This work describes how the use of a visual patient journey modeling tool significantly improved the engagement of clinical staff and their group understanding of the complex IT concepts associated with event-driven computer simulation. Such group understanding and engagement is acknowledged as critical to the successful implementation of a wide range of quality improvement initiatives [1, 2]. The specific example described in this paper relates to the improved utilisation of chemotherapy unit resources.
To provide adequate care, medical professionals have to collect not only medical information but also information that may be related to private aspects of the patient's life. With patients' increasing awareness of information privacy, healthcare providers have to pay attention to the patients' right of privacy. This study aimed to clarify the requirements of the display method of electronic patient record (EPR) screens in consideration of both patients' information privacy concerns and health professionals' information needs. For this purpose, semi-structured group interviews were conducted of 78 medical professionals. They pointed out that partial concealment of information to meet patients' requests for privacy could result in challenges in (1) safety in healthcare, (2) information sharing, (3) collaboration, (4) hospital management, and (5) communication. They believed that EPRs should (1) meet the requirements of the therapeutic process, (2) have restricted access, (3) provide convenient access to necessary information, and (4) facilitate interprofessional collaboration. This study provides direction for the development of display methods that balance the sharing of vital information and protection of patient privacy.
Medication alert systems have been implemented worldwide. The purpose of this study is evaluation of the medication alert systems from a clinical perspective. We surveyed physicians with regard to their reactions to the medication alerts. We collected the revised prescription information and assessed risk avoidance in all cases. The system reviewed 51,006 prescriptions and produced 16,718 physician alerts related to 13,823 prescriptions over the course of 1 month. We identified 45 prescriptions that were revised following the alert and four cases in which patient treatment may have been discontinued or adverse drug events (ADEs) may have occurred if the alerts had not been issued. We demonstrated that the system prevented these potential medication errors. This study adopted a clinical perspective and demonstrated that a real-time alert system can contribute to prevention of ADEs.
In Japan, medical staff must select a diagnosis procedure combination (DPC) code for each inpatient upon admission. We report on the development and evaluation of a supporting system for DPC code selection. This system, based on a machine learning method developed by Okamoto et al., makes DPC code suggestions that are derived from medical practice information pertaining to inpatients. The use of the suggestions helps medical staff select an appropriate DPC code for each inpatient. We asked health information management professionals to evaluate the system and to compare the suggested DPC codes with those selected by doctors. They reported that the system was generally useful and that using this system they could find some cases of hospitalized patients whose DPC codes needed correction. However, they also determined the precision of the system needs improvement.
Radiofrequency identification (RFID) applications have the capability to obtain real-time information on the location and properties of tagged people or objects. The efficiency and safety of the new RFID system (UHF band, 953 MHz) were tested in our hospital. We examined whether 1 to 4 persons and medical equipment with IC tags were captured by RFID readers in a laboratory. We next tested whether electric signals produced by RFID could affect medical devices. New radio frequency tags provided extensive patient identification and helped track capital equipment within a laboratory. Electric fields produced by the new RFID did not significantly affect medical devices in our hospital. New RFID system was safe and useful for tracking people and medical equipments in a hospital. As healthcare systems today involve increasingly complex and interrelated processes, the new RFID technologies may enhance patient safety, and wellness, and reduce staff workloads in a hospital.
State-of-the-art decubitus prevention focuses mainly on special decubitus mattresses, which are indicated for extremely high risk only, while other risk factors such as nutrition or physical activity are hardly considered. Therefore, a monitoring system for decubitus prevention for persons with medium risk has been developed. The system consisted of an unobtrusive sensor system and a tablet for manual input of decubitus-relevant data concerning nutrition, drinking behavior and physical activity. The system was tested in a feasibility study. Results indicate that the system is usable and can provide useful information for decubitus prevention. Future work will include a field study, evaluating the system in a long-term study.
This article presents the preliminary evaluation by dentists, teachers and parents of a serious game for dissemination of public awareness on preschool children's oral health. In this game, the player keeps a victory condition, while your tooth remains whole. Preliminary evaluation was performed in two parts. The first part was a questionnaire designed to evaluate the applicability of this technology and the opinions on the effectiveness of games in education and in oral health promotion. In the second part, the game is presented and an evaluation questionnaire of it is applied. This study had the participation of 115 persons. There was 80% approval which suggested that the game is an alternative for the prevention of dental awareness. Furthermore, the study perceives that teachers can work together with dentists in order to perform dental prevention.
Measuring the performance of electronic health records (EHR) is an important, yet un-resolved challenge. Various measurements have addressed different aspects of EHR success, yet a holistic, comprehensive measurement tool needs to be developed to capture the potential EHR success variables completely. A self-administered questionnaire survey instrument was developed based on the theoretical framework of the DeLone and McLean Information Systems Success Model. It measures nigh variables of EHR success: system quality, information quality, service quality, training, self efficacy, intention to use, use, user satisfaction and net benefits. The instrument was used to measure the performance of aged care EHR systems in three aged care organizations. The results suggest that the instrument was reliable.
