scholarly journals Development and evaluation of a customizable electron-ic medical record for clinical outcomes research and patient engagement

2016 ◽  
Vol 5 (1) ◽  
pp. 10
Author(s):  
Wayne Miller ◽  
Jennifer Patton ◽  
Patricia Lally ◽  
Joshua Cusick-Lewis ◽  
Karen Fitzpatrick ◽  
...  
Keyword(s):  
Family Practice ◽  
Patient Engagement ◽  
Information Needs ◽  
Health Workers ◽  
Data Extraction ◽  
Data Entry ◽  
Clinical Information ◽  
Clinical Effectiveness ◽  
Circle Of Care ◽  
Urban Family

Background: Electronic Medical Records (EMRs) provide a database to support clinical information needs. However, it is often difficult to access EMR-generated data to answer specific clinical-based questions. Furthermore, EMR is not designed to complete the circle of care by interacting and communicating directly with patients. The problem is even greater in rural practices, with limited resources, and with providers inexperienced in research, who are doing well to meet the daily requirements of keeping their practice doors open.Objective: Design and evaluate a customizable EMR-Reporting Tool (EMR-RT) that can be used as an adjunct to an existing EMR or as a sole-standing EMR-RT for clinical outcome's research and patient engagement.Methods: Two rural and two urban family practice clinics participated in the design and beta testing of a customizable EMR-RT for clinical effectiveness research and for patient engagement. The EMR-RT was implemented in each clinic for a 6-month clinical trial.Results: The EMR-RT used in each clinic was simplistic enough that community health workers could handle patient data entry, data management, and data extraction independently. Each clinic could incorporate clinic-specific measurement variables into the EMR-RT database with minimal effort. Changes to the EMR-RT database capabilities could be performed off-site through the Internet.Conclusions: A customizable EMR-RT was successfully designed and implemented in two rural and two urban family practice clinics. The EMR-RT was robust enough to congregate clinical research data, but flexible enough and simplistic enough that workers who were previously untrained in EMR use could quickly utilize the system.

scholarly journals The implementation of a mobile application to support community-based health workers

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A C F Martins ◽  
P L Pereira ◽  
A C C N Mafra ◽  
J L Miraglia ◽  
C N Monteiro ◽  
...  
Keyword(s):  
Health Care ◽  
Mobile Application ◽  
Total Population ◽  
Health Workers ◽  
Data Entry ◽  
Population Data ◽  
Administrative Staff ◽  
Economic Data ◽  
Process Change ◽  
Community Based

Abstract Issue Real-time access to up-to-date population information is essential to the strategic planning of primary health care (PHC). In the Brazilian public health system community-based health workers (CHWs), working as part of PHC teams, collect health, demographic and socio-economic data from individuals mainly through paper-based forms that are later entered manually into electronic information systems. Mobile applications could help to improve the quality and speed of this process facilitating the CHWs day-to-day work while improving the access to the collected information. Description of the Problem During September of 2019, a mobile application installed in tablets for the collection of health, demographic and socio-economic data was deployed for 432 CHWs of 87 PHC teams in the southern region of São Paulo, Brazil, serving a total population of 283,324 individuals. During implementation, the acceptability and challenges faced by CHWs were evaluated and the time taken to complete data entry. Results Seventy-two hours of training were offered to CHWs and other 139 professionals including managers, nurses and administrative staff (AS). Some CHWs reported concerns about the process change and fear of not being able to operate the application, especially those unfamiliar to the technology. With training and team support, fear was transformed into satisfaction with the realization of the benefits of the system. The main infrastructure challenge was the need for installation of Wi-Fi routers in some health care units, in addition to the replacement 4.4% of damaged tablets. In four months 97.6% of the total population was registered in the application. Lessons A WhatsApp group was created to clarify AS doubts, receive suggestions and disseminate guidelines. AS remained as the reference point at healthcare units and data completeness still needs to be reinforced. Key messages A mobile application was well-accepted by CHWs and could facilitate the collection of population data. A tablet app proved to be a useful tool to generate information for the PHC teams.

scholarly journals Legal needs of patients attending an urban family practice in Hamilton, Ontario, Canada: an observational study of a legal health clinic

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Gina Agarwal ◽  
Melissa Pirrie ◽  
Dan Edwards ◽  
Bethany Delleman ◽  
Sharon Crowe ◽  
...  
Keyword(s):  
Observational Study ◽  
Health Outcomes ◽  
Family Practice ◽  
Healthcare Setting ◽  
Social Determinant ◽  
Care Physician ◽  
Health Clinic ◽  
Legal Services ◽  
Future Health ◽  
Urban Family

