A “Smart” Heart Failure Sheet: Using Electronic Medical Records to Guide Clinical Decision Making

2011 ◽  
Vol 124 (2) ◽  
pp. 118-120 ◽  
Author(s):  
Lisa Battaglia ◽  
Mark D. Aronson ◽  
Naama Neeman ◽  
James D. Chang
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Scott Laing ◽  
Jay Mercer

Abstract Background Electronic medical records are widely used in family practices across Canada and can improve health outcomes. However, recent reports indicate that physicians using electronic medical records work longer and have less direct patient contact which may contribute to burnout. Therefore, new and innovative digital tools are essential to reduce physician workloads and improve patient-physician interaction to address physician burnout. The objective of this study was to assess the efficiency and accuracy of clinical decision-making when using a new preventive care point-of-care clinical decision support system (CDSS). An estimate of the potential annual time savings was also determined. This study also assessed physician reported perceived usefulness and ease of use of the CDSS. Methods Quantitative and qualitative data were collected during this study. Each participant evaluated two simulated patient charts and identified which preventive care metrics were due. The participants recorded their decisions and the time required to assess each chart. Participants then completed a Technology Acceptance Model survey regarding the perceived usefulness and ease of use of the CDSS, which included qualitative feedback. The amount of time saved was determined and participants’ clinical decision-making accuracy was scored against current Canadian preventive care guidelines. The number of preventive care specific visits completed per year was determined using clinic billing data. Results The preventive care CDSS saved an average of 195.7 s of chart review time (249.5 s vs 445.2 s; P < 0.001). A total of 1520 preventive visits were performed at Primrose and Bruyère Family Medicine Centres. Extrapolated across the organization, implementation of the new tool could save 82.6 h per year. Decision-making accuracy was not affected by the new tool (78.4% vs 80.9%, P > 0.05). Participants rated the perceived ease of use and usefulness to be very high. Conclusions New digital tools may reduce providers’ workload without impacting clinical decision-making accuracy. Participants indicated that the preventive care CDSS was useful and easy to use. Further software development and clinical studies are required to further improve and characterize the effect this new CDSS has when implemented in clinical practice.


2019 ◽  
pp. 1565-1579
Author(s):  
Kostas Giokas ◽  
Charalampos Tsirmpas ◽  
Athanasios Anastasiou ◽  
Dimitra Iliopoulou ◽  
Vassilia Costarides ◽  
...  

Chronic diseases are the leading cause of mortality and morbidity. A significant contribution to the burden of chronic diseases is the concurrence of co-morbidities. Heart failure (HF) is a complex, chronic medical condition frequently associated with co-morbidities. The current care approach for HF patients with co-morbidities is neither capable to deliver personalised care nor to halt the on-going increase of its socio-economic burden. Our approach aims to improve the complete care process for HF patients and related co-morbidities to improve outcome and quality of life. This will be achieved by the proposed standardised yet personalised patient-oriented ICT system that supports evidence-based clinical decision making as well as interaction and communication between all stakeholders with focus on the patients and their relatives to improve self-management. We propose that such a system should be build upon a novel European-wide data standard for clinical input and outcome and that it should facilitate decision making and outcome tracking by new collective intelligence algorithms.


2011 ◽  
pp. 1017-1029
Author(s):  
William Claster ◽  
Nader Ghotbi ◽  
Subana Shanmuganathan

There is a treasure trove of hidden information in the textual and narrative data of medical records that can be deciphered by text-mining techniques. The information provided by these methods can provide a basis for medical artificial intelligence and help support or improve clinical decision making by medical doctors. In this paper we extend previous work in an effort to extract meaningful information from free text medical records. We discuss a methodology for the analysis of medical records using some statistical analysis and the Kohonen Self-Organizing Map (SOM). The medical data derive from about 700 pediatric patients’ radiology department records where CT (Computed Tomography) scanning was used as part of a diagnostic exploration. The patients underwent CT scanning (single and multiple) throughout a one-year period in 2004 at the Nagasaki University Medical Hospital. Our approach led to a model based on SOM clusters and statistical analysis which may suggest a strategy for limiting CT scan requests. This is important because radiation at levels ordinarily used for CT scanning may pose significant health risks especially to children.


