scholarly journals Utilising Electronic Health Record Data to Assess the Sepsis Inpatient Care Pathway: A Feasibility Study

2021 ◽  
Author(s):  
Ling Li ◽  
Kasun Rathnayake ◽  
Tsui Yue Ong ◽  
Cliff Hughes ◽  
Vincent Lam ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Inpatient Care ◽  
Care Pathway ◽  
Clinical Information ◽  
World Health Organisation ◽  
Medical Emergency ◽  
Quality Data ◽  
Sepsis Diagnosis ◽  
Routinely Collected Data ◽  
Electronic Health

The World Health Organisation has recently declared sepsis a global medical emergency. Obtaining quality data to establish the evidence on how clinicians recognise, diagnose, and treat sepsis is still a challenge. This feasibility study aimed to utilise routinely collected data from electronic health records (EHR) to assess the sepsis inpatient care pathway. We conducted a retrospective observational cohort study which included all patients admitted to a private teaching hospital between 2015 and 2018. De-identified patient demographic and clinical data were extracted and analysed. A total of 47 sepsis patients were identified based on diagnoses recorded and a review of clinical notes. A surgical procedure was conducted on more than half of these patients (n=25, 53%). Nearly two-thirds were given antibiotics (n=30, 64%), of which 87% (n=26) were administered within 2-hours of sepsis diagnosis. Eighteen patients were admitted to ICU and 13 of them were diagnosed as septic in ICU. We identified some aspects of EHR data that could be improved. Overall, routinely collected data from clinical information systems provides rich information to assess the sepsis patient care pathway.

Architecture Models to Facilitate Communication of Clinical Information

1999 ◽  
Vol 38 (04/05) ◽  
pp. 326-331
Author(s):  
S. Kay
Keyword(s):  
Health Care ◽  
Clinical Information ◽  
Reference Architecture ◽  
Context Model ◽  
Electronic Health

AbstractThis is an account of the development and use of a context model for facilitating the communication of clinical information. Its function is to articulate the principle of context within a reference architecture for the Electronic Health Care Record (EHCR). The work required a re-examination of established models of communication, the purpose being to use them to support an architecture that could be reasonably expected to accommodate future, and by definition unforeseeable, developments in EHCR communication. The Context Model is built upon seven recognized constituents of communication. These constituents, although having their origin in the engineering of signal communication, have been found to be useful for explication both in the verbal and textual communication of narratives between people. The electronic health care record architecture supported by the model is the European prestandard ENV13606-1.

scholarly journals Improving mobility and participation of older people with vertigo, dizziness and balance disorders in primary care using a care pathway: feasibility study and process evaluation

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Eva Seckler ◽  
Verena Regauer ◽  
Melanie Krüger ◽  
Anna Gabriel ◽  
Joachim Hermsdörfer ◽  
...  
Keyword(s):  
Primary Care ◽  
Data Collection ◽  
Older People ◽  
Process Evaluation ◽  
Feasibility Study ◽  
Health Professionals ◽  
Implementation Strategy ◽  
Care Pathway ◽  
Main Trial ◽  
Telephone Helpline

Abstract Background Community-dwelling older people are frequently affected by vertigo, dizziness and balance disorders (VDB). We previously developed a care pathway (CPW) to improve their mobility and participation by offering standardized approaches for general practitioners (GPs) and physical therapists (PTs). We aimed to assess the feasibility of the intervention, its implementation strategy and the study procedures in preparation for the subsequent main trial. Methods This 12-week prospective cohort feasibility study was accompanied by a process evaluation designed according to the UK Medical Research Council’s Guidance for developing and evaluating complex interventions. Patients with VDB (≥65 years), GPs and PTs in primary care were included. The intervention consisted of a diagnostic screening checklist for GPs and a guide for PTs. The implementation strategy included specific educational trainings and a telephone helpline. Data for mixed-method process evaluation were collected via standardized questionnaires, field notes and qualitative interviews. Quantitative data were analysed using descriptive statistics, qualitative data using content analysis. Results A total of five GP practices (seven single GPs), 10 PT practices and 22 patients were included in the study. The recruitment of GPs and patients was challenging (response rates: GP practices: 28%, PT practices: 39%). Ninety-one percent of the patients and all health professionals completed the study. The health professionals responded well to the educational trainings; the utilization of the telephone helpline was low (one call each from GPs and PTs). Familiarisation with the routine of application of the intervention and positive attitudes were emphasized as facilitators of the implementation of the intervention, whereas a lack of time was mentioned as a barrier. Despite difficulties in the GPs’ adherence to the intervention protocol, the GPs, PTs and patients saw benefit in the intervention. The patients’ treatment adherence to physical therapy was good. There were minor issues in data collection, but no unintended consequences. Conclusion Although the process evaluation provided good support for the feasibility of study procedures, the intervention and its implementation strategy, we identified a need for improvement in recruitment of participants, the GP intervention part and the data collection procedures. The findings will inform the main trial to test the interventions effectiveness in a cluster RCT. Trial registration Projektdatenbank Versorgungsforschung Deutschland (German registry Health Services Research) VfD_MobilE-PHY_17_003910, date of registration: 30.11.2017; Deutsches Register Klinischer Studien (German Clinical Trials Register) DRKS00022918, date of registration: 03.09.2020 (retrospectively registered).

