Health Information Technology

Saudi Arabia is among the countries that have very high prevalence rates of diabetes and hypertension, with prevalence rates of almost 18% and 25%, respectively. The majority of patients with diabetes and hypertension fail to manage their diseases and to show up for their follow up appointments. Mhealth technology is among the interventions that have been recently adopted to overcome these issues and improve the quality of healthcare services. This study aims to evaluate the effectiveness of a mobile phone application named diabetes and hypertension application (DHA Tracking) to promote adherence for patients with diabetes and hypertension in Mecca, Saudi Arabia. The proposed intervention was designed to promote adherence via two features, namely, refill medication reminder (RMR) and doctor appointment reminder (DAR). The third feature, which is managing the number of unnecessary visits, was covered by the cumulative blood sugar test (Hemoglobin A1c) for patients with their doctors. The study examined the difference in adherence level before the intervention and after the intervention with samples of n = 199 and n = 165 for diabetes and hypertension, respectively. The mhealth intervention was found to have significant effects on both the refill medication reminder and the doctor's appointment reminder. Also, it was found that the intervention was efficient in reducing the number of unnecessary follow-up visits to around 20%. This study supports the evidence in the literature on the effectiveness of mhealth in promoting adherence to medication for patients with chronic diseases in the developing countries and specifically in Saudi Arabia. Positive social change that may result from this study is for better management of chronic disease symptoms and increase the awareness of using mhealth applications. This would improve the quality of life for patients, their families, and the community.

Telemedicine is a renowned name in the healthcare market for faster diagnosis and easy accessibility to healthcare services. Telemedicine acceptance needs to be understood under the context of TAM which helps to understand the role of in-person visits compared to online visits. It is also helpful in exploring the idea that how It is also helpful in exploring the idea that how the user experiences can be supportive in facilitation projects perceived useful in facilitation projects under perceived usefulness and perceived ease of use. The study aims to review the telemedicine acceptance under the TAM to identify the barriers and understand how technological support can be there in revealing the needs of users to increase the applicability of telemedicine. The study has adopted a primary quantitative plan to conduct the data collection and analysis process. The data has been collected from online respondents having an experience with telemedicine in some way. The sample is comprised of 100 people online filling out the Google survey form which is closed-ended. The data has been retrieved in an Excel sheet which has been further explored with the help of smart PLS software. The output helps contrast the variables and summing of the hypothesis. It has been concluded that telemedicine acceptance has increased with time under perceived usefulness. However, some technological and communication barriers need to be addressed to increase telemedicine acceptance as identified by TAM.

The well-being of individuals and communities depend on accessibility to accurate health information. A recent study shows the many communities in some regions of Nigeria lack accessibility to this information. Building on the success of partnerships between librarians and health care workers in the delivery of health information in other parts of the world, the Nigerian situation could be greatly improved through a number of strategies, as suggested.

Background: The use of health information technology (IT) has been shown to promote patient safety in Labor and Delivery (L&D) units. The use of health IT to apply safety science principles (e.g., standardization) to L&D unit processes may further advance perinatal safety. Methods: Semi-structured interviews were conducted with L&D units participating in the Agency for Healthcare Research and Quality's (AHRQ's) Safety Program for Perinatal Care (SPPC) to assess units' experience with program implementation. Analysis of interview transcripts was used to characterize the process and experience of using health IT for applying safety science principles to L&D unit processes. Results: Forty-six L&D units from 10 states completed participation in SPPC program implementation; thirty-two (70%) reported the use of health IT as an enabling strategy for their local implementation. Health IT was used to improve standardization of processes, use of independent checks, and to facilitate learning from defects. L&D units standardized care processes through use of electronic health record (EHR)-based order sets and use of smart pumps and other technology to improve medication safety. Units also standardized EHR documentation, particularly related to electronic fetal monitoring (EFM) and shoulder dystocia. Cognitive aids and tools were integrated into EHR and care workflows to create independent checks such as checklists, risk assessments, and communication handoff tools. Units also used data from EHRs to monitor processes of care to learn from defects. Units experienced several challenges incorporating health IT, including obtaining organization approval, working with their busy IT departments, and retrieving standardized data from health IT systems. Conclusions: Use of health IT played an integral part in the planning and implementation of SPPC for participating L&D units. Use of health IT is an encouraging approach for incorporating safety science principles into care to improve perinatal safety and should be incorporated into materials to facilitate the implementation of perinatal safety initiatives.

The use of health information technology (IT) has been shown to promote patient safety in Labor and Delivery (L&D) units. The use of health IT to apply safety science principles (e.g., standardization) to L&D unit processes may further advance perinatal safety. Semi-structured interviews were conducted with L&D units participating in the Agency for Healthcare Research and Quality's (AHRQ's) Safety Program for Perinatal Care (SPPC) to assess units' experience with program implementation. Analysis of interview transcripts was used to characterize the process and experience of using health IT for applying safety science principles to L&D unit processes. Forty-six L&D units from 10 states completed participation in SPPC program implementation; thirty-two (70%) reported the use of health IT as an enabling strategy for their local implementation. Health IT was used to improve standardization of processes, use of independent checks, and to facilitate learning from defects. L&D ...

