Efficient Decision Support Systems

This series is directed to diverse managerial professionals who are leading the transformation of individual domains by using expert information and domain knowledge to drive decision support systems (DSSs). The series offers a broad range of subjects addressed in specific areas such as health care, business management, banking, agriculture, environmental improvement, natural resource and spatial management, aviation administration, and hybrid applications of information technology aimed to interdisciplinary issues. This book series is composed of three volumes: Volume 1 consists of general concepts and methodology of DSSs; Volume 2 consists of applications of DSSs in the biomedical domain; Volume 3 consists of hybrid applications of DSSs in multidisciplinary domains. The book is shaped decision support strategies in the new infrastructure that assists the readers in full use of the creative technology to manipulate input data and to transform information into useful decisions for decision makers

The Anesthesia Continuing Education Market and the Value Creation From a Sustainable Unified Platform

Practicing anesthesia professionals in the United States are all governed by various profession-specific regulatory bodies that mandate continuing education (CE) requirements. To date, no unified resource exists for anesthesia professionals (i.e., Anesthesiologists, Certified Registered Nurse Anesthetists, and Anesthesiologist Assistants) to explore the CE offerings available within the marketplace. This study endeavored to convey the potential value of a unified anesthesia CE resource. It investigated how to cultivate a sustainable platform to potentially improve how anesthesia professionals search available CE offerings and to potentially enhance how anesthesia CE providers reach anesthesia professionals. This qualitative study was conducted utilizing an integrative review of the literature. The key concepts identified and investigated were network effect, segmentation, first to market, best of breed, search costs, transaction costs, minimally viable product, evolutionary phases of platforms, platform theory, platform business model, platform economy, and types of platforms. Inductive content analysis was chosen as the organizational method for the resultant qualitative data. The goal of the analysis was to create a conceptual, practical, and strategically applicable platform paradigm for the anesthesia CE marketplace driven by the insights and amalgamations from the literature. The analyzed concepts, dimensions, and indicators of platform successes and their applications potentially facilitate anesthesia professionals’ CE explorations and CE providers’ marketing efforts, as well as contextualize the overarching impacts and implications onto the anesthesia CE industry and beyond. The conclusion portrays these impacts and implications

Improving the Perioperative Experience of Patients and Families in a Pediatric Setting

Practice Problem: The experience of surgery for pediatric patients and their families can be dependent on multiple factors including adequate preparation, English language proficiency and realistic expectations. Anxiety can contribute to a negative experience that may result in poor outcomes and a damaging reflection of the healthcare team and organization. PICOT: The PICOT question that guided this project was: In preoperative pediatric patients and their families, how do therapeutic communication style and the provision of information about the perioperative experience affect their healthcare experience over eight weeks? Evidence: A multi-modal approach to providing tailored preoperative education for the child and the parent can improve their perioperative experience. The practice of sitting with patient has demonstrated improved satisfaction scores by enhancing therapeutic communication, enabling active listening and improving trust between clinicians and patients. Intervention: A bundle to improve pediatric perioperative patient’s experience included the provision of a five minute, animated, educational video offered in English and Spanish and implementing sitting between clinicians and patients and families during all interactions. Outcome: An analysis of the patient experience data reflected a decreased gap between the experiences of the English and Spanish language groups that was statistically significant. Clinical significance was demonstrated by qualitative data regarding enhanced communication from patients during the implementation period. Conclusion: This project successfully addressed the health disparities that are prevalent for pediatric perioperative patients and families and closed the gap of experience between English and Spanish language preferred groups

Integrating E-Calcutron into the Anesthesia Clinical Settings to Reduce Potential Medical Calculation Errors Among Student Registered Nurse Anesthetists

