Multi-Site Best Practice Discovery: From Free Text to Standardized Concepts to Clinical Decisions

2021 ◽  
Author(s):  
Eva K Lee ◽  
Zhunan Li ◽  
Yuanbo Wang ◽  
Matthew S Hagen ◽  
Robert Davis ◽  
...  
Keyword(s):  
Best Practice ◽  
Free Text ◽  
Clinical Decisions

scholarly journals Health Needs of Trans and Gender Diverse Adults in Australia: A Qualitative Analysis of a National Community Survey

2019 ◽  
Vol 16 (24) ◽  
pp. 5088 ◽  
Author(s):  
Sav Zwickl ◽  
Alex Wong ◽  
Ingrid Bretherton ◽  
Max Rainier ◽  
Daria Chetcuti ◽  
...  
Keyword(s):  
Health Services ◽  
Best Practice ◽  
Online Survey ◽  
Healthcare Professionals ◽  
Research Priorities ◽  
Health Service Delivery ◽  
Free Text ◽  
Healthcare Needs ◽  
Gender Diverse ◽  
And Gender

There is an increasing demand for trans and gender diverse (TGD) health services worldwide. Given the unique and diverse healthcare needs of the TGD community, best practice TGD health services should be community-led. We aimed to understand the healthcare needs of a broad group of TGD Australians, how health professionals could better support TGD people, and gain an understanding of TGD-related research priorities. An anonymous online survey received 928 eligible responses from TGD Australian adults. This paper focuses on three questions out of that survey that allowed for free-text responses. The data were qualitatively coded, and overarching themes were identified for each question. Better training for healthcare professionals and more accessible transgender healthcare were the most commonly reported healthcare needs of participants. Findings highlight a pressing need for better training for healthcare professionals in transgender healthcare. In order to meet the demand for TGD health services, more gender services are needed, and in time, mainstreaming health services in primary care will likely improve accessibility. Evaluation of training strategies and further research into optimal models of TGD care are needed; however, until further data is available, views of the TGD community should guide research priorities and the TGD health service delivery.

scholarly journals Successful utilization of the EMR in a multiple sclerosis clinic to support quality improvement and research initiatives at the point of care

2018 ◽  
Vol 4 (4) ◽  
pp. 205521731881373 ◽  
Author(s):  
Kelly Claire Simon ◽  
Afif Hentati ◽  
Susan Rubin ◽  
Tiffani Franada ◽  
Darryck Maurer ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Quality Improvement ◽  
Best Practice ◽  
Point Of Care ◽  
Free Text ◽  
Office Visits ◽  
Quality Initiatives ◽  
Practice Based Research ◽  
Demyelinating Disorders ◽  
Research Initiatives

Background Many physicians enter data into the electronic medical record (EMR) as unstructured free text and not as discrete data, making it challenging to use for quality improvement or research initiatives. Objectives The objective of this research paper was to develop and implement a structured clinical documentation support (SCDS) toolkit within the EMR to facilitate quality initiatives and practice-based research in a multiple sclerosis (MS) practice. Methods We built customized EMR toolkits to capture standardized data at office visits. Content was determined through physician consensus on necessary elements to support best practices in treating patients with demyelinating disorders. We also developed CDS tools and best practice advisories within the toolkits to alert physicians when a quality improvement opportunity exists, including enrollment into our DNA biobanking study at the point of care. Results We have used the toolkit to evaluate 541 MS patients in our clinic and begun collecting longitudinal data on patients who return for annual visits. We provide a description and example screenshots of our toolkits, and a brief description of our cohort to date. Conclusions The EMR can be effectively structured to standardize MS clinic office visits, capture data, and support quality improvement and practice-based research initiatives at the point of care.

scholarly journals CDS in a Learning Health Care System: Identifying Physicians' Reasons for Rejection of Best-Practice Recommendations in Pneumonia through Computerized Clinical Decision Support