An Overview of Novel Bioactive Compounds with Potent Anti-Inflammatory Activity via Dual COX-2 and 5-LOX Enzyme Inhibition

2021 ◽  
Vol 18 ◽  
Author(s):  
Roopal Mittal ◽  
Shailesh Sharma ◽  
Ajay Singh Kushwah
Keyword(s):  
Bioactive Compounds ◽  
Enzyme Inhibitors ◽  
World Health Organisation ◽  
The Body ◽  
Inflammatory Activity ◽  
World Health ◽  
Quality Data ◽  
The World ◽  
Cox 2 ◽  
Anti Inflammatory

Background: Inflammation is the earliest body defence mechanism in which the immune system recognises and counters the antigens and aids in healing the disease. The World Health Organisation suggests that inflammation is one of the greatest causes of death in the world. Inflammation could be acute or chronic due to the release of inflammatory mediators i.e. prostaglandins, leukotrienes due to mitogens, antigens or cytokines found in the body. Methods: Bibliographic database using pub med cites for peer-reviewed research articles with titles containing dual COX-2 and 5-LOX enzyme inhibitors, heterocyclic moieties, with AND Boolean operator's terms since last ten years of literature work. The quality papers containing the natural or synthetic lead compounds were extracted; the detailed study and conceptual framework attracted its attention. Results: Out of 127 research and review articles evaluated, 54 articles were cited to provide high quality data regarding pharmacoactive molecules having anti-inflammatory activity via dual COX-2/5-LOX inhibition. In addition, highlighting their in silico and experimental wet laboratory studies in increasing order over the past decade with the best illustration of dual enzyme inhibitory activity. Conclusion: This review gathered details of isolated bioactive compounds such as pyrazole, coumaperine, indoles, phenanthrene derivatives that have been significantly reported for anti-inflammatory activities.

scholarly journals Does the Electronic Health Card for Asylum Seekers Lead to an Excessive Use of the Health System? Results of a Survey in Two Municipalities of the German Ruhr Area

2019 ◽  
Vol 16 (7) ◽  
pp. 1178 ◽  
Author(s):  
Pia Jäger ◽  
Kevin Claassen ◽  
Notburga Ott ◽  
Angela Brand
Keyword(s):  
General Practitioners ◽  
Asylum Seekers ◽  
Inpatient Care ◽  
Healthcare Services ◽  
Initial Study ◽  
Consultation Rate ◽  
Ruhr Area ◽  
Federal States ◽  
Electronic Health ◽  
Autochthonous Population

Background: The initial and intermediate-term access of refugees to healthcare in Germany is limited. A previous study showed that the obligation to request healthcare vouchers at the social security offices decreases the asylum seekers’ consultation rate of ambulant physicians. The introduction of the Electronic Health Insurance Card (EHIC) for asylum seekers is considered skeptically by some municipalities and federal states, among other reasons due to the fear of an overuse of health care services by asylum seekers. The aim of this study is to further evaluate the data of the authors’ initial study with a new focus on inpatient care as well as a differentiation of the ambulant consultation rate into general practitioners and outpatient specialists. Methods: The now-differentiated consultation rate of the initial study as well as the asylum seekers’ use of inpatient care are compared to the values of the sex- and age-corrected autochthonous population as given by the German Health Interview and Examination Survey for Adults (DEGS1). A mean difference test (student’s t-test) is used for comparison and significance testing. Results: Asylum seekers who were in possession of the EHIC were significantly less likely to visit their ambulant general practitioners and specialists than the German autochthonous population. Simultaneously, this difference is partly compensated for by their more frequent use of impatient care. Conclusions: There is no indication that the EHIC leads to an overuse of healthcare services.