Background: Patients infected with the novel coronavirus SARS-CoV-2 are frequently hospitalized with community-acquired pneumonia (CAP). The objective of this study was to define the clinical characteristics and outcomes of hospitalized patients with SARS-CoV-2 CAP in the city of Louisville, KY. Methods: This was a retrospective observational study of 700 patients with SARS-CoV-2 infection hospitalized to eight of the adult hospitals in the city of Louisville. Patients with 1) a positive RT-PCR for SARS-CoV-2, 2) fever, cough, or shortness of breath, and 3) an infiltrate at chest imaging were defined as having SARS-CoV-2 CAP. Demographic characteristics of the study population were compared with census data from the city of Louisville. For each patient more than 500 variables were abstracted from electronic medical records and recorded using Research Electronic Data Capture software. Data was analyzed by descriptive and inferential statistics using R version 3.4.0. Results: SARS-CoV...

What if your next prescription was partly designed by AI? Drug development, once slow and costly, is now faster and smarter. AI helps scientists predict, test, and refine treatments—saving years and lives. It doesn’t replace doctors; it empowers them. Learn how AI is shaping medicine’s future.

BACKGROUND AND OBJECTIVES: To improve hospital to home transitions, a 4-element pediatric patient-centered transition bundle was developed, including: a transition readiness checklist; predischarge teach-back education; timely and complete written handoff to the primary care provider; and a postdischarge phone call. The objective of this study was to demonstrate the feasibility of bundle implementation and report initial outcomes at 4 pilot sites. Outcome measures included postdischarge caregiver ability to teach-back key home management information and 30-day reuse rates. METHODS: A multisite, observational time series using multiple planned sequential interventions to implement bundle components with non–technology-supported and technology-supported patients. Data were collected via electronic health record reviews and during postdischarge phone calls. Statistical process control charts were used to assess outcomes. RESULTS: Four pilot sites implemented the bundle between January ...

Artificial intelligence (AI) is transforming healthcare globally, but its successful integration depends on visionary leadership at the intersection of clinical practice and technology. Nurses, who represent the largest sector of the healthcare workforce, are uniquely positioned to guide this transformation. This article explores the role of nursing leadership in advancing AI-driven healthcare systems, with a focus on workflow optimization, patient outcomes, and executive decision-making. Drawing on over seven years of nursing practice and leadership experience, including contributions to open-source AI platforms such as DeepSeek, this paper argues that nurse leaders must take an active role in designing, deploying, and governing AI systems to ensure that they amplify rather than replace human care.

The well-being of individuals and communities depend on accessibility to accurate health information. A recent study shows the many communities in some regions of Nigeria lack accessibility to this information. Building on the success of partnerships between librarians and health care workers in the delivery of health information in other parts of the world, the Nigerian situation could be greatly improved through a number of strategies, as suggested.

This paper examines the importance and function of HIT in the handling of the health disparities among the racial and minority ethnic population. From researches and investigation on the utilization of health care based technologies, there were discoveries that certain kind of population, in the minority, was affected. Recent and evolving use of Information Technology in the healthcare sector among the population that is in the minority and ethnicity in critically observed, stressing the areas that utilize IT in these population different from non-minority group and highlighting the need for newer form of social means of communication in the health education and delivery sector. In this paper, the author highlights the capabilities of resolving health disparities challenges using the electronic health record (EHR) and Information Technology and the subsequent impact of health information technology in the health care industry. Furthermore, the article also identifies the notable cha...

A nesthesiologists worldwide have been using electronic systems, known as anesthesia information management systems (AIMS), for >30 years as a means to document the physiology and interventions for patients under their care. Various systems have been developed to assist in all phases of care, including preoperative evaluation, intraoperative delivery of care, and postoperative care for patients receiving anesthesia care. Widespread adoption of AIMS remains slow throughout the United States. The Institute of Medicine report in 2000, "To Err Is Human: Building a Safer Health System," highlighted the magnitude of medical errors that contribute to patient harm and was a call to action for quality improvement efforts at a national level. In 2009, the US government set the stage for the adoption of electronic health records (EHRs) under the provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act. Subsequently,

Electronic health records have led to a major transformation in the health care sector. Electronic health records have progressed the person of supply within the varied health care groups. While recognizing the modifications in health care zone, this research studied the implementation and additionally using electronic health records in three advanced countries, the United States, United Kingdom and Australia and one growing country Iraq. The comparison amongst these international locations serves as a lesson for growing international locations and has been duly acknowledged.

Background UW Medicine was one of the first health systems to encounter and treat COVID-19 patients in the United States, starting in late February 2020. Objective Here we describe the rapid rollout of capabilities by UW Medicine Information Technology Services (ITS) to support our clinical response to the COVID-19 pandemic and provide recommendations for health systems to urgently consider, as they plan their own response to this and potentially other future pandemics. Methods Our recommendations include establishing a hospital incident command structure that includes tight integration with IT, creating automated dashboards for incident command, optimizing emergency communication to staff and patients, and preparing human resources, security, other policies, and equipment to support the transition of all nonessential staff to telework.We describe how UW Medicine quickly expanded telemedicine capabilities to include most primary care providers and increasing numbers of specialty pro...

