Utilization of automated location tracking for clinical workflow analytics and visualization

abstract: The analysis of clinical workflow offers many challenges to clinical stakeholders and researchers, especially in environments characterized by dynamic and concurrent processes. Workflow analysis in such environments is essential for monitoring performance and finding bottlenecks and sources of error. Clinical workflow analysis has been enhanced with the inclusion of modern technologies. One such intervention is automated location tracking which is a system that detects the movement of clinicians and equipment. Utilizing the data produced from automated location tracking technologies can lead to the development of novel workflow analytics that can be used to complement more traditional approaches such as ethnography and grounded-theory based qualitative methods. The goals of this research are to: (i) develop a series of analytic techniques to derive deeper workflow-related insight in an emergency department setting, (ii) overlay data from disparate sources (quantitative and qualitative) to develop strategies that facilitate workflow redesign, and (iii) incorporate visual analytics methods to improve the targeted visual feedback received by providers based on the findings. The overarching purpose is to create a framework to demonstrate the utility of automated location tracking data used in conjunction with clinical data like EHR logs and its vital role in the future of clinical workflow analysis/analytics. This document is categorized based on two primary aims of the research. The first aim deals with the use of automated location tracking data to develop a novel methodological/exploratory framework for clinical workflow. The second aim is to overlay the quantitative data generated from the previous aim on data from qualitative observation and shadowing studies (mixed methods) to develop a deeper view of clinical workflow that can be used to facilitate workflow redesign. The final sections of the document speculate on the direction of this work where the potential of this research in the creation of fully integrated clinical environments i.e. environments with state-of-the-art location tracking and other data collection mechanisms, is discussed. The main purpose of this research is to demonstrate ways by which clinical processes can be continuously monitored allowing for proactive adaptations in the face of technological and process changes to minimize any negative impact on the quality of patient care and provider satisfaction.Dissertation/ThesisDoctoral Dissertation Biomedical Informatics 201

Psychiatric Case Record

Bipolar Disorder-Mania: Patient was apparently normal one-month back, Then all of a sudden he developed sleep disturbances –mainly difficult in initiation of sleep. He also started abusing his family members for unwanted things. Subsequently, he started talking excessively and irritable. Sometimes he sings film songs and dances. He used to say that God Supreme exists in himself and so he has all the powers of Almighty. With that superior power he says that he can solve all the problems in this world. He also says that he has invented herbs to keep people young. For the past one week, he talks excessively without having an hour of sleep & wanders here and there & found excessively smoking. He becomes excessively spiritual and goes to near by villages for offering prayers to God. He takes only a little food everyday and he is very much keen in personal cleanliness. Paranoid Schizophrenia: She was apparently normal 8 months back, then she developed sleep disturbances in the form of difficult in falling asleep. She was found talking & smiling to herself at night & day with mirror gazing. She started saying that her neighbour & relatives are planning to kill herself by poisoning. In this context she had frequent quarrels with them and she refused to take food prepared by her mother in law. She left the home at night without informing any one and started wandering in the road side near her home. She was complaining that she hears voices as if her neighbour & relatives were talking about her among themselves She was not doing house hold activities for past 6 months and she was not taking care of her child. Her personal hygiene was very much deteriorated slowly as she used to take bath & brush, only if she was asked to do so. She started abusing & assaulting the strangers and family members. Generalised Anxiety Disorder: Six months back he was apparently normal. He is working as a system analyst in a private bank . He had once, made a mistake in his bank work for which he was given charges by his employer, followed this event he becomes very tense and afraid whenever his boss called him. He is very cautious that he should not commit any mistakes. Even though he is not doing so, he fears that he may commit some mistake in his work. At that moment he develops palpitation, giddiness, breathlessness, excessive sweating over palms and soles. Slowly these symptoms present through out the day even when he was not in his office, and he could not control his fearfulness. For the past 6 months he didn’t sleep well. His sleep is disturbed by bad dreams. Recurrent Depressive Disorder: Patient was apparently alright 2 months back. Then she developed sleep disturbances particularly early morning awakening, she use to wake up by 3.00 am and use to brood about herself and started crying. She was not doing her domestic work as before, as she felt excess tiredness and use to take frequent rests. She developed poor communication. She had lost her interest in pleasurable activities and was not interested in watching TV, and attending family gatherings. She stayed aloof most of the time & calm, quiet and withdrawn. She was expressing her helplessness and hopelessness about the future. She started to have decline in maintaining self care. 15 days back, she frequently expressed suicidal ideas and she had attempted suicide by hanging herself and was rescued by neighbours. 5 days back, she started talking in an irrelevant manner. She was smiling to self. She was assaulting her family members. She was suspicious that her neighbour had done black magic on her and also saying that people are talking about her. She reported hearing the voice of her neighbour scolding and threatening her. Organic Brain Syndrome – Dementia: Ten months back he was apparently alright. Then his relatives noticed himself frequently misplaces things inside his home. Then he started behaving aggressively. He was beating his wife without reason. He was roaming here and there, running out of home and wandering aimlessly. He was not able to come back home when he goes out. He was brought back to home by his relatives. Slowly he developed fearfulness and tremulousness while he was staying alone. He also started saying that his family members & neighbours were talking about himself, in this context he would make frequent quarrels with them. He also started hearing voices of known male voices abusing himself in third person. He sleeps for few hour only. He is passing urine and motion inside the house. He is asking about his brother and mother-in-law who were expired long back. He behaves abnormally such as pouring water in the plate while eating. And his relatives found the symptoms were worsened by evening. All these symptoms started insidiously, increased in severity through time and attained the present state. No history of loss of appetite / crying spells / suicidal tendencies / convulsions / fever / head injury