Abstract Background Individuals living in poverty often visit their primary care physician for health problems resulting from unmet legal needs. Providing legal services for those in need may therefore improve health outcomes. Poverty is a social determinant of health. Impoverished areas tend to have poor health outcomes, with higher rates of mental illness, chronic disease, and comorbidity. This study reports on a medical-legal collaboration delivered in a healthcare setting between health professionals and lawyers as a novel way to approach the inaccessibility of legal services for those in need. Methods In this observational study, patients aged 18 or older were either approached or referred to complete a screening tool to identify areas of concern. Patients deemed to have a legal problem were offered an appointment at the Legal Health Clinic, where lawyers provided legal advice, referrals, and services for patients of the physicians. Fisher’s exact test was used to compare populations. Binary logistic regression was used to determine the factors predicting booking an appointment with the clinic. Results Eighty-four percent (n = 648) of the 770 patients screened had unmet legal needs and could benefit from the intervention, with an average of 3.44 (SD = 3.42) legal needs per patient screened. Patients with legal needs had significantly higher odds of attending the Legal Health Clinic if they were an ethnicity that was not white (OR = 2.48; 95% CI 1.14–5.39), did not have Canadian citizenship (OR = 4.40; 95% CI 1.48–13.07), had housing insecurity (OR = 3.33; 95% CI 1.53–7.24), and had difficulty performing their usual activities (OR = 2.83; 95% CI 1.08–7.43). As a result of the clinic consultations, 58.0% (n = 40) were referred to either Legal Aid Ontario or Hamilton Community Legal Clinic, 21.74% (n = 15) were referred to a private lawyer; one case was taken on by the clinic lawyer. Conclusion The Legal Health Clinic was found to fulfill unmet legal needs which were abundant in this urban family practice. This has important implications for the future health of patients and clinical practice. Utilizing a Legal Health Clinic could translate into improved health outcomes for patients by helping overcome barriers in accessing legal services and addressing social causes of adverse health outcomes.

scholarly journals Clinical effectiveness of convalescent plasma in hospitalized patients with COVID-19: a systematic review and meta-analysis

2021 ◽  
Vol 15 ◽  
pp. 175346662110280
Author(s):  
Roberto Ariel Abeldaño Zuñiga ◽  
Ruth Ana María González-Villoria ◽  
María Vanesa Elizondo ◽  
Anel Yaneli Nicolás Osorio ◽  
David Gómez Martínez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Clinical Improvement ◽  
Data Extraction ◽  
Meta Analysis ◽  
Clinical Effectiveness ◽  
Risk Of Bias ◽  
Hospitalized Patients ◽  
Low Risk ◽  
Controlled Clinical Trials

Aims: Given the variability of previously reported results, this systematic review aims to determine the clinical effectiveness of convalescent plasma employed in the treatment of hospitalized patients diagnosed with COVID-19. Methods: We conducted a systematic review of controlled clinical trials assessing treatment with convalescent plasma for hospitalized patients diagnosed with SARS-CoV-2 infection. The outcomes were mortality, clinical improvement, and ventilation requirement. Results: A total of 51 studies were retrieved from the databases. Five articles were finally included in the data extraction and qualitative and quantitative synthesis of results. The overall risk of bias in the reviewed articles was established at low-risk only in two trials. The meta-analysis suggests that there is no benefit of convalescent plasma compared with standard care or placebo in reducing the overall mortality and the ventilation requirement. However, there could be a benefit for the clinical improvement in patients treated with plasma. Conclusion: Current results led to assume that the convalescent plasma transfusion cannot reduce the mortality or ventilation requirement in hospitalized patients diagnosed with SARS-CoV-2 infection. More controlled clinical trials conducted with methodologies that ensure a low risk of bias are still needed. The reviews of this paper are available via the supplemental material section.

scholarly journals Automated data extraction software for medical summary using text mining (T-Library)

2019 ◽  
Author(s):  
Tomohide Yamada ◽  
Yoshinobu Kondo ◽  
Ryo Momosaki
Keyword(s):  
Clinical Trials ◽  
Deep Learning ◽  
Clinical Research ◽  
Data Extraction ◽  
Healthcare Providers ◽  
Clinical Information ◽  
Patient Records ◽  
Unstructured Text ◽  
Risk Engine ◽  
Easy Operation

The electronic medical record (EMR) is a source of clinical information and is used for clinical research. Clinical researchers leverage this information by employing staffs to manually extracting data from the unstructured text. This process can be both error-prone and labor-intensive. This software (T-Library) is a software which automatically extracts key clinical data from patient records and can potentially help healthcare providers and researchers save money, make treatment decisions and manage clinical trials. This software saves labor for data transcription in clinical research. This is a vital step toward getting researchers rapid access to the information they need. This is also the attempt to cluster patients’ morbid states and establish accurate and constantly updated risk engine of complications’ crises, using deep learning. Strengths: 1) Quick and Easy operation URL: http://www.picoron.com/tlibrary/

scholarly journals Clinical effectiveness of drugs in hospitalized patients with COVID-19 infection: a systematic review and meta-analysis.

