Insulin Infusion Computer Calculator Programmed Directly Into Electronic Health Record Medication Administration Record

Background: Computerized insulin infusion protocols have demonstrated higher staff satisfaction, better compliance with protocols, and increased time with glucose in range compared to paper protocols. At University of California San Diego Health (UCSDH), we implemented an insulin infusion computer calculator (IICC) and transitioned it from a web-based platform directly into the electronic medication administration record (eMAR) of our primary electronic health record (EHR). Methods: This is a retrospective analysis of 6306 adult patients at UCSDH receiving intravenous (IV) insulin infusion from March 7, 2013 to May 30, 2019. We created three periods of the study—(1) the pre-eMAR integration period; (2) the eMAR integration period; and (3) the post-eMAR integration period—and looked at the percentage of readings within goal range (90-150 mg/dL for intensive care unit [ICU], 90-180 mg/dL for non-ICU) in patients with and without hyperglycemic emergencies. As our safety endpoints, we elected to look at incidence of blood glucose (BG) readings <70 mg/dL, <54 mg/dL, and <40 mg/dL. Results: Pre-eMAR 69.8% of readings were in the 90-150 mg/dL range compared to 70.2% post-eMAR ( P = .03) and 82.7% of readings were in the 90-180 mg/dL range pre-eMAR versus 82.9% ( P = .09) post-eMAR in patients without hyperglycemic emergencies. Rates of hypoglycemia with BG <70 mg/dL were 0.43%, <54 mg/dL were 0.07%, and <40 mg/dL were 0.01% of readings pre- and post-eMAR. Conclusions: At UCSDH, our IICC has shown to be safe and effective in a wide variety of clinical situations and we were able to successfully transition it from a web-based platform directly into the eMAR of our primary EHR.

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Assessment of Data Quality of and Staff Satisfaction with an Electronic Health Record System in a Developing Country (Uganda)

Methods of Information in Medicine ◽

10.3414/me0511 ◽

2008 ◽

Vol 47 (06) ◽

pp. 489-498 ◽

Cited By ~ 13

Author(s):

S.P. Ndira ◽

K.D. Rosenberger ◽

T. Wetter

Keyword(s):

Electronic Health Record ◽

Quantitative Methods ◽

Electronic System ◽

Hospital Staff ◽

Health Record ◽

Staff Satisfaction ◽

District Health ◽

Record System ◽

Post Test ◽

Electronic Health

Summary Objectives: To assess if electronic health record systems in developing countries can improve on timeliness, availability and accuracy of routine health reports and staff satisfaction after introducing the electronic system, compared to the paper-based alternative. Methods: The research was conducted with hospital staff of Tororo District Hospital in Uganda. A comparative intervention study with qualitative and quantitative methods was used to compare the paper-based (pre-test) to the electronic system (post-test) focusing on accuracy, availability and timeliness of monthly routine reports about mothers visiting the hospital; and staff satisfaction with the electronic system as outcome measures. Results: Timeliness: pre-test 13 of 19 months delivered to the district timely, delivery dates for six months could not be established; post-test 100%. Availability: pretest 79% of reports were present at the district health office; post-test 100%. Accuracy: pre-test 73.2% of selected reports could be independently confirmed as correct; post-test 71.2%. Difficulties were encountered in finding enough mothers through direct follow up to inquire on accuracy of information recorded about them. Staff interviews showed that the electronic system is appreciated by the majority of the hospital staff. Remaining obstacles include staff workload, power shortages, network breakdowns and parallel data entry (paper-based and electronic). Conclusion: While timeliness and availability improved, improvement of accuracy could not be established. Better approaches to ascertaining accuracy have to be devised, e.g. evaluation of intended use. For success, organizational, managerial and social challenges must be addressed beyond technical aspects.

