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TitleeHealth 2015 Special Issue: Impact of Electronic Health Records on the Completeness of Clinical Documentation Generated during Diabetic Retinopathy Consultations.
AuthorsMitsch, C; Huber, P; Kriechbaum, K; Scholda, C; Duftschmid, G; Wrba, T; Schmidt-Erfurth, U
JournalApplied clinical informatics
Publication Date1 Dec 2015
Date Added to PubMed9 Oct 2015
AbstractTwo years ago, the Diabetic Retinopathy (DRP) and Traumatology clinic of the Department of Ophthalmology and Optometrics at the Medical University of Vienna, Austria switched from paper-based to electronic health records. A customized electronic health record system (EHR-S) was implemented. To assess the completeness of information documented electronically compared with manually during patient visits. The Preferred Practice Pattern for Diabetic Retinopathy published by the American Academy of Ophthalmology was distilled into a list of medical features grouped into categories to be assessed and documented during the management of patients with DRP. The last seventy paper-based records and all electronic records generated since the switch were analyzed and graded for the presence of features on the list and the resulting scores compared. In all categories, clinical documentation was more complete in the EHR group. In our setting, the implementation of an EHR-S showed a statistically significant positive impact on documentation completeness.
Linkhttp://doi.org/10.4338/ACI-2014-11-RA-0104
TitleeHealth and Clinical Documentation Systems.
AuthorsKnaup, P; Benning, NH; Seitz, MW; Eisenmann, U
JournalStudies in health technology and informatics
Publication Date25 Sep 2020
Date Added to PubMed30 Sep 2020
AbstracteHealth is the use of modern information and communication technology (ICT) for trans-institutional healthcare purposes. Important subtopics of eHealth are health data sharing and telemedicine. Most of the clinical documentation to be shared is collected in patient records to support patient care. More sophisticated approaches to electronic patient records are trans-institutional or (inter-)national. Other aims for clinical documentation are quality management, reimbursement, legal issues, and medical research. Basic prerequisite for eHealth is interoperability, which can be divided into technical, semantic and process interoperability. There is a variety of international standards to support interoperability. Telemedicine is a subtopic of eHealth, which bridges spatial distance by using ICT for medical (inter-)actions. We distinguish telemedicine among healthcare professionals and telemedicine between health care professionals and patients. Both have a great potential to face the challenges of aging societies, the increasing number of chronically ill patients, multimorbidity and low number of physicians in remote areas. With ongoing digitalization more and more data are available digitally. Clinical documentation is an important source for big data analysis and artificial intelligence. The patient has an important role: Telemonitoring, wearable technologies, and smart home devices provide digital health data from daily life. These are high-quality data which can be used for medical decisions.
Linkhttp://doi.org/10.3233/SHTI200676
TitleElectronic health, telemedicine, and new paradigms for training and care.
AuthorsTodd, CS; Mills, SJ; Innes, AL
JournalCurrent opinion in HIV and AIDS
Publication Date1 Sep 2017
Date Added to PubMed27 Jun 2017
AbstractHIV prevention and care is changing rapidly; guideline revisions and programmatic scale-up require innovative approaches to in-service training and care extension to improve provider practice and care access. We assessed recent (≤12 months) peer-reviewed publications on electronic health (eHealth), telemedicine, and other innovative provider-targeted interventions for HIV-related care. Key developments included systems merging electronic medical records (EMR) with provider clinical decision aids to prompt action, demonstration eHealth, and telemedicine projects, reviews or descriptions of technology to improve connectivity in lower resource settings, and a few trials on provider-centered interventions. Most publications were program reports and few data were available regarding efficacy of eHealth interventions for providers on patient HIV-related outcomes, notably identification and management of antiretroviral treatment failure in Kenya. Better evidence is needed for strategies to train providers and care extenders with the goal to improve impact of HIV prevention and care interventions. Rapid technology introduction and expansion may change the paradigm for improving provider knowledge and practice. Although new, the developments are promising for HIV provider-targeted eHealth and innovations for traditional training. More rigorous testing with randomized trials is needed to demonstrate impact on services for people living with HIV.
