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  1. Archetype-based conversion of EHR content models: pilot experience with a regional EHR system

    Science.gov (United States)

    2009-01-01

    Background Exchange of Electronic Health Record (EHR) data between systems from different suppliers is a major challenge. EHR communication based on archetype methodology has been developed by openEHR and CEN/ISO. The experience of using archetypes in deployed EHR systems is quite limited today. Currently deployed EHR systems with large user bases have their own proprietary way of representing clinical content using various models. This study was designed to investigate the feasibility of representing EHR content models from a regional EHR system as openEHR archetypes and inversely to convert archetypes to the proprietary format. Methods The openEHR EHR Reference Model (RM) and Archetype Model (AM) specifications were used. The template model of the Cambio COSMIC, a regional EHR product from Sweden, was analyzed and compared to the openEHR RM and AM. This study was focused on the convertibility of the EHR semantic models. A semantic mapping between the openEHR RM/AM and the COSMIC template model was produced and used as the basis for developing prototype software that performs automated bi-directional conversion between openEHR archetypes and COSMIC templates. Results Automated bi-directional conversion between openEHR archetype format and COSMIC template format has been achieved. Several archetypes from the openEHR Clinical Knowledge Repository have been imported into COSMIC, preserving most of the structural and terminology related constraints. COSMIC templates from a large regional installation were successfully converted into the openEHR archetype format. The conversion from the COSMIC templates into archetype format preserves nearly all structural and semantic definitions of the original content models. A strategy of gradually adding archetype support to legacy EHR systems was formulated in order to allow sharing of clinical content models defined using different formats. Conclusion The openEHR RM and AM are expressive enough to represent the existing clinical

  2. Archetype-based conversion of EHR content models: pilot experience with a regional EHR system

    Directory of Open Access Journals (Sweden)

    Karlsson Daniel

    2009-07-01

    Full Text Available Abstract Background Exchange of Electronic Health Record (EHR data between systems from different suppliers is a major challenge. EHR communication based on archetype methodology has been developed by openEHR and CEN/ISO. The experience of using archetypes in deployed EHR systems is quite limited today. Currently deployed EHR systems with large user bases have their own proprietary way of representing clinical content using various models. This study was designed to investigate the feasibility of representing EHR content models from a regional EHR system as openEHR archetypes and inversely to convert archetypes to the proprietary format. Methods The openEHR EHR Reference Model (RM and Archetype Model (AM specifications were used. The template model of the Cambio COSMIC, a regional EHR product from Sweden, was analyzed and compared to the openEHR RM and AM. This study was focused on the convertibility of the EHR semantic models. A semantic mapping between the openEHR RM/AM and the COSMIC template model was produced and used as the basis for developing prototype software that performs automated bi-directional conversion between openEHR archetypes and COSMIC templates. Results Automated bi-directional conversion between openEHR archetype format and COSMIC template format has been achieved. Several archetypes from the openEHR Clinical Knowledge Repository have been imported into COSMIC, preserving most of the structural and terminology related constraints. COSMIC templates from a large regional installation were successfully converted into the openEHR archetype format. The conversion from the COSMIC templates into archetype format preserves nearly all structural and semantic definitions of the original content models. A strategy of gradually adding archetype support to legacy EHR systems was formulated in order to allow sharing of clinical content models defined using different formats. Conclusion The openEHR RM and AM are expressive enough to

  3. Advanced Proficiency EHR Training: Effect on Physicians’ EHR Efficiency, EHR Satisfaction and Job Satisfaction

    Science.gov (United States)

    Dastagir, M. Tariq; Chin, Homer L.; McNamara, Michael; Poteraj, Kathy; Battaglini, Sarah; Alstot, Lauren

    2012-01-01

    The best way to train clinicians to optimize their use of the Electronic Health Record (EHR) remains unclear. Approaches range from web-based training, class-room training, EHR functionality training, case-based training, role-based training, process-based training, mock-clinic training and “on the job” training. Similarly, the optimal timing of training remains unclear--whether to engage in extensive pre go-live training vs. minimal pre go-live training followed by more extensive post go-live training. In addition, the effectiveness of non-clinician trainers, clinician trainers, and peer-trainers, remains unclearly defined. This paper describes a program in which relatively experienced clinician users of an EHR underwent an intensive 3-day Peer-Led EHR advanced proficiency training, and the results of that training based on participant surveys. It highlights the effectiveness of Peer-Led Proficiency Training of existing experienced clinician EHR users in improving self-reported efficiency and satisfaction with an EHR and improvements in perceived work-life balance and job satisfaction. PMID:23304282

  4. Advanced proficiency EHR training: effect on physicians' EHR efficiency, EHR satisfaction and job satisfaction.

    Science.gov (United States)

    Dastagir, M Tariq; Chin, Homer L; McNamara, Michael; Poteraj, Kathy; Battaglini, Sarah; Alstot, Lauren

    2012-01-01

    The best way to train clinicians to optimize their use of the Electronic Health Record (EHR) remains unclear. Approaches range from web-based training, class-room training, EHR functionality training, case-based training, role-based training, process-based training, mock-clinic training and "on the job" training. Similarly, the optimal timing of training remains unclear--whether to engage in extensive pre go-live training vs. minimal pre go-live training followed by more extensive post go-live training. In addition, the effectiveness of non-clinician trainers, clinician trainers, and peer-trainers, remains unclearly defined. This paper describes a program in which relatively experienced clinician users of an EHR underwent an intensive 3-day Peer-Led EHR advanced proficiency training, and the results of that training based on participant surveys. It highlights the effectiveness of Peer-Led Proficiency Training of existing experienced clinician EHR users in improving self-reported efficiency and satisfaction with an EHR and improvements in perceived work-life balance and job satisfaction.

  5. Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations.

    Science.gov (United States)

    Arndt, Brian G; Beasley, John W; Watkinson, Michelle D; Temte, Jonathan L; Tuan, Wen-Jan; Sinsky, Christine A; Gilchrist, Valerie J

    2017-09-01

    Primary care physicians spend nearly 2 hours on electronic health record (EHR) tasks per hour of direct patient care. Demand for non-face-to-face care, such as communication through a patient portal and administrative tasks, is increasing and contributing to burnout. The goal of this study was to assess time allocated by primary care physicians within the EHR as indicated by EHR user-event log data, both during clinic hours (defined as 8:00 am to 6:00 pm Monday through Friday) and outside clinic hours. We conducted a retrospective cohort study of 142 family medicine physicians in a single system in southern Wisconsin. All Epic (Epic Systems Corporation) EHR interactions were captured from "event logging" records over a 3-year period for both direct patient care and non-face-to-face activities, and were validated by direct observation. EHR events were assigned to 1 of 15 EHR task categories and allocated to either during or after clinic hours. Clinicians spent 355 minutes (5.9 hours) of an 11.4-hour workday in the EHR per weekday per 1.0 clinical full-time equivalent: 269 minutes (4.5 hours) during clinic hours and 86 minutes (1.4 hours) after clinic hours. Clerical and administrative tasks including documentation, order entry, billing and coding, and system security accounted for nearly one-half of the total EHR time (157 minutes, 44.2%). Inbox management accounted for another 85 minutes (23.7%). Primary care physicians spend more than one-half of their workday, nearly 6 hours, interacting with the EHR during and after clinic hours. EHR event logs can identify areas of EHR-related work that could be delegated, thus reducing workload, improving professional satisfaction, and decreasing burnout. Direct time-motion observations validated EHR-event log data as a reliable source of information regarding clinician time allocation. © 2017 Annals of Family Medicine, Inc.

  6. ResearchEHR: use of semantic web technologies and archetypes for the description of EHRs.

    Science.gov (United States)

    Robles, Montserrat; Fernández-Breis, Jesualdo Tomás; Maldonado, Jose A; Moner, David; Martínez-Costa, Catalina; Bosca, Diego; Menárguez-Tortosa, Marcos

    2010-01-01

    In this paper, we present the ResearchEHR project. It focuses on the usability of Electronic Health Record (EHR) sources and EHR standards for building advanced clinical systems. The aim is to support healthcare professional, institutions and authorities by providing a set of generic methods and tools for the capture, standardization, integration, description and dissemination of health related information. ResearchEHR combines several tools to manage EHR at two different levels. The internal level that deals with the normalization and semantic upgrading of exiting EHR by using archetypes and the external level that uses Semantic Web technologies to specify clinical archetypes for advanced EHR architectures and systems.

  7. Archetype-based conversion of EHR content models : pilot experience with a regional EHR system

    OpenAIRE

    Chen, Rong; Klein, Gunnar O; Sundvall, Erik; Karlsson, Daniel; Åhlfeldt, Hans

    2009-01-01

    Background: Exchange of Electronic Health Record (EHR) data between systems from different suppliers is a major challenge. EHR communication based on archetype methodology has been developed by openEHR and CEN/ISO. The experience of using archetypes in deployed EHR systems is quite limited today. Currently deployed EHR systems with large user bases have their own proprietary way of representing clinical content using various models. This study was designed to investigate the feasibility of re...

  8. Provider and patient satisfaction with the integration of ambulatory and hospital EHR systems.

    Science.gov (United States)

    Meyerhoefer, Chad D; Sherer, Susan A; Deily, Mary E; Chou, Shin-Yi; Guo, Xiaohui; Chen, Jie; Sheinberg, Michael; Levick, Donald

    2018-05-16

    The installation of EHR systems can disrupt operations at clinical practice sites, but also lead to improvements in information availability. We examined how the installation of an ambulatory EHR at OB/GYN practices and its subsequent interface with an inpatient perinatal EHR affected providers' satisfaction with the transmission of clinical information and patients' ratings of their care experience. We collected data on provider satisfaction through 4 survey rounds during the phased implementation of the EHR. Data on patient satisfaction were drawn from Press Ganey surveys issued by the healthcare network through a standard process. Using multivariable models, we determined how provider satisfaction with information transmission and patient satisfaction with their care experience changed as the EHR system allowed greater information flow between OB/GYN practices and the hospital. Outpatient OB/GYN providers became more satisfied with their access to information from the inpatient perinatal triage unit once system capabilities included automatic data flow from triage back to the OB/GYN offices. Yet physicians were generally less satisfied with how the EHR affected their work processes than other clinical and non-clinical staff. Patient satisfaction dropped after initial EHR installation, and we find no evidence of increased satisfaction linked to system integration. Dissatisfaction of providers with an EHR system and difficulties incorporating EHR technology into patient care may negatively impact patient satisfaction. Care must be taken during EHR implementations to maintain good communication with patients while satisfying documentation requirements.

  9. Electronic Health Record (EHR) Organizational Change: Explaining Resistance Through Profession, Organizational Experience, and EHR Communication Quality.

