Evaluating diverse electronic consultation programs with a common framework.

BackgroundElectronic consultation is an emerging mode of specialty care delivery that allows primary care providers and their patients to obtain specialist expertise without an in-person visit. While studies of individual programs have demonstrated benefits related to timely access to specialty care, electronic consultation programs have not achieved widespread use in the United States. The lack of common evaluation metrics across health systems and concerns related to the generalizability of existing evaluation efforts may be hampering further growth. We sought to identify gaps in knowledge related to the implementation of electronic consultation programs and develop a set of shared evaluation measures to promote further diffusion.MethodsUsing a case study approach, we apply the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) and the Quadruple Aim frameworks of evaluation to examine electronic consultation implementation across diverse delivery systems. Data are from 4 early adopter healthcare delivery systems (San Francisco Health Network, Mayo Clinic, Veterans Administration, Champlain Local Health Integration Network) that represent varied organizational structures, care for different patient populations, and have well-established multi-specialty electronic consultation programs. Data sources include published and unpublished quantitative data from each electronic consultation database and qualitative data from systems' end-users.ResultsOrganizational drivers of electronic consultation implementation were similar across the systems (challenges with timely and/or efficient access to specialty care), though unique system-level facilitators and barriers influenced reach, adoption and design. Effectiveness of implementation was consistent, with improved patient access to timely, perceived high-quality specialty expertise with few negative consequences, garnering high satisfaction among end-users. Data about patient-specific clinical outcomes are lacking, as are policies that provide guidance on the legal implications of electronic consultation and ideal remuneration strategies.ConclusionA core set of effectiveness and implementation metrics rooted in the Quadruple Aim may promote data-driven improvements and further diffusion of successful electronic consultation programs

Tri-Institutional Library Support: A Lesson in Forced Collaboration

This paper discusses the trials and tribulations of three separate institutional libraries supporting one new graduate-level academic program. In January 2002, a new distance graduate program in Applied Psychology began with technical, administrative, and academic support provided by three separate institutions. While one institution was initially charged with providing the bulk of library services, in reality, libraries at all three have contributed one service or another. The lead library provides remote database access and document delivery, and initially provided electronic reserves. After the first semester and several glitches, electronic reserves were moved to institutional library #2, which was also hosting the course management system. In the fall of 2002, institutional library #3 began to contribute with an information literacy module that has been incorporated into the orientation for all new students

Inovasi Media Pembelajaran Kearsipan Electronik Arsip (E-arsip) Berbasis Microsoft Office Access

Microsoft Office Access (Ms Access) is a database management system which is a Relational Database Management System. The database in Microsoft Access is a set of objects consisting of tables, queries, forms, reports. Archival system is basically to store useful various files for organizations with the specific rules so the files can be found quickly and easily. Therefore; Microsoft Office Access is an appropriate breakthrough to build archival application systems based on Microsoft Office Access. It is not only easy to be operated but also available a package of Microsoft Office program. One of the most important benefits of the database is to facilitate the access to the data. The ease of accessing the data is the implication of the order data since it is the prerequisite of a good database. The database of archiving system is an application or system design which allows the archives storage digitally. The objective of the e-archives application program using Microsoft Access is to facilitate the delivery of material practices of electronic filing (e-archives). The purposes of the scientific study are: (1) to determine the basic concept and scope of Electronic archives (e-archives), (2) To know how to use the media of electronic archives (E-archives) aided Microsoft Office Access in the learning activities for Vocational students of Office Administration program

A modular multipurpose, parameter centered electronic health record architecture

Health Information Technology is playing a key role in healthcare. Specifically, the use of electronic health records has been found to bring about most significant improvements in healthcare quality, mainly as relates to patient management, healthcare delivery and research support. Health record systems adoption has been promoted in many countries to support efficient, high quality integrated healthcare. The objective of this work is the implementation of an Electronic Health Record system based on a relational database. The system architecture is modular and based on the concentration of specific pathology related parameters in one module, therefore the system can be easily applied to different pathologies. Several examples of its application are described. It is intended to extend the system integrating genomic data

