Investigating Evaluation Frameworks for Electronic Health Record: A Literature Review

BACKGROUND: There are various electronic health records (EHRs) evaluation frameworks with multiple dimensions and numerous sets of evaluation measures, while the coverage rate of evaluation measures in a common framework varies in different studies. AIM: This study provides a literature review of the current EHR evaluation frameworks and a model for measuring the coverage rate of evaluation measures in EHR frameworks. METHODS: The current study was a comprehensive literature review and a critical appraisal study. The study was conducted in three phases. In Phase 1, a literature review of EHR evaluation frameworks was conducted. In Phase 2, a three-level hierarchical structure was developed, which includes three aspects, 12 dimensions, and 110 evaluation measures. Subsequently, evaluation measures in the identified studies were categorized based on the hierarchical structure. In Phase 3, relative frequency (RF) of evaluation measures in different dimensions and aspects for each of the identified studies were determined and categorized as follows: Appropriate, moderate, and low coverage. RESULTS: Out of a total of 8276 retrieved articles, 62 studies were considered relevant. The RF range in the second and third level of the hierarchical structure was between 8.6%–91.94% and 0.2%–61%, respectively. “Ease of use” and “system quality” were the most frequent evaluation measure and dimension. Our results indicate that identified studies cover at least one and at most nine evaluation dimensions and current evaluation frameworks focus more on the technology aspect. Almost in all identified studies, evaluation measures related to the technology aspect were covered. However, evaluation measures related to human and organization aspects were covered in 68% and 84% of the identified studies, respectively. CONCLUSION: In this study, we systematically reviewed all literature presenting any type of EHR evaluation framework and analyzed and discussed their aspects and features. We believe that the findings of this study can help researchers to review and adopt the EHR evaluation frameworks for their own particular field of usage

DETERMINE THE IMPORTANT OF KIDNEY TRANSPLANTATION ITEMS IN SELECTED COUNTRIES AND IRAN (APPLICATION REGISTRY)

Introduction: In many cases a kidney transplant is effective treatment for advanced chronic kidney disease and ESRD patients.  There are multiple items to identify candidates for a kidney transplant. So one of the problems, considerable differences in factors, because of the vastness and the variety of factors affecting them.The purpose of this study is to provide a comparative analysis of kidney transplantation items in selected countries and Iran in order to choose the most important items that will be used in iran. Methods: The study was carried out in 2015 using a comparative review method in United States, Australia, Croatia and Iran. The countries have the largest number of kidney transplants on their continent in 2014. Items in two categories (Candidate’s items and Donor’s items) was gathered from last version guidelines and execute delphi rounds and focus group(feasibility) to choose the important criteria in 3 iran’s medical centers. Data analyzed by Excel 2015. Results: Total items of candidate was twenty that five items, including “duration of dialysis”, “blood type”, “previous transplant history”, “age“ and “HLA” were considered as items affecting transplant in all three countries. Iran just included two items (duration of dialysis and blood type). After Delphi rounds and accessibility study, sexteen items were remain to gathering in iran. Total items of donor was thirteen that three items, including  “blood type”, “age“ and “HLA” were considered as items affecting transplant in all three countries. Iran just included 2 items (hepatit and blood type). After Delphi rounds and feasibility study, 11 items were remain to gathering in Iran. Croatia that adherence Euro guideline in kidney transplantation had maximum candidate’s items and United states has maximum donors items that involving in kidney transplantation Conclusion: Kidney transplantation items determine the amount of readiness kidney transplant candidates and the quality of the kidney donor. In iran this items did not intended to be the comparison candidates and just “duration of dialysis” was criterion. While in America, Europe and Australia the readiness of candidate and the quality of the kidney donor is based on the items scoring and matching. One of the deleted items as a result of feasibilty study in Iran was the HLA typing test. Due to the long time and high cost, there is no possibility of collecting it. projected is if Iran involved items in queues waiting for a transplant candidates, they will receive graft survival rate better than before

Systematic extraction of diagnostic data items for common high-risk pregnancies using Delphi technique