In Japan, POS (problem oriented system) is recommended in the clinical guideline. Therefore, the records are mainly made by SOAP. We developed a system mainly with a function which enabled our staff members of all kinds of professions including doctors to enter the patients' clinical information as an identical record, regardless if they were outpatients or inpatients, and to observe the contents chronologically. This electric patient record system is called “e-kanja recording system”. On this system, all staff members in the medical team can now share the same information. Moreover, the contents can be reviewed by colleagues; the quality of records has been improved as it is evaluated by the others.
Current approaches to designing, implementing and evaluating personal health record systems reflect the attributes and assumptions of well-educated and well to-do users (People like Us: PLUs) rather than the needs of the most disadvantaged in society (the disempowered, disengaged and disconnected: DDDs). These electronic systems for increasing accessibility to personal health information may accentuate rather than mitigate the emerging eHealth divide. Using a PubMed review of literature on personal health record systems, we identified only seven of 73 papers, and one of 29 abstracts which made specific mention of users who were disadvantaged by low literacy levels or difficulties with access to technology. This work is part of a larger study into personal health records and disadvantage.
Students with a positive impression of their studies can become more motivated. This study measured the learning impact of clinical training by comparing student impressions before and after clinical training. The study included 32 students of radiological technology in their final year with the Division of Radiological Science and Technology, Department of Health Sciences, School of Medicine, Hokkaido University. To measure student impressions of x-ray examination training, we developed a questionnaire using the semantic differential technique. The resulting factor analysis identified 2 factors that accounted for 44.9% of the 10 bipolar adjective scales. Factor 1 represented a “resistance” impression of x-ray examination training, and factor 2 represented a “responsibility” impression. The differences in factor scores before and after the clinical training suggest that student impressions are affected by clinical training.
In addition to clinical findings, patient reported outcomes (PRO) are a valuable source of information. However, the available time of a physician per patient is limited. Under these constraints, do physicians look into PRO data? By using an, electronic health record (EHR) integrated system for the documentation of PRO the data is directly available during treatment. To evaluate whether this information is used we analyzed access patterns for two types of PRO forms. 56% and 74% of these forms were accessed within routine care while 74% and 100% were analyzed for clinical research.
This paper presents a methodological approach to the design and evaluation of an interface for an ontology-based system used for designing care plans for monitoring patients at home. In order to define the care plans, physicians need a tool for creating instances of the ontology and configuring some rules. Our purpose is to develop an interface to allow clinicians to interact with the ontology. Although ontology-driven applications do not necessarily present the ontology in the user interface, it is our hypothesis that showing selected parts of the ontology in a “usable” way could enhance clinician's understanding and make easier the definition of the care plans. Based on prototyping and iterative testing, this methodology combines visualization techniques and usability methods. Preliminary results obtained after a formative evaluation indicate the effectiveness of suggested combination.
Panel data analysis is a statistical method, widely used in econometrics, which deals with two-dimensional panel data collected over time and over individuals. Cardiotocograph (CTG) which monitors fetal heart rate (FHR) using Doppler ultrasound and uterine contraction by strain gage is commonly used in intrapartum treatment of pregnant women. Although the relationship between FHR waveform pattern and the outcome such as umbilical blood gas data at delivery has long been analyzed, there exists no accumulated FHR patterns from large number of cases. As time-series economic fluctuations in econometrics such as consumption trend has been studied using panel data which consists of time-series and cross-sectional data, we tried to apply this method to CTG data. The panel data composed of a symbolized segment of FHR pattern can be easily handled, and a perinatologist can get the whole FHR pattern view from the microscopic level of time-series FHR data.
A national AIDS program evaluation system has been applied to the ranking of the performance of involved public health organizations in China since 2007. The system provides quantitative performance comparison information based on automatic mining of the data stored in a unified web-based national information system, China AIDS Comprehensive Response Information Management System (the CRIMS). Hence, the quality of the AIDS program evaluation system is directly related to the data quality in the CRIMS. This study aims to evaluate the performance of the AIDS program evaluation system. The research method is qualitative interview of public health practitioners in Jiangxi Province. The public health practitioners believed that the introduction and ongoing usage of the CRIMS has significantly transformed the practice of AIDS prevention and control. They believed that the AIDS program evaluation system has brought in increased accountability of public health. They suggested that the accuracy and completeness of AIDS program evaluation needs to go beyond the data from the CRIMS. Further research will continue to identify the unknown factors that undermine the performance of AIDS programs in China.
To prevent unexpected sudden cardiac patient death due to drug-induced Long QT syndrome (LQTS), we seek to build a computerized early detection and warning system of QTc interval increase tendency. We built an ECG database system that holds the digital waveform data and related information of the ECGs performed in out hospital, and developed an experimental detection system of QTc increase tendency. Despite the several problems about the accuracy of detection, we succeeded in extracting a patient who seemed to be drug-induced LQTS. A combination of such a detection system with more accuracy and drug prescription database would contribute to the early detection of drug-induced LQTS.