scholarly journals APnet, an innovative multidisciplinary medical information platform for acute pancreatitis

2019 ◽  
Vol 65 (2) ◽  
pp. 118-122 ◽  
Author(s):  
Yang Fei ◽  
Wei-qin Li
Keyword(s):  
Information System ◽  
Acute Pancreatitis ◽  
Health Professionals ◽  
Medical Information ◽  
Clinical Information System ◽  
Care Pathway ◽  
Clinical Information ◽  
Information Platform ◽  
Integrated Information System ◽  
Operation Phase

SUMMARY The APnet information platform aims at assisting patients suffering from acute pancreatitis, health professionals and patients' relatives in the acute pancreatitis care pathway by providing an integrated information system. The system consists of a mobile platform and a Clinical Information System. The system is currently on the formal operation phase focusing on addressing the needs of citizens of China.

Osteoarthritis Hip and Knee Service (OAHKS) in a community health setting compared to the hospital setting: A feasibility study for a new care pathway

2020 ◽  
Vol 49 ◽  
pp. 102167 ◽  
Author(s):  
Alison J. Gibbs ◽  
Nicholas F. Taylor ◽  
Raphael Hau ◽  
Christian Barton ◽  
Chris Fong ◽  
...  
Keyword(s):  
Community Health ◽  
Feasibility Study ◽  
Care Pathway ◽  
Hospital Setting

scholarly journals Joint Imaging Platform for Federated Clinical Data Analytics

2020 ◽  
pp. 1027-1038
Author(s):  
Jonas Scherer ◽  
Marco Nolden ◽  
Jens Kleesiek ◽  
Jasmin Metzger ◽  
Klaus Kades ◽  
...  
Keyword(s):  
Data Analytics ◽  
Large Scale ◽  
Image Data ◽  
Clinical Information ◽  
Quality Data ◽  
Imaging Data ◽  
University Hospitals ◽  
High Quality Data ◽  
Interactive Analysis ◽  
Legal Constraints

PURPOSE Image analysis is one of the most promising applications of artificial intelligence (AI) in health care, potentially improving prediction, diagnosis, and treatment of diseases. Although scientific advances in this area critically depend on the accessibility of large-volume and high-quality data, sharing data between institutions faces various ethical and legal constraints as well as organizational and technical obstacles. METHODS The Joint Imaging Platform (JIP) of the German Cancer Consortium (DKTK) addresses these issues by providing federated data analysis technology in a secure and compliant way. Using the JIP, medical image data remain in the originator institutions, but analysis and AI algorithms are shared and jointly used. Common standards and interfaces to local systems ensure permanent data sovereignty of participating institutions. RESULTS The JIP is established in the radiology and nuclear medicine departments of 10 university hospitals in Germany (DKTK partner sites). In multiple complementary use cases, we show that the platform fulfills all relevant requirements to serve as a foundation for multicenter medical imaging trials and research on large cohorts, including the harmonization and integration of data, interactive analysis, automatic analysis, federated machine learning, and extensibility and maintenance processes, which are elementary for the sustainability of such a platform. CONCLUSION The results demonstrate the feasibility of using the JIP as a federated data analytics platform in heterogeneous clinical information technology and software landscapes, solving an important bottleneck for the application of AI to large-scale clinical imaging data.

scholarly journals 4541 Harnessing the Power of the Electronic Medical Record in Interstitial Lung Disease

2020 ◽  
Vol 4 (s1) ◽  
pp. 48-49
Author(s):  
Erica Farrand ◽  
Eric Vittinghoff ◽  
Harold Collard
Keyword(s):  
Interstitial Lung Disease ◽  
Clinical Research ◽  
Lung Disease ◽  
Clinical Information ◽  
Demographic Variables ◽  
Data Capture ◽  
Research Quality ◽  
Quality Data ◽  
Research Database ◽  
Consensus Statements