    Science.gov (United States)

    Barrett, Ashley K

    2018-04-01

    The American Recovery and Reinvestment Act passed by the U.S. government in 2009 mandates that all healthcare organizations adopt a certified electronic health record (EHR) system by 2015. Failure to comply will result in Medicare reimbursement penalties, which steadily increase with each year of delinquency. There are several repercussions of this seemingly top-down, rule-bound organizational change-one of which is employee resistance. Given the penalties for violating EHR meaningful use standards are ongoing, resistance to this mandate presents a serious issue for healthcare organizations. This study surveyed 345 employees in one healthcare organization that recently implemented an EHR. Analysis of variance results offer theoretical and pragmatic contributions by demonstrating physicians, nurses, and employees with more experience in their organization are the most resistant to EHR change. The job characteristics model is used to explain these findings. Hierarchical regression analyses also demonstrate the quality of communication surrounding EHR implementation-from both formal and informal sources-is negatively associated with EHR resistance and positively associated with perceived EHR implementation success and EHR's perceived relative advantage.

  10. The openEHR Foundation.

    Science.gov (United States)

    Kalra, Dipak; Beale, Thomas; Heard, Sam

    2005-01-01

    The openEHR Foundation is an independent, not-for-profit organisation and community, facilitating the creation and sharing of health records by consumers and clinicians via open-source, standards-based implementations. It was formed as a union of ten-year international R&D efforts in specifying the requirements, information models and implementation of comprehensive and ethico-legally sound electronic health record systems. Between 2000 and 2004 it has grown to having an on-line membership of over 300, published a wide range of EHR information viewpoint specifications. Several groups have now begun collaborative software development, within an open source framework. This chapter summarises the formation of openEHR, its research underpinning, practical demonstrators, the principle design concepts, and the roles openEHR members are playing in international standards.

  11. Implementing electronic health records (EHRs): health care provider perceptions before and after transition from a local basic EHR to a commercial comprehensive EHR.

    Science.gov (United States)

    Krousel-Wood, Marie; McCoy, Allison B; Ahia, Chad; Holt, Elizabeth W; Trapani, Donnalee N; Luo, Qingyang; Price-Haywood, Eboni G; Thomas, Eric J; Sittig, Dean F; Milani, Richard V

    2018-06-01

    We assessed changes in the percentage of providers with positive perceptions of electronic health record (EHR) benefit before and after transition from a local basic to a commercial comprehensive EHR. Changes in the percentage of providers with positive perceptions of EHR benefit were captured via a survey of academic health care providers before (baseline) and at 6-12 months (short term) and 12-24 months (long term) after the transition. We analyzed 32 items for the overall group and by practice setting, provider age, and specialty using separate multivariable-adjusted random effects logistic regression models. A total of 223 providers completed all 3 surveys (30% response rate): 85.6% had outpatient practices, 56.5% were >45 years old, and 23.8% were primary care providers. The percentage of providers with positive perceptions significantly increased from baseline to long-term follow-up for patient communication, hospital transitions - access to clinical information, preventive care delivery, preventive care prompt, preventive lab prompt, satisfaction with system reliability, and sharing medical information (P commercial comprehensive EHR, items with significant increases and significant decreases in the percentage of providers with positive perceptions of EHR benefit were identified, overall and by subgroup.

  12. Measurement of the Clinical Usability of a Configurable EHR

    DEFF Research Database (Denmark)

    Møller-Jensen, John; Lund Pedersen, Ivan; Simonsen, Jesper

    2006-01-01

    during a series of workshops with the clinicians after which the XML configuration files were written and deployed. In parallel with this, the participants from the University identified, prioritised and further specified a number of effects related to the clinical practice to be measured. The effects......The objective of the project was to measure the clinical usability of an EHR configured by use of participatory design with clinicians from a neurological stroke unit in order to get input to the County’s future strategy for incremental implementation of EHR. The content of the EHR was defined...... requested by the clinicians focused on improving their overview and assessment of patients as well as on more efficient coordination in three specific and highly cooperative situations, viz. nursing handover, ward round and patient conference. All three situations were measured before (using paper...

  13. Patients' safety in the era of EMR/EHR automation

    Directory of Open Access Journals (Sweden)

    Bakheet Aldosari

    2017-01-01

    Full Text Available Accurate maintenance of the medical records of patients has become a worldwide problem with the rapid rise in the count of patients. Furthermore, providing them adequate health care keeping their safety in view is turning into a great challenge for physicians. As such, electronic health records (EHRs were developed to solve these issues by aiding physicians in imparting quality health care to patients as well as maintaining their safety. Nonetheless, rather than increasing their efficiency, EHRs have become a burden for the physicians as they ultimately increase their error rate and reduce output rate affecting patient safety. As health-IT is advancing progressively, new features are added to the existing EHRs with the aim to support physicians in providing better healthcare. Till date, some of the most advanced features include clinical support decision system (CDSS, computerized physician order entry (CPOE system, health information exchange (HIE, mobile documentation application, and a system of safety alerts on a dashboard. Proper training to the physicians on judiciously usage of these EHR functions is required to extract maximum benefit. Else, these can introduce a considerable number of medical errors, which can result in fatal outcomes for the patients.

  14. Mixed Influence of Electronic Health Record Implementation on Diabetes Order Patterns for Michigan Medicaid Adults.

    Science.gov (United States)

    Corser, William; Yuan, Sha

    2015-08-20

    These 2011-2013 analyses examined the authors' hypothesis that relative diabetes care order changes would be measured after electronic health record (EHR) implementation for 291 Medicaid adults who received all of their office-based care at one midwestern federally qualified health center (FQHC) over a 24-month period (n = 2727 encounters, 2489 claims). Beneficiary sociodemographic, clinical, and claims data were validated with clinic EHR and state Medicaid claims linked to providers' national identifier numbers. Overall pre-post order rate comparisons, and a series of controlled within group binary logistic models were conducted under penalized maximum likelihood estimation terms. After EHR implementation, both the overall order rates and odds ratios of per beneficiary hemoglobin A1C (HbA1C) orders increased significantly (ie, from mean of 0.65 [SD = 1.19] annual tests to 0.96 tests [SD = 1.24] [P order rates of dilated eye exams and microalbumin urine tests appeared fairly stable, the odds of eye exam orders being placed at the claims level decreased significantly (OR = 0.774, P = .0030). These mixed results provide evidence of the varied diabetes care ordering patterns likely seen from increased office use of EHR technologies. The authors attempt to explain these post-EHR differences (or lack of) that generally resemble some of the authors' results from another funded project. Ideally, these findings provide Medicaid and health care officials with a more realistic indication of how EHRs may, or may not, influence diabetes care ordering patterns for vulnerable lower-income primary health care consumers. © 2015 Diabetes Technology Society.

  15. A secure EHR system based on hybrid clouds.

    Science.gov (United States)

    Chen, Yu-Yi; Lu, Jun-Chao; Jan, Jinn-Ke

    2012-10-01

    Consequently, application services rendering remote medical services and electronic health record (EHR) have become a hot topic and stimulating increased interest in studying this subject in recent years. Information and communication technologies have been applied to the medical services and healthcare area for a number of years to resolve problems in medical management. Sharing EHR information can provide professional medical programs with consultancy, evaluation, and tracing services can certainly improve accessibility to the public receiving medical services or medical information at remote sites. With the widespread use of EHR, building a secure EHR sharing environment has attracted a lot of attention in both healthcare industry and academic community. Cloud computing paradigm is one of the popular healthIT infrastructures for facilitating EHR sharing and EHR integration. In this paper, we propose an EHR sharing and integration system in healthcare clouds and analyze the arising security and privacy issues in access and management of EHRs.

  16. Measuring Effects on the Clinical Practice from a Configured EHR

    DEFF Research Database (Denmark)

    Møller-Jensen, John; Simonsen, Jesper; K. Iversen, Rikke

    2006-01-01

    during a series of workshops with the clinicians after which the XML configuration files were written and deployed. In parallel with this, the participants from the University specified a number of effects related to the clinical practice to be measured. Measurements were focused on the requested effects......The objective of the project was to measure the clinical usability of an EHR configured by use of participatory design with clinicians from a neurological stroke unit in order to get input to the County’s future strategy for incremental implementation of EHR. The content of the EHR was defined...... and acquired using various techniques including questionnaires, interviews, observations, and Task Load Index (TLX) ratings. In total, 15 nursing handovers, 8 ward rounds, and 11 patient conferences involving a total of 35 patients and more than 20 clinicians were included in the measurements. Data from...

  17. EHR adoption among doctors who treat the elderly.

    Science.gov (United States)

    Yeager, Valerie A; Menachemi, Nir; Brooks, Robert G

    2010-12-01

    The purpose of this study is to examine Electronic Health Record (EHR) adoption among Florida doctors who treat the elderly. This analysis contributes to the EHR adoption literature by determining if doctors who disproportionately treat the elderly differ from their counterparts with respect to the utilization of an important quality-enhancing health information technology application. This study is based on a primary survey of a large, statewide sample of doctors practising in outpatient settings in Florida. Logistic regression analysis was used to determine whether doctors who treat a high volume of elderly (HVE) patients were different with respect to EHR adoption. Our analyses included responses from 1724 doctors. In multivariate analyses controlling for doctor age, training, computer sophistication, practice size and practice setting, HVE doctors were significantly less likely to adopt EHR. Specifically, compared with their counterparts, HVE doctors were observed to be 26.7% less likely to be utilizing an EHR system (OR=0.733, 95% CI 0.547-0.982). We also found that doctor age is negatively related to EHR adoption, and practice size and doctor computer savvy-ness is positively associated. Despite the fact that EHR adoption has improved in recent years, doctors in Florida who serve the elderly are less likely to adopt EHRs. As long as HVE doctors are adopting EHR systems at slower rates, the elderly patients treated by these doctors will be at a disadvantage with respect to potential benefits offered by this technology. © 2010 Blackwell Publishing Ltd.

  18. Same organization, same electronic health records (EHRs) system, different use: exploring the linkage between practice member communication patterns and EHR use patterns in an ambulatory care setting

    Science.gov (United States)

    Leykum, Luci K; McDaniel, Reuben R

    2011-01-01

    Objective Despite efforts made by ambulatory care organizations to standardize the use of electronic health records (EHRs), practices often incorporate these systems into their work differently from each other. One potential factor contributing to these differences is within-practice communication patterns. The authors explore the linkage between within-practice communication patterns and practice-level EHR use patterns. Design Qualitative study of six practices operating within the same multi-specialty ambulatory care organization using the same EHR system. Semistructured interviews and direct observation were conducted with all physicians, nurses, medical assistants, practice managers, and non-clinical staff from each practice. Measurements An existing model of practice relationships was used to analyze communication patterns within the practices. Practice-level EHR use was defined and analyzed as the ways in which a practice uses an EHR as a collective or a group—including the degree of feature use, level of EHR-enabled communication, and frequency that EHR use changes in a practice. Interview and observation data were analyzed for themes. Based on these themes, within-practice communication patterns were categorized as fragmented or cohesive, and practice-level EHR use patterns were categorized as heterogeneous or homogeneous. Practices where EHR use was uniformly high across all users were further categorized as having standardized EHR use. Communication patterns and EHR use patterns were compared across the six practices. Results Within-practice communication patterns were associated with practice-level EHR use patterns. In practices where communication patterns were fragmented, EHR use was heterogeneous. In practices where communication patterns were cohesive, EHR use was homogeneous. Additional analysis revealed that practices that had achieved standardized EHR use (uniformly high EHR use across all users) exhibited high levels of mindfulness and

  19. Same organization, same electronic health records (EHRs) system, different use: exploring the linkage between practice member communication patterns and EHR use patterns in an ambulatory care setting.