Background: Experts suggest a short duration of antibiotic therapy (DOT) in responding patients with community-acquired pneumonia (CAP). The aim of this study was to evaluate clinical outcomes after hospital discharge among patients treated with short-course antibiotic therapy (SCT) vs. long-course antibiotic therapy (LCT) for CAP. Methods: A secondary analysis of the Community-Acquired Pneumonia Organization (CAPO) database from January 2007 to June 2013 was performed, including hospitalized CAP patients who reached clinical stability within 5 days. Two groups were identified: patients who were treated with antibiotic therapy for a total duration of 5 days or less (SCT Group) vs. longer than 5 days (LCT Group). Rehospitalization and mortality were evaluated at 30 days after discharge. Results: 1,849 patients were enrolled (58% males; median age: 65 years), 179 (10%) were included in the SCT and 1,670 (90%) in the LTC group. Median DOT was 5 days in the SCT and10 days in the LTC group, p<0.001. At 30-day follow-up, there were no deaths in the SCT group, while 8 patients (0.7%) died in the LCT group, p=0.488. A total of 13 (11%) rehospitalizations were detected at 30 days after discharge in the SCT group vs. 132 (11%) in the LCT group, p=0.879. Once adjusted for several confounders, a short duration of antibiotic therapy was not associated to either adverse outcomes (OR: 1.04; 95% CI: 0.54-1.99; p=0.912). Conclusions: A duration of antibiotic therapy of ≤ 5 days does not adversely impact clinical outcomes at 30-days after discharge compared to > 5 days in patients who reached early clinical stability.

This study explores the key factors that influence the adoption of telemedicine among Nigerian clinicians. It introduces the Clinicians Telemedicine Adoption Model (CTAM), an extension of the Unified Theory of Acceptance and Use of Technology (UTAUT), developed through a cross-sectional survey of 302 clinicians across eight government hospitals in Ondo State, Nigeria. Using SmartPLS 2.0 for structural equation modelling, the study examined relationships among Clinicians Telemedicine Adoption Model (CTAM) variables and analysed demographic factors including age, gender, and profession as potential moderators. The findings show that Clinicians Telemedicine Adoption Model (CTAM) accounts for 45% of the variance in clinicians behavioural intention to use telemedicine systems. Specifically, Performance Expectancy, Effort Expectancy, Facilitating Conditions, Social Influence, and Reinforcement Factors significantly influenced clinicians' intention to adopt telemedicine, consistent with the extended Unified Theory of Acceptance and Use of Technology (UTAUT) model. Furthermore, Human Factors were significantly moderated by younger clinicians, while the medical doctor profession significantly moderated the influence of Organisational Factors. Reinforcement Factors were also significantly moderated by age, gender, and profession. By understanding these determinants, hospital management boards and the Federal Ministry of Health can be better equipped to support the successful implementation of Nigeria s national health ICT strategic framework, paving the way for more effective, technology-enhanced healthcare delivery in the near future.

Emergency department (ED) clinicians routinely decide the disposition of patients with suicidal ideation, with potential consequences for patient safety, liability, system costs and resources. An expert consensus panel recently created a six-item decision support tool for patients with passive or active suicidal ideation. Individuals scoring a zero (exhibiting none of the tool's six items) are considered "lower risk" and suitable for discharge, while those with non-zero scores are considered "elevated risk" and should receive further evaluation. The current study tested the predictive utility of this tool using existing data from the Emergency Department Safety Assessment and Follow-up Evaluation. ED patients with active suicide ideation (n=1368) were

Medication adherence monitoring has relied largely on indirect measures of pill ingestion including patient selfreport, pharmacy refills, electronically triggered pill bottles, and pill counts. Our objective is to describe an ingestible biosensor system comprising a radio-frequency identification (RFID)-tagged gelatin capsule. Once the capsule dissolves in the stomach, the RFID tag activates to transmit a unique signal to a relay device which transmits a time-stamped message to a cloud-based server that functions as a direct measure of medication adherence. We describe a constellation of mobile technologies that provide real-time direct measures of medication adherence. Optimizing connectivity, relay design, and interactivity with users are important in obtaining maximal acceptability. Potential concerns including gut retention of metallic components of the ingestible biosensor and drug dissolution within a gelatin capsule should be considered. An ingestible biosensor incorporated into a medication management system has the potential to improve medication compliance with realtime monitoring of ingestion and prompt early behavioral intervention. Integration of ingestible biosensors for multiple disease states may provide toxicologists with salient data early in the care of poisoned patients in the future. Further research on device design and interventions to improve adherence is needed and will shape the evolving world of medication adherence.