2019 ◽  
Vol 10 (01) ◽  
pp. 001-009 ◽  
Author(s):  
Barbara Jones ◽  
Dave Collingridge ◽  
Caroline Vines ◽  
Herman Post ◽  
John Holmen ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Support ◽  
Health Care System ◽  
Clinical Decision Support ◽  
Best Practice ◽  
Clinical Decision ◽  
Additional Patient ◽  
Free Text ◽  
Learning Health Care System ◽  
Care System

Background Local implementation of guidelines for pneumonia care is strongly recommended, but the context of care that affects implementation is poorly understood. In a learning health care system, computerized clinical decision support (CDS) provides an opportunity to both improve and track practice, providing insights into the implementation process. Objectives This article examines physician interactions with a CDS to identify reasons for rejection of guideline recommendations. Methods We implemented a multicenter bedside CDS for the emergency department management of pneumonia that integrated patient data with guideline-based recommendations. We examined the frequency of adoption versus rejection of recommendations for site-of-care and antibiotic selection. We analyzed free-text responses provided by physicians explaining their clinical reasoning for rejection, using concept mapping and thematic analysis. Results Among 1,722 patient episodes, physicians rejected recommendations to send a patient home in 24%, leaving text in 53%; reasons for rejection of the recommendations included additional or alternative diagnoses beyond pneumonia, and comorbidities or signs of physiologic derangement contributing to risk of outpatient failure that were not processed by the CDS. Physicians rejected broad-spectrum antibiotic recommendations in 10%, leaving text in 76%; differences in pathogen risk assessment, additional patient information, concern about antibiotic properties, and admitting physician preferences were given as reasons for rejection. Conclusion While adoption of CDS recommendations for pneumonia was high, physicians rejecting recommendations frequently provided feedback, reporting alternative diagnoses, additional individual patient characteristics, and provider preferences as major reasons for rejection. CDS that collects user feedback is feasible and can contribute to a learning health system.

Multiple Approaches to the Diagnosis of Attention Deficit Hyperactivity Disorder

2013 ◽  
Vol 8 (4) ◽  
pp. 44-57 ◽  
Author(s):  
Rui Rijo ◽  
Ricardo Martinho ◽  
Xiaocheng Ge
Keyword(s):  
Decision Making ◽  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Clinical Decision Making ◽  
Adult Life ◽  
Clinical Decision ◽  
School Age Children ◽  
Free Text ◽  
Clinical Decisions ◽  
Hyperactivity Disorder

Studies indicate that about 3-7% of school-age children have attention deficit hyperactivity disorder (ADHD). If these disorders are not diagnosed and treated early, its consequences can harshly impair the adult life of the individual. In this context, early diagnosis is critical. Clinical reasoning is a key contributor to the quality of health care. Clinical decisions at the policy level are made within a stochastic domain; decisions for individuals are usually more qualitative. In both cases, poor reasoning can result in an undesirable outcome. Clinical decisions are most typically communicated in a document through free text. Text has significant limitations (particularly ambiguity and poor structuring) whether used for analysis, or to explain the decision-making process. In safety engineering, similar problems are faced in conveying safety arguments to support certification. As a result, approaches have been developed to conveying arguments in ways which improve communication and which are more amenable to analysis. The Goal Structuring Notation (GSN) – a graphical argumentation notation for safety – was developed for those reasons. It has evolved to be one of the most widely used techniques for representing safety arguments. The use of text-mining techniques is another approach in the process of achieving or suggesting a diagnosis to the physician. This paper investigates the relative feasibility of these two approaches and discuss their complementation. Based on a case example, the benefits and problems of adopting GSN and ontology approach in clinical decision-making for ADHD are discussed and illustrated.

