Haiti’s National HIV Quality Management Program and the Implementation of an Electronic Medical Record to Drive Improvement in Patient Care

Abstract:This paper presents a model for an electronic medical record which satisfies the requirements for a faithful and structured record of patient care set out in a previous paper in this series. The model underlies the PEN & PAD clinical workstation, and it provides for a permanent, completely attributable record of patient care and the process of medical decision making. The model separates the record into two levels: direct observations of the patient and meta-statements about the use of observations in decision making and the clinical dialogue. The model is presented in terms of “descriptions” formulated in the Structured Meta Knowledge (SMK) formalism, but many of its features are more general than the specific implementation. The use of electronic medical records based on the model for decision support and the analysis of aggregated data are discussed along with potential use of the model in distributed information systems.

Download Full-text

The Patient-centred Oncology Information System – Automating your Oncology Workflow For Optimal Patient Care

European Oncology & Haematology ◽

10.17925/eoh.2012.08.4.206 ◽

2012 ◽

Vol 08 (04) ◽

pp. 206 ◽

Cited By ~ 1

Author(s):

Peter Enever ◽

Keyword(s):

Information System ◽

Radiation Therapy ◽

Patient Care ◽

Medical Record ◽

Electronic Medical Record ◽

Critical Role ◽

Advanced Treatment ◽

Clinical Workflow ◽

Treatment Techniques ◽

Optimal Patient Care

Radiation therapy has become among the safest and most effective methods for treating cancer. Technology continues to play a critical role in managing and supporting advanced treatment techniques and ensuring safer practice. For clinicians, the ability to tailor the technology to meet their specific oncology workflows is a challenge. This article discusses how, by being able to automate clinical workflow in the electronic medical record (EMR), not only delivers greater department efficiency but can help support better outcomes through optimising patient care, before, during and after treatment.

Download Full-text

Assessing the impact of a primary care electronic medical record system in three Kenyan rural health centers

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocv074 ◽

2015 ◽

Vol 23 (3) ◽

pp. 544-552 ◽

Cited By ~ 5

Author(s):

William M Tierney ◽

John E Sidle ◽

Lameck O Diero ◽

Allan Sudoi ◽

Jepchirchir Kiplagat ◽

...

Keyword(s):

Primary Care ◽

Patient Care ◽

Medical Record ◽

Electronic Medical Record ◽

Health Centers ◽

Hiv Care ◽

Record System ◽

Time Motion ◽

Public Health Reporting ◽

The Impact

Objective Efficient, effective health care requires rapid availability of patient information. We designed, implemented, and assessed the impact of a primary care electronic medical record (EMR) in three rural Kenyan health centers. Method Local clinicians identified data required for primary care and public health reporting. We designed paper encounter forms to capture these data in adult medicine, pediatric, and antenatal clinics. Encounter form data were hand-entered into a new primary care module in an existing EMR serving onsite clinics serving patients infected with the human immunodeficiency virus (HIV). Before subsequent visits, Summary Reports were printed containing selected patient data with reminders for needed HIV care. We assessed effects on patient flow and provider work with time-motion studies before implementation and two years later, and we surveyed providers’ satisfaction with the EMR. Results Between September 2008 and December 2011, 72 635 primary care patients were registered and 114 480 encounter forms were completed. During 2011, 32 193 unique patients visited primary care clinics, and encounter forms were completed for all visits. Of 1031 (3.2%) who were HIV-infected, 85% received HIV care. Patient clinic time increased from 37 to 81 min/visit after EMR implementation in one health center and 56 to 106 min/visit in the other. However, outpatient visits to both health centers increased by 85%. Three-quarters of increased time was spent waiting. Despite nearly doubling visits, there was no change in clinical officers’ work patterns, but the nurses’ and the clerks’ patient care time decreased after EMR implementation. Providers were generally satisfied with the EMR but desired additional training. Conclusions We successfully implemented a primary care EMR in three rural Kenyan health centers. Patient waiting time was dramatically lengthened while the nurses’ and the clerks’ patient care time decreased. Long-term use of EMRs in such settings will require changes in culture and workflow.