Patterns in Chaplain Documentation of Assessments and Interventions, a Descriptive Study

Abstract PATTERNS IN CHAPLAIN DOCUMENTATION OF ASSESSMENTS AND INTERVENTIONS, A DESCRIPTIVE STUDY by Kevin Eugene Adams, MDiv A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University Virginia Commonwealth University, 2015 Diane Dodd-McCue, D.B.A, Department of Patient Counseling There is increasing emphasis on the importance of evidence-based care provided by all disciplines in healthcare. The Electronic Health Record (EHR) is becoming the standard for communicating assessments, plans of care, interventions, and outcomes of patient care. The spiritual care literature demonstrates the importance of assessing religious/spiritual needs and resources and developing plans of care to address the results of such assessment (Anandarajah & Hight, 2001; Borneman, Ferrell, & Puchalski, 2010; Fitchett, 1999; Fitchett & Risk, 2009; H. G. Koenig, 2007). This literature also suggests that addressing religious/spiritual needs of patients and families in the healthcare context can affect healthcare and adherence outcomes. The purpose of this study was to identify patterns of chaplain assessment and patterns of chaplain provision of services. This descriptive study was an exploratory retrospective analysis of categorical data recorded by clinical staff chaplains in the EHR at a single all pediatric healthcare institution, using contingency tables and frequency tables. The study examined chaplain use of assessment and service descriptors and the patterns of these descriptors when documenting chaplain visits. The results indicate chaplain preference for communicating in the EHR using general themes and concepts. This reveals an opportunity for chaplains to develop and implement a model of professional identity and articulation of care that is broad enough to accommodate the diversity of religion/spirituality chaplains encounter, yet able to articulate the specifics of patient and family religion/spirituality. The results found no consistent patterns among assessments or services provided. Further, the results found no indication of patterns between assessments made and the services provided. This presents an opportunity for chaplains to develop and implement a theory-driven, construct-based model of care that will connect the different facets of spiritual care. The assessments made will lead to plans of care that involve specific interventions resulting in appropriate outcomes related to overall patient and family care

Utilizing artificial intelligence in perioperative patient flow:systematic literature review

Abstract. The purpose of this thesis was to map the existing landscape of artificial intelligence (AI) applications used in secondary healthcare, with a focus on perioperative care. The goal was to find out what systems have been developed, and how capable they are at controlling perioperative patient flow. The review was guided by the following research question: How is AI currently utilized in patient flow management in the context of perioperative care? This systematic literature review examined the current evidence regarding the use of AI in perioperative patient flow. A comprehensive search was conducted in four databases, resulting in 33 articles meeting the inclusion criteria. Findings demonstrated that AI technologies, such as machine learning (ML) algorithms and predictive analytics tools, have shown somewhat promising outcomes in optimizing perioperative patient flow. Specifically, AI systems have proven effective in predicting surgical case durations, assessing risks, planning treatments, supporting diagnosis, improving bed utilization, reducing cancellations and delays, and enhancing communication and collaboration among healthcare providers. However, several challenges were identified, including the need for accurate and reliable data sources, ethical considerations, and the potential for biased algorithms. Further research is needed to validate and optimize the application of AI in perioperative patient flow. The contribution of this thesis is summarizing the current state of the characteristics of AI application in perioperative patient flow. This systematic literature review provides information about the features of perioperative patient flow and the clinical tasks of AI applications previously identified