Career medical officers in psychiatry and addiction in NSW: description, role and educational needs

2019 ◽  
Vol 27 (5) ◽  
pp. 528-531
Author(s):  
Louise Nash ◽  
Michele Meltzer ◽  
Aspasia Karageorge
Keyword(s):  
Best Practice ◽  
Free Text ◽  
Addiction Medicine ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Training And Education ◽  
Educational Support ◽  
Medical Practitioners ◽  
South Wales ◽  
Education Needs

Objective: To describe the workforce of career medical officers (CMOs) working in psychiatry and addiction medicine across New South Wales (NSW) and to explore their training and education needs, and experience of their role. Method: A cross-sectional survey of CMOs in NSW working in psychiatry or addiction medicine. The survey consisted of quantitative data and free-text responses, and was conducted online in late 2017. Results: Of the 41 CMOs identified and sent the survey link, 25 CMOs completed the survey (61% RR). Almost half had worked as a CMO for 11 years or longer. Only six respondents held a recognised senior CMO position. Common areas of expertise were clozapine, metabolic health, and electroconvulsive therapy (ECT). One-quarter of respondents did not receive supervision. Suggested education and training improvements included an annual 1-day training symposium and monthly peer review group for CMOs. Conclusion: CMOs are an often senior group of clinicians working in important areas of service provision. Ongoing educational support for this group of medical practitioners is prudent to ensure the delivery of best practice mental health and drug health care.

scholarly journals Best Practice Guidance for Digital Contact Tracing Apps: A Cross-Disciplinary Review of the Literature. (Preprint)

2021 ◽  
Author(s):  
James O'Connell ◽  
Manzar Abbas ◽  
Sarah Beecham ◽  
Jim Buckley ◽  
Muslim Chochlov ◽  
...  
Keyword(s):  
Data Protection ◽  
Best Practice ◽  
Evidence Synthesis ◽  
Grey Literature ◽  
World Health Organisation ◽  
World Health ◽  
Contact Tracing ◽  
Free Text ◽  
User Engagement ◽  
Interface Elements

BACKGROUND Digital contact tracing apps (DCTAs) have the potential to augment contact tracing systems and disrupt Coronavirus 2019 (COVID-19) transmission. Despite many countries deploying DCTAs, few have disrupted COVID-19 transmission sufficiently to avoid the most restrictive social distancing measures. OBJECTIVE Our aim was to describe and provide best practice guidance on the design considerations of the ideal digital contact tracing app (IDCTA). METHODS We identified key considerations from the literature and used a cross disciplinary approach to develop best practice guidance for the development of the IDCTA. We conducted a search of the indexed and grey literature to identify articles describing or evaluating DCTAs. We searched Ovid Medline using a combination of free text terms and MeSH search terms. We performed a search of the grey literature using the World Health Organisation (WHO) Institutional Repository for Information Sharing, the European Centre for Disease Control (ECDC) publications library and Google, including the websites of many health protection authorities. Articles which were acceptable for inclusion in our evidence synthesis were peer-reviewed publications cohort studies, randomised trials, modelling studies, technical reports, white papers and media reports which related to digital contact tracing. RESULTS Ethical, user experience, privacy and data protection, technical, clinical, societal and evaluation considerations were identified from the literature. The IDCTA should be voluntary and should be equitably available and accessible. Therefore. the IDCTA should be disseminated, free of charge and free smart-phones or monofunctional digital contact tracing devices should be deployed in parallel to groups who may not otherwise have access to DCTAs. The IDCTA interface elements should enable multi-modal interaction (e.g., supported by voice control), with comprehensive contents that are available in different languages. Dynamic, consistently updated information on confirmed cases, testing sites, vaccination sites, current government restrictions and state preventive strategies could enhance user engagement. The IDCTA should be adherent to data protection regulation and follow the principles of privacy by design. Bluetooth LE is recommended for DCTA contact event detection but combining it with ultrasound technology may improve DCTA accuracy without significant compromises on privacy preservation and availability. A decentralised privacy preserving protocol should be followed to enable DCTA users exchange and record temporary contact numbers during contact events. The IDCTA should define and risk stratify contact events according to proximity, duration of contact and the infectiousness of the case at the time of contact. Function creep should be prevented by defining at the outset the limits of the DCTA. Defining from DCTA lauch how its effectiveness will be evaluated is important from an ethical point of view. CONCLUSIONS In conclusion, we identified from the literature key considerations when developing the IDCTA and provide a best practice approach to these considerations.

