ICMCC » Science

Guest editorial: compelling issues in telemedicine

Lodewijk — Tue, 07 May 2013 17:25:56 +0000

Recent and impendent changes resulting from the Health Information Technology for Economic and Clinical Health Act (HITECH) (part of Title XIII of the American Recovery and Reinvestment Act) of 2009 and the Patient Protection and Affordable Care Act (ACA) of 2011 offer unprecedented potential for telemedicine to play a significant role not only in reforming [...]

Patient access to complex chronic disease records on the Internet

Lodewijk — Mon, 15 Apr 2013 18:26:28 +0000

Background Access to medical records on the Internet has been reported to be acceptable and popular with patients, although most published evaluations have been of primary care or office-based practice. We tested the feasibility and acceptability of making unscreened results and data from a complex chronic disease pathway (renal medicine) available to patients over the Internet [...]

Pharmacovigilance Using Clinical Notes

Lodewijk — Sat, 13 Apr 2013 06:42:37 +0000

With increasing adoption of electronic health records (EHRs), there is an opportunity to use the free-text portion of EHRs for pharmacovigilance. We present novel methods that annotate the unstructured clinical notes and transform them into a deidentified patient–feature matrix encoded using medical terminologies. We demonstrate the use of the resulting high-throughput data for detecting drug–adverse [...]

Paper- and computer-based workarounds to electronic health record use at three benchmark institutions

Lodewijk — Tue, 09 Apr 2013 14:50:23 +0000

BACKGROUND: Healthcare professionals develop workarounds rather than using electronic health record (EHR) systems. Understanding the reasons for workarounds is important to facilitate user-centered design and alignment between work context and available health information technology tools. OBJECTIVE: To examine both paper- and computer-based workarounds to the use of EHR systems in three benchmark institutions. METHODS: Qualitative data were collected [...]

Workflow Central

Lodewijk — Mon, 08 Apr 2013 18:11:28 +0000

A little over a year ago, Deaconess Health System in Evansville, Ind., obtained a lofty perch on the digital health I.T. rung-the six-hospital system was named as a HIMSS Stage 7 organization, representing the pinnacle of electronic health record accomplishments. And indeed Deaconess is highly automated, running an Epic suite across both its inpatient and [...]

Crossing the omic chasm: A time for omic ancillary systems

Lodewijk — Thu, 04 Apr 2013 18:28:44 +0000

Despite the information gains from genome-wide association studies and next-generation sequencing (NGS), there remains a chasm between this scientific knowledge and daily clinical practice. Leveraging recent advances in genomics to improve patient care will require electronic health record (EHR) systems that incorporate genomic clinical decision support (CDS). The eMerge (Electronic Medical Records and Genomics) consortium [...]

Patient Experiences With Full Electronic Access to Health Records and Clinical Notes Through the My HealtheVet Personal Health Record Pilot: Qualitative Study

Lodewijk — Thu, 04 Apr 2013 17:59:00 +0000

BACKGROUND: Full sharing of the electronic health record with patients has been identified as an important opportunity to engage patients in their health and health care. The My HealtheVet Pilot, the initial personal health record of the US Department of Veterans Affairs, allowed patients and their delegates to view and download content in their electronic health [...]

Iproving the electronic health record—are clinicians getting what they wished for?

Lodewijk — Fri, 15 Mar 2013 19:12:19 +0000

Pleas for improvement in patient health records date back to Florence Nightingale and have persisted well into the 21st century. Computer-based records, currently referred to as electronic health records (EHRs), have been proposed as a means for improving availability, legibility, and completeness of patient information. EHRs have been commercially available since the 1970s, but their [...]

Putting health it on the path to success

Lodewijk — Thu, 14 Mar 2013 19:01:11 +0000

The promise of health information technology (HIT) is comprehensive electronic patient records when and where needed, leading to improved quality of care at reduced cost. However, physician experience and other available evidence suggest that this promise is largely unfulfilled. Comprehensive records require more than having every physician and hospital use an electronic health record (EHR) system. [...]

A survey analysis suggests that electronic health records will yield revenue gains for some practices and losses for many

Lodewijk — Wed, 06 Mar 2013 19:14:48 +0000

Health care providers remain uncertain about how they will fare financially if they adopt electronic health record (EHR) systems. We used survey data from forty-nine community practices in a large EHR pilot, the Massachusetts eHealth Collaborative, to project five-year returns on investment. We found that the average physician would lose $43,743 over five years; just [...]

