Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe

Quantifying Quality of Life

Describes technological methods and tools for objective and quantitative assessment of QoL Appraises technology-enabled methods for incorporating QoL measurements in medicine Highlights the success factors for adoption and scaling of technology-enabled methods This open access book presents the rise of technology-enabled methods and tools for objective, quantitative assessment of Quality of Life (QoL), while following the WHOQOL model. It is an in-depth resource describing and examining state-of-the-art, minimally obtrusive, ubiquitous technologies. Highlighting the required factors for adoption and scaling of technology-enabled methods and tools for QoL assessment, it also describes how these technologies can be leveraged for behavior change, disease prevention, health management and long-term QoL enhancement in populations at large. Quantifying Quality of Life: Incorporating Daily Life into Medicine fills a gap in the field of QoL by providing assessment methods, techniques and tools. These assessments differ from the current methods that are now mostly infrequent, subjective, qualitative, memory-based, context-poor and sparse. Therefore, it is an ideal resource for physicians, physicians in training, software and hardware developers, computer scientists, data scientists, behavioural scientists, entrepreneurs, healthcare leaders and administrators who are seeking an up-to-date resource on this subject

Quantifying Quality of Life

Describes technological methods and tools for objective and quantitative assessment of QoL Appraises technology-enabled methods for incorporating QoL measurements in medicine Highlights the success factors for adoption and scaling of technology-enabled methods This open access book presents the rise of technology-enabled methods and tools for objective, quantitative assessment of Quality of Life (QoL), while following the WHOQOL model. It is an in-depth resource describing and examining state-of-the-art, minimally obtrusive, ubiquitous technologies. Highlighting the required factors for adoption and scaling of technology-enabled methods and tools for QoL assessment, it also describes how these technologies can be leveraged for behavior change, disease prevention, health management and long-term QoL enhancement in populations at large. Quantifying Quality of Life: Incorporating Daily Life into Medicine fills a gap in the field of QoL by providing assessment methods, techniques and tools. These assessments differ from the current methods that are now mostly infrequent, subjective, qualitative, memory-based, context-poor and sparse. Therefore, it is an ideal resource for physicians, physicians in training, software and hardware developers, computer scientists, data scientists, behavioural scientists, entrepreneurs, healthcare leaders and administrators who are seeking an up-to-date resource on this subject