    Science.gov (United States)

    Lanham, Holly Jordan; Leykum, Luci K; McDaniel, Reuben R

    2012-01-01

    Despite efforts made by ambulatory care organizations to standardize the use of electronic health records (EHRs), practices often incorporate these systems into their work differently from each other. One potential factor contributing to these differences is within-practice communication patterns. The authors explore the linkage between within-practice communication patterns and practice-level EHR use patterns. Qualitative study of six practices operating within the same multi-specialty ambulatory care organization using the same EHR system. Semistructured interviews and direct observation were conducted with all physicians, nurses, medical assistants, practice managers, and non-clinical staff from each practice. An existing model of practice relationships was used to analyze communication patterns within the practices. Practice-level EHR use was defined and analyzed as the ways in which a practice uses an EHR as a collective or a group-including the degree of feature use, level of EHR-enabled communication, and frequency that EHR use changes in a practice. Interview and observation data were analyzed for themes. Based on these themes, within-practice communication patterns were categorized as fragmented or cohesive, and practice-level EHR use patterns were categorized as heterogeneous or homogeneous. Practices where EHR use was uniformly high across all users were further categorized as having standardized EHR use. Communication patterns and EHR use patterns were compared across the six practices. Within-practice communication patterns were associated with practice-level EHR use patterns. In practices where communication patterns were fragmented, EHR use was heterogeneous. In practices where communication patterns were cohesive, EHR use was homogeneous. Additional analysis revealed that practices that had achieved standardized EHR use (uniformly high EHR use across all users) exhibited high levels of mindfulness and respectful interaction, whereas practices that

  20. Avoiding fraud risks associated with EHRs.

    Science.gov (United States)

    Helton, Jeffrey R

    2010-07-01

    Fraud associated with electronic health records (EHRs) generally falls into two categories: inappropriate billing by healthcare providers and inappropriate access by a system's users. A provider's EHR system requires controls to be of any significant help in detecting such fraudulent activity, or in gathering transactional evidence should such activity be identified. To protect against potential EHR-related healthcare fraud, providers should follow the recommendations established in 2007 by RTI International for the Office of the National Coordinator for Health Information Technology of the U.S. Department of Health and Human Services.

  1. Improving HIV/AIDS Knowledge Management Using EHRs.

    Science.gov (United States)

    Malmberg, Erik D; Phan, Thao M; Harmon, Glynn; Nauert, Richard F

    2012-01-01

    A primary goal for the development of EHRs and EHR-related technologies should be to facilitate greater knowledge management for improving individual and community health outcomes associated with HIV / AIDS. Most of the current developments of EHR have focused on providing data for research, patient care and prioritization of healthcare provider resources in other areas. More attention should be paid to using information from EHRs to assist local, state, national, and international entities engaged in HIV / AIDS care, research and prevention strategies. Unfortunately the technology and standards for HIV-specific reporting modules are still being developed. A literature search and review supplemented by the author's own experiences with electronic health records and HIV / AIDS prevention strategies will be used. This data was used to identify both opportunities and challenges for improving public health informatics primarily through the use of latest innovations in EHRs. Qualitative analysis and suggestions are offered for how EHRs can support knowledge management and prevention strategies associated with HIV infection. EHR information, including demographics, medical history, medication and allergies, immunization status, and other vital statistics can help public health practitioners to more quickly identify at-risk populations or environments; allocate scarce resources in the most efficient way; share information about successful, evidenced-based prevention strategies; and increase longevity and quality of life. Local, state, and federal entities need to work more collaboratively with NGOs, community-based organizations, and the private sector to eliminate barriers to implementation including cost, interoperability, accessibility, and information security.

  2. Protection of electronic health records (EHRs) in cloud.

    Science.gov (United States)

    Alabdulatif, Abdulatif; Khalil, Ibrahim; Mai, Vu

    2013-01-01

    EHR technology has come into widespread use and has attracted attention in healthcare institutions as well as in research. Cloud services are used to build efficient EHR systems and obtain the greatest benefits of EHR implementation. Many issues relating to building an ideal EHR system in the cloud, especially the tradeoff between flexibility and security, have recently surfaced. The privacy of patient records in cloud platforms is still a point of contention. In this research, we are going to improve the management of access control by restricting participants' access through the use of distinct encrypted parameters for each participant in the cloud-based database. Also, we implement and improve an existing secure index search algorithm to enhance the efficiency of information control and flow through a cloud-based EHR system. At the final stage, we contribute to the design of reliable, flexible and secure access control, enabling quick access to EHR information.

  3. Usability Testing of Two Ambulatory EHR Navigators.

    Science.gov (United States)

    Hultman, Gretchen; Marquard, Jenna; Arsoniadis, Elliot; Mink, Pamela; Rizvi, Rubina; Ramer, Tim; Khairat, Saif; Fickau, Keri; Melton, Genevieve B

    2016-01-01

    Despite widespread electronic health record (EHR) adoption, poor EHR system usability continues to be a significant barrier to effective system use for end users. One key to addressing usability problems is to employ user testing and user-centered design. To understand if redesigning an EHR-based navigation tool with clinician input improved user performance and satisfaction. A usability evaluation was conducted to compare two versions of a redesigned ambulatory navigator. Participants completed tasks for five patient cases using the navigators, while employing a think-aloud protocol. The tasks were based on Meaningful Use (MU) requirements. The version of navigator did not affect perceived workload, and time to complete tasks was longer in the redesigned navigator. A relatively small portion of navigator content was used to complete the MU-related tasks, though navigation patterns were highly variable across participants for both navigators. Preferences for EHR navigation structures appeared to be individualized. This study demonstrates the importance of EHR usability assessments to evaluate group and individual performance of different interfaces and preferences for each design.

  4. CDAPubMed: a browser extension to retrieve EHR-based biomedical literature

    Directory of Open Access Journals (Sweden)

    Perez-Rey David

    2012-04-01

    Full Text Available Abstract Background Over the last few decades, the ever-increasing output of scientific publications has led to new challenges to keep up to date with the literature. In the biomedical area, this growth has introduced new requirements for professionals, e.g., physicians, who have to locate the exact papers that they need for their clinical and research work amongst a huge number of publications. Against this backdrop, novel information retrieval methods are even more necessary. While web search engines are widespread in many areas, facilitating access to all kinds of information, additional tools are required to automatically link information retrieved from these engines to specific biomedical applications. In the case of clinical environments, this also means considering aspects such as patient data security and confidentiality or structured contents, e.g., electronic health records (EHRs. In this scenario, we have developed a new tool to facilitate query building to retrieve scientific literature related to EHRs. Results We have developed CDAPubMed, an open-source web browser extension to integrate EHR features in biomedical literature retrieval approaches. Clinical users can use CDAPubMed to: (i load patient clinical documents, i.e., EHRs based on the Health Level 7-Clinical Document Architecture Standard (HL7-CDA, (ii identify relevant terms for scientific literature search in these documents, i.e., Medical Subject Headings (MeSH, automatically driven by the CDAPubMed configuration, which advanced users can optimize to adapt to each specific situation, and (iii generate and launch literature search queries to a major search engine, i.e., PubMed, to retrieve citations related to the EHR under examination. Conclusions CDAPubMed is a platform-independent tool designed to facilitate literature searching using keywords contained in specific EHRs. CDAPubMed is visually integrated, as an extension of a widespread web browser, within the standard

  5. The Impact of Physician EHR Usage on Patient Satisfaction.

    Science.gov (United States)

    Marmor, Rebecca A; Clay, Brian; Millen, Marlene; Savides, Thomas J; Longhurst, Christopher A

    2018-01-01

    The increased emphasis on patient satisfaction has coincided with the growing adoption of electronic health records (EHRs) throughout the U.S. The 2001 Institute of Medicine Report, “Crossing the Quality Chasm,” identified patient-centered care as a key element of quality health care.[1] In response to this call, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was developed to assess patients' health care experiences in the inpatient setting. Simultaneously, financial incentives have facilitated the rapid adoption of EHR applications, with 84% of hospitals maintaining at least a basic EHR in 2015 (a ninefold increase since 2008).[2] Despite the concurrent deployment of patient satisfaction surveys and EHRs, there is a poor understanding of the relationship that may exist between physician usage of the EHR and patient satisfaction. Most prior research into the impact of the EHR on physician–patient communication has been observational, describing the behaviors of physicians and patients when the clinician accesses an EHR in the exam room. Past research has shown that encounters where physicians access the EHR are often filled with long pauses,[3] and that few clinicians attempt to engage patients by sharing what they are looking at on the screen.[4] A recent meta-analysis reviewing 53 papers found that only 7 studies attempted to correlate objective observations of physician communication behaviors with patient perceptions by eliciting feedback from the patients.[5] No study used a standardized assessment tool of patient satisfaction. The authors conclude that additional work is necessary to better understand the patient perspective of the presence of an EHR during a clinical encounter. Additionally, increasing EHR adoption and emphasis on patient satisfaction have also corresponded with rising physician burnout rates.[6] [7] Prior work suggests that EHR adoption may be contributing to this trend.[8] Burnout from the EHR

  6. Taming the EHR (Electronic Health Record) - There is Hope

    Science.gov (United States)

    DiAngi, YT; Longhurst, CA; Payne, TH

    2016-01-01

    With increasing diffusion of EHR technology over the last half decade, clinician burnout is rising. As healthcare is a complex and highly regulated field, the rapid and mass adoption of EHR technology has created disruption for highly skilled workers such as clinicians. Although, much has been written about dissatisfaction with the EHR (electronic health record), a paucity of immediate solutions exists in the literature. This article suggests three actionable steps health systems and clinicians can make to expedite gains from and mitigate the effect of the EHR on clinical practice. PMID:27830215

  7. Cross border semantic interoperability for clinical research: the EHR4CR semantic resources and services

    Science.gov (United States)