Linkhttp://doi.org/10.1097/COH.0000000000000402
TitleUtilizing patient geographic information system data to plan telemedicine service locations.
AuthorsSoares, N; Dewalle, J; Marsh, B
JournalJournal of the American Medical Informatics Association : JAMIA
Publication Date1 Sep 2017
Date Added to PubMed25 Mar 2017
AbstractTo understand potential utilization of clinical services at a rural integrated health care system by generating optimal groups of telemedicine locations from electronic health record (EHR) data using geographic information systems (GISs). This retrospective study extracted nonidentifiable grouped data of patients over a 2-year period from the EHR, including geomasked locations. Spatially optimal groupings were created using available telemedicine sites by calculating patients' average travel distance (ATD) to the closest clinic site. A total of 4027 visits by 2049 unique patients were analyzed. The best travel distances for site groupings of 3, 4, 5, or 6 site locations were ranked based on increasing ATD. Each one-site increase in the number of available telemedicine sites decreased minimum ATD by about 8%. For a given group size, the best groupings were very similar in minimum travel distance. There were significant differences in predicted patient load imbalance between otherwise similar groupings. A majority of the best site groupings used the same small number of sites, and urban sites were heavily used. With EHR geospatial data at an individual patient level, we can model potential telemedicine sites for specialty access in a rural geographic area. Relatively few sites could serve most of the population. Direct access to patient GIS data from an EHR provides direct knowledge of the client base compared to methods that allocate aggregated data. Geospatial data and methods can assist health care location planning, generating data about load, load balance, and spatial accessibility.
Linkhttp://doi.org/10.1093/jamia/ocx011
TitleInpatient-outpatient shared electronic health records: telemedicine and laboratory follow-up after hospital discharge.
AuthorsReed, M; Huang, J; Brand, R; Graetz, I; Jaffe, MG; Ballard, D; Neugebauer, R; Fireman, B; Hsu, J
JournalThe American journal of managed care
Publication Date1 Oct 2020
Date Added to PubMed24 Oct 2020
AbstractContinuity of patient information across settings can improve transitions after hospital discharge, but outpatient clinicians often have limited access to complete information from recent hospitalizations. We examined whether providers' timely access to clinical information through shared inpatient-outpatient electronic health records (EHRs) was associated with follow-up visits, return emergency department (ED) visits, or readmissions after hospital discharge in patients with diabetes. Stepped-wedge observational study. As an integrated delivery system staggered implementation of a shared inpatient-outpatient EHR, we studied 241,510 hospital discharges in patients with diabetes (2005-2011), examining rates of outpatient follow-up office visits, telemedicine (phone visits and asynchronous secure messages), laboratory tests, and return ED visits or readmissions (as adverse events). We used multivariate logistic regression adjusting for time trends, patient characteristics, and medical center and accounting for patient clustering to calculate adjusted follow-up rates. For patients with diabetes, provider use of a shared inpatient-outpatient EHR was associated with a statistically significant shift toward follow-up delivered through a combination of telemedicine and outpatient laboratory tests, without a traditional in-person visit (from 22.9% with an outpatient-only EHR to 27.0% with a shared inpatient-outpatient EHR; P < .05). We found no statistically significant differences in 30-day return ED visits (odds ratio, 1.02; 95% CI, 0.96-1.09) or readmissions (odds ratio, 0.98; 95% CI, 0.91-1.06) with the shared EHR compared with the outpatient-only EHR. Real-time clinical information availability during transitions between health care settings, along with robust telemedicine access, may shift the method of care delivery without adversely affecting patient health outcomes. Efforts to expand interoperability and information exchange may support follow-up care efficiency.
Linkhttp://doi.org/10.37765/ajmc.2020.88506
TitleMeasuring electronic communication networks in virtual care teams using electronic health records access-log data.
