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1.
S Afr Med J ; 110(8): 807-811, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32880311

RESUMO

BACKGROUND: The National Institute for Health and Clinical Excellence (NICE) guidelines state that patients with dyspepsia as well as alarm symptoms, or those that are 55 years and older with new onset dyspepsia, urgently require an upper endoscopy within two weeks. The 'Be Clear on Cancer Campaign' launched by Public Health England estimated that 9% of deaths due to gastric and oesophageal cancers could have been avoided if the diagnosis was made at an earlier stage. Worcester Provincial Hospital (WPH) is a regional hospital in the Western Cape, South Africa, that due to resource constraints was unable to comply with these guidelines. An electronic endoscopy booking system was implemented in June 2014 to assist referring clinicians. OBJECTIVES: To evaluate the ability of the booking system to appropriately prioritise and accommodate clinically appropriate patients for an urgent gastroscopy within 2 weeks at WPH. METHODS: Retrospective analysis of patients booked for urgent gastroscopies using the online booking system at WPH from July 2014 to June 2017. RESULTS: A total of 1 589 gastroscopies were performed, with 1 085 (65%) categorised as urgent by the booking system algorithm, during the study period. The median (interquartile range) waiting time for urgent gastroscopies was 19 (8 - 31) days and 437 (40%) patients underwent a gastroscopy within the recommended 2-week period. Of the patients undergoing gastroscopy within 2 weeks, 87 (20%) were diagnosed with upper gastrointestinal malignancies and 73 (17%) had significant benign pathology (stricture or ulcer). A total of 150 malignancies were diagnosed in the urgent patients of whom 87 (58%) were scoped within 2 weeks. CONCLUSIONS: The volume of patients requiring urgent gastroscopy at WPH outstrips the available resources. The introduction of the online algorithm-based booking system was effective in prioritising patients. The use of this system facilitated a malignancy diagnosis rate which compares favourably with similar fast track endoscopy services in more developed countries.


Assuntos
Agendamento de Consultas , Endoscopia Gastrointestinal , Sistemas Computadorizados de Registros Médicos , Encaminhamento e Consulta/organização & administração , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Criança , Dispepsia/complicações , Endoscopia Gastrointestinal/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Programas Médicos Regionais , Estudos Retrospectivos , África do Sul , Listas de Espera , Adulto Jovem
2.
Stud Health Technol Inform ; 272: 221-224, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32604641

RESUMO

Healthcare 4.0 demands healthcare data to be shaped into a common standardized and interoperable format for achieving more efficient data exchange. What is also needed is for this healthcare data to be both easily stored and securely accessed from anywhere, and vice versa. Currently, this is achieved through the secure storage of the healthcare data in different cloud repositories and infrastructures, which however increase the difficulty of accessing it in emergency situations from healthcare practitioners, or even from the citizens' themselves. The latter need to have specific credentials for accessing healthcare data in private cloud repositories, which can be almost impossible in urgent situations where this data must be accessed no matter what. For that reason, in this paper we are proposing a new health record indexing methodology that facilitates the access of non-privileged users (e.g. healthcare practitioners), to the healthcare data stored in cloud repositories of citizens-in-need, under the circumstances of emergency cases.


Assuntos
Assistência à Saúde , Computação em Nuvem , Segurança Computacional , Registros Eletrônicos de Saúde , Sistemas Computadorizados de Registros Médicos
3.
Stud Health Technol Inform ; 271: 23-30, 2020 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-32578537

RESUMO

BACKGROUND: Privacy-preserving record linkage (PPRL) is the process of detecting dataset entries that refer to the same individual within two independent datasets, without disclosing any personal information. While applied in different fields, it particularly attained importance in the medical sector. One popular PPRL method are Bloom filters. However, Bloom filters were originally used for encoding strings only. OBJECTIVES: This paper evaluates an encoding method specifically designed for numerical data and adjusts it for encoding geocoordinates in Bloom filters. METHODS: The proposed numerical encoding of geocoordinates is compared to the string-based method by using synthetic data. RESULTS: The proposed method for encoding geocoordinates in Bloom filters attains a higher recall and precision than the conventional string encoding. CONCLUSION: Numerical encoding has the potential of increasing the record linkage quality of Bloom filters, as well as their privacy level.


Assuntos
Privacidade , Segurança Computacional , Confidencialidade , Registro Médico Coordenado , Sistemas Computadorizados de Registros Médicos , Nomes , Registros
4.
Stud Health Technol Inform ; 270: 213-217, 2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-32570377

RESUMO

The aim of our validation study was to assess the quality of hospital data for perinatal algorithms on a national level. In each hospital, we selected 150 discharge abstracts of delivery (after 22 weeks of gestation), in 2014, and their corresponding medical records. Overall, 23 hospitals were included and 3,246 discharge abstracts were studied. This first national validation study of several case-funding algorithms using various perinatal variables suggests that the French national hospital discharge abstracts database is an appropriate data source for epidemiological studies.