Background: Safety planning is a brief intervention that has become an accepted practice in many clinical settings to help prevent suicide. Even though it is quick compared to other approaches, it frequently requires 20 min or more to complete, which can impede adoption. A self-administered, Web-based safety planning application could potentially reduce clinician time, help promote standardization and quality, and provide enhanced ability to share the created plan. The aim of this study was to design, build, and test the usability of a Web-based, self-administered safety planning application. Methods: We employed a user-centered software design strategy led by a multidisciplinary team. The application was tested for usability with a target sample of suicidal patients. Detailed observations, structured usability ratings, and Think Aloud procedures were used. Suicidal ideation intensity and perceived ability to cope were assessed pre-post engagement with the Web application. Results: A total of 30 participants were enrolled. Usability ratings were generally strong, and all patients successfully built a safety plan. However, the completeness of the safety plan varied. The mean number of steps completed was 5.5 (SD 0.9) out of 6, with 90% (27/30) of participants completing at least 5 steps and 67% (20/30) completing all 6 steps. Some safety planning steps were viewed as inapplicable to some individuals. Some confusion in instructions led to modifications to improve understandability of each step. Ratings of suicide intensity after completion of the application were significantly lower than preratings, pre: mean 5.11 (SD 2.9) versus post: mean 4.46 (SD 3.0), t 27 =2.49, P=.02. Ratings of ability to cope with suicidal thoughts after completion of the application were higher than preratings, with the difference approaching statistical significance, pre: mean 5.93 (SD 2.9), post: mean 6.64 (SD 2.4), t 27 =-2.03, P=.05. We have taken the first step toward identifying the components needed to maximize usability of a self-administered, Web-based safety planning application. Results support initial consideration of the application as an adjunct to clinical contact. This allows for the clinician or other personnel to provide clarification, when needed, to help the patient build the plan, and to help review and revise the draft.

Emergency department (ED) clinicians routinely decide the disposition of patients with suicidal ideation, with potential consequences for patient safety, liability, system costs and resources. An expert consensus panel recently created a six-item decision support tool for patients with passive or active suicidal ideation. Individuals scoring a zero (exhibiting none of the tool's six items) are considered "lower risk" and suitable for discharge, while those with non-zero scores are considered "elevated risk" and should receive further evaluation. The current study tested the predictive utility of this tool using existing data from the Emergency Department Safety Assessment and Follow-up Evaluation. ED patients with active suicide ideation (n=1368) were

We present a systems perspective on IS user satisfaction that is more appropriate in digitalized organizations than prominent streams of user satisfaction research from several decades ago that focused largely on voluntary, individual use of IT. We developed this perspective by analyzing five case studies commissioned by managers facing user satisfaction issues in important ISs. Direct quotations from recorded transcripts of 111 interviews from the cases illustrated that IS user satisfaction issues involved much more than the IS itself. Both qualitative and quantitative analysis of the interview data led to the conclusion that IS user satisfaction was formed as work system participants fulfilled responsibilities within work systems that produced product/services for internal and/or external customers. The information systems were integral parts of those work systems. IS users tended to evaluate an IS in relation to the extent to which it helped them perform their work activities and fulfill their responsibilities.

In Pakistan, where distance and scarcity often define healthcare, technology is quietly rewriting the rules. This essay explores how digital tools-from telemedicine to AI diagnostics-are reshaping care in places like Dera Ismail Khan. But beyond machines and metrics, it's a reflection on what it means to heal: with empathy, with innovation, and with hope. The author shares a personal vision of blending science and soul to build a more connected future.

This pilot study tested the efficacy of an audio-visual stimulation (AVS) program for the promotion of sleep in individuals with chronic pain. Insomnia and chronic pain are common comorbid conditions and their relationship has been viewed as bidirectional. Recent studies suggest a relatively dominant role of sleep in this dyad. The premise of this pilot study was that AVS enhances low frequency while reducing high frequency brain activity resulting in decreased hyperarousal and improved sleep with potential consequent reduction in pain. We conducted a pilot intervention study of AVS using a pre-post design. Participants self-administered a 30-min AVS program nightly at bedtime for 1 month. Sleep and pain were assessed at baseline and at the conclusion of the 4-week intervention phase. Nine adults (mean age 33 ± 15.8 years; female, 89 %) completed the study. After using the AVS device for 4 weeks, significant improvement was seen in reported insomnia (ISI, p = 0.003), pain severity (...

The objective of this study was to evaluate the features of diet and nutrition apps available in the Google Play Store. A search was conducted in August 2017 using the Google Play Store database to identify apps related to diet and nutrition. Terms entered into the app search engine included &#39;diet apps&#39; and &#39;nutrition apps&#39;. The first 50 apps resulting from each search term was assessed. Duplicates were removed, and a comparative analysis was performed on the remaining diet and nutrition apps. A total of 86 diet and nutrition apps were identified. One hundred percent (n = 86) of the apps retrieved were freely available. More than half of the apps were applicable to a target user group of all ages (94%, n = 81). Stratified analysis across unique diet and nutrition apps (total, n = 72) showed a higher average rating for the diet apps (4.4) in comparison to that for the nutrition apps (4.3). Diet apps were more likely to be recently updated than the nutrition apps (72% ...