    Daniel, Christel; Ouagne, David; Sadou, Eric; Forsberg, Kerstin; Gilchrist, Mark Mc; Zapletal, Eric; Paris, Nicolas; Hussain, Sajjad; Jaulent, Marie-Christine; MD, Dipka Kalra

    2016-01-01

    With the development of platforms enabling the use of routinely collected clinical data in the context of international clinical research, scalable solutions for cross border semantic interoperability need to be developed. Within the context of the IMI EHR4CR project, we first defined the requirements and evaluation criteria of the EHR4CR semantic interoperability platform and then developed the semantic resources and supportive services and tooling to assist hospital sites in standardizing their data for allowing the execution of the project use cases. The experience gained from the evaluation of the EHR4CR platform accessing to semantically equivalent data elements across 11 European participating EHR systems from 5 countries demonstrated how far the mediation model and mapping efforts met the expected requirements of the project. Developers of semantic interoperability platforms are beginning to address a core set of requirements in order to reach the goal of developing cross border semantic integration of data. PMID:27570649

  8. The Data Gap in the EHR for Clinical Research Eligibility Screening.

    Science.gov (United States)

    Butler, Alex; Wei, Wei; Yuan, Chi; Kang, Tian; Si, Yuqi; Weng, Chunhua

    2018-01-01

    Much effort has been devoted to leverage EHR data for matching patients into clinical trials. However, EHRs may not contain all important data elements for clinical research eligibility screening. To better design research-friendly EHRs, an important step is to identify data elements frequently used for eligibility screening but not yet available in EHRs. This study fills this knowledge gap. Using the Alzheimer's disease domain as an example, we performed text mining on the eligibility criteria text in Clinicaltrials.gov to identify frequently used eligibility criteria concepts. We compared them to the EHR data elements of a cohort of Alzheimer's Disease patients to assess the data gap by usingthe OMOP Common Data Model to standardize the representations for both criteria concepts and EHR data elements. We identified the most common SNOMED CT concepts used in Alzheimer 's Disease trials, andfound 40% of common eligibility criteria concepts were not even defined in the concept space in the EHR dataset for a cohort of Alzheimer 'sDisease patients, indicating a significant data gap may impede EHR-based eligibility screening. The results of this study can be useful for designing targeted research data collection forms to help fill the data gap in the EHR.

  9. Strategies for Primary Care Stakeholders to Improve Electronic Health Records (EHRs).

    Science.gov (United States)

    Olayiwola, J Nwando; Rubin, Ashley; Slomoff, Theo; Woldeyesus, Tem; Willard-Grace, Rachel

    2016-01-01

    The use of electronic health records (EHRs) and the vendors that develop them have increased exponentially in recent years. While there continues to emerge literature on the challenges EHRs have created related to primary care provider satisfaction and workflow, there is sparse literature on the perspective of the EHR vendors themselves. We examined the role of EHR vendors in optimizing primary care practice through a qualitative study of vendor leadership and developers representing 8 companies. We found that EHR vendors apply a range of strategies to elicit feedback from their clinical users and to engage selected users in their development and design process, but priorities are heavily influenced by the macroenvironment and government regulations. To improve the "marriage" between primary care and the EHR vendor community, we propose 6 strategies that may be most impactful for primary care stakeholders seeking to influence EHR development processes. © Copyright 2016 by the American Board of Family Medicine.

  10. Method to integrate clinical guidelines into the electronic health record (EHR) by applying the archetypes approach.

    Science.gov (United States)

    Garcia, Diego; Moro, Claudia Maria Cabral; Cicogna, Paulo Eduardo; Carvalho, Deborah Ribeiro

    2013-01-01

    Clinical guidelines are documents that assist healthcare professionals, facilitating and standardizing diagnosis, management, and treatment in specific areas. Computerized guidelines as decision support systems (DSS) attempt to increase the performance of tasks and facilitate the use of guidelines. Most DSS are not integrated into the electronic health record (EHR), ordering some degree of rework especially related to data collection. This study's objective was to present a method for integrating clinical guidelines into the EHR. The study developed first a way to identify data and rules contained in the guidelines, and then incorporate rules into an archetype-based EHR. The proposed method tested was anemia treatment in the Chronic Kidney Disease Guideline. The phases of the method are: data and rules identification; archetypes elaboration; rules definition and inclusion in inference engine; and DSS-EHR integration and validation. The main feature of the proposed method is that it is generic and can be applied toany type of guideline.

  11. Nursing Student Experiences Regarding Safe Use of Electronic Health Records: A Pilot Study of the Safety and Assurance Factors for EHR Resilience Guides.

    Science.gov (United States)

    Whitt, Karen J; Eden, Lacey; Merrill, Katreena Collette; Hughes, Mckenna

    2017-01-01

    Previous research has linked improper electronic health record configuration and use with adverse patient events. In response to this problem, the US Office of the National Coordinator for Health Information Technology developed the Safety and Assurance Factors for EHR Resilience guides to evaluate electronic health records for optimal use and safety features. During the course of their education, nursing students are exposed to a variety of clinical practice settings and electronic health records. This descriptive study evaluated 108 undergraduate and 51 graduate nursing students' ratings of electronic health record features and safe practices, as well as what they learned from utilizing the computerized provider order entry and clinician communication Safety and Assurance Factors for EHR Resilience guide checklists. More than 80% of the undergraduate and 70% of the graduate students reported that they experienced user problems with electronic health records in the past. More than 50% of the students felt that electronic health records contribute to adverse patient outcomes. Students reported that many of the features assessed were not fully implemented in their electronic health record. These findings highlight areas where electronic health records can be improved to optimize patient safety. The majority of students reported that utilizing the Safety and Assurance Factors for EHR Resilience guides increased their understanding of electronic health record features.

  12. Representing knowledge, data and concepts for EHRS using DCM.

    Science.gov (United States)

    Goossen, William

    2011-01-01

    With the move towards next generations of Electronic Health Record Systems (EHRS), the focus changes from administrative and data retrieval and data entry system capabilities towards clinical functions. The representation of the clinical knowledge and evidence base into EHRS becomes an important asset for health care, with its own challenges. Clinician's do want EHRS support but do not want to standardize care, they do want unified terminology and structured data entry but also free text. In addition, information modelers challenge each other for the best solution, and care pathways and other workflows seem to differ for each situation. Such diverging approaches add complexity to the already difficult situation around Information Technology in health care, the EHRS in particular. This paper argues that a change is necessary to adopt Detailed Clinical Modeling as a method to organize clinical knowledge, represent concepts and define data in such a manner that it allows for semantics to be exchanged without being trapped in a specific technology. DCM help to fulfill the requirements for the enter data once, reuse multiple times paradigm for EHRS.

  13. Dealing with organizational change when implementing EHR systems

    DEFF Research Database (Denmark)

    Høstgaard, Anne Marie; Nøhr, Christian

    2004-01-01

    The article is based upon a case study carried out at Skejby Hospital in Denmark. The research shows that the employees have some expectations when implementing an EHR system, thus hospital management provided the organization with important information before the implementation of a new EHR system....

  14. International developments in openEHR archetypes and templates.

    Science.gov (United States)

    Leslie, Heather

    Electronic Health Records (EHRs) are a complex knowledge domain. The ability to design EHRs to cope with the changing nature of health knowledge, and to be shareable, has been elusive. A recent pilot study1 tested the applicability of the CEN 13606 as an electronic health record standard. Using openEHR archetypes and tools2, 650 clinical content specifi cations (archetypes) were created (e.g. for blood pressure) and re-used across all clinical specialties and contexts. Groups of archetypes were aggregated in templates to support clinical information gathering or viewing (e.g. 80 separate archetypes make up the routine antenatal visit record). Over 60 templates were created for use in the emergency department, antenatal care and delivery of an infant, and paediatric hearing loss assessment. The primary goal is to define a logical clinical record architecture for the NHS but potentially, with archetypes as the keystone, shareable EHRs will also be attainable. Archetype and template development work is ongoing, with associated evaluation occurring in parallel.

  15. Quality requirements for EHR archetypes.

    Science.gov (United States)

    Kalra, Dipak; Tapuria, Archana; Austin, Tony; De Moor, Georges

    2012-01-01

    The realisation of semantic interoperability, in which any EHR data may be communicated between heterogeneous systems and fully understood by computers as well as people on receipt, is a challenging goal. Despite the use of standardised generic models for the EHR and standard terminology systems, too much optionality and variability exists in how particular clinical entries may be represented. Clinical archetypes provide a means of defining how generic models should be shaped and bound to terminology for specific kinds of clinical data. However, these will only contribute to semantic interoperability if libraries of archetypes can be built up consistently. This requires the establishment of design principles, editorial and governance policies, and further research to develop ways for archetype authors to structure clinical data and to use terminology consistently. Drawing on several years of work within communities of practice developing archetypes and implementing systems from them, this paper presents quality requirements for the development of archetypes. Clinical engagement on a wide scale is also needed to help grow libraries of good quality archetypes that can be certified. Vendor and eHealth programme engagement is needed to validate such archetypes and achieve safe, meaningful exchange of EHR data between systems.

  16. ORBDA: An openEHR benchmark dataset for performance assessment of electronic health record servers.

    Directory of Open Access Journals (Sweden)

    Douglas Teodoro

    Full Text Available The openEHR specifications are designed to support implementation of flexible and interoperable Electronic Health Record (EHR systems. Despite the increasing number of solutions based on the openEHR specifications, it is difficult to find publicly available healthcare datasets in the openEHR format that can be used to test, compare and validate different data persistence mechanisms for openEHR. To foster research on openEHR servers, we present the openEHR Benchmark Dataset, ORBDA, a very large healthcare benchmark dataset encoded using the openEHR formalism. To construct ORBDA, we extracted and cleaned a de-identified dataset from the Brazilian National Healthcare System (SUS containing hospitalisation and high complexity procedures information and formalised it using a set of openEHR archetypes and templates. Then, we implemented a tool to enrich the raw relational data and convert it into the openEHR model using the openEHR Java reference model library. The ORBDA dataset is available in composition, versioned composition and EHR openEHR representations in XML and JSON formats. In total, the dataset contains more than 150 million composition records. We describe the dataset and provide means to access it. Additionally, we demonstrate the usage of ORBDA for evaluating inserting throughput and query latency performances of some NoSQL database management systems. We believe that ORBDA is a valuable asset for assessing storage models for openEHR-based information systems during the software engineering process. It may also be a suitable component in future standardised benchmarking of available openEHR storage platforms.