To protect patients' privacy and to improve the convenience of research, Asan Medical Center (AMC) has been developing a de-identification system for biomedical research, which mainly consists of three components: de-identification tool, search tool, and chart review tool. The de-identification tool can substitute a randomly assigned research ID for a hospital patient ID, remove the identifiers in the structured format, and mask them in the unstructured format, i.e., texts. The search tool can find the number of patients which satisfies given criteria. The chart review tool can provide de-identified patient's clinical data for review. We found that clinical data warehouse was essential for successful implementation of de-identification system, and this system should be tightly linked to an electronic institutional review board system for easy operation of honest brokers.
13 volunteers walked on a treadmill at 6 different speeds while wearing different accelerometers on different body positions, a spirometry unit and heart rate devices. The goal of this experiment was to find which position on a person's body and which of the sensors is best to measure physical activity (PA) in people by means of an accelerometer.
In the education of medical professionals, imitation medical records and associated documents were developed as electronic teaching materials for students in order to teach collaboration among medical professionals such as nurses, therapists and medical social workers. The roles of each medical professional and the flow of clinical practice were taught using progress tables, including medical treatment, clinical examination, and the contents of care, so that the contents of medical examination were understood based on a time series. Students' understanding of the flow of medical practice was evaluated based on the amount of description in the table before and after explanation of the important points of the clinical process concerning each medical professional. The comments of students who received the lessons suggested that this approach was useful for understanding actual clinical practice and how to utilize a progress table and to prepare information.
In Japan, medical information systems, including electronic medical records, are being introduced increasingly at medical and nursing fields. Nurse administrators, who are involved in the introduction of medical information systems and who must make proper judgment, are particularly required to have at least minimal knowledge of computers and networks and the ability to think about easy-to-use medical information systems. However, few of the current generation of nurse administrators studied information science subjects in their basic education curriculum. It can be said that information education for nurse administrators has become a pressing issue. Consequently, in this study, we conducted a survey of participants taking the first level program of the education course for Japanese certified nurse administrators to ascertain the actual conditions, such as the information environments that nurse administrators are in, their anxiety attitude to computers. Comparisons over the seven years since 2004 revealed that although introduction of electronic medical records in hospitals was progressing, little change in attributes of participants taking the course was observed, such as computer anxiety.
Fall events and their severe consequences represent not only a threatening problem for the affected individual, but also cause a significant burden for health care systems. Our research work aims to elucidate some of the prospects and problems of current sensor-based fall risk assessment approaches. Selected results of a questionnaire-based survey given to experts during topical workshops at international conferences are presented.
The majority of domain experts confirmed that fall risk assessment could potentially be valuable for the community and that prediction is deemed possible, though limited. We conclude with a discussion of practical issues concerning adequate outcome parameters for clinical studies and data sharing within the research community. All participants agreed that sensor-based fall risk assessment is a promising and valuable approach, but that more prospective clinical studies with clearly defined outcome measures are necessary.
The e-service NjuRen is a clinical decision support system used by physicians to calculate patients' renal function and provide support for selection of appropriate drug and dosage for patients with renal failure. Project NjuRen is a collaboration between Stockholm County Council and Jönköping International Business School and aims at evaluating the socio-economic impact of implementing IT-systems in healthcare. The project consist of several steps, first the development and adaptation of a model to measure innovation effects. In the second step the development of a survey to capture factual impacts and effects. Finally, in the third step to translate the effects into socio-economic terms. The result will help decision makers to identify the achieved benefits and outcomes that the implementation of the system has brought with it.
The objective of the AAL-FOOD project (funded by the AAL Joint Programme and VINNOVA) is to develop e-services that assist elderly in their procurement, preparation and the social construct of eating food to maintain a diverse nutritional intake, and hence stay healthy longer. The project consists of members from Denmark, Italy, Netherlands, Romania and Sweden. The AAL-FOOD project has so far completed collecting user requirements from potential users in Italy, Romania and the Netherlands and identified opportunities for design solutions made available through an IT-platform under development. Service classifications have been identified as well as identification of 13 potential e-services which in turn have been ranked in accordance of technical feasibility and implementation. Here we present preliminary results from on-going evaluation work conducted in the AAL-FOOD project. The evaluation aims at identifying effects of innovations through the offering of e-services directed at elderly within their homes.
One year ago the portal of Medical Data Models (http://medical-data-models.org) was presented as a resource for the scientific community. As of November 2012 there are approximately 3,300 forms with 102,000 items available in the CDISC ODM format. First descriptive analyses regarding form metadata demonstrate the capability of such a repository to identify commonly used medical concepts. Most common items are administrative attributes which indicates that more clinical information are needed to increase the secondary use of data documented within these forms.