Pharmacist-conducted medication reconciliation at hospital admission using information technology in Taiwan

Lodewijk — Tue, 05 Mar 2013 21:00:02 +0000

Objectives Obtaining an accurate medication history upon admission to the hospital can be challenging and time-consuming. This study evaluated the efficacy of a medication reconciliation program, conducted by pharmacists, with the assistance of medication usage data from the Taiwan National Health Insurance (NHI). Characteristics of patients at high risk for drug discrepancies were also determined. [...]

Information overload and missed test results in electronic health record–based settings

Lodewijk — Tue, 05 Mar 2013 20:36:45 +0000

Electronic health record (EHR)-based alerts are often used to notify practitioners of abnormal test results, but follow-up failures (missed results) continue to occur in outpatient settings. In the Department of Veterans Affairs (VA), abnormal test result alerts are generated automatically for prespecified abnormal laboratory values or manually by the interpreting radiologist when an unexpected finding [...]

Types and Origins of Diagnostic Errors in Primary Care Settings

Lodewijk — Thu, 28 Feb 2013 18:50:40 +0000

IMPORTANCE Diagnostic errors are an understudied aspect of ambulatory patient safety. OBJECTIVES To determine the types of diseases missed and the diagnostic processes involved in cases of confirmed diagnostic errors in primary care settings and to determine whether record reviews could shed light on potential contributory factors to inform future interventions. DESIGN We reviewed medical [...]

If We Offer it, Will They Accept? Factors Affecting Patient Use Intentions of Personal Health Records and Secure Messaging

Lodewijk — Wed, 27 Feb 2013 19:46:51 +0000

Background: Personal health records (PHRs) are an important tool for empowering patients and stimulating health action. To date, the volitional adoption of publicly available PHRs by consumers has been low. This may be partly due to patient concerns about issues such as data security, accuracy of the clinical information stored in the PHR, and challenges with [...]

Early Results of the Meaningful Use Program for Electronic Health Records

Lodewijk — Thu, 21 Feb 2013 19:40:07 +0000

In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act established Medicare and Medicaid incentive programs to encourage the adoption of electronic health records (EHRs) by hospitals and eligible professionals. Under Medicare, eligible professionals who show “meaningful use” of certified EHRs are eligible for payments up to $44,000, whereas eligible professionals who [...]

Scaling Up mHealth: Where Is the Evidence?

Lodewijk — Wed, 13 Feb 2013 18:42:42 +0000

Mark Tomlinson and colleagues question whether there is sufficient evidence on implementation and effectiveness to match the wide enthusiasm for mHealth interventions, and propose a global strategy to determine needed evidence to support mHealth scale-up.

The Disparity Information and Communication Technology for Developing Countries has in the Delivery of Healthcare Information

Lodewijk — Fri, 08 Feb 2013 15:48:14 +0000

Information and Communication Technologies (ICT) have merged into the world of healthcare slowly but surely. However, the marriage between the use of technology and its full impact in the health sector has not been fully realised. The focus of this paper is to highlight the impact of ICT on revolutionising access to healthcare information and [...]

Use of Health IT for Higher-Value Critical Care

Lodewijk — Fri, 01 Feb 2013 17:07:02 +0000

The patient had not yet coded but was spiraling downward, prompting a request for a bed in the intensive care unit (ICU). But the ICU had no available beds. Hours passed before the decision was made that another patient could safely be “bumped” out of the unit to accommodate our patient. After the transfer, in [...]

Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA

Lodewijk — Fri, 01 Feb 2013 09:39:05 +0000

In response to mounting evidence that use of electronic medical record systems may cause unintended consequences, and even patient harm, the AMIA Board of Directors convened a Task Force on Usability to examine evidence from the literature and make recommendations. This task force was composed of representatives from both academic settings and vendors of electronic [...]

The Effectiveness of Mobile-Health Technology-Based Health Behaviour Change or Disease Management Interventions for Health Care Consumers: A Systematic Review

Lodewijk — Sat, 26 Jan 2013 18:47:39 +0000

Background Mobile technologies could be a powerful media for providing individual level support to health care consumers. We conducted a systematic review to assess the effectiveness of mobile technology interventions delivered to health care consumers. Methods and Findings We searched for all controlled trials of mobile technology-based health interventions delivered to health care consumers using MEDLINE, EMBASE, PsycINFO, [...]