Models to optimise medication safety in elderly and oncology inpatients

Medication therapy is recognised as a high-risk process. German Federal Ministry of Health has proposed certain measures to ensure an optimal medication process with the aim of reducing medication errors and thereby avoidable risks for the patient in drug therapy. The concept is called medication safety. Its centre of attention is fostering awareness of medication safety among patients, physicians, pharmacists and caregivers, to improve information on medicines and intersectional communication about drug therapy as well as facilitation of medication safety research. A central point represents the need for greater involvement and information of the patient with regard to his medication therapy. The focus of this thesis is to propose models to optimise medication safety in the hospital setting. The first part of the thesis presents a study protocol for multi-professional model to reduce drug-related readmissions in care-dependent elderly. The protocol is based on the foundation of Spirit 2013 statement, which defines standard protocol items for clinical trials. The model recognises the need for safer medication use through the concerted efforts of all caregivers. It has been developed and recently tested in a pilot study. First results showed the model’s tendency toward active collaboration among the ward-based caregivers and outlined a positive impact on medication safety. However, its effectiveness has still to be assessed in a full-scale evaluation with an adequate sample size. The planed evaluation study is an open randomised controlled trial supplemented by a qualitative evaluation of the intervention. During the hospital stay, patients are randomly allocated to either a control or an intervention group. Control group represent current medical standard of care where the intervention represents multi-professional care according to the defined Standard Operating Procedure for this purpose. After the hospital stay, both patient groups are followed up in the same manner for 12 months to assess the long-term efficacy of the model with a patient-relevant outcome – drug-related hospital readmissions. Qualitative assessment in this evaluation study consists of patient interviews at the end of the hospital stay and focus group for care providers after the study intervention time. Integrating qualitative methodologies implies studying individuals in their natural setting to characterise and provide potential explanations for particular events and behaviours. Evaluation of the model using mixed-methods approach should provide a useful example for further improvements of multi-professional complex intervention models and medication safety in Germany. The second part of this thesis presents the model of optimised pharmaceutical care service on the oncology ward and development of a prediction model. It is a pilot study outlined by STROBE and TRIPOD statement. Pharmaceutical care service was assessed in terms of management of drug-related problems (DRPs). The aim was to develop DRP prognostic model. The pharmaceutical care model was further assessed in terms of number, type and risk factors of DRPs leading to intervention, type of intervention provided, and PRO-CTCAE symptom burden and impact on pharmaceutical intervention. The most important measurements were: German PRO-CTCAE core item set (weekly assessment, recall period 7 days, 12 symptom item clusters, three dimensions: frequency, severity, interference), adverse drug reaction risk score on admission, APS-Doc® classification system for drug-related problems and Doku-PIK documentation system for pharmaceutical intervention, both developed for the hospital setting. In the study sample of 101 patients, 46 were women. Average age was 65 years and average stay on the ward was 10 days. The most frequent diagnoses were malignant neoplasm of bronchus or lung, diffuse large B-cell lymphoma and multiple myeloma. On average each patient had two DRPs leading to pharmaceutical intervention. The most common drug-related problems were drug-drug interactions, drug dosage, drug prescription/monitoring, indication and contraindication. The most frequent pharmaceutical interventions were symptom surveillance, information to physicians and nurses, initiated diagnostic tests, stop/pause the drug and change of the drug dose. The most frequently reported PRO-CTCAE symptoms were fatigue, anxiety and sadness, and pain. For 13 patients pharmaceutical recommendations were based on the PRO-CTCAE items. The implementation rate of pharmaceutical recommendations by the ward-based team was 93 %. Poisson regression model was performed to assess risk factors predicting pattern of DRPs leading to pharmaceutical intervention on the oncology ward. In the second step, the regression was used to combine multiple predictors by assigning relative weights to each predictor to obtain a probability of DRP during the stay on the oncology ward. There are two models to be distinguished: the initial or up to 5th day on the study ward, and follow-up model from the 5th day up to 10th day on the study ward. Significant risk factors in the initial model were ECOG performance score, adverse drug reaction risk score and presence of heart failure; in the follow-up model ECOG performance score and presence of renal failure. Prognostic ability of both regression models was assessed with ROC curve showing AUC of 0.777 (95 % CI 0.686 – 0.868, SE 0.046, p < 0.001) and AUC of 0.683 (95 % CI 0.532 – 0.835, SE 0.077, p = 0.033), respectively. Based on the initial regression model, DRP prognostic model has been proposed (AUC of 0.790 (95 % CI 0.697 – 0.883, SE 0.048, p < 0.001), with a scoring system from 0 to 10 and cut off at 5. That means patients with 5 or more points are according to the Initial DRP prognostic model highly probable to experience DRP leading to a pharmaceutical intervention during the five-day stay on oncology ward. The pilot study has showed that cancer patients exhibit many DRPs requiring a pharmaceutical intervention. PRO-CTCAE may support pharmaceutical care on the oncology ward. The high acceptance of the intervention indicates the need of a pharmacist as integrated part of the oncology ward-based team. The initial DRP prognostic model may assist pharmacist to prioritise their service and to optimise their workload. But small study sample and lack of internal validation limits score interpretation, considering current results provisional and calling for the score development and validation in a study with bigger sample size. The approach, however, provides the methodology for further research of the most optimised patient-oriented, quality-driven, outcome-based oncology ward teamwork

Adherence to Antiretroviral Therapy in Adults: A Guide for Trainers

Over the last five years, there has been a rapid change in treatment strategies for HIV infection. With the advent of newer antiretrovirals, treatment has moved from mono-therapy and bi-therapy to triple drug therapy or Highly Active Antiretroviral Therapy. One of the foremost concerns of ARV programs is the ability of people living with HIV/AIDS to maintain near perfect adherence over the long term. To achieve the goal of antiretroviral therapy (ART), undetectable levels of the virus in the blood, patients are required to maintain more than 90–95% adherence. Adherence is defined as a patient’s ability to follow a treatment plan, take medications at prescribed times and frequencies, and follow restrictions regarding food and other medications. This Adherence Training Manual was developed by the Horizons Program of the Population Council for the Antiretroviral Therapy Program in Mombasa, Kenya. It was designed for health workers including physicians, clinical officers, and adherence nurse counselors in ARV programs. It consists of four modules to be conducted over four sessions, which can be conducted as part of a comprehensive ART training program

pHealth 2021. Proc. of the 18th Internat. Conf. on Wearable Micro and Nano Technologies for Personalised Health, 8-10 November 2021, Genoa, Italy

