44,662 research outputs found

    Summarisation and visualisation of e-Health data repositories

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    At the centre of the Clinical e-Science Framework (CLEF) project is a repository of well organised, detailed clinical histories, encoded as data that will be available for use in clinical care and in-silico medical experiments. We describe a system that we have developed as part of the CLEF project, to perform the task of generating a diverse range of textual and graphical summaries of a patient’s clinical history from a data-encoded model, a chronicle, representing the record of the patient’s medical history. Although the focus of our current work is on cancer patients, the approach we describe is generalisable to a wide range of medical areas

    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

    Electronic Health Records and Support For Primary Care Teamwork

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    This study examined primary care practices' experiences using electronic health records (EHRs) as they strive to function as teams in patientcentered medical homes (PCMHs). We identify how EHRs facilitate and pose challenges to teamwork and how practices overcame such challenges. We describe solutions and identify opportunities to improve care processes as well as EHR functionalities and policies, to support teamwork

    Is There an App for That? Electronic Health Records (EHRs) and a New Environment of Conflict Prevention and Resolution

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    Katsh discusses the new problems that are a consequence of a new technological environment in healthcare, one that has an array of elements that makes the emergence of disputes likely. Novel uses of technology have already addressed both the problem and its source in other contexts, such as e-commerce, where large numbers of transactions have generated large numbers of disputes. If technology-supported healthcare is to improve the field of medicine, a similar effort at dispute prevention and resolution will be necessary

    Patient safety in health care professional educational curricula: examining the learning experience

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    This study has investigated the formal and informal ways pre-registration students from four healthcare professions learn about patient safety in order to become safe practitioners. The study aims to understand some of the issues which impact upon teaching, learning and practising patient safety in academic, organisational and practice „knowledge? contexts. In Stage 1 we used a convenience sample of 13 educational providers across England and Scotland linked with five universities running traditional and innovative courses for doctors, nurses, pharmacists and physiotherapists. We gathered examples of existing curriculum documents for detailed analysis, and interviewed course directors and similar informants. In Stage 2 we undertook 8 case studies to develop an in-depth investigation of learning and practice by students and newly qualified practitioners in universities and practice settings in relation to patient safety. Data were gathered to explore the planning and implementation of patient safety curricula; the safety culture of the places where learning and working take place; the student teacher interface; and the influence of role models and organisational culture on practice. Data from observation, focus groups and interviews were transcribed and coded independently by more than one of the research team. Analysis was iterative and ongoing throughout the study. NHS policy is being taken seriously by course leaders, and Patient Safety material is being incorporated into both formal and informal curricula. Patient safety in the curriculum is largely implicit rather than explicit. All students very much value the practice context for learning about patient safety. However, resource issues, peer pressure and client factors can influence safe practice. Variations exist in students? experience, in approach between university tutors, different placement locations – the experience each offers – and the quality of the supervision available. Relationships with the mentor or clinical educator are vital to student learning. The role model offered and the relationship established affects how confident students feel to challenge unsafe practice in others. Clinicians are conscious of the tension between their responsibilities as clinicians (keeping patients safe), and as educators (allowing students to learn under supervision). There are some apparent gaps in curricular content where relevant evidence already exists – these include the epidemiology of adverse events and error, root cause analysis and quality assessment. Reference to the organisational context is often absent from course content and exposure limited. For example, incident reporting is not being incorporated to any great extent in undergraduate curricula. Newly qualified staff were aware of the need to be seen to practice in an evidence based way, and, for some at least, the need to modify „the standard? way of doing things to do „what?s best for the patient?. A number of recommendations have been made, some generic and others specific to individual professions. Regulators? expectations of courses in relation to patient 9 safety education should be explicit and regularly reviewed. Educators in all disciplines need to be effective role models who are clear about how to help students to learn about patient safety. All courses should be able to highlight a vertical integrated thread of teaching and learning related to patient safety in their curricula. This should be clear to staff and students. Assessment for this element should also be identifiable as assessment remains important in driving learning. All students need to be enabled to constructively challenge unsafe or non-standard practice. Encounters with patients and learning about their experiences and concerns are helpful in consolidating learning. Further innovative approaches should be developed to make patient safety issues 'real' for students

    Information Quality in Secondary Use of EHR Data : A Case Study of Quality Management in a Norwegian Hospital

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    The motivation for undertaking this study relates to my experiences from practice in a public hospital, where I have observed variations in reaching organizational goals of quality management informed by electronic health records (EHR) data. For example, while some departments and units have long-time traditions in meeting the quality goals that are set locally, regionally, or nationally, other departments and units struggle to meet the same quality goals. Thus, generating actionable information by reusing routinely collected EHR data does not necessary lead to action in response to the information. This process of generating information from existing EHR data, and communicating and using such information for organizational purposes, may be challenging in a highly complex environment such as health care organizations. Within this process, information quality (IQ) may influence actors’ perceptions of action possibilities the information offers, thus influencing the actual use of the information required to reach organizational goals. EHR data can be used for clinical purposes at the point-of-care (i.e., primary use) and reused for purposes that do not involve patient treatment directly (i.e., secondary use). Examples of such secondary use includes quality management, research, and policy development. Though it is widely accepted that IQ influences the use of EHR systems and the information generated by EHR systems, research on the implications of IQ on health care processes is limited: the focus of the current literature is concerned with defining and assessing IQ in primary use of EHR data, whereas the role of IQ in secondary use of EHR data remains unclear. Thus, this dissertation investigates the role of IQ in secondary use of EHR data in an organizational context. This dissertation addresses this practical and theoretical challenge by focusing on the overall research objective of understanding the role of IQ in secondary use of EHR data. To address this research objective, this dissertation explores the following research questions: RQ1. How do human actors influence in transformation of IQ while generating, communicating, and using information in secondary use of EHR data? RQ2. What are the underlying generative mechanisms through which IQ transforms in the process of secondary use of EHR data?publishedVersio

    Review of Professional Doctorates

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    This review concerns the range and type of Professional Doctorates offered in Ireland and internationally. It looks at their growth, fields of study, structure of programmes and distinctions between them and the PhD
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