Assuntos
Confiabilidade dos Dados , Bases de Dados Factuais , Hospitais/estatística & dados numéricos , Sistemas Computadorizados de Registros Médicos/normas , Parto , Alta do Paciente/estatística & dados numéricos , Assistência Perinatal/estatística & dados numéricos , Algoritmos , Feminino , França , Humanos , Recém-Nascido , Gravidez
5.
Stud Health Technol Inform ; 270: 228-232, 2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-32570380

RESUMO

INTRODUCTION: Computable phenotypes are gaining importance as structured and reproducible method of using electronic health data to identify people with certain clinical conditions. A formal standard is not available for defining and formally representing phenotyping algorithms. In this paper, we have tried to build a formal representation of such phenotyping algorithm. METHODS: We built EN 13606 EHR standard for building clinical archetypes to represent the computable phenotyping algorithm for 'diagnosis of cardiac failure'. As part of this work, we created a set of new clinical archetypes for defining 'cardiac failure diagnosis'. The EN13606 editor called Object Dictionary Client was used which was in-house developed by University College London. We evaluated the ability of EN 13606 to provide clinical archetypes to define EHR phenotyping algorithms using the predefined desiderata for the purpose [Mo et al]. RESULTS: EN 13606 archetypes could represent phenotype components grouped and nested based on their logical meaning. It was possible to build the EHR phenotyping algorithm with the clinical elements and their interrelationships along with hierarchical structure and temporal criteria. But the specific mathematical calculation and temporal relations involved in the algorithm was difficult to incorporate. These will need to be coded and integrated within the clinical information system. These archetypes can be mapped for comparison with the openEHR models. Binding to external clinical terminology is fully supported. However, it does not satisfy all the desiderata defined by Mo et al. A possible way could be an approach using phenotype ontologies and its architectural representation integrated with ISO interoperability. CONCLUSION: The EN13606 archetypes can be used to define the phenotype algorithm that basically identifies patients by a set of clinical characteristics in their records. Phenotype representations defined in EN 13606 do not satisfy all the desiderata proposed by Mo et al. and thus currently has a limited ability to define the computable phenotyping algorithms. Further work is required to make the EN13606 standard to fully support the objective.


Assuntos
Registros Eletrônicos de Saúde , Registro Médico Coordenado/métodos , Sistemas Computadorizados de Registros Médicos/organização & administração , Fenótipo , Medicina de Precisão , Algoritmos , Sistemas de Gerenciamento de Base de Dados , Estudos de Viabilidade , Humanos , Armazenamento e Recuperação da Informação , Londres , Sistemas Computadorizados de Registros Médicos/normas , Modelos Teóricos
6.
Stud Health Technol Inform ; 270: 262-266, 2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-32570387

RESUMO

The IT- and data protection concept of the FAmiliäres Risiko für das KOloRektale Karzinom (FARKOR) project will be presented. FARKOR is a risk adapted screening-project in Bavaria, Germany focusing on young adults with familial colorectal cancer (CRC). For each participant, data from different sources have to be integrated: Treatment records centrally administered by the resident doctors association (KVB), data from health insurance companies (HIC), and patient reported lifestyle data. Patient privacy rights must be observed. Record Linkage is performed by a central independent trust center. Data are decrypted, integrated and analyzed in a secure part of the scientific evaluation center with no connection to the internet (SECSP). The presented concept guarantees participants privacy through different identifiers, separation of responsibilities, data pseudonymization, public-private key encryption of medical data and encrypted data transfer.


Assuntos
Segurança Computacional , Confidencialidade , Registro Médico Coordenado , Sistemas Computadorizados de Registros Médicos , Privacidade , Alemanha , Humanos , Seguro Saúde , Registro Médico Coordenado/métodos , Direitos do Paciente
7.
JMIR Public Health Surveill ; 6(3): e19773, 2020 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-32484782