2018 ◽  
Vol 10 (3) ◽  
pp. e26-e26 ◽  
Author(s):  
Paul Taylor ◽  
Miriam J Johnson ◽  
Dawn Wendy Dowding

ObjectivesTo improve the ability of clinical staff to recognise end of life in hospital inpatients dying as a result of cancer and heart failure, and to generate new hypotheses for further research.MethodsThis mixed-methods study used decision theory as a theoretical basis. It involved a parallel databases-convergent design, incorporating findings from previously published research, with equal priority to study groups and synthesis by triangulation. The individual arms were (1) a retrospective cohort study of 102 patients with cancer and 81 patients with heart failure in an acute trust in the North of England, and(2) a semistructured interview study of 19 healthcare professionals caring for the same patient groups.ResultsThe synthesis of findings demonstrated areas of agreement, partial agreement, silence and dissonance when comparing the cohort findings with the interview findings. Trajectories of change are identified as associated with poor prognosis in both approaches, but based on different parameters. Management of patients has a significant impact on decision-making. The decision process requires repeated, iterative assessments and may benefit from a multidisciplinary approach. Uncertainty is a defining characteristic of the overall process, and objective parameters only have a limited role in predicting end of life.ConclusionsThe role of uncertainty is important as a trigger for discussions and a defined stage in a patient’s illness journey. This is consistent with current approaches to recognising irreversible deterioration in those with serious illness. This study contributes ongoing evidence that these concepts are vital for decision-making.


2020 ◽  
Vol 10 (11) ◽  
pp. 784
Author(s):  
Peihao Fan ◽  
Xiaojiang Guo ◽  
Xiguang Qi ◽  
Mallika Matharu ◽  
Ravi Patel ◽  
...  

Around 800,000 people worldwide die from suicide every year and it’s the 10th leading cause of death in the US. It is of great value to build a mathematic model that can accurately predict suicide especially in high-risk populations. Several different ML-based models were trained and evaluated using features obtained from electronic medical records (EMRs). The contribution of each feature was calculated to determine how it impacted the model predictions. The best-performing model was selected for analysis and decomposition. Random forest showed the best performance with true positive rates (TPR) and positive predictive values (PPV) of greater than 80%. The use of Aripiprazole, Levomilnacipran, Sertraline, Tramadol, Fentanyl, or Fluoxetine, a diagnosis of autistic disorder, schizophrenic disorder, or substance use disorder at the time of a diagnosis of both PTSD and bipolar disorder, were strong indicators for no SREs within one year. The use of Trazodone and Citalopram at baseline predicted the onset of SREs within one year. Additional features with potential protective or hazardous effects for SREs were identified by the model. We constructed an ML-based model that was successful in identifying patients in a subpopulation at high-risk for SREs within a year of diagnosis of both PTSD and bipolar disorder. The model also provides feature decompositions to guide mechanism studies. The validation of this model with additional EMR datasets will be of great value in resource allocation and clinical decision making.


2019 ◽  
Vol 29 (3) ◽  
pp. 513-521
Author(s):  
Jose A. Delgado Rodríguez ◽  
Maria I. Pastor García ◽  
Cristina Gómez Cobo ◽  
Antonia R. Pons Más ◽  
Isabel Llompart Alabern ◽  
...  

Introduction: Communication of laboratory critical risk results is essential for patient safety, as it allows early decision making. Our aims were: 1) to retrospectively evaluate the current protocol for telephone notification of critical risk results in terms of rates, efficiency and recipient satisfaction, 2) to assess their use in clinical decision making and 3) to suggest alternative tools for a better assessment of notification protocols. Materials and methods: The biochemical critical risk result notifications reported during 12 months by routine and STAT laboratories in a tertiary care hospital were reviewed. Total number of reports, time for the notification and main magnitudes with critical risk results were calculated. The use of notifications in clinical decision making was assessed by reviewing medical records. Satisfaction with the notification protocol was assessed through an online questionnaire to requesting physicians and nurses. Results: Critical result was yielded by 0.1% of total laboratory tests. Median time for notification was 3.2 min (STAT) and 16.9 min (routine). The magnitudes with a greater number of critical results were glucose and potassium for routine analyses, and troponin, sodium for STAT. Most notifications were not reflected in the medical records. Overall mean satisfaction with the protocol was 4.2/5. Conclusion: The results obtained indicate that the current protocol is appropriate. Nevertheless, there are some limitations that hamper the evaluation of the impact on clinical decision making. Alternatives were proposed for a proper and precise evaluation.


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