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Using a Cloud-based Electronic Health Record During Disaster Response: A Case Study in Fukushima, March 2011

Prehospital and Disaster Medicine ◽

10.1017/s1049023x1300037x ◽

2013 ◽

Vol 28 (4) ◽

pp. 383-387 ◽

Cited By ~ 10

Author(s):

Takashi Nagata ◽

John Halamka ◽

Shinkichi Himeno ◽

Akihiro Himeno ◽

Hajime Kennochi ◽

...

Keyword(s):

Electronic Health Record ◽

Disaster Response ◽

Nuclear Power ◽

Large Scale ◽

Health Record ◽

Publication Type ◽

Web Based ◽

Electronic Health ◽

Medical Teams

AbstractFollowing the Great East Japan Earthquake on March 11, 2011, the Japan Medical Association deployed medical disaster teams to Shinchi-town (population: approximately 8,000), which is located 50 km north of the Fukushima Daiichi nuclear power plant. The mission of the medical disaster teams sent from Fukuoka, 1,400 km south of Fukushima, was to provide medical services and staff a temporary clinic for six weeks. Fear of radiation exposure restricted the use of large medical teams and local infrastructure. Therefore, small volunteer groups and a cloud-hosted, web-based electronic health record were implemented. The mission was successfully completed by the end of May 2011. Cloud-based electronic health records deployed using a “software as a service” model worked well during the response to the large-scale disaster.NagataT, HalamkaJ, KennochiH, HimenoS, HimenoA, HashizumeM. Using a cloud-based electronic health record during disaster response: a case study in Fukushima, March 2011. Prehosp Disaster Med. 2013;28(4):1-5.

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Implementation of Electronic Health Record as a Clinical Information Tool to Improve Gastric Cancer Care

Applied Health Information Technology ◽

10.18502/ahit.v1i1.5255 ◽

2021 ◽

Author(s):

Leila Shahmoradi ◽

Rogayeh KhoramiMoghadam ◽

Marjan Ghazisaeedi ◽

Marsa Gholamzadeh

Keyword(s):

Gastric Cancer ◽

Electronic Health Record ◽

Cancer Care ◽

Clinical Information ◽

Health Record ◽

Functional Requirements ◽

Record System ◽

Web Based ◽

Electronic Health ◽

And Performance

Aim: According to the high prevalence of gastric cancer in Iran, this study aimed to develop a gastric cancer electronic health record (EHR) to improve outpatient gastric cancer care. Method: This study represented the stepwise process used to develop a web-based gastric cancer EHR to overcome the documentation problems and cancer care complications. These iterative phases included determining the required minimum data sets (MDS), designing, developing and implementation, and usability evaluation. The system functional and non-functional requirements were determined using needs assessment. The MDSs were identified through consensus by a multidisciplinary expert panel. Finally, the web-based system was implemented in PHP language. Results: Initially, the required datasets were verified by experts. Later, an EHR-based gastric cancer system was implemented successfully to support outpatient cancer care. Based on the analysis, the functional requirements and main modules of the system were specified. The designed system reached an acceptable level of usability and performance. Conclusion: The system was successfully implemented in the gastric cancer clinic. Implementation of an electronic health record system can not only provide ease of access to clinical information, but also improve the quality of complicated cancer care.

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Exploring a Clinically Friendly Web-Based Approach to Clinical Decision Support Linked to the Electronic Health Record: Design Philosophy, Prototype Implementation, and Framework for Assessment

JMIR Medical Informatics ◽

10.2196/medinform.3586 ◽

2014 ◽

Vol 2 (2) ◽

pp. e20 ◽

Cited By ~ 7

Author(s):

Perry Miller ◽

Michael Phipps ◽

Sharmila Chatterjee ◽

Nallakkandi Rajeevan ◽

Forrest Levin ◽

...