RESUMO

BACKGROUND: Routinely recorded primary care data have been used for many years by sentinel networks for surveillance. More recently, real world data have been used for a wider range of research projects to support rapid, inexpensive clinical trials. Because the partial national lockdown in the United Kingdom due to the coronavirus disease (COVID-19) pandemic has resulted in decreasing community disease incidence, much larger numbers of general practices are needed to deliver effective COVID-19 surveillance and contribute to in-pandemic clinical trials. OBJECTIVE: The aim of this protocol is to describe the rapid design and development of the Oxford Royal College of General Practitioners Clinical Informatics Digital Hub (ORCHID) and its first two platforms. The Surveillance Platform will provide extended primary care surveillance, while the Trials Platform is a streamlined clinical trials platform that will be integrated into routine primary care practice. METHODS: We will apply the FAIR (Findable, Accessible, Interoperable, and Reusable) metadata principles to a new, integrated digital health hub that will extract routinely collected general practice electronic health data for use in clinical trials and provide enhanced communicable disease surveillance. The hub will be findable through membership in Health Data Research UK and European metadata repositories. Accessibility through an online application system will provide access to study-ready data sets or developed custom data sets. Interoperability will be facilitated by fixed linkage to other key sources such as Hospital Episodes Statistics and the Office of National Statistics using pseudonymized data. All semantic descriptors (ie, ontologies) and code used for analysis will be made available to accelerate analyses. We will also make data available using common data models, starting with the US Food and Drug Administration Sentinel and Observational Medical Outcomes Partnership approaches, to facilitate international studies. The Surveillance Platform will provide access to data for health protection and promotion work as authorized through agreements between Oxford, the Royal College of General Practitioners, and Public Health England. All studies using the Trials Platform will go through appropriate ethical and other regulatory approval processes. RESULTS: The hub will be a bottom-up, professionally led network that will provide benefits for member practices, our health service, and the population served. Data will only be used for SQUIRE (surveillance, quality improvement, research, and education) purposes. We have already received positive responses from practices, and the number of practices in the network has doubled to over 1150 since February 2020. COVID-19 surveillance has resulted in tripling of the number of virology sites to 293 (target 300), which has aided the collection of the largest ever weekly total of surveillance swabs in the United Kingdom as well as over 3000 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serology samples. Practices are recruiting to the PRINCIPLE (Platform Randomised trial of INterventions against COVID-19 In older PeopLE) trial, and these participants will be followed up through ORCHID. These initial outputs demonstrate the feasibility of ORCHID to provide an extended national digital health hub. CONCLUSIONS: ORCHID will provide equitable and innovative use of big data through a professionally led national primary care network and the application of FAIR principles. The secure data hub will host routinely collected general practice data linked to other key health care repositories for clinical trials and support enhanced in situ surveillance without always requiring large volume data extracts. ORCHID will support rapid data extraction, analysis, and dissemination with the aim of improving future research and development in general practice to positively impact patient care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/19773.


Assuntos
Ensaios Clínicos como Assunto , Infecções por Coronavirus/epidemiologia , Medicina Geral/organização & administração , Sistemas Computadorizados de Registros Médicos , Pneumonia Viral/epidemiologia , Vigilância em Saúde Pública , Humanos , Pandemias , Atenção Primária à Saúde/organização & administração , Sociedades Médicas , Reino Unido/epidemiologia
8.
Artigo em Inglês | MEDLINE | ID: mdl-32517176

RESUMO

Continued tobacco use after cancer diagnosis is detrimental to treatment and survivorship. The current reach of evidence-based tobacco treatments in cancer patients is low. As a part of the National Cancer Institute Cancer Center Cessation Initiative, the Mayo Clinic Cancer Center designed an electronic health record (EHR, Epic©)-based process to automatically refer ambulatory oncology patients to tobacco use treatment, regardless of intent to cease tobacco use("opt out"). The referral and patient scheduling, accomplished through a best practice advisory (BPA) directed to staff who room patients, does not require a co-signature from clinicians. This process was piloted for a six-week period starting in July of 2019 at the Division of Medical Oncology, Mayo Clinic, Rochester, MN. All oncology patients who were tobacco users were referred for tobacco treatment by the rooming staff (n = 210). Of these, 150 (71%) had a tobacco treatment appointment scheduled, and 25 (17%) completed their appointment. We conclude that an EHR-based "opt-out" approach to refer patients to tobacco dependence treatment that does not require active involvement by clinicians is feasible within the oncology clinical practice. Further work is needed to increase the proportion of scheduled patients who attend their appointments.