In order to better designing of electronic health record system in Iran, integration of health information systems based on a common language must be done to interpret and exchange this information with this system is required. This study provides a conceptual model of radiology reporting system using unified modeling language. The proposed model can solve the problem of integration this information system with the electronic health record system. By using this model and design its service based, easily connect to electronic health record in Iran and facilitate transfer radiology report data. Methods: This is a cross-sectional study that was conducted in 2013. The study population was 22 experts that working at the Imaging Center in Imam Khomeini Hospital in Tehran and the sample was accorded with the community. Research tool was a questionnaire that prepared by the researcher to determine the information requirements. Content validity and test-retest method was used to measure validity and reliability of questioner respectively. Data analyzed with average index, using SPSS. Also Visual Paradigm software was used to design a conceptual model. Based on the requirements assessment of experts and related texts, administrative, demographic and clinical data and radiological examination results and if the anesthesia procedure performed, anesthesia data suggested as minimum data set for radiology report and based it class diagram designed. Also by identifying radiology reporting system process, use case was drawn. According to the application of radiology reports in electronic health record system for diagnosing and managing of clinical problem of the patient, with providing the conceptual Model for radiology reporting system; in order to systematically design it, the problem of data sharing between these systems and electronic health records system would eliminate.

Diabetes self-management (DSM) training helps prevent diabetic complications. eHealth approaches may improve its optimal use. The aims were to determine a) acceptability of e-HealthyStrides © (an interactive, Internet-based, patient-driven, diabetes self-management support and social networking program) among Morehouse Community Physicians' Network diabetics; b) efficacy for DSM behavior change c) success factors for use of e-HealthyStrides © . Baseline characteristics of pilot study participants are reported. Of those approached, 13.8% agreed to participate. Among participants, 96% were Black, 77% female; age 56±9.2 years; education: 44% college or higher and 15% less than 12th grade; 92.5% with home computers. Over half (51%) failed the Diabetes Knowledge Test. Nearly half (47%) were at goal A1C; 24% at goal blood pressure; 3% at goal LDL cholesterol level. Median (SD) Diabetes Empowerment Scale score = 3.93 (0.72) but managing psychosocial aspects = 3.89 (0.89) scored lower than other domains. There was low overall confidence for DSM behaviors. Assistance with healthy eating was the most frequently requested service. Requestors were more obese with worse A1C than others. Chronic care delivery scored average with high scores for counseling and problem solving but low scores for care coordination and follow up.

The use of Information and Communications Technology (ICT) in health systems is increasing worldwide. While it is assumed that ICT holds great potential to make health services more efficient and grant patients more empowerment, research on these trends is at an early stage. Building on a study of the impact of ICT on physicians and patients in Israel, a Short Term Scientific Mission (STSM) sponsored by COST Net in conjunction with CIES/ISCTE IUL (Portugal) facilitated a comparison of ICT in health in Israel and Portugal. The comparison focused on patient empowerment, physician behavior and the role of government in implementing ICT. The research in both countries was qualitative in nature. In-depth interviews with the Ministry of Health (MOH), the private sector, patients associations, health plans and researchers were used to collect data. Purposeful sampling was used to select respondents, and secondary sources were used for triangulation. The findings indicate that respondents in both countries feel that patient empowerment has indeed been furthered by introduction of ICT. Regarding physicians, in both countries ICT is seen as providing more information that can be used in medical decision making. Increased access of patients to web-based medical information can strengthen the role of patients in decision making and improve the physician-patient relationship, but also shift the latter in ways that may require adjustments in physician orientation. Physician uptake of ICT in both countries involves overcoming certain barriers, such as resistance to change. At the national level, important differences were found between the two countries. While in Israel, ICT was promoted and adopted by the meso level of the health system, in particular the health plans and government intervention can be found in a later stage, in Portugal the government was the main developer and national strategies were built from the beginning. These two approaches present different advantages and disadvantages. Government involvement in earlier stages could provide benefit in terms of interoperability of systems between different healthcare organizations. However, innovation could be slowed down due to government bureaucracy or lack of leadership. The work provides information in order to understand and improve ICT services. Additionally, it provides input regarding impact of ICT on the physician/patient relationship and national policies in the area.

The present study investigated factors that explain patient trust in health technology and the relationship between patient trust in technology and trust in their care provider. Sociotechnical systems theory states that changes in one part of the system are likely related to other parts of the system. Therefore, attitudes about technologies, like trust, are likely related to other aspects of the system. Contributing to appropriate trust at the technological, interpersonal, and system levels can potentially lead to positive health outcomes. The study described in this manuscript used data collected from 101 patients with a Trust in Medical Technology instrument. The instrument measured patients' trust in 1) their providers, 2) the technology, and 3) how their providers used the technology. Measure 3 was positively associated with measures 1 and 2, while measures 1 and 2 were not positively or negatively associated with one another.. These results may indicate that patient assessments of the trustworthiness of care providers and technologies are based on their observations of how providers use technologies. Practitioner Summary-Though patients are not active users of technologies in health care, the results of this study show that their perceptions of how providers use technology are related to their trust in both technology and the care provider. Study findings have implications for how trust is conceptualized and measured in interpersonal relationships and in technologies.