Download Full-text

Thinking Volume First: Developing a Multifaceted Systematic Approach to Volume Management in Hemodialysis

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358119879776 ◽

2019 ◽

Vol 6 ◽

pp. 205435811987977 ◽

Cited By ~ 1

Author(s):

Daniel Blum ◽

William Beaubien-Souligny ◽

Samuel A. Silver ◽

Ron Wald

Keyword(s):

Medical Record ◽

Electronic Medical Record ◽

Nurse Practitioners ◽

Volume Overload ◽

Management Program ◽

Emergency Department Visits ◽

Volume Status ◽

Sources Of Information ◽

Volume Management ◽

Abnormal Volume

Purpose of review: Volume overload and hypovolemia-induced symptoms are common in the hemodialysis (HD) population and frequently result in emergency department visits and hospitalization. A structured strategy for the reporting, evaluation, and management of disordered volume status may improve clinical outcomes and the patient experience. We developed a new strategy that systematically addresses volume issues by leveraging the electronic medical record, technological adjuncts, and multidisciplinary expertise to institute new processes of care in our HD unit. Sources of information: This initiative was implemented in a unit located in an urban academic hospital where 250 patients receive maintenance HD. This initiative involved a multidisciplinary team of health professionals including physicians, nurse practitioners, social workers, and dieticians. Methods: We generated volume metrics for HD recipients based on routinely collected data from the unit’s electronic medical record. We then engaged stakeholders in a root cause analysis to identify the major causes of abnormal volume metrics locally. We subsequently developed interventions that were designed to address each of the major causes in a pragmatic and sustainable program. Key findings: The final product was a local volume management program with 3 components. First, we integrated volume metric reporting into the routine surveillance bloodwork reports across our unit. This enabled the clinical teams to more easily target patients at risk for volume-related adverse events and provide them with closer surveillance. Those identified with abnormal volume metrics were then evaluated with the use of technologic adjuncts such as lung ultrasound and bioimpedance spectroscopy to complement traditional assessments of volume status. Finally, those with abnormal volume metrics underwent rigorous interdisciplinary review for potential nutritional/social interventions. Limitations: While we report the successful initial implementation of the program within a single center, it remains unclear whether this initiative will lead to meaningful benefits for HD recipients, be readily applicable in other centers, or be sustainable in the long term. Implications: This volume management program will need further evaluation linked to outcome assessment and feasibility in other centers before wider adoption is advocated.

Download Full-text

Effective quality management practices in routine clinical next-generation sequencing

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2015-1190 ◽

2016 ◽

Vol 54 (5) ◽

Cited By ~ 15

Author(s):

Francine B. de Abreu ◽

Jason D. Peterson ◽

Christopher I. Amos ◽

Wendy A. Wells ◽

Gregory J. Tsongalis

Keyword(s):

Next Generation Sequencing ◽

Quality Management ◽

Patient Care ◽

Management Practices ◽

Clinical Laboratory ◽

Management Program ◽

Next Generation ◽

Ion Pgm ◽

Routine Clinical Laboratory ◽

Generation Sequencing

AbstractBackground:Molecular technologies have allowed laboratories to detect and establish the profiles of human cancers by identifying a variety of somatic variants. In order to improve personalized patient care, we have established a next-generation sequencing (NGS) test to screen for somatic variants in primary or advanced cancers. In this study, we describe the laboratory quality management program for NGS testing, and also provide an overview of the somatic variants identified in over 1000 patient samples as well as their implications in clinical practice.Methods:Over the past one-and-a-half years, our laboratory received a total of 1028 formalin-fixed, paraffin-embedded (FFPE) tumor tissues, which consisted of non-small-cell lung carcinomas (NSCLCs), colon adenocarcinomas, glioma/glioblastomas, melanomas, breast carcinomas, and other tumor types. During this time period, we implemented a series of quality control (QC) checks that included (1) pre-DNA extraction, (2) DNA quantification, (3) DNA quality, (4) library quantification, (5) post-emulsification PCR, and (6) post-sequencing metrics. At least 10 ng of genomic DNA (gDNA) were used to prepare barcoded libraries using the AmpliSeq CHPv2. Samples were multiplexed and sequenced on Ion Torrent 318 chips using the Ion PGM System. Variants were identified using the Variant Caller Plugin, and annotation and functional predictions were performed using the Golden Helix SVS.Results:A total of 1005 samples passed QC1–3, and following additional library preparation QC checkpoints, 877 samples were sequenced. Samples were classified into two categories: wild-type (127) and positive for somatic variants (750). Somatic variants were classified into clinically actionable (60%) and non-actionable (40%).Conclusions:The use of NGS in routine clinical laboratory practice allowed for the detection of tumor profiles that are essential for the selection of targeted therapies and identification of applicable clinical trials, contributing to the improvement of personalized patient care in oncology.

Download Full-text