India Antimicrobial Stewardship and Resistance (INTEREST): A Needs Assessment Survey

Background: The emergence and spread of antimicrobial resistance is a major problem in India with significant knowledge on whether this is a systems–based, prescriber and patient characteristic based or diagnostic technologies–based issue. Methods: An electronic survey was sent to select distribution list of intensive care units (ICU) and hospital inpatient (medicine ward) providers from India. Survey questions included antimicrobial clinical practice data, access to electronic medical records, microbiological diagnostic techniques, and access to microbiology data. The survey focused on antimicrobial prescription trends and their association with diagnostic techniques. Results: There were 90 responses from 18 states in 65 ZIP codes. They had median of 187.5 beds (IQR, 40–470). Representative responders had a median age of 40 years (IQR, 31–53). Among the responders, 73 (81%) were men. Of the 90 responses, 48 providers (52%) practiced solely in ICUs (medical and surgical) and 40 providers (45%) practiced solely on the medical ward or floor, with the rest practicing in other units. In total, 31 centers (34%) reported full access to electronic medical records, and 53 centers (59%) had access to wi-fi or Internet. Interestingly, 27 centers (30%) needed to use personal provider phone data for Internet access. Only 26 centers (29%) had electronic microbiological data. Also, 63 respondents (70%) agreed to de-escalation behavior after receiving microbiological data. In addition, 55 respondents (61%) agreed that patients have easy access to outpatient antibiotics without an appropriate prescription, over the counter. Furthermore, 58 responders (64%) said that antibiotic resistance was a major problem at their center, and 61 responders (68%) were familiar with antimicrobial stewardship programs. Among the centers, 69 (77%) had no access to formal infectious disease programs at their center. Only 27 centers (30%) had a formal Clostridium difficile–associated infection reporting and control program. Only 28 centers (31%) had a formal occupational health program. Conclusions: In a large-scale, semistructured, online survey, most issues related to easy availability of antibiotics and lack of “electronization” of medical and microbiological records. It was reassuring that most providers expressed knowledge of the existing antimicrobial stewardship program.Funding: NoneDisclosures: None

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Effect of Communication Errors During Calls to an Antimicrobial Stewardship Program

Infection Control and Hospital Epidemiology ◽

10.1086/523861 ◽

2007 ◽

Vol 28 (12) ◽

pp. 1374-1381 ◽

Cited By ~ 27

Author(s):

Darren R. Linkin ◽

Neil O. Fishman ◽

J. Richard Landis ◽

Todd D. Barton ◽

Steven Gluckman ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Medical Records ◽

Academic Medical Center ◽

Patient Data ◽

Antimicrobial Stewardship Program ◽

Stewardship Program ◽

Prior Approval ◽

Increased Risk ◽

Telephone Calls ◽

Microbiological Data

Objective.To determine how inaccurate communication of patient data by clinicians in telephone calls to the prior-approval antimicrobial stewardship program (ASP) staff affects the incidence of inappropriate antimicrobial recommendations made by ASP practitioners.Design.A retrospective cohort design was used. The accuracy of the patient data communicated was evaluated against patients' medical records to identify predetermined, clinically significant inaccuracies. Inappropriate antimicrobial recommendations were defined having been made if an expert panel unanimously rated the actual recommendations as inappropriate after reviewing vignettes derived from inpatients' medical records.Setting.The setting was an academic medical center with a prior-approval ASP.Patients.All inpatient subjects of ASP prior-approval calls were eligible for inclusion.Results.Of 200 ASP telephone calls, the panel agreed about whether or not antimicrobial recommendations were inappropriate for 163 calls (82%); these 163 calls were then used as the basis for further analyses. After controlling for confbunders, inaccurate communication was found to be associated with inappropriate antimicrobial recommendations (odds ratio [OR], of 2.2; P = .03). In secondary analyses of specific data types, only inaccuracies in microbiological data were associated with the study outcome (OR, 7.5; P = .002). The most common reason panelists gave for rating a recommendation as inappropriate was that antimicrobial therapy was not indicated.Conclusions.Inaccurate communication of patient data, particularly microbiological data, during prior-approval calls is associated with an increased risk of inappropriate antimicrobial recommendations from the ASP. Clinicians and ASP practitioners should work to confirm that critical data has been communicated accurately prior to use of that data in prescribing decisions.