Objective-The aim of this study was to identify and describe the use of electronic health records for information sharing between patients and clinicians in primary care encounters. This topic is particularly important as computers and other technologies are increasingly implemented in multi-user health care settings where interactions and communication between patients and clinicians are integral to interpersonal and organizational outcomes. Method-An ethnographic approach was used to classify the encounters into distinct technologyuse patterns based on clinicians` interactions with the technology and patients. Each technologyuse pattern was quantitatively analysed to assist with comparison. Quantitative analysis was based on duration of patient and clinician gaze at EHR. Findings-Physicians employed three different styles to share information using EHRs: • Active information-sharing, in which a clinician turns the monitor towards the patient and uses the computer to actively share information with the patient; • Passive information-sharing, when a clinician does not move the monitor, but the patient might see the monitor by leaning in if they choose; and • Technology withdrawal, when a clinician does not share the monitor with the patient. variety of technology-mediated information-sharing styles may be effective in providing patient-centred care. New EHR designs may be needed to facilitate information sharing between patients and clinicians.

OBJECTIVES: Electronic health records (EHR) enable transmission and tracking of referrals between primarycare practitioners (PCPs) and subspecialists. We used an EHR to examine follow-up actions on electronic referral communication in a large multispecialty VA facility. METHODS: We retrieved outpatient referrals to five subspecialties between October 2006 and December 2007, and queried the EHR to determine their status: completed, discontinued (returned to PCP), or unresolved (no action taken by subspecialist). All unresolved referrals, and random samples of discontinued and completed referrals were reviewed to determine whether subspecialists took follow-up actions (i.e., schedule appointments anytime in the future) within 30 days of referral-receipt. For referrals without timely follow-up, we determined whether inaction was supported by any predetermined justifiable reasons or associated with certain referral characteristics. We also reviewed if PCPs took the required action on returned information. RESULTS: Of 61,931 referrals, 22,535 were discontinued (36.4%), and 474 were unresolved (0.8%). We selected 412 discontinued referrals randomly for review. Of these, 52% lacked follow-up actions within 30 days. Appropriate justifications for inaction were documented in 69.8% (150/215) of those without action and included lack of prerequisite testing by the PCP and subspecialist opinion that no intervention was required despite referral. We estimated that at 30 days, 6.3% of all referrals were associated with an unexplained lack of follow-up actions by subspecialists. Conversely, 7.4% of discontinued referrals returned to PCPs were associated with an unexplained lack of follow-up. CONCLUSIONS: Although the EHR facilitates transmission of valuable information at the PCP-subspecialist interface, unexplained communication breakdowns in the referral process persist in a subset of cases.

We sought to understand underserved patients' preferences for health information technology (HIT) and examine the current use of personal health records (PHRs) in Community Health Centers (CHCs) serving low-income, uninsured, and underinsured patients. Forty-three patients and 49 clinic staff, administrators, and providers from these CHC systems were interviewed using open-ended questions assessing patient experience, perceptions of the CHC, access barriers, strategies used to overcome access barriers, technology access and use, and clinic operations and workflow. All seven CHC systems were at some stage of implementing PHRs, with two clinics having already completed implementation. Indiana CHCs have experienced barriers to implementing and using PHRs in a way that provides value for patients or providers/staff. There was a general lack of awareness among patients regarding the existence of PHRs, their benefits and a lack of effective promotion to patients. Most patients have access to the internet, primarily through mobile phones, and desire greater functionality in order to communicate with CHCs and manage their health conditions. Despite decades of research, there remain barriers to the adoption and use of PHRs. Novel approaches must be developed to achieve the desired impact of PHRs on patient engagement, communication and satisfaction. Our findings provide a roadmap to greater engagement of patients via PHRs by expanding functionality, training both patients and clinic providers/staff, and incorporating adult learning strategies. • Applied computing➝Consumer health • Applied computing➝Health care information systems • Applied computing➝Health informatics

BACKGROUND Oncology has increasing outpatient activity related to increased cancer incidence, better survival rates and more treatments. Innovative technological solutions could help deal with this increasing demand and digital patient-reported outcome measures (PROMs) to identify those patients that need a face-to-face (FTF) appointment is one potential approach. OBJECTIVE Our study aimed to assess the feasibility of digital PROM questionnaires to enable remote symptom monitoring for patients on cancer treatment and their ability to determine the requirement for a FTF appointment. METHODS This study was performed at a tertiary oncology centre between December 2018 and February 2019. Target clinics covered both systemic therapy and radiotherapy cohorts. The Common Terminology Criteria for Adverse Events (CTCAE) helped form the basis for acute toxicity questionnaires which were adapted into patient-friendly language. Treatment-specific digital PROM questionnaires were answered by pat...

Background Physicians practicing in ambulatory care are adopting electronic health record (EHR) systems. Governments promote this adoption with financial incentives, some hinged on improvements in care. These systems can improve care but most demonstrations of successful systems come from a few highly computerized academic environments. Those findings may not be generalizable to typical ambulatory settings, where evidence of success is largely anecdotal, with little or no use of rigorous methods. The purpose of our pilot study was to evaluate the impact of a diabetes specific chronic disease management system (CDMS) on recording of information pertinent to guideline-concordant diabetes care and to plan for larger, more conclusive studies. Methods Using a before–after study design we analyzed the medical record of approximately 10 patients from each of 3 diabetes specialists (total = 31) who were seen both before and after the implementation of a CDMS. We used a checklist of key clin...

