236 research outputs found

    Discrepancies in Written Versus Calculated Durations in Opioid Prescriptions: Pre-Post Study.

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    BACKGROUND: The United States is in the midst of an opioid epidemic. Long-term use of opioid medications is associated with an increased risk of dependence. The US Centers for Disease Control and Prevention makes specific recommendations regarding opioid prescribing, including that prescription quantities should not exceed the intended duration of treatment. OBJECTIVE: The purpose of this study was to determine if opioid prescription quantities written at our institution exceed intended duration of treatment and whether enhancements to our electronic health record system improved any discrepancies. METHODS: We examined the opioid prescriptions written at our institution for a 22-month period. We examined the duration of treatment documented in the prescription itself and calculated a duration based on the quantity of tablets and doses per day. We determined whether requiring documentation of the prescription duration affected these outcomes. RESULTS: We reviewed 72,314 opioid prescriptions, of which 16.96% had a calculated duration that was greater than what wasdocumented in the prescription. Making the duration a required field significantly reduced this discrepancy (17.95% vs 16.21%,P CONCLUSIONS: Health information technology vendors should develop tools that, by default, accurately represent prescription durations and/or modify doses and quantities dispensed based on provider-entered durations. This would potentially reduce unintended prolonged opioid use and reduce the potential for long-term dependence

    Costs of Health IT: Beginning to Understand the Financial Impact of a Dental School EHR

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    Health Information Technology (Health IT) constitutes an integral component of the operations of most academic dental institutions nowadays. However, the expenses associated with the acquisition and the ongoing maintenance of these complex systems have often been buried among costs for other electronic infrastructure systems, distributed across various cost centers including unmeasured central campus support, covered centrally and therefore difficult to quantify, and spread over years, denying school administrators a clear understanding of the resources that have been dedicated to Health IT. The aim of this study was to understand the financial impact of Health IT at four similar U.S. dental schools: two schools using a purchased Electronic Health Record (EHR), and two schools that developed their own EHR. For these schools, the costs of creating (2.5million)andsustaining(2.5 million) and sustaining (174,000) custom EHR software were significantly higher than acquiring (500,000)andsustaining(500,000) and sustaining (121,000) purchased software. These results are based on historical data and should not be regarded as a gold standard for what a complete Health IT suite should cost. The presented data are intended to inform school administrators about the myriad of costs associated with Health IT and give them a point of reference when comparing costs or making estimates for implementation projects

    Methods to Facilitate the Capture, Use, and Reuse of Structured and Unstructured Clinical Data.

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    Electronic health records (EHRs) have great potential to improve quality of care and to support clinical and translational research. While EHRs are being increasingly implemented in U.S. hospitals and clinics, their anticipated benefits have been largely unachieved or underachieved. Among many factors, tedious documentation requirements and the lack of effective information retrieval tools to access and reuse data are two key reasons accounting for this deficiency. In this dissertation, I describe my research on developing novel methods to facilitate the capture, use, and reuse of both structured and unstructured clinical data. Specifically, I develop a framework to investigate potential issues in this research topic, with a focus on three significant challenges. The first challenge is structured data entry (SDE), which can be facilitated by four effective strategies based on my systematic review. I further propose a multi-strategy model to guide the development of future SDE applications. In the follow-up study, I focus on workflow integration and evaluate the feasibility of using EHR audit trail logs for clinical workflow analysis. The second challenge is the use of clinical narratives, which can be supported by my innovative information retrieval (IR) technique called “semantically-based query recommendation (SBQR)”. My user experiment shows that SBQR can help improve the perceived performance of a medical IR system, and may work better on search tasks with average difficulty. The third challenge involves reusing EHR data as a reference standard to benchmark the quality of other health-related information. My study assesses the readability of trial descriptions on ClinicalTrials.gov and found that trial descriptions are very hard to read, even harder than clinical notes. My dissertation has several contributions. First, it conducts pioneer studies with innovative methods to improve the capture, use, and reuse of clinical data. Second, my dissertation provides successful examples for investigators who would like to conduct interdisciplinary research in the field of health informatics. Third, the framework of my research can be a great tool to generate future research agenda in clinical documentation and EHRs. I will continue exploring innovative and effective methods to maximize the value of EHRs.PHDInformationUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/135845/1/tzuyu_1.pd

    The Indiana Chronic Disease Management Program

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    The Indiana Chronic Disease Management Program (ICDMP) is intended to improve the quality and cost-effectiveness of care for Medicaid members with congestive heart failure (chronic heart failure), diabetes, asthma, and other conditions. The ICDMP is being assembled by Indiana Medicaid primarily from state and local resources and has seven components: (1) identification of eligible participants to create regional registries, (2) risk stratification of eligible participants, (3) nurse care management for high-risk participants, (4) telephonic intervention for all participants, (5) an Internet-based information system, (6) quality improvement collaboratives for primary care practices, and (7) program evaluation. The evaluation involves a randomized controlled trial in two inner-city group practices, as well as a statewide observational design. This article describes the ICDMP, highlights challenges, and discusses approaches to its evaluation