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Building on Antimicrobial Stewardship Programs Through Integration with Electronic Medical Records: The Australian Experience

Infectious Diseases and Therapy ◽

10.1007/s40121-020-00392-5 ◽

2021 ◽

Author(s):

Kelly A. Cairns ◽

Matthew D. M. Rawlins ◽

Sean D. Unwin ◽

Fiona F. Doukas ◽

Rosemary Burke ◽

...

Keyword(s):

Electronic Medical Records ◽

Antimicrobial Stewardship ◽

Medical Records ◽

Australian Experience

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Optimizing EMR User Experience: A Human Factors Approach to Hardware Assessment and Design for Inpatient and Emergency Units

Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care ◽

10.1177/2327857918071022 ◽

2018 ◽

Vol 7 (1) ◽

pp. 97-102 ◽

Cited By ~ 1

Author(s):

Catherine Dulude ◽

Chantal Trudel ◽

W. James King ◽

Karen Macaulay ◽

Jennifer Gillert ◽

...

Keyword(s):

Electronic Medical Records ◽

User Satisfaction ◽

Medical Records ◽

Participatory Design ◽

Easy Access ◽

Just In Time ◽

Successful Implementation ◽

End User ◽

System A ◽

Emergency Units

Many factors contribute to the successful implementation and adoption of electronic medical records (EMRs). Easy access to the EMR, where and when required by clinicians, is a key component of adoption and end-user satisfaction with the system. A pediatric hospital implementing an integrated EMR used multiple methods within an iterative human-centered design (HCD) framework to develop hardware and access solutions supporting future EMR workflows in Inpatient and Emergency Departments. Context of use analysis, participatory design methods, preliminary analysis of evaluative simulations and tacit knowledge of the project team led to the development of guiding principles for hardware implementation and solutions supporting just-in-time documentation within the constraints of existing facility design.

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Intelligent Techniques for Analysis of Big Data About Healthcare and Medical Records

10.4018/978-1-6684-3662-2.ch021 ◽

2022 ◽

pp. 431-454

Author(s):

Pinar Kirci

Keyword(s):

Operating System ◽

Big Data ◽

Electronic Medical Records ◽

Data Storage ◽

Medical Records ◽

Data Access ◽

Efficient Solutions ◽

Unstructured Data ◽

Distributed File System ◽

Healthcare Industry

To define huge datasets, the term of big data is used. The considered “4 V” datasets imply volume, variety, velocity and value for many areas especially in medical images, electronic medical records (EMR) and biometrics data. To process and manage such datasets at storage, analysis and visualization states are challenging processes. Recent improvements in communication and transmission technologies provide efficient solutions. Big data solutions should be multithreaded and data access approaches should be tailored to big amounts of semi-structured/unstructured data. Software programming frameworks with a distributed file system (DFS) that owns more units compared with the disk blocks in an operating system to multithread computing task are utilized to cope with these difficulties. Huge datasets in data storage and analysis of healthcare industry need new solutions because old fashioned and traditional analytic tools become useless.