02 ‘Have you had the surgery?’: A survey of transgender and non-binary patients’ experiences of interacting with the ambulance service

2019 ◽  
Vol 36 (10) ◽  
pp. e2.2-e2
Author(s):  
Chloé Barley ◽  
Alec Tooms
Keyword(s):  
Best Practice ◽  
Small Sample Size ◽  
Demographic Data ◽  
Training Session ◽  
Small Sample ◽  
Ambulance Service ◽  
Free Text ◽  
Health Issues ◽  
Positive Experiences ◽  
Survey Responses

BackgroundPre-hospital research around the experience of transgender and non-binary (TNB) patients is scarce, with existing articles lacking input from TNB patients. This research aimed to collate TNB patients’ experiences of interacting with the ambulance service. A secondary aim was to gather TNB patients’ opinions regarding the education of ambulance clinicians on TNB health issues.MethodAn online-based, mixed-methods survey was created. A range of free text, multiple choice and Likert-scaled questions were used. Advertisement on social media was tailored to target TNB individuals who have had patient contact with the ambulance service. All respondents were anonymous and voluntary. This survey was conducted by TNB individuals in a personal capacity, without funding.Results72% of the 25 respondents rated their experience as satisfactory or above. 40% reported that identifying as TNB affected the way they were treated and 40% reported that they were asked about their gender by the ambulance crew. In free text answers, the main themes identified were the misidentification of gender, the use of incorrect pronouns, hospital handovers, intrusive/irrelevant questioning and the need for training.ConclusionsThe responses suggest that TNB patients feel that being asked about their gender is important however ambulance staff sometimes struggled to address this sensitively. Positive experiences included having gender and pronouns addressed in hospital handover which can form a recommendation for best practice. Negative experiences were associated with being misgendered, using incorrect pronouns and intrusive/irrelevant questioning. Survey responses led to practical recommendations for ambulance staff interacting with TNB patients, including the authors creating a training session which has received positive feedback from clinicians. Limitations include small sample size, potential for response bias due to survey being self-selecting and missing demographic data. Recommendations for further research are to provide a more in-depth exploration of TNB experience and of ambulance staff views.

An electronic intervention to improve structured cancer stage data capture.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 151-151
Author(s):  
Kerin B. Adelson ◽  
Kim Framski ◽  
Patricia Lazette ◽  
Teresita Vega ◽  
Rogerio Lilenbaum
Keyword(s):  
Clinical Trial ◽  
Decision Support ◽  
Best Practice ◽  
Cancer Staging ◽  
Free Text ◽  
Cancer Stage ◽  
Outcomes Analysis ◽  
Support Tool ◽  
Palliative Care Consultation ◽  
Number Of Patients

151 Background: Cancer Staging is critical for prognosticating, treatment planning, outcomes analysis, registry reporting and clinical trial eligibility determination. Oncology EHRs have structured staging modules but use by physicians is inconsistent. Typically, stage is entered as unstructured free text in clinical notes and cannot be used for reporting. Instead, institutions depend the tumor registry (TR) which typically lag 6 months behind. Our Cancer Committee determined that real-time capture of structured cancer staging was an imperative. Methods: We created an EPIC best practice advisory (BPA) decision support tool that requires physicians to enter cancer stage if the following criteria are met: 1)unstaged cancer on the problem list 2)EPIC staging module exists for that cancer 3)physician is from a specialty with staging expertise. This BPA was implemented 12/18/14. If physicians chose not to stage they had to enter a reason why. Choices were: 1) cancer diagnosed before 2014, at which the BPA was permanently removed 2) staging studies not yet completed, at which the BPA fired at a future encounter 3) Not a staging provider, at which the BPA no longer fires for that individual provider 4) Cannot stage: document reason, at which the BPA was permanently removed. Results: We used TR data to determine the number of patients who were eligible for staging. In 12 months prior to the intervention, 1480/5222, or 28% of patients who were eligible for staging were staged in the structured staging module. After we launched the intervention, between 12/18/14 and 4/30/15, 1654/1831 or 90% of eligible patients were staged electronically. This is an absolute improvement of > 200% Conclusions: Electronic decision support can dramatically improve rates of structured staging. Such data allows automated reports for clinical trial screening, outcomes analysis, quality comparisons, and reporting. We are now building automated reports for: clinical trial eligibility, Commission on Cancer/ QOPI breast, colon and lung measures, rates of palliative care consultation for advanced disease and outcome measures like disease free interval by stage and overall survival.

