5,631 research outputs found

    Developing Targeted Interventions to Advance Maternal Health in a Geographic Medicaid Accountable Care Organization: Lessons From the Implementation of Camden Delivers

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    Through the design and launch of Camden Delivers the Coalition developed targeted interventions within an ACO infrastructure to advance maternal health in a Medicaid-covered population. Key insights from this process include the need to:* Utilize data to understand community need and design interventions around that need* Establish a population health surveillance system to produce actionable data to intervene with a complex population* Institute a tiered intervention system targeted to identified need, and* Leverage and coordinate across existing resources in the community to reduce duplication.Going forward, with the infrastructure developed by the Coalition to collect and review health data, along with the intricate web of community partners and resources, the next step in this program is to enhance feedback loops between partners and to help navigate patients seamlessly between partners during the highly fragmented experience of managing a pregnancy and healthcare during the interconception period. A formal network of communication between patients, case workers, care managers, providers and community resources through more sophisticated use of data and convening will allow us to support vulnerable patients in an even more effective manner. The Coalition looks forward to playing this convener role and working across groups to the end of better care management services and improved health for women of maternal age in Camden

    A conceptual framework and protocol for defining clinical decision support objectives applicable to medical specialties.

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    BackgroundThe U.S. Centers for Medicare and Medicaid Services established the Electronic Health Record (EHR) Incentive Program in 2009 to stimulate the adoption of EHRs. One component of the program requires eligible providers to implement clinical decision support (CDS) interventions that can improve performance on one or more quality measures pre-selected for each specialty. Because the unique decision-making challenges and existing HIT capabilities vary widely across specialties, the development of meaningful objectives for CDS within such programs must be supported by deliberative analysis.DesignWe developed a conceptual framework and protocol that combines evidence review with expert opinion to elicit clinically meaningful objectives for CDS directly from specialists. The framework links objectives for CDS to specialty-specific performance gaps while ensuring that a workable set of CDS opportunities are available to providers to address each performance gap. Performance gaps may include those with well-established quality measures but also priorities identified by specialists based on their clinical experience. Moreover, objectives are not constrained to performance gaps with existing CDS technologies, but rather may include those for which CDS tools might reasonably be expected to be developed in the near term, for example, by the beginning of Stage 3 of the EHR Incentive program. The protocol uses a modified Delphi expert panel process to elicit and prioritize CDS meaningful use objectives. Experts first rate the importance of performance gaps, beginning with a candidate list generated through an environmental scan and supplemented through nominations by panelists. For the highest priority performance gaps, panelists then rate the extent to which existing or future CDS interventions, characterized jointly as "CDS opportunities," might impact each performance gap and the extent to which each CDS opportunity is compatible with specialists' clinical workflows. The protocol was tested by expert panels representing four clinical specialties: oncology, orthopedic surgery, interventional cardiology, and pediatrics

    Addendum to Informatics for Health 2017: Advancing both science and practice

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    This article presents presentation and poster abstracts that were mistakenly omitted from the original publication

    Information Services Annual Report 2017-2018

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    Multisensory legal machines and legal act production

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    This paper expands on the concept of legal machine which was presented first at IRIS 2011 in Salzburg. The research subjects are (1) the creation of institutional facts by machines, and (2) multimodal communication of legal content to humans. Simple examples are traffic lights and vending machines. Complicated examples are computer-based information systems in organisations, form proceedings workflows, and machines which replace officials in organisations. The actions performed by machines have legal importance and draw legal consequences. Machines similarly as humans can be imposed status-functions of legal actors. The analogy of machines with humans is in the focus of this paper. Legal content can be communicated by machines and can be perceived by all of our senses. The content can be expressed in multimodal languages: textual, visual, acoustic, gestures, aircraft manoeuvres, etc. The concept of encapsulatation of human into machine is proposed. Herein humanintended actions are communicated through the machine’s output channel. Encapsulations can be compared with deities and mythical creatures that can send gods’ messages to people through the human mouth. This paper also aims to identify law production patterns by machines