OBJECTIVES/GOALS: Harnessing the EHR to support clinical research is critical for the study of rare diseases such as interstitial lung disease (ILD). However no studies have compared EHR and research-quality data in the ILD population. Our objectives were to (1) identify ILD patients and extract clinical data from an EHR system and (2) assess the performance of ILD data capture. METHODS/STUDY POPULATION: Case validated algorithms were implemented to identify patients from the University of California San Francisco EHR and extract key ILD clinical information including, demographic variables, process measures and patient outcomes. Key clinical information were defined based on consensus statements and ILD clinical trials. A subset of ILD patients, had variables recorded in both the EHR and a separate ILD longitudinal research database. The completeness of EHR data capture and level of agreement were compared between three data collection methods: (1) data manually and systematically collected for an ILD research database (gold standard), (2) data automatically extracted from structured fields in the EHR, and (3) data extracted from unstructured data sources. RESULTS/ANTICIPATED RESULTS: We identified 5857 ILD patients in the EHR, of which 2100 patients had data available in the both the EHR and research database. Baseline demographic variables, co-morbidities, use of diagnostic testing, pharmacotherapy were accurately extracted from structured fields. Outcome measures, including lung physiology, radiographic patterns, pathology results, and health related quality of life (HRQoL) were unevenly extracted from structured fields alone. With the exception of HRQoL, these measures were accurately captured in unstructured EHR sources. Notably, certain metrics were better defined in the EHR, including health care resource utilization metrics, acute exacerbations, medication side effects, supplemental oxygen use and specialty care referrals (rheumatology, lung transplant, palliative care, etc). DISCUSSION/SIGNIFICANCE OF IMPACT: A large real-world ILD cohort can be algorithmically extracted from the EHR along with key clinical variables with accuracy comparable to protocol-driven research databases. Rigorous assessment of the types of disease-specific variables that are present in EHR-derived data will inform future interventions to improve the fidelity, accessibility and use of the EHR in clinical research.

Factors influencing the use of electronic health record systems to provide follow-up care to cancer survivors.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 182-182
Author(s):  
Guadalupe R. Palos ◽  
Maria Alma Rodriguez ◽  
Paula A. Lewis-Patterson ◽  
Rachel Harris ◽  
Lewis E. Foxhall
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Clinical Information ◽  
Primary Care Providers ◽  
Self Report ◽  
Care Providers ◽  
Convenience Sample ◽  
Major Barrier ◽  
Care Plans ◽  
Electronic Health

182 Background: One of the expected benefits of electronic health records (EHRs) is their interoperability to remotely access and exchange clinical information across systems and clinicians. Cancer survivors’ treatment summaries (TSs) and care plans (CPs) are documents that can be electronically transferred from oncologists to primary care providers. We conducted a needs assessment to identify factors which influenced EHRs in meeting these expectations in rural and underserved primary care settings. Methods: Clinicians from 2 family practice health care systems, located in central and northeast Texas were surveyed. REDCap, a web-based system, was used to develop, manage, and distribute the survey to a convenience sample of clinical staff from both settings. Survey questions focused on respondents’ demographic and clinical practice characteristics, current experience with TSs and CPs, and type of EHR used. Results: A total of 26 surveys were included in this analysis. Respondents were primarily physicians (73%). Overall 61.5% reported that ≤ 25% of their patients were diagnosed with cancer or currently had cancer. A patient’s self-report was the primary method used by majority of respondents to determine if a patient had a history of cancer. 80.8% indicated they would be interested in learning more about the use and development of TSs and CPs. Barriers reported towards the use of EHRs to deliver TSs and CPs included: EHRs interference with workflow (60%); limited knowledge on how to develop TSs and CPs (48%), inadequate access to IT resources (48%), and inefficient EHR systems (44%). In these settings, EHRs used were: Epic (61.6%), Aria (30.8%), and Medit (7.7%). Respondents’ comments on EHRs weaknesses included: “the two systems…do not completely communicate with each other” or “no place where a cancer treatment summary or survivorship plan is documented”. Conclusions: Primary care providers identified limitations in EHR operability as a major barrier to retrieving health information required for TSs and CPs. Clinicians in rural or underserved regions may benefit from education and retraining in EHR systems.

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