The Influence of EHR Components on Admission Decisions

Medical organizations are implementing electronic health record (EHR) systems in order to improve medical decision-making. The goal of this study was to characterize the specific data components that improve the process of medical decision-making in an emergency department (ED). The outcome measures were the decision to admit/discharge a patient, and differences in single-day admission rates with/without EHR IS. A database containing 3.2 million ED referrals from seven main Israeli hospitals was subjected to log file analysis. We found that viewing medical history via the EHR IS significantly affects admission decisions. The data show a reduction in the number of avoidable single-day admissions but an increase in the rate of prolonged admissions. Previous admissions, laboratory tests, imaging and previous surgeries were the most influential information components

The Contribution of Information Technology to Emergency Medicine

Information systems have been adopted in many fields including the healthcare industry. Indeed, keeping abreast of theadvances of the technological age, many medical organizations have invested heavily in information technologies (IT),aiming at improving medical decision-making and increasing its efficiency. Despite their advantages, information systems donot always provide the vital medical information required for medical decision-making, and the decisions may result in adecreased level of quality of care and unnecessary costs.The objective of this research is to evaluate the contribution of IT to decision-makers (physicians) at the point of care ofemergency departments (EDs). We evaluate the contribution of the medical information to medical decisions by using twomethods: the track log-file analysis and an experimental study. Our results lead to the major conclusion that using ITcontributes to increasing the proportion of correct admission decisions

THE IMPACT OF INFORMATION TECHNOLOGY ON ADMISSION DECISIONS

Information systems have been adopted in many fields, no less so in the health industry. Indeed, keeping abreast of the advances of the technological age, many medical organizations have invested heavily in information technologies (IT), aiming at improving medical decision-making and increasing its efficiency. Despite their obvious advantages, the systems do not always immediately provide the vital medical information required for critical decision-making, and the decisions that are based on this partial information may result in a decreased level of quality of care and unnecessary costs. The objective of this research is to evaluate the contribution of IT to decision-makers (physicians) at the point of care of emergency departments (EDs) by investigating whether the information systems (IS) have improved the medical outcomes, in the complex and highly stressful environment of the ED, with time constraints and overcrowding. We evaluated the contribution of the medical information to admission decisions by using two research methods: the track log-file analysis (with statistical tools) and an experimental study. The results were obtained using a unique database containing 3,219,910 referrals to the ED on seven main hospitals in Israel. Our results lead to the major conclusion that viewing medical history contributes to many clinical and admission decisions and clearly reduces the number of avoidable admissions

ADOPTION OF ELECTRONIC HEALTH RECORDS SYSTEM: DIFFERENTIATING MAIN ASSOCIATIONS

Health organizations are implementing health information technologies such as electronic health records (EHR), information systems (IS), and health information exchange (HIE) networks to improve decision-making. However, over the years, the healthcare environment has demonstrated numerous unsuccessful implementations of such technologies. One of the reasons is that physicians tend not to make use of these technologies in the healthcare environment. The various explanations put forward typically refer to patient, physician, and/or work environment-related factors. \ \ This study evaluated the factors associated with the EHR use among physicians in the complex environment of emergency departments. \ \ We used log-files retrieved from an integrative and interoperable EHR that serves Israeli hospitals. We found that EHR was primarily consulted for patients presenting with internal diagnoses, patients of older age, and it was used more by internists than by surgical specialists. Furthermore, EHR usage was larger for admitted patients than for those discharged. \ \ The findings show factors associated with EHR use and suggest that it is mostly related to case-specific features and to physician specialty. The findings strongly suggest that when planning assimilation projects for EHR systems and HIE networks, attention should be paid to those factors associated with system usage. Specifically, in order to increase the efficiency of the system, and enhance its use in the ED environment, physicians´ preferences and practice-related needs need to be taken into account. Furthermore, well-thought IT design and implementation are necessary to generate an increase in meaningful use of HIT, which can serve both physicians´ and patients´ needs

Improving Medical Decision-Making Using Electronic Health Record Systems

This paper evaluates the contribution of an electronic health records (EHR) system to efficient decision-making by physicians, and investigates whether these systems lead to more efficient medical care in emergency departments (ED). Log-files of patient visits and admissions were retrieved from an integrative EHR system that serves seven main hospitals owned by a large health maintenance organization (HMO). This study focused on readmissions within seven days and single-day admissions, problems that concern hospitals around the world. The findings indicate that using an EHR system in the EDs correlates with a decreased number of readmissions within seven days as well as with a reduced number of single-day admissions. The results provide evidence that using EHR system may contribute to efficiency in an ED by assisting decision-making. We believe this is the first data set that investigates the impact of an EHR on hospital efficiency at the scale of HMO

Polycyclodextrin–Clay Composites: Regenerable Dual-Site Sorbents for Bisphenol A Removal from Treated Wastewater

The greatest challenge of wastewater treatment is the removal of trace concentrations of persistent micropollutants in the presence of the high concentration of effluent organic matter (EfOM). Micropollutant removal by sorbents is a common practice, but sorbent employment is often limited because of fouling induced by EfOM and challenging sorbent regeneration. We directly addressed these two issues by designing regenerable dual-site composite sorbents based on polymerized β-cyclodextrin, modified with a cationic group (pCD⁺) and adsorbed to montmorillonite (pCD⁺-MMT). This dual-site composite was tailored to simultaneously target an emerging micropollutant, bisphenol A (BPA), through inclusion in β-cyclodextrin cavities and target anionic EfOM compounds, through electrostatic interactions. The removal of BPA from treated wastewater by the composite was not compromised despite the high removal of EfOM. The composites outperformed many recently reported sorbents. Differences in composite performance was discussed in terms of their structures, as characterized with TGA, XRD, BET and SEM. The simultaneous filtration of BPA and EfOM from wastewater by pCD⁺-MMT columns was demonstrated. Furthermore, successful in-column regeneration was obtained by selectively eluting EfOM and BPA, with brine and alkaline solutions, respectively. Finally, the composites removed trace concentrations of numerous high priority micropollutants from treated wastewater more efficiently than commercial activated carbon. This study highlights the potential to design novel dual-site composites as selective and regenerable sorbents for advanced wastewater treatment

Gossypol-Cross-Linked Boronic Acid-Modified Hydrogels: A Functional Matrix for the Controlled Release of an Anticancer Drug

Anticancer drug gossypol cross-links phenylboronic acid-modified acrylamide copolymer chains to form a hydrogel matrix. The hydrogel is dissociated in an acidic environment (pH 4.5), and its dissociation is enhanced in the presence of lactic acid (an α-hydroxy carboxylic acid) as compared to formic acid. The enhanced dissociation of the hydrogel by lactic acid is attributed to the effective separation of the boronate ester bridging groups through the formation of a stabilized complex between the boronic acid substituent and the lactic acid. Because lactic acid exists in cancer cells in elevated amounts and the cancer cells’ environment is acidic, the cross-linked hydrogel represents a stimuli-responsive matrix for the controlled release of gossypol. The functionality is demonstrated and characterized by rheology and other spectroscopic means