  17. ORBDA: An openEHR benchmark dataset for performance assessment of electronic health record servers

    Science.gov (United States)

    Sundvall, Erik; João Junior, Mario; Ruch, Patrick; Miranda Freire, Sergio

    2018-01-01

    The openEHR specifications are designed to support implementation of flexible and interoperable Electronic Health Record (EHR) systems. Despite the increasing number of solutions based on the openEHR specifications, it is difficult to find publicly available healthcare datasets in the openEHR format that can be used to test, compare and validate different data persistence mechanisms for openEHR. To foster research on openEHR servers, we present the openEHR Benchmark Dataset, ORBDA, a very large healthcare benchmark dataset encoded using the openEHR formalism. To construct ORBDA, we extracted and cleaned a de-identified dataset from the Brazilian National Healthcare System (SUS) containing hospitalisation and high complexity procedures information and formalised it using a set of openEHR archetypes and templates. Then, we implemented a tool to enrich the raw relational data and convert it into the openEHR model using the openEHR Java reference model library. The ORBDA dataset is available in composition, versioned composition and EHR openEHR representations in XML and JSON formats. In total, the dataset contains more than 150 million composition records. We describe the dataset and provide means to access it. Additionally, we demonstrate the usage of ORBDA for evaluating inserting throughput and query latency performances of some NoSQL database management systems. We believe that ORBDA is a valuable asset for assessing storage models for openEHR-based information systems during the software engineering process. It may also be a suitable component in future standardised benchmarking of available openEHR storage platforms. PMID:29293556

  18. ORBDA: An openEHR benchmark dataset for performance assessment of electronic health record servers.

    Science.gov (United States)

    Teodoro, Douglas; Sundvall, Erik; João Junior, Mario; Ruch, Patrick; Miranda Freire, Sergio

    2018-01-01

    The openEHR specifications are designed to support implementation of flexible and interoperable Electronic Health Record (EHR) systems. Despite the increasing number of solutions based on the openEHR specifications, it is difficult to find publicly available healthcare datasets in the openEHR format that can be used to test, compare and validate different data persistence mechanisms for openEHR. To foster research on openEHR servers, we present the openEHR Benchmark Dataset, ORBDA, a very large healthcare benchmark dataset encoded using the openEHR formalism. To construct ORBDA, we extracted and cleaned a de-identified dataset from the Brazilian National Healthcare System (SUS) containing hospitalisation and high complexity procedures information and formalised it using a set of openEHR archetypes and templates. Then, we implemented a tool to enrich the raw relational data and convert it into the openEHR model using the openEHR Java reference model library. The ORBDA dataset is available in composition, versioned composition and EHR openEHR representations in XML and JSON formats. In total, the dataset contains more than 150 million composition records. We describe the dataset and provide means to access it. Additionally, we demonstrate the usage of ORBDA for evaluating inserting throughput and query latency performances of some NoSQL database management systems. We believe that ORBDA is a valuable asset for assessing storage models for openEHR-based information systems during the software engineering process. It may also be a suitable component in future standardised benchmarking of available openEHR storage platforms.

  19. Leveraging EHRs to improve hospital performance: the role of management.

    Science.gov (United States)

    Adler-Milstein, Julia; Woody Scott, Kirstin; Jha, Ashish K

    2014-11-01

    Recent studies fail to find a consistent relationship between adoption of electronic health records (EHRs) and improved hospital performance. We sought to examine whether the quality of hospital management modifies the association between EHR adoption and outcomes related to cost and quality. Retrospective study of a random sample of US acute care hospitals. Management quality was assessed via phone interviews with clinical managers predominantly from cardiac units in a random sample of 325 hospitals using a validated scale of management practices in 4 areas: operations, performance monitoring, target setting, and talent management. American Hospital Association InformationTechnology Supplement data captured whether or not these hospitals had at least a basic EHR. Acute myocardial infarction (AMI) outcomes included risk-adjusted 30-day mortality, average length-of-stay, and average payment per discharge measured using MedPAR data. Ordinary least squares regressions assessed whether management quality modifies the relationship between EHR adoption and AMI outcomes. While we found no association between EHR adoption and our outcomes, management quality modified the relationship in the predicted direction. For length of stay, the coefficient on the interaction between EHR and management was -1.48 (P = .05) and for payment, it was -7786.74 (P = .014). We did not find strong evidence of effect modification for mortality (coefficient = -0.05; P = .37). Coupled with ongoing policy efforts to achieve nationwide EHR adoption is a growing unease that our national investment may not result in better, more efficient care. Our study is among the first to offer empirical evidence that management quality may help explain why some hospitals see substantial gains from EHR adoption while others do not.

  20. Advanced and secure architectural EHR approaches.

    Science.gov (United States)

    Blobel, Bernd

    2006-01-01

    Electronic Health Records (EHRs) provided as a lifelong patient record advance towards core applications of distributed and co-operating health information systems and health networks. For meeting the challenge of scalable, flexible, portable, secure EHR systems, the underlying EHR architecture must be based on the component paradigm and model driven, separating platform-independent and platform-specific models. Allowing manageable models, real systems must be decomposed and simplified. The resulting modelling approach has to follow the ISO Reference Model - Open Distributing Processing (RM-ODP). The ISO RM-ODP describes any system component from different perspectives. Platform-independent perspectives contain the enterprise view (business process, policies, scenarios, use cases), the information view (classes and associations) and the computational view (composition and decomposition), whereas platform-specific perspectives concern the engineering view (physical distribution and realisation) and the technology view (implementation details from protocols up to education and training) on system components. Those views have to be established for components reflecting aspects of all domains involved in healthcare environments including administrative, legal, medical, technical, etc. Thus, security-related component models reflecting all view mentioned have to be established for enabling both application and communication security services as integral part of the system's architecture. Beside decomposition and simplification of system regarding the different viewpoint on their components, different levels of systems' granularity can be defined hiding internals or focusing on properties of basic components to form a more complex structure. The resulting models describe both structure and behaviour of component-based systems. The described approach has been deployed in different projects defining EHR systems and their underlying architectural principles. In that context

  1. TeenBP: Development and Piloting of an EHR-Linked Clinical Decision Support System to Improve Recognition of Hypertension in Adolescents.

    Science.gov (United States)

    Kharbanda, Elyse O; Nordin, James D; Sinaiko, Alan R; Ekstrom, Heidi L; Stultz, Jerry M; Sherwood, Nancy E; Fontaine, Patricia L; Asche, Steve E; Dehmer, Steven P; Amundson, Jerry H; Appana, Deepika X; Bergdall, Anna R; Hayes, Marcia G; O'Connor, Patrick J

    2015-01-01

    Blood pressure (BP) is routinely measured in children and adolescents during primary care visits. However, elevated BP or hypertension is frequently not diagnosed or evaluated further by primary care providers. Barriers to recognition include lack of clinician buy-in, competing priorities, and complexity of the standard BP tables. We have developed and piloted TeenBP- a web-based, electronic health record (EHR) linked system designed to improve recognition of prehypertension and hypertension in adolescents during primary care visits. Important steps in developing TeenBP included the following: review of national BP guidelines, consideration of clinic workflow, engagement of clinical leaders, and evaluation of the impact on clinical sites. Use of a web-based platform has facilitated updates to the TeenBP algorithm and to the message content. In addition, the web-based platform has allowed for development of a sophisticated display of patient-specific information at the point of care. In the TeenBP pilot, conducted at a single pediatric and family practice site with six clinicians, over a five-month period, more than half of BPs in the hypertensive range were clinically recognized. Furthermore, in this small pilot the TeenBP clinical decision support (CDS) was accepted by providers and clinical staff. Effectiveness of the TeenBP CDS will be determined in a two-year cluster-randomized clinical trial, currently underway at 20 primary care sites. Use of technology to extract and display clinically relevant data stored within the EHR may be a useful tool for improving recognition of adolescent hypertension during busy primary care visits. In the future, the methods developed specifically for TeenBP are likely to be translatable to a wide range of acute and chronic issues affecting children and adolescents.

  2. Integrating Process Mining and Cognitive Analysis to Study EHR Workflow.

    Science.gov (United States)

    Furniss, Stephanie K; Burton, Matthew M; Grando, Adela; Larson, David W; Kaufman, David R

    2016-01-01

    There are numerous methods to study workflow. However, few produce the kinds of in-depth analyses needed to understand EHR-mediated workflow. Here we investigated variations in clinicians' EHR workflow by integrating quantitative analysis of patterns of users' EHR-interactions with in-depth qualitative analysis of user performance. We characterized 6 clinicians' patterns of information-gathering using a sequential process-mining approach. The analysis revealed 519 different screen transition patterns performed across 1569 patient cases. No one pattern was followed for more than 10% of patient cases, the 15 most frequent patterns accounted for over half ofpatient cases (53%), and 27% of cases exhibited unique patterns. By triangulating quantitative and qualitative analyses, we found that participants' EHR-interactive behavior was associated with their routine processes, patient case complexity, and EHR default settings. The proposed approach has significant potential to inform resource allocation for observation and training. In-depth observations helped us to explain variation across users.

  3. Are all certified EHRs created equal? Assessing the relationship between EHR vendor and hospital meaningful use performance.

    Science.gov (United States)

    Holmgren, A Jay; Adler-Milstein, Julia; McCullough, Jeffrey

    2017-11-24

    The federal electronic health record (EHR) certification process was intended to ensure a baseline level of system quality and the ability to support meaningful use criteria. We sought to assess whether there was variation across EHR vendors in the degree to which hospitals using products from those vendors were able to achieve high levels of performance on meaningful use criteria. We created a cross-sectional national hospital sample from the Office of the National Coordinator for Health Information Technology EHR Products Used for Meaningful Use Attestation public use file and the Centers for Medicare & Medicaid Services Medicare EHR Incentive Program Eligible Hospitals public use file. We used regression models to assess the relationship between vendor and hospital performance on 6 Stage 2 Meaningful Use criteria, controlling for hospital characteristics. We also calculated how much variation in performance is explained by vendor choice. We found significant associations between specific vendor and level of hospital performance for all 6 meaningful use criteria. Epic was associated with significantly higher performance on 5 of the 6 criteria; relationships for other vendors were mixed, with some associated with significantly worse performance on multiple criteria. EHR vendor choice accounted for between 7% and 34% of performance variation across the 6 criteria. A nontrivial proportion of variation in hospital meaningful use performance is explained by vendor choice, and certain vendors are more often associated with better meaningful use performance than others. Our results suggest that policy-makers should improve the certification process by including more "real-world" scenario testing and provider feedback or ratings to reduce this variation. Hospitals can use these results to guide interactions with vendors. Vendor choice accounts for a meaningful proportion of variation in hospital meaningful use performance, and specific vendors are consistently associated

  4. Assessing the relationship between patient safety culture and EHR strategy.

    Science.gov (United States)

    Ford, Eric W; Silvera, Geoffrey A; Kazley, Abby S; Diana, Mark L; Huerta, Timothy R

    2016-07-11

    Purpose - The purpose of this paper is to explore the relationship between hospitals' electronic health record (EHR) adoption characteristics and their patient safety cultures. The "Meaningful Use" (MU) program is designed to increase hospitals' adoption of EHR, which will lead to better care quality, reduce medical errors, avoid unnecessary cost, and promote a patient safety culture. To reduce medical errors, hospital leaders have been encouraged to promote safety cultures common to high-reliability organizations. Expecting a positive relationship between EHR adoption and improved patient safety cultures appears sound in theory, but it has yet to be empirically demonstrated. Design/methodology/approach - Providers' perceptions of patient safety culture and counts of patient safety incidents are explored in relationship to hospital EHR adoption patterns. Multi-level modeling is employed to data drawn from the Agency for Healthcare Research and Quality's surveys on patient safety culture (level 1) and the American Hospital Association's survey and healthcare information technology supplement (level 2). Findings - The findings suggest that the early adoption of EHR capabilities hold a negative association to the number of patient safety events reported. However, this relationship was not present in providers' perceptions of overall patient safety cultures. These mixed results suggest that the understanding of the EHR-patient safety culture relationship needs further research. Originality/value - Relating EHR MU and providers' care quality attitudes is an important leading indicator for improved patient safety cultures. For healthcare facility managers and providers, the ability to effectively quantify the impact of new technologies on efforts to change organizational cultures is important for pinpointing clinical areas for process improvements.