Introduction The quality of clinical decisions being made every day by on-call physicians are totally based on the quality of medical information they receive during telephone consultations with residents. Some basic factors such as the right selection of medical items, type and format, and also the volume of such information may highly affect the quality of remote consultations. Therefore, developing a trusted standard model for such clinical communication seems vital. In this research, we used Delphi technique to develop a set of information items in form of clinical decision archetypes to standardize teleconsultation in high-risk pregnancies. Methods A multi-stage cross-sectional study was conducted to exploit the diagnostic items for the most common high-risk pregnancies in three obstetrics and gynecology department of educational hospitals, Mashhad, Iran.      Results Our study revealed eclampsia/preeclampsia, hemorrhage, PROM, pre-term and post-term delivery as the most common high-risk pregnancies in the hospitals being studied. 189 clinically-important items were extracted from scientific references and then hand-filtered to 128 items by the participating gynecology and obstetrics experts. The final items were categorized into five classes including general information, chief complaint / current problem, medical history, clinical examination, and paraclinic tests. Conclusion  In this study, a set of clinical decision archetype was developed to improve the decisions being made in high risk pregnancies

A systematic review on reminder systems in physical therapy

Background: The main goal of physical therapy is to help the patient gain a better health status. Several studies have investigated the use of reminders to prevent such failures on the patients’ side. This article presents a systematic review of the literature concerning reminders in physical therapy. Methods: Databases were searched until May 2017 and literatures were found from April 1992 until 2017. The literature recruitment strategy was based on applying several keywords and Medical Subject Heading (MeSH) combination running against title and abstract, including concepts such as reminder, physical therapy. The finally selected articles were categorized through reminder aspects such as how, who feedback. Data were extracted according to PRISMA guidelines. Results: In 47% of studies, the reminder was sent to the patients, 29% to the physical therapists and 12% to the caretaker team. In 24% of the studies, paper-based letters were main medium for reminders while the rest were various types of media like emails and SMS mobile text messages. 35% of the articles showed positive effects of the reminders. Conclusions: Many reminder methods consisted of SMS, phone calls, letters, emails and notices on the wall were used in physical therapy. Reminders may be used to improve patients' adherence to exercise programs

Surgical Decompression of Thoracic Ossification of the Posterior Longitudinal Ligament through Posterior Approach: A Case Report

Thoracic ossification of the posterior longitudinal ligament (OPLL) is a rare condition that is mainlyaccompanied by cervical OPLL or ossification of thoracic ligamentum flavum. In case of causing neurologicalmanifestations, it is preferred to treat the condition surgically. Several surgical procedures were introduced,including anterior, posterior, or combined approaches. Laminectomy with instrumented fusion is the mostpopular procedure utilized via the posterior approach. A 32-year-old obese woman, who suffered from backpain and weakness in both lower extremities for one month, was referred to our spine outpatient clinic. Imagingrevealed lower thoracic OPLL (T7/T8 & T8/T9 & T9/T10). The posterior longitudinal ligament had a mixedossification pattern (beaked and continuing cylindrical). To maintain thoracic spine stability and prevent futurekyphosis, we performed laminectomy and long segment fixation (T7 to T12). The post-operative neurologicalexamination revealed a considerable increase in muscle strength and significant pain relief

Systematic Design of the Minimum Data Set Storage: An Essential Need to Create Purposed for Archiving

Introduction: Medical records are considered as an essential element of patient’s health care provision. Due to a rising service provision by healthcare centers, there is an increase in the medical record loads as well. It has led to a series of problems‌, such as limited physical space, records wearing and an increased need for resources. Moreover, the most important efficiency of records, which is their application in clinical research, is questioned. In the present study, researchers have presented a model of minimum data sets which helps to index and electronically archive hard-copy records according to the selected data and metadata. Method: This study was an applied research type, conducted in three stages in 2013 via modified Delphi technique. Target population consisted of specialists working in hospitals. As the sample, 8 physicians who were specialists or subspecialists participated in interviews and filled out checklist surveys. The collected data were later analyzed using Excel 2013. Results: The results show that data elements such as “final diagnosis” and “operations and others” were the most common items considered by the physicians in clinical follow up, and most common medical records was “operation’s repots” . Finding significant correlation among physician’s research questions was not possible due to large variety of subjects. Conclusion: The researchers presented a framework of minimum data sets for a purposive archiving of records for clinical and research-based applications. This framework can act as the applied goal setting of the retrieval model based on physicians’ clinical requirements in their medical follow-ups. Furthermore, considering physicians’ needs for accessing records through analyzing their probable requests can provide a possibility of data retrieval in diverse conditions