scholarly journals Successful Physician Training Program for Large Scale EMR Implementation

2015 ◽  
Vol 06 (01) ◽  
pp. 80-95 ◽  
Author(s):  
L.A. Stevens ◽  
E.S. Mailes ◽  
B.A. Goad ◽  
C.A. Longhurst ◽  
J.L. Pantaleoni
Keyword(s):  
Training Program ◽  
Large Scale ◽  
Best Practice ◽  
Training Programs ◽  
Essential Element ◽  
Physician Satisfaction ◽  
Physician Training ◽  
Free Text ◽  
Institutional Investment ◽  
Physician Engagement

SummaryEnd-user training is an essential element of electronic medical record (EMR) implementation and frequently suffers from minimal institutional investment. In addition, discussion of successful EMR training programs for physicians is limited in the literature. The authors describe a successful physician-training program at Stanford Children’s Health as part of a large scale EMR implementation. Evaluations of classroom training, obtained at the conclusion of each class, revealed high physician satisfaction with the program. Free-text comments from learners focused on duration and timing of training, the learning environment, quality of the instructors, and specificity of training to their role or department. Based upon participant feedback and institutional experience, best practice recommendations, including physician engagement, curricular design, and assessment of proficiency and recognition, are suggested for future provider EMR training programs. The authors strongly recommend the creation of coursework to group providers by common workflow.Citation: Pantaleoni JL, Stevens LA, Mailes ES, Goad BA, Longhurst CA. Successful physician training program for large scale EMR implementation. Appl Clin Inf 2015; 6: 80–95http://dx.doi.org/10.4338/ACI-2014-09-CR-0076

Electronic Intervention to Improve Structured Cancer Stage Data Capture

2016 ◽  
Vol 12 (10) ◽  
pp. e949-e956 ◽  
Author(s):  
Michael Cecchini ◽  
Kim Framski ◽  
Patricia Lazette ◽  
Teresita Vega ◽  
Michael Strait ◽  
...  
Keyword(s):  
Decision Support ◽  
Best Practice ◽  
Decision Support Tool ◽  
Cancer Staging ◽  
Free Text ◽  
Cancer Stage ◽  
Support Tool ◽  
Clinical Notes ◽  
Practice Advisory ◽  
Electronic Intervention

Purpose: Cancer staging is critical for prognostication, treatment planning, and determining clinical trial eligibility. Electronic health records (EHRs) have structured staging modules, but physician use is inconsistent. Typically, stage is entered as unstructured free text in clinical notes and cannot easily be used for reporting. Methods: We created an Epic Best Practice Advisory (BPA) decision support tool that requires physicians to enter cancer stage in a structured module. If certain conditions are met, the BPA is triggered as a hard stop, and the physician cannot chart until staging is complete or a reason for not staging is selected. We used Plan, Do, Study, Act methodology to inform the intervention and compared preexisting staging rates to rates at 4, 8, and 12 months postintervention. Results: For 12 months before BPA implementation, 1,480 of 5,222 (28%) patients had cancer stage structured within the Epic problem list. From 1 to 4 months after the BPA 2,057 of 1,788 (115%) cases were staged in Epic. In the 5- to 8-month period after the BPA, 1,057 of 1,893 (56%) cases were staged, and 9 to 12 months after the BPA 1,082 of 1,817 (60%) were staged. Conclusion: Electronic decision support improves the rate of structured cancer staging at our institution. The staging rates between 56% and 60% for the 5- to 8-month and 9- to 12-month periods likely reflect accurate postintervention staging rates, whereas the initial 115% rate for 1 to 4 months is inflated by providers staging cancers diagnosed before the BPA.

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