  5. Exploring physicians' extended use of electronic health records (EHRs): A social influence perspective.

    Science.gov (United States)

    Wang, Wen; Zhao, Xiping; Sun, Jinglei; Zhou, Guangquan

    2016-12-01

    Once electronic health records (EHRs) have been fully implemented and integrated into the daily work of a healthcare organisation/hospital, there is considerable pressure on management to demonstrate the benefits that these systems can deliver to the organisation. One practical way to maximise the value and highlight the benefits of EHRs is to encourage physicians to increase and extend their use of EHR functions. This study used a social influence theory context to examine the impact of mechanisms of social influence on the intentions of physicians to extend their use of EHRs. A survey of physicians (n = 205) in a first-class comprehensive hospital in southern China was conducted approximately 2 years after the hospital's introduction of EHRs. A 16-item questionnaire was developed to measure the impact of four social influence factors (reward, punishment, social image and group norm) on physicians' intentions to extend their use of EHRs. The research model included two additional control variables (perceived usefulness and perceived ease of use) to account for potential covariance among social influence measures. The study's research model showed significant relationships between physicians' responses on two of the social influence measures (rewards and group norm) and their intentions to extend their use of EHRs. Punishment and social image measures did not influence physicians' intentions to increase their use of EHRs. These findings have suggested that for healthcare organisations to maximise the benefits of EHRs, the efforts of hospital management should be directed towards rewarding those physicians who increase their use of EHRs; and to promoting and reinforcing the increased usage of EHRs among physicians as a group norm. © The Author(s) 2016.

  6. EHR Learning - It's about Nursing, Leadership and Long-Term Commitments.

    Science.gov (United States)

    Furlong, Karen E

    2016-01-01

    Despite a global commitment to the adoption of technologies, such as electronic health records (EHRs), to support the delivery of health services, there is little empirical guidance to support effective planning for the integration of these tools into practice settings (Suter et al. 2009). In particular, although EHR learning is known to positively influence integration (Byrne 2012), individual perspectives are often overlooked because of investigative designs that devalue such viewpoints by exploring the utility of technologies rather than the lived experiences of individual users of the technology. Therefore, this qualitative study offered nurse participants opportunities to make sense of EHR learning through talking about their experiences. This narrative inquiry was a collaborative interpretive method of discovery: stories and thematic analysis were the two separate yet complementary frames used to support data analysis. Finally, several practice implications and recommendations about EHR learning are presented with an emphasis placed upon patient safety as a way to impart accountability on behalf of learners, educators and those charged with governing responsibilities during times of EHR integration. Copyright © 2016 Longwoods Publishing.

  7. Funding alternatives in EHR adoption: beyond HITECH incentives and traditional approaches.

    Science.gov (United States)

    Wang, Tiankai; Wang, Yangmei; Biedermann, Sue

    2013-05-01

    The meaningful use incentives under HITECH may be inadequate to address the financial challenges many hospitals face in implementing electronic health records (EHRs). Hospitals can fill the capital gap between EHR costs and available funds by exploring other potential funding sources. These sources include additional grants, funding permissible under EHR regulations, vendor financing, and tax benefits under IRS Section 179.

  8. The Effect of a Learning Environment Using an Electronic Health Record (EHR) on Undergraduate Nursing Students' Behaviorial Intention to Use an EHR

    Science.gov (United States)

    Foley, Shawn

    2011-01-01

    The purpose of this study was to explore the effect of a learning environment using an Electronic Health Record (EHR) on undergraduate nursing students' behavioral intention (BI) to use an EHR. BI is defined by Davis (1989) in the Technology Acceptance Model (TAM) as the degree to which a person has formulated conscious plans to perform or not…

  9. Contribution of Clinical Archetypes, and the Challenges, towards Achieving Semantic Interoperability for EHRs.

    Science.gov (United States)

    Tapuria, Archana; Kalra, Dipak; Kobayashi, Shinji

    2013-12-01

    The objective is to introduce 'clinical archetype' which is a formal and agreed way of representing clinical information to ensure interoperability across and within Electronic Health Records (EHRs). The paper also aims at presenting the challenges building quality labeled clinical archetypes and the challenges towards achieving semantic interoperability between EHRs. Twenty years of international research, various European healthcare informatics projects and the pioneering work of the openEHR Foundation have led to the following results. The requirements for EHR information architectures have been consolidated within ISO 18308 and adopted within the ISO 13606 EHR interoperability standard. However, a generic EHR architecture cannot ensure that the clinical meaning of information from heterogeneous sources can be reliably interpreted by receiving systems and services. Therefore, clinical models called 'clinical archetypes' are required to formalize the representation of clinical information within the EHR. Part 2 of ISO 13606 defines how archetypes should be formally represented. The current challenge is to grow clinical communities to build a library of clinical archetypes and to identify how evidence of best practice and multi-professional clinical consensus should best be combined to define archetypes at the optimal level of granularity and specificity and quality label them for wide adoption. Standardizing clinical terms within EHRs using clinical terminology like Systematized Nomenclature of Medicine Clinical Terms is also a challenge. Clinical archetypes would play an important role in achieving semantic interoperability within EHRs. Attempts are being made in exploring the design and adoption challenges for clinical archetypes.

  10. Modelling of Operative Report Documents for Data Integration into an openEHR-Based Enterprise Data Warehouse.

    Science.gov (United States)

    Haarbrandt, Birger; Wilschko, Andreas; Marschollek, Michael

    2016-01-01

    In order to integrate operative report documents from two operating room management systems into a data warehouse, we investigated the application of the two-level modelling approach of openEHR to create a shared data model. Based on the systems' analyses, a template consisting of 13 archetypes has been developed. Of these 13 archetypes, 3 have been obtained from the international archetype repository of the openEHR foundation. The remaining 10 archetypes have been newly created. The template was evaluated by an application system expert and through conducting a first test mapping of real-world data from one of the systems. The evaluation showed that by using the two-level modelling approach of openEHR, we succeeded to represent an integrated and shared information model for operative report documents. More research is needed to learn about the limitations of this approach in other data integration scenarios.

  11. Safer electronic health records safety assurance factors for EHR resilience

    CERN Document Server

    Sittig, Dean F

    2015-01-01

    This important volume provide a one-stop resource on the SAFER Guides along with the guides themselves and information on their use, development, and evaluation. The Safety Assurance Factors for EHR Resilience (SAFER) guides, developed by the editors of this book, identify recommended practices to optimize the safety and safe use of electronic health records (EHRs). These guides are designed to help organizations self-assess the safety and effectiveness of their EHR implementations, identify specific areas of vulnerability, and change their cultures and practices to mitigate risks.This book pr

  12. Effects of exam room EHR use on doctor-patient communication: a systematic literature review.

    Science.gov (United States)

    Kazmi, Zainab

    2013-01-01

    High levels of funding have been invested in health information technologies, especially electronic health records (EHRs), in an effect to coordinate and organize patient health data. However, the effect of EHRs in the exam room on doctor-patient communication has not been sufficiently explored. Objective The purpose of this systematic review was to determine how physician use of EHRs in medical consultations affects doctor-patient communication, both in terms of patient perceptions and actual physician behaviours. The reviewer conducted a comprehensive online database search in March 2013 of EMBASE, MEDLINE, and SCOPUS, using a combination of synonyms of the terms "patient", "doctor", "communication", and "EHR" or "computing". For inclusion in this review, articles had to be published in English, take place in an outpatient setting and demonstrate an empirical investigation into whether EHR affects doctor-patient communication. The reviewer then analysed 13 articles that met the inclusion criteria. Studies showed EHR use encouraged biomedical questioning of the patient, and encouraged patient-led questioning and doctor-led information provision. EHR-related behaviours such as keyboarding and screen gaze impaired relationships with patients, by reducing eye contact, rapport, and provision of emotional support. EHRs negatively affected physician-led patient-centred communication. Computer use may have amplified existing physician behaviours regarding medical record use. We noted both positive and negative effects of EHR use. This review highlights the need for increased EHR-specific communication training to mitigate adverse effects and for continued acknowledgement of patient perspectives.

  13. Linking to MedlinePlus

    Science.gov (United States)

    ... want to link patients or healthcare providers from electronic health record (EHR) systems to relevant MedlinePlus information, use MedlinePlus ... updates Subscribe to RSS Follow us Disclaimers Copyright Privacy Accessibility Quality Guidelines Viewers & Players MedlinePlus Connect for ...

  14. Monitoring the development and diffusion of EHR systems in Denmark

    DEFF Research Database (Denmark)

    Nøhr, Christian; Andersen, Stig Kjær; Vingtoft, Søren

    2003-01-01

    The danish EHR Oberservatory has monitored Danish EHR projects for several years with respect to a number of parameters such as diffusion, diffusin rate, barriers and limitations, and experience gained. The results of the 2002 monitoring reveal that investment in IT is relatively low...

  15. EHR implementation in South Africa: how do we get it right?

    Science.gov (United States)

    Yogeswaran, Parimalaranie; Wright, Graham

    2010-01-01

    In an environment of expanding demand on the health care system to provide equitable, accessible and safe health care, usage of information communication technology is one of the strategies identified to fulfil such expectations. Electronic Health Record (EHR) is an important tool towards achieving better health care using such technology, although, across the world EHR implementation has experienced a high failure rate. Nevertheless South Africa has made a strategic decision to implement EHR system in the public health sector. An evaluation toolkit was developed, to measure the state of readiness of health institutions in South Africa in implementing EHR based on Kaplan and Norton's work on Balanced Score Card (BSC), and the subsequent variant model developed by Protti. A Critical Success Factor (CSF) scorecard to assess the state of readiness and a Balanced Score Card matrix to be used as a strategic framework was developed. These tools were validated using critiques by a panel of experts. The toolkit developed has the potential to assist the organization towards a better EHR implementation path.

