A Scalable Parametric-RBAC Architecture for the Propagation of a Multi-modality, Multi-resource Informatics System

2009 ◽  
pp. 114-124 ◽  
Author(s):  
Remo Mueller ◽  
Van Anh Tran ◽  
Guo-Qiang Zhang
Keyword(s):  
Informatics System

scholarly journals FRI0510 THE FREQUENCY OF CONTRACEPTION DOCUMENTATION IN WOMEN ON AND OFF TERATOGENIC ANTI-RHEUMATIC MEDICATIONS IN THE RISE REGISTRY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 853.2-854
Author(s):  
M. Clowse ◽  
J. LI ◽  
M. Birru Talabi ◽  
A. Eudy ◽  
G. Schmajuk
Keyword(s):  
African American Women ◽  
White Women ◽  
Contraceptive Use ◽  
Statistical Significance ◽  
Hormonal Contraceptives ◽  
Research Support ◽  
Informatics System ◽  
Contraceptive Effectiveness ◽  
Highly Effective ◽  
Effective Contraception

Background:Several of the most commonly prescribed medications for women with rheumatic disease are teratogens, posing a risk for pregnancy loss and birth defects if taken in pregnancy. To prevent these life-altering complications, it is important that all women taking teratogenic medications avoid pregnancy through abstinence or contraception.Objectives:We sought to understand the accessibility to contraceptive data within the RISE Registry and to test whether, compared to other women, those prescribed a teratogen would be more likely to have documentation of contraceptive.Methods:Data were derived from Rheumatology Informatics System for Effectiveness (RISE), a national EHR-enabled rheumatology registry that passively collects data on all patients seen by participating practices. As of 2018, RISE held validated data from 1,113 clinicians in 226 practices, representing an estimated 32% of the U.S. clinical rheumatology workforce. Female patients between the ages 18-45 with an anti-rheumatic medication prescribed within the RISE system in 2018 were stratified into one of 3 groups: 1) Any teratogen (methotrexate, mycophenolate, mycophenolic acid, cyclophosphamide, leflunomide, thalidomide, lenalidomide); 2) Only pregnancy-compatible medications (hydroxychloroquine, azathioprine, or a TNF-α inhibitors [TNFi]); and 3) Any medication with unknown teratogenicity (non-TNF biologics and new small molecule medications). We identified the most recent contraceptive medication or device reported in 2018 using structured fields in the EHR. Contraceptive effectiveness was classified as ‘highly effective’ (IUD, Nexplanon, and surgical) and ‘effective’ (oral contraceptives, depo-provera, patch, ring), and unknown (type not reported). Statistical significance was assessed using Stata SE 15.1.Results:In 2018, 110,359 women between the ages of 18-45 were prescribed an anti-rheumatic medication within the RISE Registry. Of these, 11,569 (10.5%) had a contraceptive documented at the last visit. The frequency of contraception documentation varied between practices, ranging from 0% to 28.7% (median 9.2%).Contraception was documented slightly less often in women receiving teratogens (9.8%) compared to women receiving only pregnancy-compatible medications (10.4%, p=0.04) and medications with unknown pregnancy risks (10.0%, p=0.67).The frequency of contraceptive documentation in women prescribed a teratogen varied significantly by race with white women having the highest rate (11.0%) compared to African-American women (7.4%, p<0.001), Hispanic women (5.5%, p<0.001), and Asian women (8.4%, p=0.08).The type of contraceptive documented did not vary significantly between medication group. Highly effective contraception was rarely documented (1.4-1.6%) and moderately-effective hormonal contraceptives were more frequently documented (6.3-8.2%).Conclusion:This study is limited to the analysis of structured fields within the RISE Registry, thereby missing contraceptive documentation within the clinician notes. Increased uniformity in documentation and/or analysis of visit notes will be essential to use the RISE Registry to study the implementation of published contraceptive guidelines. While the documentation of contraception identified in this analysis of the RISE Registry likely under-estimates actual contraceptive use, it reveals important gaps in care. Contrary to what was expected, women prescribed a teratogen were not more likely than other women to have a documented contraceptive. Additionally, important racial disparities in contraception documentation suggest that rheumatologists may not addressing reproductive health needs equally across patient populations.Acknowledgments Disclaimer:This data was supported by the ACR’s RISE Registry. However, the views expressed represent those of the authors, not necessarily those of the ACRDisclosure of Interests:Megan Clowse Grant/research support from: GSK, Pfizer, Consultant of: UCB, Astra-Zeneca, Speakers bureau: UCB, Jing Li: None declared, Mehret Birru Talabi: None declared, Amanda Eudy: None declared, Gabriela Schmajuk Grant/research support from: Pfizer