Assuntos
Registros Eletrônicos de Saúde , Neoplasias/complicações , Neoplasias/epidemiologia , Encaminhamento e Consulta , Abandono do Hábito de Fumar/métodos , Tabagismo/diagnóstico , Tabagismo/terapia , Humanos , Sistemas Computadorizados de Registros Médicos , Neoplasias/etiologia , Neoplasias/patologia , Uso de Tabaco , Interface Usuário-Computador
9.
J Am Med Inform Assoc ; 27(6): 860-866, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: covidwho-42077

RESUMO

OBJECTIVE: To rapidly deploy a digital patient-facing self-triage and self-scheduling tool in a large academic health system to address the COVID-19 pandemic. MATERIALS AND METHODS: We created a patient portal-based COVID-19 self-triage and self-scheduling tool and made it available to all primary care patients at the University of California, San Francisco Health, a large academic health system. Asymptomatic patients were asked about exposure history and were then provided relevant information. Symptomatic patients were triaged into 1 of 4 categories-emergent, urgent, nonurgent, or self-care-and then connected with the appropriate level of care via direct scheduling or telephone hotline. RESULTS: This self-triage and self-scheduling tool was designed and implemented in under 2 weeks. During the first 16 days of use, it was completed 1129 times by 950 unique patients. Of completed sessions, 315 (28%) were by asymptomatic patients, and 814 (72%) were by symptomatic patients. Symptomatic patient triage dispositions were as follows: 193 emergent (24%), 193 urgent (24%), 99 nonurgent (12%), 329 self-care (40%). Sensitivity for detecting emergency-level care was 87.5% (95% CI 61.7-98.5%). DISCUSSION: This self-triage and self-scheduling tool has been widely used by patients and is being rapidly expanded to other populations and health systems. The tool has recommended emergency-level care with high sensitivity, and decreased triage time for patients with less severe illness. The data suggests it also prevents unnecessary triage messages, phone calls, and in-person visits. CONCLUSION: Patient self-triage tools integrated into electronic health record systems have the potential to greatly improve triage efficiency and prevent unnecessary visits during the COVID-19 pandemic.


Assuntos
Agendamento de Consultas , Betacoronavirus , Infecções por Coronavirus , Autoavaliação Diagnóstica , Sistemas Computadorizados de Registros Médicos , Pandemias , Participação do Paciente , Portais do Paciente , Pneumonia Viral , Triagem/métodos , Centros Médicos Acadêmicos , Adulto , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , São Francisco , Autocuidado , Telemedicina/organização & administração
10.
JMIR Public Health Surveill ; 6(2): e18606, 2020 04 02.
Artigo em Inglês | MEDLINE | ID: covidwho-31012

RESUMO

BACKGROUND: The Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) and Public Health England (PHE) have successfully worked together on the surveillance of influenza and other infectious diseases for over 50 years, including three previous pandemics. With the emergence of the international outbreak of the coronavirus infection (COVID-19), a UK national approach to containment has been established to test people suspected of exposure to COVID-19. At the same time and separately, the RCGP RSC's surveillance has been extended to monitor the temporal and geographical distribution of COVID-19 infection in the community as well as assess the effectiveness of the containment strategy. OBJECTIVES: The aims of this study are to surveil COVID-19 in both asymptomatic populations and ambulatory cases with respiratory infections, ascertain both the rate and pattern of COVID-19 spread, and assess the effectiveness of the containment policy. METHODS: The RCGP RSC, a network of over 500 general practices in England, extract pseudonymized data weekly. This extended surveillance comprises of five components: (1) Recording in medical records of anyone suspected to have or who has been exposed to COVID-19. Computerized medical records suppliers have within a week of request created new codes to support this. (2) Extension of current virological surveillance and testing people with influenza-like illness or lower respiratory tract infections (LRTI)-with the caveat that people suspected to have or who have been exposed to COVID-19 should be referred to the national containment pathway and not seen in primary care. (3) Serology sample collection across all age groups. This will be an extra blood sample taken from people who are attending their general practice for a scheduled blood test. The 100 general practices currently undertaking annual influenza virology surveillance will be involved in the extended virological and serological surveillance. (4) Collecting convalescent serum samples. (5) Data curation. We have the opportunity to escalate the data extraction to twice weekly if needed. Swabs and sera will be analyzed in PHE reference laboratories. RESULTS: General practice clinical system providers have introduced an emergency new set of clinical codes to support COVID-19 surveillance. Additionally, practices participating in current virology surveillance are now taking samples for COVID-19 surveillance from low-risk patients presenting with LRTIs. Within the first 2 weeks of setup of this surveillance, we have identified 3 cases: 1 through the new coding system, the other 2 through the extended virology sampling. CONCLUSIONS: We have rapidly converted the established national RCGP RSC influenza surveillance system into one that can test the effectiveness of the COVID-19 containment policy. The extended surveillance has already seen the use of new codes with 3 cases reported. Rapid sharing of this protocol should enable scientific critique and shared learning. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/18606.