    Research Information Management in the United States : Part 1—Findings and Recommendations. Part 2—Case Studies

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    The Research Information Management in the United States two-part report series provides a first-of-its-kind documentation of RIM practices at US research universities that presents a thorough examination of RIM practices, goals, stakeholders, and system components. Research information management (RIM) is a rapidly growing area of investment in US research universities. While RIM practices are mature in Europe and other locales in support of nationalized reporting requirements, RIM practices at US research universities have taken a different—and characteristically decentralized—course. A complex environment characterized by multiple use cases, stakeholders, and systems has resulted. This report provides a landscape overview of the state of research information management in the United States, makes sense of the complexity, and offers recommendations targeted at University leaders and other institutional decision makers. Part 1—Findings and Recommendations This report provides much-needed context for institutional leaders to examine their own local practices by proposing: - A summary of six discrete RIM use cases - A RIM system framework - Recommendations for RIM stakeholders Part 2—Case Studies  This companion report offers an in-depth narrative of the RIM practices at five US research institutions:- Penn State University- Texas A&M University - Virginia Tech- UCLA- University of Miam

    Health Information Technology in the United States, 2008

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    Provides updated survey data on health information technology (HIT) and electronic health records adoption, with a focus on providers serving vulnerable populations. Examines assessments of HIT's effect on the cost and quality of care and emerging issues

    Health Care Leaders\u27 Experiences of Electronic Medical Record Adoption and Use

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    Adoption of electronic medical record (EMR) technology systems of meaningful use has been slow despite the mandate by the U.S. government. The purpose of this single case study was to explore strategies used by health care leaders to implement EMR technology systems of meaningful use to take advantage of federal incentive payments. Diffusion of innovation theory provided the conceptual framework for the study. Semistructured interviews were conducted with 6 health care leaders from a military installation in the Southeast United States. Data were analyzed using software, coding, and inductive analyses. The 3 prominent themes were patient, provider, and champion. Alerts from an EMR technology system can increase providers\u27 awareness and improve patient safety. Providers\u27 involvement in every phase of an EMR system\u27s implementation can improve the adoption rate. Champions play a critical role in successful adoption and implementation of EMR systems. Results of this study may assist health care leaders in implementing EMR systems to take advantage of federal incentive payments. Implications for positive social change include enhanced delivery of safe, high-quality health care

    How do mobile devices support clinical work on hospital wards: an investigation of the selection and use of computing devices

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    The mobile and information intensive nature of clinical work in hospital settings presents a critical challenge: how to provide clinicians with access to information at the time and place of need? This challenge is particularly pertinent to decision-makers responsible for the selection of computing devices. Mobile devices are often promoted as a means to meet this challenge, with existing literature tending to portray the mobility of devices as inherently beneficial. However, evidence to clearly demonstrate how mobile devices support clinical work is limited. This research aimed to generate new knowledge to contribute to answering two significant questions: (i) how do decision-makers select computing devices? and (ii) how do mobile devices support clinical work practices? The research was conducted in two stages. In stage one, interviews were conducted with 28 individuals involved in decisions regarding the selection of computing devices for hospital wards. Decision-makers reported a range of factors that influenced device selection. Role of the user, types of tasks, and location of tasks, for example, were deemed important. In stage two, a mixed methods design comprising structured observations, interviews, and field notes was employed. A sample of 38 clinicians, on two wards of a metropolitan hospital, was observed for 90 hours. In total 4,423 clinical tasks were recorded, capturing key information about tasks doctors and nurses undertake, where, and devices used. The findings provide evidence validating core assumptions about mobile devices: namely, that they support clinicians work by facilitating access to information at patients bedsides. Notably, mobile devices also supported work away from the bedside and whilst clinicians were in transit, allowing continuity in work processes. However, mobile devices did not provide the best fit for all tasks and additional factors, such as the temporal rhythms of the ward and structure of ward round teams, affected how mobile devices supported work. Integration of findings from the two stages resulted in the development of a detailed list of factors that influence the use of mobile devices on hospital wards. This new evidence provides valuable knowledge to guide the selection of computing devices to support, and potentially optimise, clinical work

    Patient Safety and Quality: An Evidence-Based Handbook for Nurses

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    Compiles peer-reviewed research and literature reviews on issues regarding patient safety and quality of care, ranging from evidence-based practice, patient-centered care, and nurses' working conditions to critical opportunities and tools for improvement
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