The Rise of Electronic Health Record Adoption Among Family Physicians

Lodewijk — Tue, 15 Jan 2013 17:10:54 +0000

PURPOSE Realizing the benefits of adopting electronic health records (EHRs) in large measure depends heavily on clinicians and providers’ uptake and meaningful use of the technology. This study examines EHR adoption among family physicians using 2 different data sources, compares family physicians with other office-based medical specialists, assesses variation in EHR adoption among family physicians [...]

Inviting patients to read their doctors’ notes: a quasi-experimental study and a look ahead

Lodewijk — Tue, 15 Jan 2013 15:39:47 +0000

BACKGROUND Little information exists about what primary care physicians (PCPs) and patients experience if patients are invited to read their doctors’ office notes. OBJECTIVE To evaluate the effect on doctors and patients of facilitating patient access to visit notes over secure Internet DESIGN Quasi-experimental trial of PCPs and patient volunteers in a year-long program that provided patients with electronic [...]

Primary care physician shortages could be eliminated through use of teams, nonphysicians, and electronic communication

Lodewijk — Fri, 11 Jan 2013 18:02:04 +0000

Most existing estimates of the shortage of primary care physicians are based on simple ratios, such as one physician for every 2,500 patients. These estimates do not consider the impact of such ratios on patients’ ability to get timely access to care. They also do not quantify the impact of changing patient demographics on the [...]

Protect the patient from whom? When patients contest governmentality and seek more expert guidance

Lodewijk — Thu, 10 Jan 2013 17:56:18 +0000

This article presents findings from an empirical study among patients and professionals involved in a preventive health program at a Danish hospital. It shows how patients enrolled in the program interact with health professionals in ways that challenge assumptions common to governmentality studies of prevention and health promotion. This literature has successfully explored how contemporary [...]

Small Physician Practices In New York Needed Sustained Help To Realize Gains In Quality From Use Of Electronic Health Records

Lodewijk — Tue, 08 Jan 2013 17:43:28 +0000

The 2009 American Recovery and Reinvestment Act spurred adoption of electronic health records (EHRs) in the United States, through such measures as financial incentives to providers through Medicare and Medicaid and regional extension centers, which provide ongoing technical assistance to practices. Yet the relationship between EHR adoption and quality of care remains poorly understood. We [...]

What It Will Take To Achieve The As-Yet-Unfulfilled Promises Of Health Information Technology

Lodewijk — Tue, 08 Jan 2013 17:25:55 +0000

A team of RAND Corporation researchers projected in 2005 that rapid adoption of health information technology (IT) could save the United States more than $81 billion annually. Seven years later the empirical data on the technology’s impact on health care efficiency and safety are mixed, and annual health care expenditures in the United States have [...]

Prevalence of Copied Information by Attendings and Residents in Critical Care Progress Notes

Lodewijk — Sun, 06 Jan 2013 16:31:00 +0000

Objectives: To determine the prevalence and mechanism of copying among ICU physicians using an electronic medical record. Design: Retrospective cohort study. Setting: Medical ICU of an urban, academic medical center. Patients: Two thousand sixty-eight progress notes of 135 patients generated by 62 residents and 11 attending physicians between August 1, 2009, and December 31, 2009. Interventions: None. Measurements and Main Results: EIghty-two percent of all residents [...]

Separate may not be equal: A preliminary investigation of clinical correlates of electronic psychiatric record accessibility in academic medical centers

Lodewijk — Sun, 06 Jan 2013 16:08:50 +0000

Objectives Electronic Medical Records (EMR) have the potential to improve the coordination of healthcare in this country, yet the field of psychiatry has lagged behind other medical disciplines in its adoption of EMR. Methods Psychiatrists at 18 of the top US hospitals completed an electronic survey detailing whether their psychiatric records were stored electronically and accessible [...]

Chapter 13: Mining Electronic Health Records in the Genomics Era

Lodewijk — Fri, 04 Jan 2013 18:35:05 +0000

The combination of improved genomic analysis methods, decreasing genotyping costs, and increasing computing resources has led to an explosion of clinical genomic knowledge in the last decade. Similarly, healthcare systems are increasingly adopting robust electronic health record (EHR) systems that not only can improve health care, but also contain a vast repository of disease and [...]

Successful Implementation of a Telemedicine-Based Counseling Program for High-Risk Patients With Breast Cancer

Lodewijk — Thu, 03 Jan 2013 18:29:36 +0000

An interactive audio and video telemedicine feasibility program was established to provide counseling on breast cancer risk-reducing strategies for underserved, high-risk Alaskan native women through a collaboration among the Alaska Native Medical Center, the Mayo Clinic Breast Clinic, Mayo’s Center for Innovation, and the Alaska Federal Health Care Access Network. The telemedicine model included a [...]