Keyword(s):

Decision Support ◽

Electronic Health Record ◽

Clinical Decision Support ◽

Clinical Decision ◽

Health Record ◽

Web Based ◽

Prototype Implementation ◽

Design Philosophy ◽

Electronic Health

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Electronic Health Record and Web-Based Resources

10.1542/9781581106411-1-ch004 ◽

2008 ◽

pp. 28-38

Author(s):

S. Andrew Spooner

Keyword(s):

Electronic Health Record ◽

Health Record ◽

Web Based ◽

Electronic Health

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Health IT Usability Focus Section: Adapting EHR-Based Medication Instructions to Comply with Plain Language Guidance—A Randomized Experiment

Applied Clinical Informatics ◽

10.4338/aci-2017-06-ra-0111 ◽

2017 ◽

Vol 08 (04) ◽

pp. 1127-1143

Author(s):

Jessica Ancker ◽

Alexander Send ◽

Baria Hafeez ◽

Snezana Osorio ◽

Erika Abramson

Keyword(s):

Electronic Health Record ◽

English Language ◽

College Education ◽

Medication Administration ◽

Health Record ◽

Plain Language ◽

Patient Centered ◽

Percentage Point Increase ◽

Point Increase ◽

Electronic Health

Objective Patient instructions are generally written by clinicians. However, clinician-centered language is challenging for patients to understand; in the case of pediatric medication instructions, consequences can be serious. Using examples of clinician-written medication instructions from an electronic health record, we conducted an experiment to determine whether parental misinterpretations would be reduced by instructions that followed best practices for plain language. Methods We selected examples of dosing instructions from after-visit summaries in a commercial electronic health record. A demographically diverse sample of parents and adult caregivers was recruited from an online panel to participate in an English-language experiment, in which they received a comprehension questionnaire with either original after-visit summary instructions or instructions revised to comply with federal and other sources of plain-language guidance. Results Nine-hundred and fifty-one respondents completed the experiment; 50% were women, the mean age was 36 years, and 38% had less than a 4-year college education. The revisions were associated with an 8 percentage point increase in correct answers overall (from 55% to 63%, p < 0.001), although revisions were not equally effective for all instructions. Health literacy and health numeracy were strong and independent predictors of comprehension. Overall, mistakes on comprehension questions were common, with respondents missing an average of 41% (6.1 of 15) of questions. Conclusion In this experimental study, a relatively simple intervention of revising text was associated with a modest reduction in frequency of misinterpretations of medication instructions. As a supplement to more intensive high-touch interventions, revising electronic health record output to replace complex language with patient-centered language in an automated fashion is a potentially scalable solution that could reduce medication administration errors by parents.

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Web-based personal health records: the personal electronic health record (pEHR) multicentred trial

Journal of Telemedicine and Telecare ◽

10.1258/135763307781645086 ◽

2007 ◽

Vol 13 (1_suppl) ◽

pp. 32-34 ◽

Cited By ~ 7

Author(s):

George E Karagiannis ◽

Vasileios G Stamatopoulos ◽

Michael Rigby ◽

Takis Kotis ◽

Elisa Negroni ◽

...

Keyword(s):

Health Care ◽

Electronic Health Record ◽

Health Care Professionals ◽

Large Scale ◽

Study Groups ◽

Third Party ◽

Health Record ◽

User Friendliness ◽

Web Based ◽

Electronic Health

A multicentre trial of a Web-based personal electronic health record (pEHR) service was conducted in three different European hospitals. A total of 150 patients and 22 health-care professionals were involved. The service was customised according to the needs of three groups of patients who had congenital heart disease, Parkinson's disease and type 2 diabetes. Two structured questionnaires, one for patients and one for health-care professionals, were used to collect their views on the pEHR service. The questions were about usability and user friendliness, safety and trustworthiness, reliability, functionality, satisfaction and the potential revenue model of the service in the case of future deployment. Patients perceived the service as very motivating and felt that it could help them in managing their clinical information. Health-care professionals showed a very positive attitude towards the use of the service and its potential for future large-scale deployment. They were also keen to recommend the service to their patients. Both study groups were unwilling to pay for the service and preferred it to be sponsored by a third party (e.g. the National Health Service).

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