Assuntos
Infecções por Coronavirus/epidemiologia , Coronavirus , Notificação de Doenças/métodos , Sistemas Computadorizados de Registros Médicos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Vigilância em Saúde Pública/métodos , Betacoronavirus , Surtos de Doenças , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Saúde Pública , Vigilância de Evento Sentinela
11.
Soins ; 65(842): 29-32, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32245555

RESUMO

In July 2016, the National Health Insurance re-launched the shared medical record, a tool for sharing information between health professionals and patients. Its use has been growing among doctors for more than a year now, and more healthcare institutions are rolling it out.


Assuntos
Disseminação de Informação/métodos , Sistemas Computadorizados de Registros Médicos , Relações Médico-Paciente , Assistência à Saúde/organização & administração , Humanos , Programas Nacionais de Saúde
12.
Arch. argent. pediatr ; 118(2): 132-135, abr. 2020. ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1100246

RESUMO

Introducción. El subdiagnóstico y subregistro de sobrepeso y obesidad en pediatría es muy frecuente. El uso de una historia clínica electrónica podría contribuir favorablemente. El objetivo fue conocer el porcentaje de registro de este problema por pediatras de cabecera y analizar si se asociaba con la realización de estudios complementarios.Métodos. Estudio de corte transversal. Se evaluó el registro del problema en pacientes pediátricos con sobrepeso y obesidad, y la presencia de resultados de glucemia, triglicéridos y colesterol de alta densidad en pacientes obesos.Resultados. Se analizaron 7471 pacientes con sobrepeso y obesidad; el registro adecuado del problema fue del 19 %. El 44 % de los obesos (n = 1957) tenía registro adecuado y el 32 %, resultados de laboratorio, con asociación significativa entre variables.Conclusiones. Los porcentajes de registro de sobrepeso y obesidad y realización de estudios complementarios fueron bajos. El registro del problema se asoció a mayor solicitud de estudios


Introduction. Under-diagnosis and under-recording of overweight and obesity in pediatrics is very common. Using an electronic medical record may be helpful. The objective was to establish the percentage of recording of this problem by primary care pediatricians and analyze if it was associated with the performance of ancillary tests.Methods. Cross-sectional study. The recording of this problem among overweight and obese pediatric patients and the presence of blood glucose, triglycerides, and high-density lipoprotein cholesterol results in obese patients were assessed.Results. A total of 7471 overweight and obese patients were included; this health problem was adequately recorded in only 19 %. Among all obese patients (n = 1957), 44 % had adequate recording of this health problem; 32 % had lab test results showing a significant association among outcome measures.Conclusions. The percentage of overweight and obesity recording and ancillary test performance was low. Recording was associated with a higher level of test ordering


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Sistemas Computadorizados de Registros Médicos/estatística & dados numéricos , Sobrepeso/epidemiologia , Registros Eletrônicos de Saúde , Obesidade/epidemiologia , Triglicerídeos , Glicemia , Estudos Transversais , HDL-Colesterol
13.
JMIR Public Health Surveill ; 6(2): e18606, 2020 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-32240095

RESUMO

BACKGROUND: The Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) and Public Health England (PHE) have successfully worked together on the surveillance of influenza and other infectious diseases for over 50 years, including three previous pandemics. With the emergence of the international outbreak of the coronavirus infection (COVID-19), a UK national approach to containment has been established to test people suspected of exposure to COVID-19. At the same time and separately, the RCGP RSC's surveillance has been extended to monitor the temporal and geographical distribution of COVID-19 infection in the community as well as assess the effectiveness of the containment strategy. OBJECTIVES: The aims of this study are to surveil COVID-19 in both asymptomatic populations and ambulatory cases with respiratory infections, ascertain both the rate and pattern of COVID-19 spread, and assess the effectiveness of the containment policy. METHODS: The RCGP RSC, a network of over 500 general practices in England, extract pseudonymized data weekly. This extended surveillance comprises of five components: (1) Recording in medical records of anyone suspected to have or who has been exposed to COVID-19. Computerized medical records suppliers have within a week of request created new codes to support this. (2) Extension of current virological surveillance and testing people with influenza-like illness or lower respiratory tract infections (LRTI)-with the caveat that people suspected to have or who have been exposed to COVID-19 should be referred to the national containment pathway and not seen in primary care. (3) Serology sample collection across all age groups. This will be an extra blood sample taken from people who are attending their general practice for a scheduled blood test. The 100 general practices currently undertaking annual influenza virology surveillance will be involved in the extended virological and serological surveillance. (4) Collecting convalescent serum samples. (5) Data curation. We have the opportunity to escalate the data extraction to twice weekly if needed. Swabs and sera will be analyzed in PHE reference laboratories. RESULTS: General practice clinical system providers have introduced an emergency new set of clinical codes to support COVID-19 surveillance. Additionally, practices participating in current virology surveillance are now taking samples for COVID-19 surveillance from low-risk patients presenting with LRTIs. Within the first 2 weeks of setup of this surveillance, we have identified 3 cases: 1 through the new coding system, the other 2 through the extended virology sampling. CONCLUSIONS: We have rapidly converted the established national RCGP RSC influenza surveillance system into one that can test the effectiveness of the COVID-19 containment policy. The extended surveillance has already seen the use of new codes with 3 cases reported. Rapid sharing of this protocol should enable scientific critique and shared learning. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/18606.