An objective study of the impact of the electronic medical record on outcomes in trauma patients

Lodewijk — Thu, 03 Jan 2013 18:14:04 +0000

It is commonly believed that the electronic medical record (EMR) will improve patient outcomes. However, there is scant published literature to support this claim and no studies in any surgical population. Our hypothesis was that the EMR would not improve objective outcome measures in patients with traumatic injury. Prospectively collected data from our university-based Level [...]

Electronic Health Records: Current Issues in Oncology

Lodewijk — Thu, 03 Jan 2013 17:29:50 +0000

“The electronic world continues to advance in the 21st century. In 2009, the American Recovery and Reinvestment Act (ARRA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act were enacted; in response, hospitals and oncology physician offices have or are implementing electronic health records (EHRs). As with any new technology or process, [...]

Understanding the factors that influence the adoption and meaningful use of social media by physicians to share medical information

Lodewijk — Wed, 02 Jan 2013 19:26:12 +0000

BACKGROUND Within the medical community there is persistent debate as to whether the information available through social media is trustworthy and valid, and whether physicians are ready to adopt these technologies and ultimately embrace them as a format for professional development and lifelong learning. OBJECTIVE To identify how physicians are using social media to share and exchange medical [...]

A semantic-web oriented representation of the clinical element model for secondary use of electronic health records data

Lodewijk — Sat, 29 Dec 2012 15:53:20 +0000

The clinical element model (CEM) is an information model designed for representing clinical information in electronic health records (EHR) systems across organizations. The current representation of CEMs does not support formal semantic definitions and therefore it is not possible to perform reasoning and consistency checking on derived models. This paper introduces our efforts to represent [...]

Primary care practitioners’ views on test result management in EHR-enabled health systems: a national survey

Lodewijk — Sat, 29 Dec 2012 15:41:48 +0000

CONTEXT: Failure to notify patients of test results is common even when electronic health records (EHRs) are used to report results to practitioners. We sought to understand the broad range of social and technical factors that affect test result management in an integrated EHR-based health system. METHODS: Between June and November 2010, we conducted a cross-sectional, web-based [...]

The implications of e-health system delivery strategies for integrated healthcare: Lessons from England

Lodewijk — Sat, 29 Dec 2012 14:43:38 +0000

Purpose This paper explores the implications that different technical strategies for sharing patient information have for healthcare workers and, as a consequence, for the extent to which these systems provide support for integrated care. Methods Four technical strategies were identified and the forms of coupling they made with healthcare agencies were classified. A study was [...]

Electronic Health Records and the Increasing Complexity of Medical Practice: “It Never Gets Easier, You Just Go Faster”

Lodewijk — Sat, 29 Dec 2012 14:16:56 +0000

Electronic health records (EHRs) continue to make physicians’ lives more complicated. Through the EHR, physicians are being asked to take on ever more tasks that were previously done by office staff or are totally new to medical practice. Physicians maintain coded lists of diagnoses, medications, and allergies; enter orders; initiate referrals; fill out billing forms; [...]

Future of electronic health records: implications for decision support

Lodewijk — Mon, 17 Dec 2012 17:44:40 +0000

The potential benefits of the electronic health record over traditional paper are many, including cost containment, reductions in errors, and improved compliance by utilizing real-time data. The highest functional level of the electronic health record (EHR) is clinical decision support (CDS) and process automation, which are expected to enhance patient health and healthcare. The authors [...]

Standardized Functions for Smartphone Applications: Examples from Maternal and Child Health

Lodewijk — Sat, 15 Dec 2012 09:57:01 +0000

Millennium Development Goals (MDGs) are unlikely to be met in most low- and middle-income countries (LMIC). Smartphones and smartphone proxy systems using simpler phones, equipped with the capabilities to identify location/time and link to the web, are increasingly available and likely to provide an excellent platform to support healthcare self-management, delivery, quality, and supervision. Smart [...]

An automated tool for detecting medication overuse based on the electronic health records

Lodewijk — Fri, 14 Dec 2012 15:38:04 +0000

PURPOSE: Medication overuse is a serious concern in healthcare as it leads to increased expenditures, side effects, and morbidities. Identifying overuse is only possible through excluding appropriate indications that are primarily mentioned in unstructured notes. We developed a framework for automatic identification of medication overuse and applied it to proton pump inhibitors (PPIs). METHODS: We first created [...]