AuthorsZhu, X; Tu, SP; Sewell, D; Yao, NA; Mishra, V; Dow, A; Banas, C
JournalInternational journal of medical informatics
Publication Date1 Aug 2019
Date Added to PubMed5 Jun 2019
AbstractTo develop methods for measuring electronic communication networks in virtual care teams using electronic health records (EHR) access-log data. For a convenient sample of 100 surgical colorectal cancer patients, we used time-stamped EHR access-log data extracted from an academic medical center's EHR system to construct communication networks among healthcare professionals (HCPs) in each patient's virtual care team. We measured communication linkages between HCPs using the inverse of the average time between access events in which the source HCPs sent information to and the destination HCPs retrieved information from the EHR system. Social network analysis was used to examine and visualize communication network structures, identify principal care teams, and detect meaningful structural differences across networks. We conducted a non-parametric multivariate analysis of variance (MANOVA) to test the association between care teams' communication network structures and patients' cancer stage and site. The 100 communication networks showed substantial variations in size and structures. Principal care teams, the subset of HCPs who formed the core of the communication networks, had higher proportions of nurses, physicians, and pharmacists and a lower proportion of laboratory medical technologists than the overall networks. The distributions of conditional uniform graph quantiles suggested that our network-construction technique captured meaningful underlying structures that were different from random unstructured networks. MANOVA results found that the networks' topologies were associated with patients' cancer stage and site. This study demonstrates that it is feasible to use EHR access-log data to measure and examine communication networks in virtual care teams. The proposed methods captured salient communication patterns in care teams that were associated with patients' clinical differences.
Linkhttp://doi.org/10.1016/j.ijmedinf.2019.05.012
TitleElectronic health records implementation in Morocco: Challenges of silo efforts and recommendations for improvements.
AuthorsParks, R; Wigand, RT; Othmani, MB; Serhier, Z; Bouhaddou, O
JournalInternational journal of medical informatics
Publication Date1 Sep 2019
Date Added to PubMed25 Aug 2019
AbstractElectronic Health Records (EHRs) interventions hold the promise for enabling better healthcare. However, the implementation of EHR systems has been scarce in developing countries. The objective of this study is to investigate the state of EHRs implementation in Morocco; and draw insights for potential improvements. University Medical Centers, known by locals in French as Centres Hospitalier Universitaires (CHU), are the largest and most advanced public healthcare centers in Morocco. A two-phase qualitative study was conducted in four out of the five CHUs. Phase One involved data collection through semi-structured interviews with 27 clinician champions, administrators, and medical directors. Phase Two included a brainstorming session during a health informatics conference held in Fes, Morocco. The data were analyzed using inductive analysis. We identified five main categories of challenges due to silo strategies: (1) EHRs selection and weak bargaining power, (2) identical errors repeated across silos, (3) a lack of interoperability standards, (4) insufficient human and financial, and (5) missed cooperation and collaboration opportunities. While identifying these silo challenges is an important milestone, proposing guidelines to address these challenges can bring Morocco and similar developing countries a step closer to improving healthcare through the use of health informatics and EHRs. Our recommendations for public healthcare organizations are threefold: (1) recognize the power of partnerships among all CHUs, (2) establish an e-health framework, and (3) seek national and international collaborations to drive and shape the eHealth agenda. Furthermore, we align our recommendations with the World Health Organization toolkit for an eHealth strategy to further benefit developing countries. This study identifies the challenges faced by the Moroccan EHRs implementation silo-ed strategy, and it proposes practical and fundamental guidelines to address these challenges and develop an interoperable and sustainable national eHealth system in Morocco and similar developing countries.
Linkhttp://doi.org/10.1016/j.ijmedinf.2019.05.026
TitleConstructive eHealth evaluation: lessons from evaluation of EHR development in 4 Danish hospitals.