Assuntos
Infecções por Coronavirus/epidemiologia , Coronavirus , Notificação de Doenças/métodos , Sistemas Computadorizados de Registros Médicos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Vigilância em Saúde Pública/métodos , Betacoronavirus , Surtos de Doenças , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Saúde Pública , Vigilância de Evento Sentinela
14.
J Am Med Inform Assoc ; 27(6): 860-866, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32267928

RESUMO

OBJECTIVE: To rapidly deploy a digital patient-facing self-triage and self-scheduling tool in a large academic health system to address the COVID-19 pandemic. MATERIALS AND METHODS: We created a patient portal-based COVID-19 self-triage and self-scheduling tool and made it available to all primary care patients at the University of California, San Francisco Health, a large academic health system. Asymptomatic patients were asked about exposure history and were then provided relevant information. Symptomatic patients were triaged into 1 of 4 categories-emergent, urgent, nonurgent, or self-care-and then connected with the appropriate level of care via direct scheduling or telephone hotline. RESULTS: This self-triage and self-scheduling tool was designed and implemented in under 2 weeks. During the first 16 days of use, it was completed 1129 times by 950 unique patients. Of completed sessions, 315 (28%) were by asymptomatic patients, and 814 (72%) were by symptomatic patients. Symptomatic patient triage dispositions were as follows: 193 emergent (24%), 193 urgent (24%), 99 nonurgent (12%), 329 self-care (40%). Sensitivity for detecting emergency-level care was 87.5% (95% CI 61.7-98.5%). DISCUSSION: This self-triage and self-scheduling tool has been widely used by patients and is being rapidly expanded to other populations and health systems. The tool has recommended emergency-level care with high sensitivity, and decreased triage time for patients with less severe illness. The data suggests it also prevents unnecessary triage messages, phone calls, and in-person visits. CONCLUSION: Patient self-triage tools integrated into electronic health record systems have the potential to greatly improve triage efficiency and prevent unnecessary visits during the COVID-19 pandemic.


Assuntos
Agendamento de Consultas , Betacoronavirus , Infecções por Coronavirus , Autoavaliação Diagnóstica , Sistemas Computadorizados de Registros Médicos , Pandemias , Participação do Paciente , Portais do Paciente , Pneumonia Viral , Triagem/métodos , Centros Médicos Acadêmicos , Adulto , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , São Francisco , Autocuidado , Telemedicina/organização & administração
16.
J Am Med Inform Assoc ; 27(6): 853-859, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32208481

RESUMO

OBJECTIVE: To describe the implementation of technological support important for optimizing clinical management of the COVID-19 pandemic. MATERIALS AND METHODS: Our health system has confirmed prior and current cases of COVID-19. An Incident Command Center was established early in the crisis and helped identify electronic health record (EHR)-based tools to support clinical care. RESULTS: We outline the design and implementation of EHR-based rapid screening processes, laboratory testing, clinical decision support, reporting tools, and patient-facing technology related to COVID-19. DISCUSSION: The EHR is a useful tool to enable rapid deployment of standardized processes. UC San Diego Health built multiple COVID-19-specific tools to support outbreak management, including scripted triaging, electronic check-in, standard ordering and documentation, secure messaging, real-time data analytics, and telemedicine capabilities. Challenges included the need to frequently adjust build to meet rapidly evolving requirements, communication, and adoption, and to coordinate the needs of multiple stakeholders while maintaining high-quality, prepandemic medical care. CONCLUSION: The EHR is an essential tool in supporting the clinical needs of a health system managing the COVID-19 pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Registros Eletrônicos de Saúde , Sistemas Computadorizados de Registros Médicos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Telemedicina , Interface Usuário-Computador , Centros Médicos Acadêmicos/organização & administração , California/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Bases de Dados Factuais , Sistemas de Apoio a Decisões Clínicas , Humanos , Informática Médica , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia
17.
Lancet Psychiatry ; 7(2): 135-147, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31974072