    Maximising the benefits of radio frequency identification technology (RFID) integration in clinical contexts : a linear conduit

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    Radio Frequency Identification Technology (RFIO) has been explored for various process enhancements in clinical contexts, particularly hospitals, for asset tracking. The technology has been accepted in such environments, as it is inexpensive and, in principle, uncomplicated to integrate with other clinical support systems. It is perceived to offer many benefits to currently resource critical/strained clinical environments. This research investigation focuses on the exploitation of the potential of the technology, to enhance processes in clinical environments. In this paper, the researchers aimed to uncover if the technology, as presently deployed, has been able to achieve its potential and, in particular, if it has been fully integrated into processes in a way that maximises the benefits that were perceived. This research is part of a larger investigation that aims to develop a meta-model for integration of RFIO into processes in a form that will maximise benefits that may be achievable in clinical environments. As the first phase of the investigation, the key learning from a clinical context (hospital), which has deployed RFIO and attempted to integrate it into the processes, to enable better efficiencies, is presented in this paper. The case method has been used as a methodological framework. Two clinical contexts (hospitals) are involved in the larger project, which constitutes two phases. In Phase 1, semi structured interviews were conducted with a selected number of participants involved with the RFIO deployment project, before and after, in clinical context 1 (hereinafter named as CCl). The results were then synthesised drawing a set of key learning, from different viewpoints (implementers and users), as reported in this paper. These results outline a linear conduit for a new proposed implementation (CC2). On completion of the phase II, the researchers aim to construct a meta-model for maximising the potential of RFIO in clinical contexts. This paper is limited to the first phase that aims to draw key learning to inform the linear conduit.<br /

    Educating Nurses on Workflow Changes from Electronic Health Record Adoption

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    Workflow issues related to adoption of the electronic health record (EHR) has led to unsafe workarounds, decreased productivity, inefficient clinical documentation and slow rates of EHR adoption. The problem addressed in this quality improvement project was nurses\u27 lack of knowledge about workflow changes due to EHR adoption. The purpose of this project was to identify changes in workflow and to develop an educational module to communicate the changes. This project was guided by both the ADDIE model (analysis, design, development, implementation, and evaluation) and the diffusion of innovations theory. Five stages were involved: process mapping, cognitive walkthrough, eLearning module development, pilot study, and evaluation. The process maps and cognitive walkthrough revealed significant workflow changes particularly in clinical practice guidelines, emergency department treatment plan, and the interdisciplinary care plan. The eLearning module was developed to describe workflow changes using gamification, scenario-based learning, and EHR simulation. The 14-item course evaluation included a 6-point Likert scale and closed- and open-ended questions. A purposive sample of nurses (N = 30) from the emergency department and inpatient care areas were invited to complete the eLearning module and course evaluation. Data were collected until saturation was achieved (n = 15). Descriptive statistics revealed the participants\u27 positive learning experience. This quality improvement project is expected to contribute to positive social change by facilitating the effective use of the new EHR which can improve the quality of patient care, promote patient safety, reduce healthcare costs, and improve patient outcomes

    The complexities of managing historic buildings with BIM

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    Purpose The adoption of building information modelling (BIM) in managing built heritage is an exciting prospect, but one that presents complexities additional to those of modern buildings. If challenges can be identified and overcome, the adoption of historic BIM (HBIM) could offer efficiencies in how heritage buildings are managed. Design/methodology/approach Using Durham Cathedral as a case study, we present the workflows applied to create an asset information model to improve the way this unique UNESCO World Heritage Site is managed, and in doing so, set out the challenges and complexities in achieving an HBIM solution. Findings This study identifies the need for a better understanding of the distinct needs and context for managing historic assets, and the need for heritage information requirements (HIR) that reflect this. Originality/value This study presents first-hand findings based on a unique application of BIM at Durham Cathedral, a UNESCO World Heritage Site. The study provides a better understanding of the challenges and drivers of HBIM adoption across the heritage sector and underlines the need for information requirements that are unique to historical buildings/assets to deliver a coherent and relevant HBIM approach
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