scholarly journals Graphical display of diagnostic test results in electronic health Records: a comparison of 8 systems

2015 ◽  
Vol 22 (4) ◽  
pp. 900-904 ◽  
Author(s):  
Dean F Sittig ◽  
Daniel R Murphy ◽  
Michael W Smith ◽  
Elise Russo ◽  
Adam Wright ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Laboratory Test ◽  
Clinical Laboratory ◽  
Negative Impact ◽  
Laboratory Data ◽  
Test Results ◽  
Health Records ◽  
Laboratory Test Results ◽  
Data Points ◽  
Electronic Health

Abstract Accurate display and interpretation of clinical laboratory test results is essential for safe and effective diagnosis and treatment. In an attempt to ascertain how well current electronic health records (EHRs) facilitated these processes, we evaluated the graphical displays of laboratory test results in eight EHRs using objective criteria for optimal graphs based on literature and expert opinion. None of the EHRs met all 11 criteria; the magnitude of deficiency ranged from one EHR meeting 10 of 11 criteria to three EHRs meeting only 5 of 11 criteria. One criterion (i.e., the EHR has a graph with y-axis labels that display both the name of the measured variable and the units of measure) was absent from all EHRs. One EHR system graphed results in reverse chronological order. One EHR system plotted data collected at unequally-spaced points in time using equally-spaced data points, which had the effect of erroneously depicting the visual slope perception between data points. This deficiency could have a significant, negative impact on patient safety. Only two EHR systems allowed users to see, hover-over, or click on a data point to see the precise values of the x–y coordinates. Our study suggests that many current EHR-generated graphs do not meet evidence-based criteria aimed at improving laboratory data comprehension.

scholarly journals An individualized risk prediction model for new-onset, progression and regression of chronic kidney disease in a retrospective cohort of patients with type 2 diabetes under primary care in Hong Kong

2020 ◽  
Author(s):  
Lin Yang ◽  
Tsun Kit Chu ◽  
Jinxiao Lian ◽  
Cheuk Wai Lo ◽  
Shi Zhao ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Electronic Health Records ◽  
Laboratory Test ◽  
List Type ◽  
Test Results ◽  
Health Records ◽  
Laboratory Test Results ◽  
Electronic Health ◽  
New Onset

AbstractObjectivesThis study is aimed to develop and validate a prediction model for multi-state transitions across different stages of chronic kidney disease in patients with type 2 diabetes mellitus under primary care.SettingWe retrieved the anonymized electronic health records of a population based retrospective cohort in Hong Kong.ParticipantsA total of 26,197 patients were included in the analysis.Primary and secondary outcome measuresThe new-onset, progression, and regression of chronic kidney disease were defined by the transitions of four stages that were classified by combining glomerular filtration rate and urine albumin-to-creatinine ratio. We applied a multi-scale multi-state Poisson regression model to estimate the rates of the stage transitions by integrating the baseline demographic characteristics, routine laboratory test results and clinical data from electronic health records.ResultsDuring the mean follow-up time of 1.7 years, there were 2,935 patients newly diagnosed with chronic kidney disease, 1,443 progressed to the next stage and 1,971 regressed into an earlier stage. The models achieved the best performance in predicting the new-onset and progression with the predictors of sex, age, body mass index, systolic blood pressure, diastolic blood pressure, serum creatinine, HbA1c, total cholesterol, LDL, HDL, triglycerides and drug prescriptions.ConclusionsThis study demonstrated that individual risks of new-onset and progression of chronic kidney disease can be predicted from the routine physical and laboratory test results. The individualized prediction curves developed from this study could potentially be applied to routine clinical practices, to facilitate clinical decision making, risk communications with patients and early interventions.Article summaryStrengths of this studyEarly predictions for chronic kidney disease progression and timely intervention is critical for clinical management of patients with diabetes.We successfully developed a multi-scale multi-state Poisson regression models that achieved the satisfactory performance in predicting the new-onset and progression of chronic kidney diseases.The model incorporates the predictors of demographic characteristics, routine laboratory test results and clinical data from electronic health records.The individualized prediction curves could potentially be applied to facilitate clinical decision making, risk communications with patients and early interventions of CKD progression.Limitations of this studyThe cohort has a relatively short follow-up period and the retrospective study design might suffer from report bias and selection bias.

scholarly journals The Postencounter Form System: Viewpoint on Efficient Data Collection Within Electronic Health Records (Preprint)

2019 ◽  
Author(s):  
Philip Held ◽  
Randy A Boley ◽  
Walter G Faig ◽  
John A O'Toole ◽  
Imran Desai ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Medical Center ◽  
Health Records ◽  
Clinical Notes ◽  
The Road ◽  
Clinical Encounters ◽  
Efficient Data ◽  
Data Points ◽  
Electronic Health ◽  
Using Data

UNSTRUCTURED Electronic health records (EHRs) offer opportunities for research and improvements in patient care. However, challenges exist in using data from EHRs due to the volume of information existing within clinical notes, which can be labor intensive and costly to transform into usable data with existing strategies. This case report details the collaborative development and implementation of the postencounter form (PEF) system into the EHR at the Road Home Program at Rush University Medical Center in Chicago, IL to address these concerns with limited burden to clinical workflows. The PEF system proved to be an effective tool with over 98% of all clinical encounters including a completed PEF within 5 months of implementation. In addition, the system has generated over 325,188 unique, readily-accessible data points in under 4 years of use. The PEF system has since been deployed to other settings demonstrating that the system may have broader clinical utility.