Strategies For Improving Epistasis Detection And Replication

Genome-wide association studies (GWAS) have been extensively critiqued for their perceived inability to adequately elucidate the genetic underpinnings of complex disease. Of particular concern is “missing heritability,” or the difference between the total estimated heritability of a phenotype and that explained by GWAS-identified loci. There are numerous proposed explanations for this missing heritability, but a frequently ignored and potentially vastly informative alternative explanation is the ubiquity of epistasis underlying complex phenotypes. Given our understanding of how biomolecules interact in networks and pathways, it is not unreasonable to conclude that the effect of variation at individual genetic loci may non-additively depend on and should be analyzed in the context of their interacting partners. It has been recognized for over a century that deviation from expected Mendelian proportions can be explained by the interaction of multiple loci, and the epistatic underpinnings of phenotypes in model organisms have been extensively experimentally quantified. Therefore, the dearth of inspiring single locus GWAS hits for complex human phenotypes (and the inconsistent replication of these between populations) should not be surprising, as one might expect the joint effect of multiple perturbations to interacting partners within a functional biological module to be more important than individual main effects. Current methods for analyzing data from GWAS are not well-equipped to detect epistasis or replicate significant interactions. The multiple testing burden associated with testing each pairwise interaction quickly becomes nearly insurmountable with increasing numbers of loci. Statistical and machine learning approaches that have worked well for other types of high-dimensional data are appealing and may be useful for detecting epistasis, but potentially require tweaks to function appropriately. Biological knowledge may also be leveraged to guide the search for epistasis candidates, but requires context-appropriate application (as, for example, two loci with significant main effects may not have a significant interaction, and vice versa). Rather than renouncing GWAS and the wealth of associated data that has been accumulated as a failure, I propose the development of new techniques and incorporation of diverse data sources to analyze GWAS data in an epistasis-centric framework

Strategies Physicians Apply to Value-Based Patient Care for Quality Reimbursement

Low-quality value-based patient care negatively impacts physicians’ ability to maintain private solo practices. Physicians who lack strategies to apply value-based patient care may lose their ability to stay in a private solo practice. Grounded in the complex adaptive system theory, the purpose of this qualitative multiple case study was to explore strategies used by private solo physicians that provided value-based patient care. Participants were four physicians in solo private practice who successfully applied value-based patient care to maintain their private solo practice. Data were collected from semistructured interviews and organizational documents and analyzed using thematic analysis. Three themes emerged: (a) electronic medical record fitness with the physician, (b) sharing of workload to reduce burnout, and (c) choosing the right outsourced billing service. A key recommendation for solo practitioners is to select an EMR system to achieve value-based patient care and correct payer reimbursement. The implications for positive social change include the potential for physicians to improve healthcare delivery to benefit the health, dignity, and quality of life for local citizens

Meducation: A Randomized Controlled Trial of an Online Educational Video Intervention to Improve Glaucoma Eye Drop Technique and Adherence

Glaucoma is the second-leading cause of blindness in the United States. Progression of glaucoma can be prevented by reducing intraocular pressure using eye drop medications, but patients tend to have difficulty instilling eye drops correctly. Short educational videos may be helpful to instruct patients on correct eye drop instillation, but only one small study testing an educational video for glaucoma eye drop technique has been performed to date. Therefore, the objective of this dissertation was to determine the effectiveness of an online video intervention in improving self-efficacy, technique, and adherence to eye drops in glaucoma patients. Ninety-two patients with glaucoma, who self-administered their own eye drops and had less than perfect technique, were enrolled in this pilot randomized controlled trial. They were randomized to watch the Meducation® eye drop technique video in the intervention group, or a nutrition video in the control group. Five eye drop technique steps were assessed using objective video recordings at baseline, immediately after the video, and 1 month later. The secondary outcomes were eye drop technique self-efficacy and medication adherence. Linear regression models were used to determine whether the intervention group had better self-efficacy, technique, and adherence than the control group after adjusting for important covariates. Adjusted for baseline self-efficacy, intervention patients had better eye drop technique self-efficacy than controls immediately after the video (p=0.024) and at 1 month (p=0.015). Adjusted for baseline technique and other covariates, eye drop technique averaged 0.75 steps better in intervention patients than controls immediately after the video (p=0.002) and 0.63 steps better at 1 month (p=0.011). The intervention did not significantly improve adherence. Participants’ mean rating of usefulness of the video was 3.40 on a 4-point scale. Patients’ most preferred method for having access to the intervention was in the doctor’s office exam room, but also desired online options for watching the video. We concluded that a short educational video can significantly improve glaucoma patients’ self-efficacy and eye drop technique. The video should be disseminated in multiple ways: in the exam room when drops are prescribed as well as online.Doctor of Philosoph