2020 ◽  
Author(s):  
Roberto Ariel Abeldano Zuniga ◽  
Silvia Coca ◽  
Giuliana Abeldano ◽  
Ruth Ana Maria Gonzalez Villoria
Keyword(s):  
Systematic Review ◽  
Clinical Improvement ◽  
Low Income ◽  
Randomized Clinical Trials ◽  
Data Extraction ◽  
Meta Analysis ◽  
Clinical Effectiveness ◽  
Hospitalized Patients ◽  
Low Income Countries ◽  
Qualitative Synthesis

Objective. The aim was to assess the clinical effectiveness of drugs used in hospitalized patients with COVID-19 infection. Method. We conducted a systematic review of randomized clinical trials assessing treatment with remdesivir, chloroquine, hydroxychloroquine, lopinavir, ritonavir, dexamethasone, and convalescent plasma, for hospitalized patients with a diagnosis of SARS-CoV-2 infection. The outcomes were mortality, clinical improvement, duration of ventilation, duration of oxygen support, duration of hospitalization), virological clearance, and severe adverse events. Results. A total of 48 studies were retrieved from the databases. Ten articles were finally included in the data extraction and qualitative synthesis of results. The meta-analysis suggests a benefit of dexamethasone versus standard care in the reduction of risk of mortality at day 28; and the clinical improvement at days 14 and 28 in patients treated with remdesivir. Conclusions. Dexamethasone would have a better result in hospitalized patients, especially in low-resources settings. Significance of results. The analysis of the main treatments proposed for hospitalized patients is of vital importance to reduce mortality in low-income countries; since the COVID-19 pandemic had an economic impact worldwide with the loss of jobs and economic decline in countries with scarce resources. Keywords: Drugs; Antivirals; Clinical improvement; Mortality; COVID-19; SARS-CoV2.

scholarly journals Deprescribing intervention activities mapped to guiding principles for use in general practice: a scoping review

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e052547
Author(s):  
Amy Coe ◽  
Catherine Kaylor-Hughes ◽  
Susan Fletcher ◽  
Elizabeth Murray ◽  
Jane Gunn
Keyword(s):  
General Practice ◽  
Family Practice ◽  
Data Extraction ◽  
Controlled Trial ◽  
Future Research ◽  
Original Research ◽  
Practice Staff ◽  
Quasi Experimental ◽  
Guiding Principles ◽  
Randomised Controlled

ObjectiveTo identify and characterise activities for deprescribing used in general practice and to map the identified activities to pioneering principles of deprescribing.SettingPrimary care.Data sourcesMedline, EMBASE (Ovid), CINAHL, Australian New Zealand Clinical Trials Registry (ANZCTR), Clinicaltrials.gov, ISRCTN registry, OpenGrey, Annals of Family Medicine, BMC Family Practice, Family Practice and British Journal of General Practice (BJGP) from inception to the end of June 2021.Study selectionIncluded studies were original research (randomised controlled trial, quasi-experimental, cohort study, qualitative and case studies), protocol papers and protocol registrations.Data extractionScreening and data extraction was completed by one reviewer; 10% of the studies were independently reviewed by a second reviewer. Coding of full-text articles in NVivo was conducted and mapped to five deprescribing principles.ResultsFifty studies were included. The most frequently used activities were identification of appropriate patients for deprescribing (76%), patient education (50%), general practitioners (GP) education (48%), and development and use of a tapering schedule (38%). Six activities did not align with the five deprescribing principles. As such, two principles (engage practice staff in education and appropriate identification of patients, and provide feedback to staff about deprescribing occurrences within the practice) were added.ConclusionActivities and guiding principles for deprescribing should be paired together to provide an accessible and comprehensive guide to deprescribing by GPs. The addition of two principles suggests that practice staff and practice management teams may play an instrumental role in sustaining deprescribing processes within clinical practice. Future research is required to determine the most of effective activities to use within each principle and by whom.

Physician satisfaction with electronic medical records (EMRs): Time for an intelligent health record?