Herbal Remedies: Effects on Clinical Laboratory Tests

2006 ◽  
Vol 130 (4) ◽  
pp. 521-528 ◽  
Author(s):  
Amitava Dasgupta ◽  
David W. Bernard
Keyword(s):  
Chinese Medicine ◽  
Laboratory Test ◽  
Alternative Medicine ◽  
Clinical Laboratory ◽  
Herbal Remedies ◽  
Test Results ◽  
Abnormal Laboratory ◽  
St John's Wort ◽  
Laboratory Test Results ◽  
Laboratory Results

AbstractContext.—Complementary and alternative medicine (herbal medicines) can affect laboratory test results by several mechanisms.Objective.—In this review, published reports on effects of herbal remedies on abnormal laboratory test results are summarized and commented on.Data Sources.—All published reports between 1980 and 2005 with the key words herbal remedies or alternative medicine and clinical laboratory test, clinical chemistry test, or drug-herb interaction were searched through Medline. The authors' own publications were also included. Important results were then synthesized.Data Synthesis.—Falsely elevated or falsely lowered digoxin levels may be encountered in a patient taking digoxin and the Chinese medicine Chan Su or Dan Shen, owing to direct interference of a component of Chinese medicine with the antibody used in an immunoassay. St John's wort, a popular herbal antidepressant, increases clearance of many drugs, and abnormally low cyclosporine, digoxin, theophylline, or protease inhibitor concentrations may be observed in a patient taking any of these drugs in combination with St John's wort. Abnormal laboratory results may also be encountered owing to altered pathophysiology. Kava-kava, chaparral, and germander cause liver toxicity, and elevated alanine aminotransferase, aspartate aminotransferase, and bilirubin concentrations may be observed in a healthy individual taking such herbal products. An herbal product may be contaminated with a Western drug, and an unexpected drug level (such as phenytoin in a patient who never took phenytoin but took a Chinese herb) may confuse the laboratory staff and the clinician.Conclusions.—Use of alternative medicines may significantly alter laboratory results, and communication among pathologists, clinical laboratory scientists, and physicians providing care to the patient is important in interpreting these results.

The Impact of the Global, Extensible Electronic Health Record

2011 ◽  
pp. 3-13 ◽  
Author(s):  
David W. Forslund ◽  
David G. Kilman
Keyword(s):  
Electronic Health Records ◽  
Negative Impact ◽  
Global Scale ◽  
Global Perspective ◽  
Health Records ◽  
Technological Advances ◽  
The World ◽  
Electronic Health ◽  
The Impact

With the arrival of the “World Wide Web,” we have witnessed a transition toward a truly global perspective with respect to electronic health records. In recent years, much more discussion has focused on the potential for international virtual electronic health records and what is required for them to become a reality in the world today (Kilman & Forslund, 1997). As the Internet becomes more ubiquitous and Web-enabled, we see access to electronic health records using these technologies becoming more commonplace. Even so, these Web-enabled health records still remain technologically isolated from other medical records in the distributed continuum of care; much of the standardization challenge still stands before us. We have witnessed startling technological advances, but we still face considerable obstacles to the goal of having globally standardized electronic health records. In this chapter we describe some of the issues associated with Web-enabled health records, the role of standards in the evolution of Web-enabled health records, and some of the barriers to the development of globally accessible electronic health records. We discuss possible ways to overcome these barriers and the kinds of benefits and opportunities that global health records will help provide. The global scale perspective makes more evident the very real and potentially tragic consequences of prolonged and unnecessary delays in deploying these technologies. Therefore, in an effort to promote a fuller consciousness of health safety, the chapter concludes with a comparative look at the negative impact of impediments in the movement toward global extensible electronic health records.

Terminology of cardiac troponin assays and data censoring

2017 ◽  
Vol 55 (11) ◽  
Author(s):  
Petr Jarolim
Keyword(s):  
Laboratory Test ◽  
Cardiac Troponin ◽  
Clinical Laboratory ◽  
Clinical Information ◽  
Reference Population ◽  
Test Results ◽  
Clinical Laboratory Test ◽  
Laboratory Test Results ◽  
Data Censoring ◽  
Selection Of

AbstractWe discuss the sensitivity terminology of cardiac troponin assays and its dependence on the selection of the reference population. In addition, the need for reasonable censoring of clinical laboratory test results is contrasted with potential loss of valuable clinical information.

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