Student registered nurse anesthetists (SRNAs) are educated in nurse anesthesia programs so they can one day become certified registered nurse anesthetists (CRNAs). Through the training program, SRNAs work in the anesthesia setting to apply what they learn from the classroom setting. Chipas and Mckenna (2011) found that SRNAs are more stressed than CRNAs. Melius (2012) looked at math anxiety and found a correlation between high math anxiety and poor math performance in nurses. Stress and math anxiety can cause poor math performance (Caviola, Carey, Mammarella, & Szucs, 2017). In the anesthesia clinical setting, stress and math anxiety may cause negative consequences for patients in the form of the wrong dose of medication being administered. This doctoral project created an automated medical calculation spreadsheet on Microsoft Excel. The spreadsheet is called E-Calcutron. E-Calcutron was created to aid SRNAs in calculating weight-based anesthesia medications and to improve patient safety. The investigator gave a presentation on stress, math anxiety, and E-Calcutron to SRNAs enrolled in a nurse anesthesia program in Mississippi. A pre and post-education questionnaire was utilized to gain feedback from SRNAs who participated in the study. The findings were that a majority of SRNAs sampled experienced math anxiety, and a majority of the SRNAs were experiencing stress in the clinical setting. Other findings were that the majority of SRNAs sampled indicated that E-Calcutron could help decrease medical calculation errors, stress levels, and math anxiety; and that the program should be integrated into the anesthesia clinical so SRNAs could use the program. E-Calcutron has the potential to increase patient safety by potentially decreasing dosage errors among SRNAs

25th International Congress of the European Association for Endoscopic Surgery (EAES) Frankfurt, Germany, 14-17 June 2017 : Oral Presentations

Introduction: Ouyang has recently proposed hiatal surface area (HSA) calculation by multiplanar multislice computer tomography (MDCT) scan as a useful tool for planning treatment of hiatus defects with hiatal hernia (HH), with or without gastroesophageal reflux (MRGE). Preoperative upper endoscopy or barium swallow cannot predict the HSA and pillars conditions. Aim to asses the efficacy of MDCT’s calculation of HSA for planning the best approach for the hiatal defects treatment. Methods: We retrospectively analyzed 25 patients, candidates to laparoscopic antireflux surgery as primary surgery or hiatus repair concomitant with or after bariatric surgery. Patients were analyzed preoperatively and after one-year follow-up by MDCT scan measurement of esophageal hiatus surface. Five normal patients were enrolled as control group. The HSA’s intraoperative calculation was performed after complete dissection of the area considered a triangle. Postoperative CT-scan was done after 12 months or any time reflux symptoms appeared. Results: (1) Mean HSA in control patients with no HH, no MRGE was cm2 and similar in non-complicated patients with previous LSG and cruroplasty. (2) Mean HSA in patients candidates to cruroplasty was 7.40 cm2. (3) Mean HSA in patients candidates to redo cruroplasty for recurrence was 10.11 cm2. Discussion. MDCT scan offer the possibility to obtain an objective measurement of the HSA and the correlation with endoscopic findings and symptoms. The preoperative information allow to discuss with patients the proper technique when a HSA[5 cm2 is detected. During the follow-up a correlation between symptoms and failure of cruroplasty can be assessed. Conclusions: MDCT scan seems to be an effective non-invasive method to plan hiatal defect treatment and to check during the follow-up the potential recurrence. Future research should correlate in larger series imaging data with intraoperative findings

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

Applications of Automated Identification Technology in EHR/EMR

Although both the electronic health record (EHR) and the electronic medical record (EMR) store an individuals computerized health information and the terminologies are often used interchangeably, there are some differences between them. Three primary approaches in Automated Identification Technology (AIT) are barcoding, radio frequency identification (RFID), and biometrics. In this paper, technology intelligence, progress, limitations, and challenges of EHR/EMR are introduced. The applications and challenges of barcoding, RFID, and biometrics in EHR/EMR are presented respectively

Information Systems and Healthcare XXXIV: Clinical Knowledge Management Systems—Literature Review and Research Issues for Information Systems

Knowledge Management (KM) has emerged as a possible solution to many of the challenges facing U.S. and international healthcare systems. These challenges include concerns regarding the safety and quality of patient care, critical inefficiency, disparate technologies and information standards, rapidly rising costs and clinical information overload. In this paper, we focus on clinical knowledge management systems (CKMS) research. The objectives of the paper are to evaluate the current state of knowledge management systems diffusion in the clinical setting, assess the present status and focus of CKMS research efforts, and identify research gaps and opportunities for future work across the medical informatics and information systems disciplines. The study analyzes the literature along two dimensions: (1) the knowledge management processes of creation, capture, transfer, and application, and (2) the clinical processes of diagnosis, treatment, monitoring and prognosis. The study reveals that the vast majority of CKMS research has been conducted by the medical and health informatics communities. Information systems (IS) researchers have played a limited role in past CKMS research. Overall, the results indicate that there is considerable potential for IS researchers to contribute their expertise to the improvement of clinical process through technology-based KM approaches