RESUMO

BACKGROUND: Psychiatric disorders are established risk factors for self-harm. However, variation in the risk of self-harm by specific psychiatric disorder and stratified by gender and age is rarely examined in population-representative samples. This study aimed to investigate the risk of self-harm following diagnosis of different psychiatric disorders in an Asian population, through a review of inpatient records retrieved from the Hong Kong Clinical Data Analysis and Reporting System (CDARS). METHODS: For this nested case-control study, the inpatient data of people admitted for any reason to Hong Kong public hospitals, between Jan 1, 2000, and Dec 31, 2010, were extracted from CDARS. Cases were people aged 10 years or older who had been admitted to inpatient care with a first-listed record of psychiatric disorder during the study period. The seven psychiatric disorders of interest were: depression, alcohol misuse or dependence, personality disorders, bipolar disorders, anxiety disorders, schizophrenia, and substance misuse or dependence. Two control patients were matched per case from a subsample of all individuals with the same gender, age, and admission time (ie, same calendar year and month), who did not have any record of the psychiatric disorders of interest. Any patients with a history of self-harm diagnosis before, or at the same time as, the first diagnosis of psychiatric disorder (cases) or admission (controls), were excluded. For each diagnostic category, a Cox proportional hazard regression model was fitted to estimate the adjusted hazard ratio (HR; plus 95% CIs) of associated self-harm, adjusting for gender, age, control-matched admission time, 20 districts of residence, physical comorbidities established as risk factors for self-harm (diabetes, asthma, migraine, epilepsy, HIV, and cancer), and presence of the six other psychiatric disorders. We repeated this analysis in subgroups stratified by gender (male and female) and by age (adolescent, 10-24 years; young adult, 25-44 years; middle-aged, 45-64 years; and older people, ≥65 years). FINDINGS: Between 2000 and 2010, we followed up a cohort of 86 353 people with a first-recorded diagnosis of a psychiatric disorder of interest, and 134 857 matched controls. The highest risk of self-harm was observed in patients with substance misuse or dependence (adjusted HR vs matched controls, 9·6 [95% CI 8·4-11·0]), followed by those with personality disorders (3·7 [2·8-4·9]) and alcohol misuse or dependence (3·2 [2·9-3·7]). When stratified by gender and age, the highest risk of self-harm behaviour was found in the substance misuse or dependence group for both genders (for female patients: adjusted HR vs matched controls, 7·7 [6·0-9·8]; and for male patients, 10·5 [8·9-12·4]), and for all age groups (adolescent: 9·6 [7·2-12·7]; young adults: 10·2 [8·4-12·3]; middle-aged: 11·2 [8·0-15·6], and older people: 3·2 [1·7-6·1]). INTERPRETATION: First-recorded diagnoses of psychiatric disorders were significantly associated with an elevated risk of subsequent self-harm. The associations varied considerably by diagnostic categories across gender and age subgroups. Our findings highlight the need to develop more efficient and targeted preventive measures in psychiatric care management, with specific attention to demographic characteristics linked to increased risk within the same diagnostic category. FUNDING: None.


Assuntos
Transtornos de Ansiedade/epidemiologia , Transtorno Bipolar/epidemiologia , Transtorno Depressivo/epidemiologia , Transtornos da Personalidade/epidemiologia , Esquizofrenia/epidemiologia , Comportamento Autodestrutivo/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Estudos de Casos e Controles , Criança , Feminino , Seguimentos , Hong Kong/epidemiologia , Hospitais Públicos/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Sistemas Computadorizados de Registros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Risco , Fatores Sexuais , Adulto Jovem
18.
Pathologe ; 41(1): 52-59, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31960116

RESUMO

Pathology reports are important clinical documents for the diagnosis, treatment, and follow-up of often severe diseases. They are subject to a series of formal and substantive requirements that are anchored in several jurisdictions, which also apply to the digital form of these records. Only a few of the currently used digital document formats meet these requirements and are at the same time interoperable, regardless of the computer platforms used. Practically, they are only partially used in pathology laboratories, practice management, and hospital information systems. The consistent use of these standard formats for pathological findings reports provided a clear digital added value for both pathologists and clinicians as well as their patients.


Assuntos
Sistemas Computadorizados de Registros Médicos/normas , Patologia/normas , Humanos
19.
Rheumatology (Oxford) ; 59(1): 39-45, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31834405

RESUMO

Health-related information is increasingly being collected and stored digitally. These data, either structured or unstructured, are becoming the ubiquitous assets that might enable us to comprehensively map out a patient's health journey from an asymptomatic state of wellness to disease onset and its trajectory. These new data could provide rich real-world evidence for better clinical care and research, if they can be accessed, linked and analyzed-all of which are possible. In this review, these opportunities will be explored through a case vignette of a patient with OA, followed by discussion on how this digitalized real-world evidence could best be utilized, as well as the challenges of data access, quality and maintaining public trust.


