES: Medical records are critical to patient care, but often contain incomplete information. In UK hospitals, record-keeping is traditionally undertaken by junior doctors, who are increasingly completing early-career placements in psychiatry, but negative attitudes towards psychiatry may affect their performance. Little is known about the accuracy of medical records in psychiatry in general. This study aimed to evaluate the accuracy of Electronic Medical Records (EMRs) pertinent to clinical decision-making ("rationale") for prescribing completed by junior doctors during a psychiatry placement, focusing on the differences between psychotropic vs. non-psychotropic drugs and the temporal association during their placement. RESULTS: EMRs of 276 participants yielding 780 ward round entries were analysed, 100% of which were completed by Foundation Year or General Practice specialty training junior doctors rather than more senior clinicians. Compared with non-psychotropic drugs, documentation of prescribing rationale for psychotropic drugs was less likely (OR = 0.24, 95% CI 0.16-0.36, p < 0.001). The rate of rationale documentation significantly declined over time especially for psychotropic drugs (p < 0.001). Prescribing documentation of non-psychotropic drugs for people with mental illness is paradoxically more accurate than that of psychotropic drugs. Early-career junior doctors are therefore increasingly shaping EMRs of people receiving psychiatric care.


Assuntos
Atitude do Pessoal de Saúde , Competência Clínica , Educação de Pós-Graduação em Medicina/métodos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Psiquiatria/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Educação de Pós-Graduação em Medicina/normas , Registros Eletrônicos de Saúde/normas , Feminino , Grupos Focais/métodos , Grupos Focais/estatística & dados numéricos , Humanos , Internato e Residência/normas , Internato e Residência/estatística & dados numéricos , Masculino , Corpo Clínico Hospitalar/psicologia , Corpo Clínico Hospitalar/normas , Corpo Clínico Hospitalar/estatística & dados numéricos , Pessoa de Meia-Idade , Psiquiatria/estatística & dados numéricos , Reprodutibilidade dos Testes , Estresse Psicológico/psicologia , Reino Unido , Adulto Jovem
19.
BMC Health Serv Res ; 19(1): 558, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399096

RESUMO

BACKGROUND: Some of the advantages of implementing electronic emergency department information systems (EDIS) are improvements in data availability and simplification of statistical evaluations of emergency department (ED) treatments. However, for multi-center evaluations, standardized documentation is necessary. The AKTIN project ("National Emergency Department Register: Improvement of Health Services Research in Acute Medicine in Germany") has used the "German Emergency Department Medical Record" (GEDMR) published by the German Interdisciplinary Association of Intensive and Emergency Care as the documentation standard for its national data registry. METHODS: Until March 2016 the documentation standard in ED was the pen-and-paper version of the GEDMR. In April 2016 we implemented the GEDMR in a timeline-based EDIS. Related to this, we compared the availability of structured treatment information of traumatological patients between pen-and-paper-based and electronic documentation, with special focus on the treatment time. RESULTS: All 796 data fields of the 6 modules (basic data, severe trauma, patient surveillance, anesthesia, council, neurology) were adapted for use with the existing EDIS configuration by a physician working regularly in the ED. Electronic implementation increased availability of structured anamnesis and treatment information. However, treatment time was increased in electronic documentation both immediately (2:12 ± 0:04 h; n = 2907) and 6 months after implementation (2:18 ± 0:03 h; n = 4778) compared to the pen-and-paper group (1:43 ± 0:02 h; n = 2523; p < 0.001). CONCLUSIONS: We successfully implemented standardized documentation in an EDIS. The availability of structured treatment information was improved, but treatment time was also increased. Thus, further work is necessary to improve input time.


Assuntos
Documentação/estatística & dados numéricos , Registros Eletrônicos de Saúde/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Sistema de Registros/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Alemanha , Humanos , Masculino , Estudos Retrospectivos
20.
Can Assoc Radiol J ; 70(3): 212-218, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31376884

RESUMO

PURPOSE: Secondary usage of patient data has recently become of increasing interest for the development and application of computer analytic techniques. Strict oversight of these data is required and the individual patients themselves are integral to providing guidance. We sought to understand patients' attitudes to sharing their imaging data for research purposes. These images could provide a great wealth of information for researchers. METHODS: Patients from the Greater Toronto Area attending Sunnybrook Health Sciences Centre for imaging (magnetic resonance imagining, computed tomography, or ultrasound) examination areas were invited to participate in an electronic survey. RESULTS: Of the 1083 patients who were approached (computed tomography 609, ultrasound 314, and magnetic resonance imaging 160), 798 (74%) agreed to take the survey. Overall median age was 60 (interquartile range = 18, Q1 = 52, Q3 = 70), 52% were women, 42% had a university degree, and 7% had no high school diploma. In terms of willingness to share de-identified medical images for research, 76% were willing (agreed and strongly agreed), while 7% refused. Most participants gave their family physicians (73%) and other physicians (57%) unconditional data access. Participants chose hospitals/research institutions to regulate electronic images databases (70%), 89% wanted safeguards against unauthorized access to their data, and over 70% wanted control over who will be permitted, for how long, and the ability to revoke that permission. CONCLUSIONS: Our study found that people are willing to share their clinically acquired de-identified medical images for research studies provided that they have control over permissions and duration of access.


Assuntos
Confidencialidade/psicologia , Diagnóstico por Imagem/psicologia , Registros Eletrônicos de Saúde/estatística & dados numéricos , Troca de Informação em Saúde/estatística & dados numéricos , Opinião Pública , Sujeitos da Pesquisa/psicologia , Adolescente , Adulto , Fatores Etários , Idoso , Canadá , Segurança Computacional , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Fatores de Tempo , Adulto Jovem
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