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Electronic Medical Records and Public Perceptions

International Journal of Healthcare Information Systems and Informatics ◽

10.4018/jhisi.2013070103 ◽

2013 ◽

Vol 8 (3) ◽

pp. 38-57

Author(s):

Tarik Abdel-Monem ◽

Mitchel N. Herian ◽

Nancy Shank

Keyword(s):

Electronic Medical Records ◽

Medical Records ◽

Online Survey ◽

Public Attitudes ◽

Public Perceptions ◽

Deliberative Discussion ◽

The Impact ◽

Opinion Polls

Public attitudes about electronic medical records (EMRs) have been primarily gauged by one-time opinion polls. The authors investigated the impact of an interactive deliberative polling process on general attitudes towards EMRs and perceptions of governmental roles in the area. An initial online survey was conducted about EMRs among a sample of respondents (n = 138), and then surveyed a sub-sample after they had engaged in a deliberative discussion about EMR issues with peers and policymakers (n = 24). Significant changes in opinions about EMRs and governmental roles were found following the deliberative discussion. Overall support for EMRs increased significantly, although concerns about security and confidentiality remained. This indicates that one way to address concerns about EMRs is to provide opportunities for deliberation with policymakers. The policy and theoretical implications of these findings are briefly discussed within.

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Completeness and accuracy of anthropometric measurements in electronic medical records for children attending primary care

BMJ Health & Care Informatics ◽

10.14236/jhi.v25i1.963 ◽

2018 ◽

Vol 25 (1) ◽

pp. 19-26 ◽

Cited By ~ 7

Author(s):

Sarah Carsley ◽

Catherine S. Birken ◽

Patricia C. Parkin ◽

Eleanor Pullenayegum ◽

Karen Tu

Keyword(s):

Primary Care ◽

Body Mass Index ◽

Electronic Medical Records ◽

Body Mass ◽

Medical Records ◽

Data Access ◽

World Health ◽

Z Score ◽

Data Completeness ◽

Weight Data

BackgroundElectronic medical records (EMRs) from primary care may be a feasible source of height and weight data. However, the use of EMRs in research has been impeded by lack of standardisation of EMRs systems, data access and concerns about the quality of the data.ObjectivesThe study objectives were to determine the data completeness and accuracy of child heights and weights collected in primary care EMRs, and to identify factors associated with these data quality attributes.MethodsA cross-sectional study examining height and weight data for children <19 years from EMRs through the Electronic Medical Record Administrative data Linked Database (EMRALD), a network of family practices across the province of Ontario. Body mass index z-scores were calculated using the World Health Organization Growth Standards and Reference.ResultsA total of 54,964 children were identified from EMRALD. Overall, 93% had at least one complete set of growth measurements to calculate a body mass index (BMI) z-score. 66.2% of all primary care visits had complete BMI z-score data. After stratifying by visit type 89.9% of well-child visits and 33.9% of sick visits had complete BMI z-score data; incomplete BMI z-score was mainly due to missing height measurements. Only 2.7% of BMI z-score data were excluded due to implausible values.ConclusionsData completeness at well-child visits and overall data accuracy were greater than 90%. EMRs may be a valid source of data to provide estimates of obesity in children who attend primary care.

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The "Epic" Challenge of Optimizing Antimicrobial Stewardship: The Role of Electronic Medical Records and Technology

Clinical Infectious Diseases ◽

10.1093/cid/cit318 ◽

2013 ◽

Vol 57 (7) ◽

pp. 1005-1013 ◽

Cited By ~ 50

Author(s):

R. Kullar ◽

D. A. Goff ◽

L. T. Schulz ◽

B. C. Fox ◽

W. E. Rose

Keyword(s):

Electronic Medical Records ◽

Antimicrobial Stewardship ◽

Medical Records

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52. Direct Communication Improves Response Time to Acceptance of Antimicrobial Stewardship Interventions

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.254 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S146-S146

Author(s):

Humaira Shafi ◽

Stephen G Donoghue ◽

Jonathan Seah ◽

Pu En Ow Yong ◽

Wee Boon Lee

Keyword(s):