Integrating technology into standard weight loss treatment: A randomized controlled trial

Lodewijk — Thu, 13 Dec 2012 17:06:17 +0000

Background A challenge in intensive obesity treatment is making care scalable. Little is known about whether the outcome of physician-directed weight loss treatment can be improved by adding mobile technology. Methods We conducted a 2-arm, 12-month study (October 1, 2007, through September 31, 2010). Seventy adults (body mass index >25 and ≤40 [calculated as [...]

A semantic framework to protect the privacy of Electronic Health Records with non-numerical attributes

Lodewijk — Wed, 12 Dec 2012 16:22:05 +0000

Structured patient data like Electronic Health Records (EHRs) are a valuable source for clinical research. However, the sensitive nature of such information requires some anonymisation procedure to be applied before releasing the data to third parties. Several studies have shown that the removal of identifying attributes, like the Social Security Number, is not enough to [...]

Healthcare information systems: a patient-user perspective

Lodewijk — Wed, 12 Dec 2012 15:57:34 +0000

The user in this paper is not a medical specialist but a real user of healthcare, a patient. The paper starts by looking at the lack of impact of information systems (ISs) in healthcare, examining the causes as published in the literature. An overview of these causes is enriched by the concerns arising from the [...]

Automated Detection and Classification of Type 1 Versus Type 2 Diabetes Using Electronic Health Record Data

Lodewijk — Tue, 11 Dec 2012 10:12:59 +0000

OBJECTIVE To create surveillance algorithms to detect diabetes and classify type 1 versus type 2 diabetes using structured electronic health record (EHR) data. RESEARCH DESIGN AND METHODS We extracted 4 years of data from the EHR of a large, multisite, multispecialty ambulatory practice serving ∼700,000 patients. We flagged possible cases of diabetes using laboratory test results, [...]

Biomedical data privacy: problems, perspectives, and recent advances

Lodewijk — Mon, 10 Dec 2012 18:51:44 +0000

The notion of privacy in the healthcare domain is at least as old as the ancient Greeks. Several decades ago, as electronic medical record (EMR) systems began to take hold, the necessity of patient privacy was recognized as a core principle, or even a right, that must be upheld. This belief was re-enforced as computers [...]

Clinician Perceptions of Pediatric Growth Chart Use and Electronic Health Records in Kentucky

Lodewijk — Sat, 08 Dec 2012 11:21:10 +0000

Background: Growth chart recording is a key component of pediatric care. EHR systems could provide several growth charting functionalities compared to paper methods. To our knowledge, there has been no U.S. study exploring clinicians’ perceptions and practices related to recording of growth parameters as they adapt to electronic methods. Objectives: To explore clinician practices regarding recording growth [...]

Health Information Technology Knowledge and Skills Needed by HIT Employers

Lodewijk — Sat, 08 Dec 2012 10:59:09 +0000

Objective: To evaluate the health information technology (HIT) workforce knowledge and skills needed by HIT employers. Methods: Statewide face-to-face and online focus groups of identified HIT employer groups in Austin, Brownsville, College Station, Dallas, El Paso, Houston, Lubbock, San Antonio, and webinars for rural health and nursing informatics. Results: HIT employers reported needing an HIT workforce with diverse [...]

Approaches to the prevention and management of childhood obesity: The role of social networks and the use of social media and related electronic technologies a scientific statement from the American Heart Association

Lodewijk — Fri, 07 Dec 2012 11:39:20 +0000

Despite the significant attention and resources committed to the prevention and treatment of childhood obesity, the epidemic shows no sign of abating. Although all children are at risk for obesity, there are marked disparities by race/ethnicity, socioeconomic status, neighborhood, and access to health care. Any successful approach to addressing the overall burden of obesity must [...]

Association of Online Patient Access to Clinicians and Medical Records With Use of Clinical Services

Lodewijk — Wed, 05 Dec 2012 09:48:07 +0000

Context Prior studies suggest that providing patients with online access to health records and e-mail communication with physicians may substitute for traditional health care services. Objective To assess health care utilization by both users and nonusers of online access to health records before and after initiation of MyHealthManager (MHM), a patient online access system. Design, [...]

Screening electronic veterans’ health records for medication discontinuation

Lodewijk — Mon, 27 Aug 2012 16:44:10 +0000

Objectives: Determine the viable yield of screening electronic Veterans Health Administration (VHA) records to identify patients who stop taking a long-term medication for reasons that might be addressed by healthcare providers. Study Design: Prospectively screened cohort with mailed follow-up of positive screens. Methods: Electronic healthcare records were screened to identify patients receiving care in a Veterans Administration [...]