Assuntos
Sistemas Computadorizados de Registros Médicos , Ensaios Clínicos Pragmáticos como Assunto/métodos , Humanos , Aplicativos Móveis , Projetos de Pesquisa
20.
Repert. med. cir ; 29((Núm. Supl.1.)): 34-44, 2020. Il., dibujos, tablas
Artigo em Inglês, Espanhol, Português | LILACS, COLNAL | ID: biblio-1118448

RESUMO

Introducción:los coronavirus son una amplia familia de virus que logran causar enfermedades tanto en animales como en humanos. En humanos, se sabe que varios coronavirus ocasionan infecciones respiratorias que consiguen ir desde el resfriado común hasta enfermedades más complicadas como el síndrome respiratorio de Oriente Medio (MERS) y el síndrome respiratorio agudo severo (SRAS). El coronavirus que se ha manifestado más recientemente causa la enfermedad por coronavirus COVID-19. Objetivo: presentar un pronóstico con el uso del modelo lineal de Brown de la dinámica de transmisión del COVID- 19 en Colombia. Materiales y métodos: para desarrollar la investigación se utilizó la base de datos de las personas infectadas con el COVID-19, la información de los datos corresponde al período 6 de marzo 2020 al 10 de mayo de 2020. Para su análisis de predicción se manejó el método de predicción modelo de BROWN, utilizando el paquete estadístico SPSS v.25. Resultados:se determinó por análisis de predicción que el número total de infectados por el COVID-19 en Colombia a 31 de agosto de 2020 estarán alrededor de 69848, de esta población 41110 corresponde a hombres y 28738 a mujeres. Conclusiones: se evidenció una alta población de casos confirmados por coronavirus en Colombia a 31 de agosto de 2020; esto pone en alerta la red pública hospitalaria del país, además que obliga a las personas y comunidades a mantenerse en cuarentena por la emergencia sanitaria.


Introduction: Coronaviruses is a broad family of viruses that manage to infect both animals and humans. Several coronaviruses are known to cause respiratory infections in humans, ranging from a common cold to more complicated conditions such as the Middle East Respiratory Syndrome (MERS) and the Severe Acute Respiratory Syndrome (SARS). The newly emerged coronavirus causes coronavirus disease 2019 (COVID-19). Objective: to predict the transmission dynamics of COVID-19 in Colombia using Brown ́s linear model. Materials and Methods: the database including people infected with Covid-19 was used to develop the research. This information corresponds to the period between March 6 2020 and May 10 2020. The Brown ́s model method was used for the predictive analysis in the SPSS v.25 statistical package. Results: our prediction analysis indicates that the number of people infected by COVID-19 in Colombia by August 31 2020 will be around 69848; of this population, 41110 would be men and 28738 women Conclusions: a high population of confirmed cases of coronavirus in Colombia is forecasted as of August 31 2020; this places the public hospital network of the country on alert and forces individuals and communities to remain in quarantine due to the health emergency.


Introdução: Os coronavírus são uma ampla família de vírus que conseguem causar doenças em animais e humanos. Em humanos, sabe-se que vários coronavírus causam infecções respiratórias que variam do resfriado comum a doenças mais complicadas, como a síndrome respiratória do Oriente Médio (MERS) e a síndrome respiratória aguda grave (SARS). O coronavírus manifestado mais recentemente causa a doença de coronavírus COVID-19. Objetivo:apresentar uma previsão com o uso do modelo linear de Brown da dinâmica de transmissão do COVID-19 na Colômbia. Metodologia: Para desenvolver a pesquisa, foi utilizado o banco de dados de pessoas infectadas com COVID-19, as informações dos dados correspondem ao período de 6 de março de 2020 a 20 de abril de 2020. Para sua análise de previsão, o método de previsão do modelo BROWN, usando o pacote estatístico SPSS v.25. Resultados:Foi determinado por análise de previsão que o número total de infectados com COVID-19 na Colômbia em 31 de julho seria de 33.219 casos confirmados, 17213 casos para homens e 16006 para mulheres. Conclusões:Uma alta população de casos confirmados por Coronavírus na Colômbia foi evidenciada em 31 de julho de 2020, o que coloca em alerta a rede de hospitais públicos do país, além de forçar a quarentena de pessoas e comunidades devido à emergência de saúde.


Assuntos
Humanos , Masculino , Feminino , Infecções por Coronavirus , Transmissão de Doença Infecciosa , Sistemas Computadorizados de Registros Médicos
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