  16. Importance-Satisfaction Analysis for Primary Care Physicians’ Perspective on EHRs in Taiwan

    Directory of Open Access Journals (Sweden)

    Cheng-Hsun Ho

    2014-06-01

    Full Text Available The Taiwan government has been promoting Electronic Health Records (EHRs to primary care physicians. How to extend EHRs adoption rate by measuring physicians’ perspective of importance and performance of EHRs has become one of the critical issues for healthcare organizations. We conducted a comprehensive survey in 2010 in which a total of 1034 questionnaires which were distributed to primary care physicians. The project was sponsored by the Department of Health to accelerate the adoption of EHRs. 556 valid responses were analyzed resulting in a valid response rate of 53.77%. The data were analyzed based on a data-centered analytical framework (5-point Likert scale. The mean of importance and satisfaction of four dimensions were 4.16, 3.44 (installation and maintenance, 4.12, 3.51 (product effectiveness, 4.10, 3.31 (system function and 4.34, 3.70 (customer service respectively. This study provided a direction to government by focusing on attributes which physicians found important but were dissatisfied with, to close the gap between actual and expected performance of the EHRs. The authorities should emphasize the potential advantages in meaningful use and provide training programs, conferences, technical assistance and incentives to enhance the national level implementation of EHRs for primary physicians.

  17. EHR Incentive Programs - Data and Reports

    Data.gov (United States)

    U.S. Department of Health & Human Services — As of March 2013, more than 259,000 health care providers received payment for participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive...

  18. Dynamic CDM strategies in an EHR environment.

    Science.gov (United States)

    Bieker, Michael; Bailey, Spencer

    2012-02-01

    A dynamic charge description master (CDM) integrates information from clinical ancillary systems into the charge-capture process, so an organization can reduce its reliance on the patient accounting system as the sole source of billing information. By leveraging the information from electronic ancillary systems, providers can eliminate the need for paper charge-capture forms and see increased accuracy and efficiency in the maintenance of billing information. Before embarking on a dynamic CDM strategy, organizations should first determine their goals for implementing an EHR system, include revenue cycle leaders on the EHR implementation team, and carefully weigh the pros and cons of CDM design decisions.

  19. Domain Modeling and Application Development of an Archetype- and XML-based EHRS. Practical Experiences and Lessons Learnt.

    Science.gov (United States)

    Kropf, Stefan; Chalopin, Claire; Lindner, Dirk; Denecke, Kerstin

    2017-06-28

    Access to patient data within the hospital or between hospitals is still problematic since a variety of information systems is in use applying different vendor specific terminologies and underlying knowledge models. Beyond, the development of electronic health record systems (EHRSs) is time and resource consuming. Thus, there is a substantial need for a development strategy of standardized EHRSs. We are applying a reuse-oriented process model and demonstrate its feasibility and realization on a practical medical use case, which is an EHRS holding all relevant data arising in the context of treatment of tumors of the sella region. In this paper, we describe the development process and our practical experiences. Requirements towards the development of the EHRS were collected by interviews with a neurosurgeon and patient data analysis. For modelling of patient data, we selected openEHR as standard and exploited the software tools provided by the openEHR foundation. The patient information model forms the core of the development process, which comprises the EHR generation and the implementation of an EHRS architecture. Moreover, a reuse-oriented process model from the business domain was adapted to the development of the EHRS. The reuse-oriented process model is a model for a suitable abstraction of both, modeling and development of an EHR centralized EHRS. The information modeling process resulted in 18 archetypes that were aggregated in a template and built the boilerplate of the model driven development. The EHRs and the EHRS were developed by openEHR and W3C standards, tightly supported by well-established XML techniques. The GUI of the final EHRS integrates and visualizes information from various examinations, medical reports, findings and laboratory test results. We conclude that the development of a standardized overarching EHR and an EHRS is feasible using openEHR and W3C standards, enabling a high degree of semantic interoperability. The standardized

  20. Barriers to ambulatory EHR: who are 'imminent adopters' and how do they differ from other physicians?

    Directory of Open Access Journals (Sweden)

    Nir Menachemi

    2006-06-01

    Conclusion Policy and decision makers interested in promoting the adoption of EHR among physicians should focus on the needs and barriers of those most likely to adopt EHR. Given that imminent adopters differ considerably from their peers, current EHR incentive programmes that focus on financial barriers only might prove sub-optimal in achieving immediate widespread EHR adoption.

  1. Medicare and Medicaid programs; modifications to the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program for 2014 and other changes to EHR Incentive Program; and health information technology: revision to the certified EHR technology definition and EHR certification changes related to standards. Final rule.

    Science.gov (United States)

    2014-09-04

    This final rule changes the meaningful use stage timeline and the definition of certified electronic health record technology (CEHRT) to allow options in the use of CEHRT for the EHR reporting period in 2014. It also sets the requirements for reporting on meaningful use objectives and measures as well as clinical quality measure (CQM) reporting in 2014 for providers who use one of the CEHRT options finalized in this rule for their EHR reporting period in 2014. In addition, it finalizes revisions to the Medicare and Medicaid EHR Incentive Programs to adopt an alternate measure for the Stage 2 meaningful use objective for hospitals to provide structured electronic laboratory results to ambulatory providers; to correct the regulation text for the measures associated with the objective for hospitals to provide patients the ability to view online, download, and transmit information about a hospital admission; and to set a case number threshold exemption for CQM reporting applicable for eligible hospitals and critical access hospitals (CAHs) beginning with FY 2013. Finally, this rule finalizes the provisionally adopted replacement of the Data Element Catalog (DEC) and the Quality Reporting Document Architecture (QRDA) Category III standards with updated versions of these standards.

  2. How to successfully select and implement electronic health records (EHR) in small ambulatory practice settings.

    Science.gov (United States)

    Lorenzi, Nancy M; Kouroubali, Angelina; Detmer, Don E; Bloomrosen, Meryl

    2009-02-23

    Adoption of EHRs by U.S. ambulatory practices has been slow despite the perceived benefits of their use. Most evaluations of EHR implementations in the literature apply to large practice settings. While there are similarities relating to EHR implementation in large and small practice settings, the authors argue that scale is an important differentiator. Focusing on small ambulatory practices, this paper outlines the benefits and barriers to EHR use in this setting, and provides a "field guide" for these practices to facilitate successful EHR implementation. The benefits of EHRs in ambulatory practices include improved patient care and office efficiency, and potential financial benefits. Barriers to EHRs include costs; lack of standardization of EHR products and the design of vendor systems for large practice environments; resistance to change; initial difficulty of system use leading to productivity reduction; and perceived accrual of benefits to society and payers rather than providers. The authors stress the need for developing a flexible change management strategy when introducing EHRs that is relevant to the small practice environment; the strategy should acknowledge the importance of relationship management and the role of individual staff members in helping the entire staff to manage change. Practice staff must create an actionable vision outlining realistic goals for the implementation, and all staff must buy into the project. The authors detail the process of implementing EHRs through several stages: decision, selection, pre-implementation, implementation, and post-implementation. They stress the importance of identifying a champion to serve as an advocate of the value of EHRs and provide direction and encouragement for the project. Other key activities include assessing and redesigning workflow; understanding financial issues; conducting training that is well-timed and meets the needs of practice staff; and evaluating the implementation process. The EHR

  3. How to successfully select and implement electronic health records (EHR in small ambulatory practice settings

    Directory of Open Access Journals (Sweden)

    Detmer Don E

    2009-02-01

    Full Text Available Abstract Background Adoption of EHRs by U.S. ambulatory practices has been slow despite the perceived benefits of their use. Most evaluations of EHR implementations in the literature apply to large practice settings. While there are similarities relating to EHR implementation in large and small practice settings, the authors argue that scale is an important differentiator. Focusing on small ambulatory practices, this paper outlines the benefits and barriers to EHR use in this setting, and provides a "field guide" for these practices to facilitate successful EHR implementation. Discussion The benefits of EHRs in ambulatory practices include improved patient care and office efficiency, and potential financial benefits. Barriers to EHRs include costs; lack of standardization of EHR products and the design of vendor systems for large practice environments; resistance to change; initial difficulty of system use leading to productivity reduction; and perceived accrual of benefits to society and payers rather than providers. The authors stress the need for developing a flexible change management strategy when introducing EHRs that is relevant to the small practice environment; the strategy should acknowledge the importance of relationship management and the role of individual staff members in helping the entire staff to manage change. Practice staff must create an actionable vision outlining realistic goals for the implementation, and all staff must buy into the project. The authors detail the process of implementing EHRs through several stages: decision, selection, pre-implementation, implementation, and post-implementation. They stress the importance of identifying a champion to serve as an advocate of the value of EHRs and provide direction and encouragement for the project. Other key activities include assessing and redesigning workflow; understanding financial issues; conducting training that is well-timed and meets the needs of practice staff

  4. Importance-Satisfaction Analysis for Primary Care Physicians’ Perspective on EHRs in Taiwan †

    Science.gov (United States)

    Ho, Cheng-Hsun; Wen, Hsyien-Chia; Chu, Chi-Ming; Wu, Yi-Syuan; Wang, Jen-Leng

    2014-01-01

    The Taiwan government has been promoting Electronic Health Records (EHRs) to primary care physicians. How to extend EHRs adoption rate by measuring physicians’ perspective of importance and performance of EHRs has become one of the critical issues for healthcare organizations. We conducted a comprehensive survey in 2010 in which a total of 1034 questionnaires which were distributed to primary care physicians. The project was sponsored by the Department of Health to accelerate the adoption of EHRs. 556 valid responses were analyzed resulting in a valid response rate of 53.77%. The data were analyzed based on a data-centered analytical framework (5-point Likert scale). The mean of importance and satisfaction of four dimensions were 4.16, 3.44 (installation and maintenance), 4.12, 3.51 (product effectiveness), 4.10, 3.31 (system function) and 4.34, 3.70 (customer service) respectively. This study provided a direction to government by focusing on attributes which physicians found important but were dissatisfied with, to close the gap between actual and expected performance of the EHRs. The authorities should emphasize the potential advantages in meaningful use and provide training programs, conferences, technical assistance and incentives to enhance the national level implementation of EHRs for primary physicians. PMID:24914640

  5. 45 CFR 170.470 - Effect of revocation on the certifications issued to complete EHRs and EHR Modules.

    Science.gov (United States)

    2010-10-01

    ... HUMAN SERVICES HEALTH INFORMATION TECHNOLOGY HEALTH INFORMATION TECHNOLOGY STANDARDS, IMPLEMENTATION SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Temporary Certification Program for HIT § 170.470 Effect of revocation on the certifications issued to complete EHRs and...