AuthorsHøstgaard, AMB; Bertelsen, P; Nøhr, C
JournalBMC medical informatics and decision making
Publication Date20 Apr 2017
Date Added to PubMed22 Apr 2017
AbstractInformation and communication sources in the healthcare sector are replaced with new eHealth technologies. This has led to problems arising from the lack of awareness of the importance of end-user involvement in eHealth development and of the difficulties caused by using traditional summative evaluation methods. The Constructive eHealth evaluation method (CeHEM) provides a solution to these problems by offering an evaluation framework for supporting and facilitating end-user involvement during all phases of eHealth development. The aim of this paper is to support this process by sharing experiences of the eHealth evaluation method used in the introduction of electronic health records (EHR) in the North Denmark Region of Denmark. It is the first time the fully developed method and the experiences on using the CeHEM in all five phases of a full lifecycle framework is presented. A case study evaluation of the EHR development process in the North Denmark Region was conducted from 2004 to 2010. The population consisted of clinicians, IT professionals, administrators, and vendors. The study involved 4 hospitals in the region. Data were collected using questionnaires, observations, interviews, and insight gathered from relevant documents. The evaluation showed a need for a) Early involvement of clinicians, b) The best possible representation of clinicians, and c) Workload reduction for those involved. The consequences of not providing this were a lack of ownership of decisions and negative attitudes towards the clinical benefits related to these decisions. Further, the result disclosed that by following the above recommendations, and by providing feedback to the 4 actor groups, the physicians' involvement was improved. As a result they took ownership of decisions and gained a positive attitude to the clinical benefits. The CeHEM has proven successful in formative evaluation of EHR development and can point at important issues that need to be taken care of by management. The method provides a framework that takes care of feedback and learning during eHealth development. It can thus support successful eHealth development in a broader context while building on a well-known success factor: end-user involvement in eHealth development.
Linkhttp://doi.org/10.1186/s12911-017-0444-2
TitleDigital Translucence: Adapting Telemedicine Delivery Post-COVID-19.
AuthorsKannampallil, T; Ma, J
JournalTelemedicine journal and e-health : the official journal of the American Telemedicine Association
Publication Date1 Sep 2020
Date Added to PubMed20 May 2020
AbstractIn nearly 1 month, with a rapidly expanding corona virus disease 2019 (COVID-19), telemedicine has been transformed into an essential service for delivering routine clinical care. This transformation occurred as a crisis management response-driven by the need to provide care for patients with physical distancing measures in place. However, the current rapid adoption of telemedicine presents a transitional state between one that existed before the pandemic and one that could potentially be better aligned with the delivery of a personalized model of care. Using the conceptual framework of digital translucence-situating virtual encounters with more nuanced information regarding patients-we describe the role of integrated remote monitoring and virtual care tools aligned with the patient's electronic health record for adapting telemedicine delivery post-COVID-19.
Linkhttp://doi.org/10.1089/tmj.2020.0158
TitleProposing New Blockchain Challenges in eHealth.
AuthorsAlonso, SG; Arambarri, J; López-Coronado, M; de la Torre Díez, I
JournalJournal of medical systems
Publication Date7 Feb 2019
Date Added to PubMed8 Feb 2019
AbstractThe blockchain technology has reached a great boom in the health sector, due to its importance to overcome interoperability and security challenges of the EHR and EMR systems in eHealth. The main objective of this work is to show a review of the existing research works in the literature, referring to the new blockchain technology applied in ehealth and exposing the possible research lines and trends in which this technology can be focused. The search for blockchain studies in eHealth field was carried out in the following databases: IEEE Xplore, Google Scholar, Science Direct, PubMed, Web of Science and ResearchGate from 2010 to the present. Different search criteria were established such as: "Blockchain" AND ("eHealth" OR "EHR" OR "electronic health records" OR "medicine") selecting the papers considered of most interest. A total of 84 publications on blockchain in eHealth were found, of which 18 have been identified as relevant works, 5.56% correspond to the year 2016, 22.22% to 2017 and 72.22% to 2018. Many of the publications found show how this technology is being developed and applied in the health sector and the benefits it provides. The new blockchain technology applied in eHealth identifies new ways to share the distributed view of health data and promotes the advancement of precision medicine, improving health and preventing diseases.
Linkhttp://doi.org/10.1007/s10916-019-1195-7
MNCHFPRHHIV/AIDSMalariaNoncommunicable diseaseCOVID-19Decision-makingEducation & trainingBehavior changeGovernancePrivacy & securityEquityCHWsYouth & adolescentsSystematic reviewsProtocols & research designMedical RecordsLaboratoryPharmacyHuman ResourcesmHealthSMSChatbotsAI