Prediction models to measure transplant readiness of patients with renal failure: A systematic review

Predicting the future of illness, a patient is facing helps the physicians to choose the best strategy to manage the disease. Models for predicting the readiness of candidates for kidney transplant can be very promising. This study sought to systematically review the predictive models and algorithms that assess the readiness of renal transplant candidates in different countries. This systematic review study was according to PRISMA-P protocol in PubMed and Science Direct databases and general search engines up to March 2017. Eligible studies were those that introduced a model to assess the readiness for renal transplantation of patients with chronic renal failure from cadavers and this assessment led to scoring prioritization or superiority among patients. We found 28 studies from 11 countries that met the search criteria and >50% of them were published from 2015 onward. Of the studies, nine models and algorithms were extracted that included 12 factors. Some models, including the European and Scandinavian models, were used jointly between different countries. All the models had at least four factors, and nearly 90% of the models considered four or five factors to measure kidney transplantation readiness. More than 50% of the models had age, dialysis duration, HLA type, and emergency status factors and, dialysis duration. Predictive models are important for renal transplant because of the significant reduction in number of cadavers and longer wait of candidates for a kidney transplant. Further studies can examine the effect of these models on the survival of the kidney transplant

Usability evaluation of obstetrics and gynecology information system using cognitive walkthrough method

Background and aim: Obstetrics and gynecology information system is a critical component of the HIS in social security organization health centers. The objective of this study was to evaluate the usability of this system using the cognitive walkthrough method. Also, the present study provided a detailed formal description of how the cognitive usability evaluation can be applied and reported for a health care information system. Methods: This study was conducted at the Mashhad University of Medical Sciences' usability lab from March 2016 to June 2017. A two-phase approach was used to conduct the cognitive walkthrough evaluation: preparatory and evaluation. The preparation was done in three stages: first, we investigated users’ capabilities and background knowledge through a semi-structured interview. Second, the evaluation scenario was developed based on the most common tasks in routine workflow of users. Finally, each task was broken down into sequences of actions. In the evaluation phase, three usability experts independently assessed each action using a four-item checklist. Problems were categorized thematically and were reported from three different perspectives: Question-based, Task-based, and Evaluator-based. The data were then analyzed to understand the contribution of each task, along with its mean severity score. Results: Evaluators’ responses were compared and any conflict was resolved in an expert panel. A total of 116 usability problems were identified based on the consensus of the evaluators. Inadequate system feedback was found to be the main source of 43% of the problems, and resulted in users confusion. Conclusion: Since the system was evaluated in its pilot implementation phase, there was an opportunity to prevent future potential usability problems. The use of a mixed quantitative and qualitative approach in this usability study provided a more comprehensive perspective of the system problems. This study provided a detailed description of conducting CW usability evaluation which can be used as a practical guide for future studie

Ranking different factors influencing flight delay

Flight interruption is one of the most important issues in today’s airline industry. Every year, most airlines spend significant amount of money to compensate flight delays. Therefore, it is important to detect important factors influencing on flight delays. This paper presents an empirical investigation to determine important factors on this issue. The study also asks some decision makers to make pairwise comparison and ranks various factors using the art of analytical hierarchy process. The study determines that technical defects and delayed entry were among the most important factors to blame for flight delays. In addition, announcing the postponement, replacement aircraft and path replacement are among the most important decisions facing managers in the aviation industry during the disruption of the flight