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 318-318
Author(s):  
Ajeet Gajra ◽  
Dewilka Simons ◽  
Yolaine Jeune-Smith ◽  
Amy W. Valley ◽  
Bruce A. Feinberg
Keyword(s):  
Medical Records ◽  
Healthcare Delivery ◽  
Data Entry ◽  
Community Setting ◽  
Clinical Information ◽  
Data Access ◽  
Physician Satisfaction ◽  
Remote Access ◽  
Direct Patient Care ◽  
Cancer Management

318 Background: EMRs are devised to improve the quality and efficiency of healthcare delivery and to reduce medical errors. Despite the widespread use of EMRs, various factors can limit their effectiveness in improving healthcare quality. General EMR use has been cited as a factor contributing to increased workload and clinician burnout in oncology and other specialties. The objective of this qualitative research study was to identify barriers perceived by medical oncologists and hematologists (mO/H) in utilizing EMR software and factors associated with levels of satisfaction. Methods: Between January and April 2021, mO/H from across the U.S. were invited to complete a web-based survey about various trends and critical issues in oncology care. Demographics about the physicians and characteristics of their practices were captured as well in the survey. Responses were aggregated and analyzed using descriptive statistics. Results: A total of 369 mO/H completed the survey: 72% practice in a community setting; 47% identified as a hospital employee; they have an average of 19 years of clinical experience and spend on average 86% of their working time in direct patient care, seeing 17 patients per day on average on clinic days. Most (99%) of mO/H surveyed use an EMR software at their practice, with Epic (45%) and OncoEMR (16%) being the most common. Regarding satisfaction, 16% and 50% reported feeling highly satisfied and satisfied, respectively, with their current EMR, and 3% and 11% reported feeling very dissatisfied or dissatisfied, respectively. Some (19%) stated that they have considered changing their EMR, and 68% are unsure how EMR licensing fees for their practice are paid. EMR pain points most commonly experienced were: time-consuming, e.g., too many steps/click (70%); interoperability, e.g., difficulty sharing information across institutions or other EMR software (45%); data entry issues, e.g., difficulty entering clinical information, scheduling patient visits and reminders, or ordering multiple labs (38%); and poor workflow support (31%). The most useful aspects/features of their EMR software reported were availability of information, e.g., preloaded protocols, chemotherapy regimens and pathways (64%); data access (64%); and multiple access points, including remote access (37%). Conclusions: Satisfaction with EMR were generally positive among the mO/H surveyed. However, there are multiple deterrents to the efficient use of current EMR systems. This information is essential in the design of next-generation EMR (an Intelligent Medical Records system) to allow for incorporation of aspects most useful to the end-users, such as pathway access, preloaded information on cancer management as well as ease of access and portability, and a user experience that minimizes clicks and reduces physician time with EMR.

Harvesting Deep Web Data Through Produser Involvement

The Dark Web ◽  
2018 ◽  
pp. 175-198 ◽  
Author(s):  
Tomasz Kaczmarek ◽  
Dawid Grzegorz Węckowski
Keyword(s):  
Information Needs ◽  
Data Extraction ◽  
End Users ◽  
Deep Web ◽  
End User ◽  
Web Data ◽  
User Perspective ◽  
Complex Process ◽  
Integration Techniques

Acquiring the data from the deep Web is a complex process, which requires understanding of Website navigation issues, data extraction, and integration techniques. Currently existing solutions to automate it are not ready to cover the whole deep Web and require skills and knowledge to be applied in practice. However, several systems were created, which approach the problem by involving end users who are able to bring the data from the deep Web to the surface while creating solutions for their own information needs. The authors study these systems in the chapter from the end user perspective, investigating their interfaces, languages that they expose to end users, and the platforms that accompany the systems to involve end users and allow them to share the results of their work.

The MOBEL Project

2011 ◽  
pp. 1171-1190
Author(s):  
Inger Dybdahl Sorby ◽  
Line Melby ◽  
Yngve Dahl ◽  
Gry Seland
Keyword(s):  
Communication Systems ◽  
Information Needs ◽  
System Development ◽  
Point Of Care ◽  
User Involvement ◽  
Clinical Information ◽  
Problem Area ◽  
Patient Centered ◽  
Mobile Information ◽  
Information And Communication

This chapter presents results and experiences from the MOBEL (MOBile ELectronic patient record) project at the Norwegian University of Science and Technology (NTNU) in Trondheim, Norway. MOBEL was a multidisciplinary research project established in 2000. The problem area of the project was communication and information needs in hospital wards, and the aim of the project was to develop and explore methods and prototypes for point of care clinical information systems (PoCCS) that support clinicians in their patient-centered activities. The chapter summarizes four sub studies performed during the project. Each study presents different approaches to user-centered design of PoCCS. Findings from these studies confirm the need for mobile information and communication technology (ICT) in hospitals. Furthermore, the studies demonstrate how more user involvement and complementary approaches to traditional requirements engineering (RE) and system development methods can be useful when developing mobile information and communication systems for clinicians.

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