Indications for exchange or explantation of phakic implantable collamer lens with central port in patients with and without keratoconus

AIM: To evaluate the causes of phakic implantable collamer lens (ICL) exchange/explantation in patients with and without keratoconus (KC) at two tertiary hospitals in Riyadh, Saudi Arabia. METHODS: A retrospective chart review of all patients who underwent ICL (model V4c with central port) exchange/explantation was performed using the electronic medical record systems. All available preoperative and postoperative data were documented for each patient. RESULTS: Over 7y, 2283 ICL implantation procedures were performed; 46 implants (2%) required exchange (21 implants)/explantation (25 implants), of which 14 cases (30.4%) were patients with KC. Indications for ICL exchange/explantation in non-KC group were vault measurement, cataract formation, increased intraocular pressure, inaccurate refraction, and patient dissatisfaction in 22 (68.75%), 4 (12.5%), 3 (9.37%), 2 (6.25%), and 1 (3.12%) case, respectively. The most common indication for ICL exchange/explantation in the KC group was inaccurate vault sizing in 11 patients (78.57%), inaccurate refraction in 2 patients (14.28%), and patient dissatisfaction postoperatively in 1 (7.14%) case. CONCLUSION: ICL implantation results in predictable refractive outcomes over the long term with exchange/explantation rates comparable to previous literature. Improper vault size is the most common cause of ICL exchange/explantation among patients with or without KC.

Chemotherapy roadmaps in pediatric oncology: A digital electronic medical record integrated solution

Background Delivery of antineoplastic regimens in the pediatric setting is facilitated by a paper roadmap. Paper roadmaps are the key safety tool required for safe ordering. Electronic medical record systems offer technological solutions for ordering antineoplastic regimens, however, do not offer a solution that integrates paper roadmaps digitally. Methods A multidisciplinary project team implemented real-time clinician scanning of paper roadmaps into the electronic medical record. Results The rate of missing roadmaps decreased from an average of 1.6 to 0.8 per week. Pharmacists gained 3 h of productivity daily. Providers spend an average of 35–45 s and a total of seven clicks each time a roadmap is scanned. Overall, the clinical systems analyst spent less than 1 h of total build time. Conclusion Implementing roadmap scanning decreased the rate of missing roadmaps, increased pharmacist productivity, and required a nominal amount of analyst and provider time. In addition, this solution allows for concurrent viewing of the roadmap files from any connected computer, facilitating an easier co-signature process for providers, pharmacists, and nurses. Practice Implications These results suggest that implementing real-time scanning of roadmaps can improve oncology care efficiency while maintaining the same safety rigor that paper roadmaps offer.

Factors Influencing Electronic Medical Record Systems Success in Selected Tertiary Healthcare Facilities in South-West, Nigeria

Survey research design of the correlational type was employed for this study using stratified random sampling to select two hundred and forty-five (245) respondents. The research instrument which was a structured questionnaire was tagged Adoption Factors and Usage Evaluation of Electronic medical record systems System Success. A total of 222 copies research questionnaire were filled and returned. A statistical package for social science application was used in analysing the results of the research using Pearson Product Moment Correlation Coefficient for hypotheses one and two, and multiple regression analysis for the hypotheses three and four. The result from the study revealed that there was a positive significant correlation between adoption factors and EMRS systems’ success (r= 0.440) and there was a strong positive correlation between usage evaluation and system success of EMRS in the two healthcare facilities (r= 0.618). More so, findings showed that adoption factors jointly and significantly affect EMRS system success with coefficient of 0.648, and a multiple R square of 0.420. And there was also a relative contribution of adoption factors (β = 0.215) and usage evaluation (0.526) on EMRS success. The study concludes that electronic medical record systems have become a standard for every healthcare facility for improvement in the efficiency and profitability of the organisations. The study therefore recommends that, all healthcare facilities in Nigeria should adopt the electronic medical record systems, and all healthcare providers should be given thorough training on the use of EMRS.

Artificial Intelligence in Health Care

Although not always considered a domain of digital health, artificial intelligence (AI) and machine learning (ML) are inseparable, given that virtually all digital health tools utilize advance algorithm technologies. For example, a wearable device is not directly measuring sleep. It is measuring movement, electrical impulses, and other variables that are processed via algorithm and presented as a representation of sleep. Beyond digital devices, AI is being seen as a revolution in health care driven by the hopes that algorithms running on electronic medical record systems will predict when a patient is turning septic or that AI will free clinicians from tedious tasks. Much of this is coming true, but there is also a growing list of potential hazards such as trusting “black boxes,” racial bias, and poor technical execution. This chapter discusses ways to find the right balance between the progress and problems of AI in health care.