Antimicrobial Stewardship ◽

Medical Records ◽

Text Messaging ◽

Text Message ◽

Direct Communication ◽

Stewardship Program ◽

Medical Discipline ◽

Significant Difference ◽

Empiric Antibiotic ◽

Acceptance Rates

Abstract Background Hospital antimicrobial stewardship program (ASP) reviews broad-spectrum antibiotics and recommends interventions to optimise antimicrobial use. However, about 30% of interventions are not accepted. This project aims to improve the response rate and time for acceptance of ASP interventions by direct communication with providers (via call or text messaging) once an intervention was made. Methods Pre-direct communication (PC) phase lasted from 1st Jan - 31st Dec 2017. A typed intervention was placed into the patient’s medical records for the team to review. Thereafter, a direct communication (DC) phase ran from 1st Jan 2018 - 31st Jan 2019. Teams were immediately notified of any ASP interventions made via a call or text message, in addition to the document placed in the medical records. Specialty, acceptance rates, type of intervention and time to acceptance was recorded. Overall acceptance was counted if team followed the ASP recommendations within 48 hours. Results A total of 621 interventions were made over the 25-month period (PC n=334, DC n=287). We found that direct communications did not improve the overall acceptance rates (PC 66% vs. DC 65%, p=0.791), but significantly improved same day acceptance rates (PC 15% [49/334] vs. DC 33% [96/287], p< 0.001). This trend for higher same-day acceptance was also noted regardless of specialty. It increased from 15% to 45% (p< 0.001) for medicine & 15% to 25% (p=0.025) for surgery. Furthermore, overall acceptance for medical discipline was significantly higher in the DC phase (68% to 80%, p=0.024); no significant difference noted for the surgical disciplines. Same-day acceptance also improved when we compared the most common types of interventions (culture based de-escalation, discontinue antibiotic, narrow empirical coverage). In addition, DC helped narrow empiric antibiotic choices, with improvements in both same-day and overall acceptance of interventions (increased from 8% to 43%, p< 0.001 and 57% to 78%, p=0.12, respectively). Conclusion Direct communication with clinicians boosted same-day acceptance for ASP interventions. In addition, it increased overall acceptance for medical disciplines, and to narrow empiric antibiotic use. Future efforts will focus on in-person strategy with surgical teams for fruitful results. Disclosures All Authors: No reported disclosures

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Authorized Shared Electronic Medical Record System with Proxy Re-Encryption and Blockchain Technology

Sensors ◽

10.3390/s21227765 ◽

2021 ◽

Vol 21 (22) ◽

pp. 7765

Author(s):

Weizhe Chen ◽

Shunzhi Zhu ◽

Jianmin Li ◽

Jiaxin Wu ◽

Chin-Ling Chen ◽

...

Keyword(s):

Access Control ◽

Medical Record ◽

Electronic Medical Record ◽

Electronic Medical Records ◽

Medical Records ◽

Data Privacy ◽

Data Access ◽

Electronic Medical Record System ◽

Record System ◽

Medical Record System

With the popularity of the internet 5G network, the network constructions of hospitals have also rapidly developed. Operations management in the healthcare system is becoming paperless, for example, via a shared electronic medical record (EMR) system. A shared electronic medical record system plays an important role in reducing diagnosis costs and improving diagnostic accuracy. In the traditional electronic medical record system, centralized database storage is typically used. Once there is a problem with the data storage, it could cause data privacy disclosure and security risks. Blockchain is tamper-proof and data traceable. It can ensure the security and correctness of data. Proxy re-encryption technology can ensure the safe sharing and transmission of relatively sensitive data. Based on the above situation, we propose an electronic medical record system based on consortium blockchain and proxy re-encryption to solve the problem of EMR security sharing. Electronic equipment in this process is connected to the blockchain network, and the security of data access is ensured through the automatic execution of blockchain chaincodes; the attribute-based access control method ensures fine-grained access to the data and improves the system security. Compared with the existing electronic medical records based on cloud storage, the system not only realizes the sharing of electronic medical records, but it also has advantages in privacy protection, access control, data security, etc.

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