Smart mobile systems – microsystems, smart textiles, smart implants, sensor-controlled medical devices – together with related body, local and wide-area networks up to cloud services, have become important enablers for telemedicine and the next generation of healthcare services. The multilateral benefits of pHealth technologies offer enormous potential for all stakeholder communities, not only in terms of improvements in medical quality and industrial competitiveness, but also for the management of healthcare costs and, last but not least, the improvement of patient experience. This book presents the proceedings of pHealth 2021, the 18th in a series of conferences on wearable micro and nano technologies for personalized health with personal health management systems, hosted by the University of Genoa, Italy, and held as an online event from 8 – 10 November 2021. The conference focused on digital health ecosystems in the transformation of healthcare towards personalized, participative, preventive, predictive precision medicine (5P medicine). The book contains 46 peer-reviewed papers (1 keynote, 5 invited papers, 33 full papers, and 7 poster papers). Subjects covered include the deployment of mobile technologies, micro-nano-bio smart systems, bio-data management and analytics, autonomous and intelligent systems, the Health Internet of Things (HIoT), as well as potential risks for security and privacy, and the motivation and empowerment of patients in care processes. Providing an overview of current advances in personalized health and health management, the book will be of interest to all those working in the field of healthcare today

Implementation Science for Point-of-Care Diagnostics

This book focuses on the application of implementation science methods to enable the rapid uptake and sustainable implementation of new diagnostics into routine health practices to strengthen health systems.Diagnostics are essential for the success of universal health coverage and improved health outcomes. The increased development and deployment of diagnostics for use at the point of care will not guarantee improved access to diagnostics and health outcomes if their implementation is not optimized. Optimal implementation will need to be guided by theories and methods that aim to promote evidence-based practices and findings of research into routine practice, taking into consideration quality systems and contexts

IoT Applications Computing

The evolution of emerging and innovative technologies based on Industry 4.0 concepts are transforming society and industry into a fully digitized and networked globe. Sensing, communications, and computing embedded with ambient intelligence are at the heart of the Internet of Things (IoT), the Industrial Internet of Things (IIoT), and Industry 4.0 technologies with expanding applications in manufacturing, transportation, health, building automation, agriculture, and the environment. It is expected that the emerging technology clusters of ambient intelligence computing will not only transform modern industry but also advance societal health and wellness, as well as and make the environment more sustainable. This book uses an interdisciplinary approach to explain the complex issue of scientific and technological innovations largely based on intelligent computing

The Factors Influencing the Behavioural Intention of Overweight Adults to Use Wearable Devices for Sustained Health Monitoring

The volume of wearable devices that can be used for sustained health monitoring purposes is continuously growing within the healthcare sector. These devices allow users to track their own activity levels in real time. However, there are factors that may inhibit the behavioural intention to sustain the use of wearable devices for health monitoring in the long term by overweight adults. These factors include privacy concerns, costs of obtaining wearable devices, theft, frequent charging and short battery life of wearable devices and bulkiness of some wearable devices. It is against this backdrop that this study examined the factors influencing the behavioural intention of overweight adults in South Africa to make use of wearable devices for sustained health monitoring. This research made use of the Expectation Confirmation Model (ECM) as the theoretical foundation of the study. In achieving the aim of this study, a qualitative research approach was used. The purposive sampling technique was selected to identify twenty (20) overweight adults (aged 18-59 years) who are using wearable devices in East London, South Africa. Interviews were conducted with the twenty participants to identify the factors that will influence their behavioural intention to make use of wearable devices to monitor their health. Through thematic analysis, data provided by participants was grouped and summarised into relevant themes to answer the main research question. The study developed a framework that identifies the factors influencing behavioural intention of overweight adults to continue using wearable devices for sustained health monitoring. The factors that were identified include confirmation, perceived usefulness and satisfaction of wearable devices for sustained health monitoring. The realisation of weight loss, monitoring of daily activities and calories through the use of wearable devices was found to positively influence the behavioural intention of the users of wearable devices to continue their usage. However, the major factors that may inhibit the continuous usage of wearable devices for sustained health monitoring are privacy concerns, costs of obtaining wearable devices, theft, frequent charging and short battery life of wearable devices and bulkiness of some wearable devices. Based on the findings, the study recommended the following: (1) the wearable device manufacturers should assure the users of their privacy and confidentiality by providing the needed ii | P a g e interfaces for this purpose; (2) the manufacturers of wearable devices should make the devices less bulky so that they can be more portable; (3) South African government should provide security operatives in isolated areas where people are not feeling secure; (4) the manufacturers of wearable devices make the purchase prices of wearable devices more affordable, especially for low income people; and (5) the manufacturers of wearable devices should improve on battery life and quality of wearable devices so that the devices are more time efficient and require less charging of the devices