Background: The notion of preoperative visiting has been in existence since the 1960s and its value and worth in relation to healthcare delivery has been debated consistently since the term preoperative-visit is often confusing. However, little is known about knowledge, attitude and practice of preoperative visits among perioperative nurses in Nigeria. Objectives: The study sought to determine knowledge, attitude and practice of Nigerian perioperative nurses towards the practice of preoperative visits and to identify barriers militating against the practice. Design: This is a countrywide cross-sectional descriptive survey. Results: One hundred and forty six Nigerian perioperative nurses among the conferenceattendees gave consent to participate in this study. Half of the participants-70(50%) of the participants worked with tertiary health facilitiesand 71(52.2%) were from the conference host region (Southwest, Nigeria).The majority (97.3%) of the participants possess good knowledge of preoperative visit. Equally, 139 (96%)of them acknowledged that the practice of preoperative visit is very important to perioperative nursing careas well as to the teeming patients.About two-third (63%) of the participants reported that they practice preoperative patient visit while 53 (37%) did not. Ninety two (72%) of the participants stated that they often document their opinions during preoperative visits to patients. Major factors militating against the practice of preoperative visit include timing of the visits (89%) and work overload (66%). It is equally important to note that 27 (18%) of the participantsidentified shortage of perioperative nurses as a barrier to preoperative visit. Years of experience, workplace, age and professional rank were associated withthe practice of preoperative visit. Conclusion: Most perioperative nurses in Nigeria have formally acquired knowledge of preoperative visit. However, there is a notable gap between their knowledge and attitude towards it. Therefore, they require periodic reminder through continuing professional development programs on their responsibilities towards the recipients/beneficiaries of the perioperative nursing care.

Medication reconciliation (MedRec) is essential for reducing patient harm caused by medication discrepancies across care transitions. Electronic support has been described as a promising approach to moving MedRec forward. We systematically reviewed the evidence about electronic tools that support MedRec, by (a) identifying tools; (b) summarizing their characteristics with regard to context, tool, implementation, and evaluation; and (c) summarizing key messages for successful development and implementation. We searched PubMed, the Cumulative Index to Nursing and Allied Health Literature, Embase, PsycINFO, and the Cochrane Library, and identified additional reports from reference lists, reviews, and patent databases. Reports were included if the electronic tool supported medication history taking and the identification and resolution of medication discrepancies. Two researchers independently selected studies, evaluated the quality of reporting, and extracted data. Eighteen reports rel...

An important feature of COVID-19, the disease produced by the new coronavirus SARS-CoV-2, is the high number of health care workers (HCWs) that acquire the disease. In an initial report of 138 patients hospitalized with COVID-19 pneumonia in China, 40 patients (29%) were HCWs. One reason why HCWs are at higher risk of acquiring COVID-19 is because some patients with COVID-19 are admitted to the hospital without the classical presentation, and are therefore not tested for the disease early during hospitalization. Presently in the US, it is recommended to test for COVID-19 when physicians suspect the disease. This subjective approach may allow hospital transmission of COVID-19 from patients without the classical clinical presentation. The primary objective of this study is to establish a surveillance system for early identification of patients hospitalized with COVID-19 to allow for early implementation of infection control interventions in an attempt to prevent transmission of COVID-19 to HCWs and other hospitalized patients. We are proposing to test all patients who present to the emergency departments and/ or are hospitalized with signs and symptoms of respiratory infection or gastrointestinal infection for SARS-CoV-2, regardless of clinical suspicion of COVID-19. Biological samples obtained from all patients having symptoms of respiratory or gastrointestinal infection will be tested using real-time polymerase chain reaction (RT-PCR) for detection of SARS-CoV-2. Using a robotic instrument, the CMP laboratory will be able to test more than 500 samples a day. Data will be reported in real-time to participating hospitals for rapid implementation of infection control measures.

The limited availability of biological samples from patients testing positive for SARS CoV-2 to be available for future research was quickly identified at the onset of the COVID-19 pandemic. In response to this need, a COVID-19 biobank was initiated by the University of Louisville Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID). The COVID-19 biobank contains waste samples obtained from patients hospitalized with COVID-19 in any of the nine Louisville, Kentucky area hospitals during the timeframe of April 13, 2020 through 09-20-2020. The COVID-19 biobank stores approximately1,623 waste samples with 2,127 aliquots for distribution. All samples are linked to clinical data. The methods described in this paper are intended for use as a guide for other research institutions interested in developing a COVID-19 biobank.