Evolving health information technology and the timely availability of visit diagnoses from ambulatory visits: A natural experiment in an integrated delivery system

<p>Abstract</p> <p>Background</p> <p>Health information technology (HIT) may improve health care quality and outcomes, in part by making information available in a timelier manner. However, there are few studies documenting the changes in timely availability of data with the use of a sophisticated electronic medical record (EMR), nor a description of how the timely availability of data might differ with different types of EMRs. We hypothesized that timely availability of data would improve with use of increasingly sophisticated forms of HIT.</p> <p>Methods</p> <p>We used an historical observation design (2004–2006) using electronic data from office visits in an integrated delivery system with three types of HIT: Basic, Intermediate, and Advanced. We calculated the monthly percentage of visits using the various types of HIT for entry of visit diagnoses into the delivery system's electronic database, and the time between the visit and the availability of the visit diagnoses in the database.</p> <p>Results</p> <p>In January 2004, when only Basic HIT was available, 10% of office visits had diagnoses entered on the same day as the visit and 90% within a week; 85% of office visits used paper forms for recording visit diagnoses, 16% used Basic at that time. By December 2006, 95% of all office visits had diagnoses available on the same day as the visit, when 98% of office visits used some form of HIT for entry of visit diagnoses (Advanced HIT for 67% of visits).</p> <p>Conclusion</p> <p>Use of HIT systems is associated with dramatic increases in the timely availability of diagnostic information, though the effects may vary by sophistication of HIT system. Timely clinical data are critical for real-time population surveillance, and valuable for routine clinical care.</p

INOVASI MEDIA PEMBELAJARAN KEARSIPAN ELECTRONIK ARSIP (E-ARSIP) BERBASIS MICROSOFT OFFICE ACCESS

Microsoft Office Access (Ms Access) is a database management system which is a Relational Database Management System. The database in Microsoft Access is a set of objects consisting of tables, queries, forms, reports. Archival system is basically to store useful various files for organizations with the specific rules so the files can be found quickly and easily. Therefore; Microsoft Office Access is an appropriate breakthrough to build archival application systems based on Microsoft Office Access. It is not only easy to be operated but also available a package of Microsoft Office program. One of the most important benefits of the database is to facilitate the access to the data. The ease of accessing the data is the implication of the order data since it is the prerequisite of a good database. The database of archiving system is an application or system design which allows the archives storage digitally. The objective of the e-archives application program using Microsoft Access is to facilitate the delivery of material practices of electronic filing (e-archives). The purposes of the scientific study are: (1) to determine the basic concept and scope of Electronic archives (e-archives), (2) To know how to use the media of electronic archives (E-archives) aided Microsoft Office Access in the learning activities for Vocational students of Office Administration program.</em

Educating the leaders of tomorrow : the library without walls

A description of library services offered to students in distance programs within Canada and Ecuador

A robust digital image watermarking using repetition codes against common attacks

Digital watermarking is hiding the information inside a digital media to protect for such documents against malicious intentions to change such documents or even claim the rights of such documents. Currently the capability of repetition codes on various attacks in not sufficiently studied. In this project, a robust frequency domain watermarking scheme has been implemented using Discrete Cosine Transform (DCT). The idea of this scheme is to embed an encoded watermark using repetition code (3, 1) inside the cover image pixels based on Discrete Cosine Transform (DCT) embedding technique. The proposed methods have undergone several simulation attacks tests in order to check up and compare their robustness against various attacks, like salt and pepper, speckle, compress, Gaussian, image contrast, resizing and cropping attack. The robustness of the watermarking scheme has been calculated using Peak Signal-To-Noise Ratio (PSNR), Mean Squared Error (MSE) and Normalized Correlations (NC). In our experiments, the results show that the robustness of a watermark with repetition codes is much better than without repetition code