FRI0524 THE ACR’S RHEUMATOLOGY INFORMATICS SYSTEM FOR EFFECTIVENESS (RISE) REGISTRY SUPPORTS SMALL RHEUMATOLOGY PRACTICES FOR FEDERAL QUALITY REPORTING PROGRAM

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 861-862
Author(s):  
Z. Izadi ◽  
T. Johansson ◽  
J. LI ◽  
G. Schmajuk ◽  
J. Yazdany
Keyword(s):  
Quality Measures ◽  
Quality Reporting ◽  
Practice Characteristics ◽  
Informatics System ◽  
Group Practices ◽  
Status Assessment ◽  
And Performance ◽  
Reporting Programs

Background:The Rheumatology Informatics System for Effectiveness (RISE) Registry was developed by the ACR to help rheumatologists improve quality of care and meet federal reporting requirements. In the current quality program administered by the U.S. Centers for Medicare and Medicaid services, rheumatologists are scored on quality measures, and performance is tied to financial incentives or penalties. Rheumatoid arthritis (RA)-specific quality measures can only be submitted through RISE to federal programs.Objectives:This study used data from the RISE registry to investigate rheumatologists’ federal reporting patterns on five RA-specific quality measures in 2018 and investigated the effect of practice characteristics on federal reporting of these measures.Methods:We analyzed data on all rheumatologists who continuously participated in RISE between Jan 2017 to Dec 2018 and who had patients eligible for at least one RA-specific measure. Five measures were examined: tuberculosis screening before biologic use, disease activity assessment, functional status assessment, assessment and classification of disease prognosis, and glucocorticoid management. We assessed whether or not rheumatologists reported specific quality measures via RISE. We investigated the effect of practice characteristics (practice structure; number of providers; geographic region) on the likelihood of reporting using adjusted analyses that controlled for measure performance (performance in 2018; change in performance from 2017; and performance relative to national average performance). Analyses accounted for clustering by practice.Results:Data from 799 providers from 207 practices managing 213,757 RA patients was examined. The most common practice structure was a single-specialty group practice (53%), followed by solo (28%) and multi-specialty group practice (12%). Most providers (73%) had patients eligible for all five RA quality measures. Federal reporting of quality measures through RISE varied significantly by provider, ranging from no reporting (60%) to reporting all eligible RA measures (12.2%). Reporting through RISE also varied significantly by quality measure and was highest for functional status assessment (36%) and lowest for assessment and classification of disease prognosis (20%). Small practices (1-4 providers) were more likely to report all eligible RA quality measures compared to larger practices (21%, 6%; p<0.001). In adjusted analyses, solo practices were more likely than single-specialty group practices to report RA measures (42%, 31%; p<0.027) while multispecialty group practices were less likely (18%, 31%; p<0.001). Additionally, higher performance in 2018 and performance ≥ the national average performance was associated with federal reporting of the measures through RISE (p≤0.004).Conclusion:Forty percent of U.S. rheumatologists participating in RISE used the registry for federal quality reporting. Physicians using RISE for reporting were disproportionately in small and solo practices, suggesting that the registry is fulfilling an important role in helping these practices participate in national quality reporting programs. Supporting small practices is especially important given the workforce shortages in rheumatology. We observed that practices reporting through RISE had higher measure performance than other participating practices, which suggests that the registry is facilitating quality improvement. Studies are ongoing to further investigate the impact of federal quality reporting programs and RISE participation on the quality of rheumatologic care in the United States.Disclaimer: This data was supported by the ACR’s RISE Registry. However, the views expressed represent those of the authors, not necessarily those of the ACR.Disclosure of Interests:Zara Izadi: None declared, Tracy Johansson: None declared, Jing Li: None declared, Gabriela Schmajuk Grant/research support from: Pfizer, Jinoos Yazdany Grant/research support from: Pfizer

scholarly journals Lessons from Implementing a Combined Workflow-Informatics System for Diabetes Management

2008 ◽  
Vol 15 (4) ◽  
pp. 524-533 ◽  
Author(s):  
A. H. Zai ◽  
R. W. Grant ◽  
G. Estey ◽  
W. T. Lester ◽  
C. T. Andrews ◽  
...  
Keyword(s):  
Diabetes Management ◽  
Informatics System

Hazardous Material Informatics System using Spatial Profiler

2021 ◽  
Author(s):  
Prajeesha . ◽  
Mohit N Bagur ◽  
Pranav Sankar M ◽  
Amrita Ramesh ◽  
Siddhanth Srikanth
Keyword(s):  
Hazardous Material ◽  
Material Informatics ◽  
Informatics System
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