Implementation of EMR-based standardized antibiotic desensitization protocols and its impact on providers

Background: As desensitization protocols become more readily available and published, more institutions are implementing them and searching for ways to streamline the process. There have been no published studies to date on the effect that electronic medical record systems (EMR) have on the safety and efficiency of β-lactam antibiotic desensitization. Objective: The purpose of this study was to evaluate the changes in workflow, efficiency, and medical errors after implementation of β-lactam antibiotic desensitization. Methods: A collaborative effort between the Allergy/Immunology Division and the Pharmacy Department led to the creation and implementation of antibiotic desensitization order sets. Pre- and postimplementation of β-lactam antibiotic surveys were sent to pharmacists and allergy/immunology fellows and attendings at a single-center tertiary care center. Results: There were only 26 valid respondents (12.3%) to both the pre- and postimplementation surveys. The percentage of respondents who thought that the time needed to prepare desensitization materials was < 4 hours increased from 23% to 77% (p < 0.001). The percentage of respondents who thought that the time needed to input electronic desensitization orders was < 1 hour increased from 19% to 54% (p = 0.002). The percentage of respondents who identified zero errors increased from 42% to 92% (p = 0.001). The perception of the overall desensitization process efficiency significantly increased (p < 0.001). Conclusion: Creation of standardized electronic β-lactam antibiotic desensitization order sets significantly decreased the time taken to order and prepare materials and increased overall efficiency.

The place of Referent Tracking in Biomedical Informatics

Terminological systems, including coding and classification systems, are used in electronic medical record systems to facilitate the interpretation of structured data by providing terms and codes with a relatively precise meaning. When a clinician selects a term or code from such system and enters it in the medical record of a patient, then, from an ontological perspective and as a consequence of how ter-minological systems are currently integrated in electronic medical record systems, an assertion has been made to the effect that the patient exhibits, or exhibited, some phenomenon of type T. It is however left unspecified which phenomenon in particular is of the designated type T. In other words: such records contain explic-it references, i.e. the terms or codes, but the referents of these references are not explicitly identified! Because referents can be referenced in many different ways, types used as references can be about many referents, and referents may change so they become of a different type, data analytics application which rely on types only are prone to drawing erroneous conclusions. Referent Tracking is a method-ology for data management which allows assertions only to be made with explicit reference to the referents they are about. This chapter offers an introduction to the principles upon which the methodology rests and how these principles can be applied to improve the quality of the problem list in medical records.

Virtuelle Medizin in der Behandlung von Sucht in den USA, Kanada und darüber hinaus

ZusammenfassungInsbesondere während der aktuellen Corona-Pandemie hat der Gebrauch virtueller Lösungen in der Medizin international stark zugenommen. Es gibt eine zunehmende Akzeptanz gerade auch in dem Bereich der hausärztlichen Versorgung, der Behandlung psychischer Störungen und der Abhängigkeitserkrankungen.Die Entwicklung ist international unterschiedlich, v. a, wenn man die USA und Kanada auf der einen Seite und Europa, insbesondere Deutschland, andererseits vergleicht. In Nordamerika hat bei dem Einsatz von moderner Technologie die Einführung von „Electronic Medical Record Systems“ eine dominierende Rolle gespielt. Diese ist insbesondere auf Abrechnung und Dokumentation zu Versicherungszwecken fokussiert. Daneben gibt es zunehmend Apps, die spezifische therapeutische Ansätze zu implementieren helfen. Die Anwendung virtueller Ansätze im Suchtbereich ist begrenzt, aber in Teilen sehr innovativ und auf deutsche Verhältnisse anwendbar. Wie in Europa gibt es auch in Nordamerika nur sehr begrenzte Forschungskapazitäten und prinzipiell Widerstand bei den medizinischen Berufsgruppen bezüglich der Anwendungsmöglichkeiten und der Rolle im Behandlungsprozess. Mehr Kooperation würde international zu einer Beschleunigung der Entwicklung und der Etablierung gemeinsamer Standards beitragen sowie die Behandlungssysteme bedeutend verbessern.