Community acquired pneumonia (CAP) is a common and serious illness. Most CAP patients are treated in outpatient facilities and only 20% of CAP patients require hospitalization . Among hospitalized CAP patients, the majority of deaths occur during the early days of hospitalization . Early recognition of severity of CAP is essential for initiation of appropriate empiric antibiotic treatment, aggressive diagnostic work-up, and adequate supportive care. Management strategies for CAP patients depend on the severity of CAP and risk of mortality. In patients with severe CAP, a respiratory specimen does not always yield a positive microbiological culture or definitive pathogen. Furthermore, there is no single factor which can predict the severity of CAP . Physicians frequently use scoring systems to assess the severity of disease and to predict likely clinical outcomes [4]. However, these scores have limitations, including age of the patient, failure to account for certain comorbidities, and other social factors [5]. These limitations have led to exploring the use of biomarkers to improve clinical management of patients with CAP. To aid clinicians in predicting risk and to treat patients with CAP, biomarkers can provide rapid information [3] and supplement accepted clinical scoring systems. Biomarkers provide quantitative information which is easy to interpret, reliable and reproducible. One of the biomarkers used to predict clinical outcomes is C-reactive protein (CRP). CRP is named for its ability to interact with C-polysaccharide within the cellular wall of Streptococcus pneumoniae , and this interaction labels them for opsonization. CRP is an acute phase protein which is predominantly synthesized by the liver [7] in response to inflammatory cytokines IL-6, IL-1β or TNFalpha [8], particularly in response to infection and tissue injury. These inflammatory cytokines are produced by macrophages and monocytes to destroy the pathogens at the site of infection or injury. CRP has a half-life of 19 hours in plasma . Once the inflammatory stimulus is removed, the CRP level decreases rapidly. Several studies have documented that the serum CRP level serves as a good marker for diagnosis of CAP and predicts clinical severity of disease , although the absolute CRP levels used for clinical decisions vary considerably. For conventional serum CRP assays approved by FDA [12], however, the typical cutoffs are broken out in in the following manner: healthy individuals: less than or equal to 5 mg/L, Acute range: 20-500 mg/L.

Insufficient infrastructure is one of the challenges facing investigators in the field of clinical research. At the University of Louisville (UofL) Division of Infectious Diseases, we developed a multidisciplinary coordinating center with the aim to support investigators in all aspects of the clinical research process. The objective of this article is to describe the composition and the role of the different units of the UofL Clinical Research Coordinating Center. The different components of the Center can serve as a template for institutions interested in developing a clinical research support infrastructure.

Background: Predicting if a hospitalized patient with community-acquired pneumonia (CAP) will or will not survive after admission to the hospital is important for research purposes as well as for institution of early patient management interventions. Although population-level mortality prediction scores for these patients have been around for many years, novel patient-level algorithms are needed. The objective of this study was to assess several statistical and machine learning models for their ability to predict 30-day mortality in hospitalized patients with CAP. Methods: This was a secondary analysis of the University of Louisville (UofL) Pneumonia Study database. Six different statistical and/or machine learning methods were used to develop patientlevel prediction models for hospitalized patients with CAP. For each model, nine different statistics were calculated to provide measures of the overall performance of the models. Results: A total of 3249 unique hospitalized patients with CAP were enrolled in the study, 2743 were included in the model building (training) dataset, while the remaining 686 were included in the testing dataset. From the full population, death at 30-days post discharge was documented in 458 (13.4%) patients. All models resulted in high variation in the ability to predict survivors and non-survivors at 30 days. In conclusion, this study suggests that accurate patient-level prediction of 30-day mortality in hospitalized patients with CAP is difficult with statistical and machine learning approaches. It will be important to evaluate novel variables and other modeling approaches to better predict poor clinical outcomes in these patients to ensure early and appropriate interventions are instituted.

Pneumocystis pneumonia (PCP) is an opportunistic infection caused by the fungus Pneumocystis jirovecii. Infection with P. jirovecii can result in serious illness in patients with a weakened immune system, and can lead to death if it is not properly diagnosed and treated. Direct detection of P. jirovecii in lower respiratory tract specimens such as bronchoalveolar lavage (BAL) is preferred for rapid diagnosis, a laboratory service currently not available locally. We report here the development of a diagnostic real-time Polymerase Chain Reaction (PCR) assay using BAL specimens to detect P. jirovecii. By targeting the multi-copy mitochondrial large subunit ribosomal RNA gene (mtLSU rRNA) of P. jirovecii, assay sensitivity is increased. Primer pairs were designed to include a fluorescent reporter dye-labeled primer with a unique MultiCode® base pair isoC on the 5'end and one unlabeled primer. The performance characteristics were determined on the Luminex ARIES® instrument, combining DNA extraction, amplification and detection into a one-step process. The cassette contains the reagents needed to perform all of the steps including extraction, purification, amplification, and detection, plus a sample processing control. Accuracy, precision, sensitivity, specificity and stability studies were conducted to validate the assay to meet CLIA requirements. The analytical sensitivity was 89.1%, and the analytical specificity was 100%. The assay could reliably detect 200 organisms/ mL, crossing thresholds (Ct) and melt temperatures (Tm) were consistent, and no cross-reactivity was observed with other pathogens known to cause respiratory infections. The results demonstrated that these primers are specific to Pneumocystis jirovecii. The real-time PCR method using the ARIES® system allowed for rapid and sensitive detection of Pneumocystis pneumonia infections with P. jirovecii using clinical respiratory specimens.

The study database for CAPO currently resides in a web-hosted instance of the REDCap electronic data capture software. REDCap is a secure web application for building and managing online surveys and databases. Members of CAPO access the REDCap instance remotely from its web URL using a web browser and their assigned user credentials. Demographic and clinical history information can then be entered for new cases in the database.