Users’ Perception on Factors Contributing to Electronic Medical Records Systems Use: A Focus Group Discussion Study in Healthcare Facilities Setting in Kenya

Background Electronic Medical Records systems (EMRs) adoption in healthcare to facilitate work processes have become common in many countries. Although EMRs are associated with quality patient care, patient safety and cost reduction, their adoption rates are comparatively low. Understanding factors associated with usage of implemented EMRs are critical for advancing successful implementations and scale-up sustainable initiatives. The aim of this study was to explore end users’ perceptions and experiences on factors facilitating and hindering EMRs use in healthcare facilities in Kenya. Methods Focus group discussions were conducted with EMRs users (n=20) each representing a healthcare facility determined by the performance of the EMRs implementation. Content analysis was performed on the transcribed data and relevant themes derived.Results Six thematic categories for both facilitators and barriers emerged, and these related to: (1) system functionalities; (2) training; (3) technical support; (4) human factors; (5) infrastructure, and (6) EMR operation mode. The identified facilitators included: easiness of use and learning of the system, efficiency of EMRs in patient data management, responsiveness of Information Technical (IT) support, user training on EMR system upgrades. The identified barriers included: frequent power blackouts, inadequate computers, retrospective data entry (RDE) EMRs operation mode, lack of continuous training on system upgrades, and delayed IT support. Conclusion Users in an LMIC setting generally believed that the EMRs improved work process, with multiple identified facilitators and barriers to their use. Most users perceived system functionality and training as motivators to EMRs use, while infrastructure challenge was the greatest barrier.

2405When do cardiac rhythm management device complications occur?

Background The rate of implantation of cardiac rhythm management devices continues to increase but it is difficult to compare the complication rates of routine cardiac implantable electronic device procedures as the follow-up durations published in literature vary widely (peri-procedure to 3 years). Purpose We demonstrate the appropriate follow-up duration for a complication to be attributed to an index procedure, by analysing the complications within the first year of routine cardiac implantable electronic device procedures (primary implant, generator replacement, lead revision only, generator and lead revision, system upgrade and reburial) and the timing of complication interventions. Methods A retrospective database was constructed of all de novo CIED operations performed at a tertiary cardio-thoracic centre between April 2008 – March 2016. Procedures were identified from theatre logbooks, with demographic and procedural data extracted from contemporaneously maintained health records (paper and electronic). Objective complications were defined as follows; 1. Any pneumothorax identified on chest x-ray, 2. Any pericardial effusion identified on transthoracic echocardiogram performed post procedure due to intra-operative clinical concern, 3. Haematoma requiring surgical evacuation, 4. Device pocket revision or system reburial, 5. Lead intervention requiring repositioning or placement of a new lead and 6. System explant/ extraction due to any indication. Post-operative complications were identified through theatre log books and cross-referenced with 3 contemporaneously maintained records (clinical health records, TOMCAT electronic database, audit department archive). All data collection was performed by a single investigator, independent of the procedures performed and operating physicians. Results 10,125 procedures were reviewed; 6,583 primary implant procedures, 2,170 generator replacements, 382 lead revisions, 253 generator and lead interventions, 575 system upgrades and 162 reburial procedures. The procedures involved 3,403 female patients and 6,722 male, with a median age 73 years (±13.7). 2,303 procedures were acute and 7,822 elective. The complication rates were; 4.3% primary implant, 4.0% generator replacements, 12.6% lead revisions, 13.0% generator and lead interventions, 6.9% system upgrades and 22.8% reburial procedures. The timing of complication intervention varied significantly (Figure 1). Timing of Complication Intervention Conclusion Complications within the first year of any cardiac implantable electronic device intervention is common, particularly system reburials, lead revisions and generator and lead procedures. 10% of complications after generator replacement, system upgrades or reburial procedures occurred at between 36–52 weeks. For lead and combined generator and lead procedures this figure rose to approximately 15%.

I/O performance of the Santos Dumont supercomputer

In this article, we study the I/O performance of the Santos Dumont supercomputer, since the gap between processing and data access speeds causes many applications to spend a large portion of their execution on I/O operations. For a large-scale expensive supercomputer, it is essential to ensure applications achieve the best I/O performance to promote efficient usage. We monitor a week of the machine’s activity and present a detailed study on the obtained metrics, aiming at providing an understanding of its workload. From experiences with one numerical simulation, we identified large I/O performance differences between the MPI implementations available to users. We investigated the phenomenon and narrowed it down to collective I/O operations with small request sizes. For these, we concluded that the customized MPI implementation by the machine’s vendor (used by more than 20% of the jobs) presents the worst performance. By investigating the issue, we provide information to help improve future MPI-IO collective write implementations and practical guidelines to help users and steer future system upgrades. Finally, we discuss the challenge of describing applications I/O behavior without depending on information from users. That allows for identifying the application’s I/O bottlenecks and proposing ways of improving its I/O performance. We propose a methodology to do so, and use GROMACS, the application with the largest number of jobs in 2017, as a case study.