  6. Facilitating secondary use of medical data by using openEHR archetypes.

    Science.gov (United States)

    Kohl, Christian D; Garde, Sebastian; Knaup, Petra

    2010-01-01

    Clinical trials are of high importance for medical progress. But even though more and more clinical data is available in electronic patient records (EPRs) and more and more electronic data capture (EDC) systems are used in trials, there is still a gap which makes EPR / EDC interoperability difficult and hampers secondary use of medical routine data. The openEHR architecture for Electronic Health Records is based on a two level modeling approach which makes use of 'archetypes'. We want to analyze whether archetypes can help to bridge this gap by building an integrated EPR / EDC system based on openEHR archetypes. We used the 'openEHR Reference Framework and Application' (Opereffa) and existing archetypes for medical data. Furthermore, we developed dedicated archetypes to document study meta data. We developed a first prototype implementation of an archetype based integrated EPR / EDC system. Next steps will be the evaluation of an extended prototype in a real clinical trial scenario. Opereffa was a good starting point for our work. OpenEHR archetypes proved useful for secondary use of health data.

  7. Annotating Logical Forms for EHR Questions.

    Science.gov (United States)

    Roberts, Kirk; Demner-Fushman, Dina

    2016-05-01

    This paper discusses the creation of a semantically annotated corpus of questions about patient data in electronic health records (EHRs). The goal is to provide the training data necessary for semantic parsers to automatically convert EHR questions into a structured query. A layered annotation strategy is used which mirrors a typical natural language processing (NLP) pipeline. First, questions are syntactically analyzed to identify multi-part questions. Second, medical concepts are recognized and normalized to a clinical ontology. Finally, logical forms are created using a lambda calculus representation. We use a corpus of 446 questions asking for patient-specific information. From these, 468 specific questions are found containing 259 unique medical concepts and requiring 53 unique predicates to represent the logical forms. We further present detailed characteristics of the corpus, including inter-annotator agreement results, and describe the challenges automatic NLP systems will face on this task.

  8. Understanding Study Participants Views on Co-Creation of Data and Use of EHR in Clinical Studies.

    Science.gov (United States)

    Scott Duncan, Therese; Hägglund, Maria

    2018-01-01

    In order to increase clinical trial participation, the reasons for participating need to be observed. Since there is rather inadequate information concerning how individuals such as patients, decides to participate in clinical trials semi-structured interviews have been done. Examining the use of EHR in clinical trials and co-creation of data, the result showed that it is important for the researches to have access to the patients' EHR and for the patients to contribute with their own ideas of research. Important aspects of further participation in clinical trials were that it should be fun and informative. The patients agreed on that the effort of participating could decrease with the use of electronically collection and self-reporting of data, e.g. through a patient portal.

  9. Building Chronic Kidney Disease Clinical Practice Guidelines Using the openEHR Guideline Definition Language.

    Science.gov (United States)

    Lin, Ching-Heng; Lo, Ying-Chih; Hung, Pei-Yuan; Liou, Der-Ming

    2016-12-07

    As a result of the disease's high prevalence, chronic kidney disease (CKD) has become a global public health problem. A clinical decision support system that integrates with computer-interpretable guidelines (CIGs) should improve clinical outcomes and help to ensure patient safety. The openEHR guideline definition language (GDL) is a formal language used to represent CIGs. This study explores the feasibility of using a GDL approach for CKD; it also attempts to identify any potential gaps between the ideal concept and reality. Using the Kidney Disease Improving Global Outcomes (KDIGO) anemia guideline as material, we designed a development workflow in order to establish a series of GDL guidelines. Focus group discussions were conducted in order to identify important issues related to GDL implementation. Ten GDL guidelines and 37 archetypes were established using the KDIGO guideline document. For the focus group discussions, 16 clinicians and 22 IT experts were recruited and their perceptions, opinions and attitudes towards the GDL approach were explored. Both groups provided positive feedback regarding the GDL approach, but raised various concerns about GDL implementation. Based on the findings of this study, we identified some potential gaps that might exist during implementation between the GDL concept and reality. Three directions remain to be investigated in the future. Two of them are related to the openEHR GDL approach. Firstly, there is a need for the editing tool to be made more sophisticated. Secondly, there needs to be integration of the present approach into non openEHR-based hospital information systems. The last direction focuses on the applicability of guidelines and involves developing a method to resolve any conflicts that occur with insurance payment regulations.

  10. Modeling healthcare authorization and claim submissions using the openEHR dual-model approach

    Science.gov (United States)

    2011-01-01

    Background The TISS standard is a set of mandatory forms and electronic messages for healthcare authorization and claim submissions among healthcare plans and providers in Brazil. It is not based on formal models as the new generation of health informatics standards suggests. The objective of this paper is to model the TISS in terms of the openEHR archetype-based approach and integrate it into a patient-centered EHR architecture. Methods Three approaches were adopted to model TISS. In the first approach, a set of archetypes was designed using ENTRY subclasses. In the second one, a set of archetypes was designed using exclusively ADMIN_ENTRY and CLUSTERs as their root classes. In the third approach, the openEHR ADMIN_ENTRY is extended with classes designed for authorization and claim submissions, and an ISM_TRANSITION attribute is added to the COMPOSITION class. Another set of archetypes was designed based on this model. For all three approaches, templates were designed to represent the TISS forms. Results The archetypes based on the openEHR RM (Reference Model) can represent all TISS data structures. The extended model adds subclasses and an attribute to the COMPOSITION class to represent information on authorization and claim submissions. The archetypes based on all three approaches have similar structures, although rooted in different classes. The extended openEHR RM model is more semantically aligned with the concepts involved in a claim submission, but may disrupt interoperability with other systems and the current tools must be adapted to deal with it. Conclusions Modeling the TISS standard by means of the openEHR approach makes it aligned with ISO recommendations and provides a solid foundation on which the TISS can evolve. Although there are few administrative archetypes available, the openEHR RM is expressive enough to represent the TISS standard. This paper focuses on the TISS but its results may be extended to other billing processes. A complete

  11. Educating Health Professionals about the Electronic Health Record (EHR: Removing the Barriers to Adoption

    Directory of Open Access Journals (Sweden)

    Paule Bellwood

    2011-03-01

    Full Text Available In the healthcare industry we have had a significant rise in the use of electronic health records (EHRs in health care settings (e.g. hospital, clinic, physician office and home. There are three main barriers that have arisen to the adoption of these technologies: (1 a shortage of health professional faculty who are familiar with EHRs and related technologies, (2 a shortage of health informatics specialists who can implement these technologies, and (3 poor access to differing types of EHR software. In this paper we outline a novel solution to these barriers: the development of a web portal that provides facility and health professional students with access to multiple differing types of EHRs over the WWW. The authors describe how the EHR is currently being used in educational curricula and how it has overcome many of these barriers. The authors also briefly describe the strengths and limitations of the approach.

  12. Mining Electronic Health Records using Linked Data.

    Science.gov (United States)

    Odgers, David J; Dumontier, Michel

    2015-01-01

    Meaningful Use guidelines have pushed the United States Healthcare System to adopt electronic health record systems (EHRs) at an unprecedented rate. Hospitals and medical centers are providing access to clinical data via clinical data warehouses such as i2b2, or Stanford's STRIDE database. In order to realize the potential of using these data for translational research, clinical data warehouses must be interoperable with standardized health terminologies, biomedical ontologies, and growing networks of Linked Open Data such as Bio2RDF. Applying the principles of Linked Data, we transformed a de-identified version of the STRIDE into a semantic clinical data warehouse containing visits, labs, diagnoses, prescriptions, and annotated clinical notes. We demonstrate the utility of this system though basic cohort selection, phenotypic profiling, and identification of disease genes. This work is significant in that it demonstrates the feasibility of using semantic web technologies to directly exploit existing biomedical ontologies and Linked Open Data.

  13. Observing health professionals' workflow patterns for diabetes care - First steps towards an ontology for EHR services.

    Science.gov (United States)

    Schweitzer, M; Lasierra, N; Hoerbst, A

    2015-01-01

    Increasing the flexibility from a user-perspective and enabling a workflow based interaction, facilitates an easy user-friendly utilization of EHRs for healthcare professionals' daily work. To offer such versatile EHR-functionality, our approach is based on the execution of clinical workflows by means of a composition of semantic web-services. The backbone of such architecture is an ontology which enables to represent clinical workflows and facilitates the selection of suitable services. In this paper we present the methods and results after running observations of diabetes routine consultations which were conducted in order to identify those workflows and the relation among the included tasks. Mentioned workflows were first modeled by BPMN and then generalized. As a following step in our study, interviews will be conducted with clinical personnel to validate modeled workflows.

  14. The challenge of electronic health records (EHRs) design and implementation: responses of health workers to drawing a 'big and rich picture' of a future EHR programme using animated tools.

    Science.gov (United States)

    Jenkings, K Neil; Wilson, Robert G

    2007-01-01

    To investigate the use of animation tools to aid visualisation of problems for discussion within focus groups, in the context of healthcare workers discussing electronic health records (EHRs). Ten healthcare staff focus groups, held in a range of organisational contexts. Each focus group was in four stages: baseline discussion, animator presentation, post-animator discussion and questionnaire. Audio recordings of the focus groups were transcribed and coded and the emergent analytic themes analysed for issues relating to EHR design and implementation. The data allowed a comparison of baseline and post-animator discussion. The animator facilitated discussion about EHR issues and these were thematically coded as: Workload; Sharing Information; Access to Information; Record Content; Confidentiality; Patient Consent; and Implementation. We illustrate that use of the animator in focus groups is one means to raise understanding about a proposed EHR development. The animator provided a visual 'probe' to support a more proactive and discursive localised approach to end-user concerns, which could be part of an effective stakeholder engagement and communication strategy crucial in any EHR or health informatics implementation programme. The results of the focus groups were to raise salient issues and concerns, many of which anticipated those that have emerged in the current NHS Connecting for Health Care Records programme in England. Potentially, animator-type technologies may facilitate the user ownership which other forms of dissemination appear to be failing to achieve.

  15. Semantic processing of EHR data for clinical research.

    Science.gov (United States)

    Sun, Hong; Depraetere, Kristof; De Roo, Jos; Mels, Giovanni; De Vloed, Boris; Twagirumukiza, Marc; Colaert, Dirk

    2015-12-01

    There is a growing need to semantically process and integrate clinical data from different sources for clinical research. This paper presents an approach to integrate EHRs from heterogeneous resources and generate integrated data in different data formats or semantics to support various clinical research applications. The proposed approach builds semantic data virtualization layers on top of data sources, which generate data in the requested semantics or formats on demand. This approach avoids upfront dumping to and synchronizing of the data with various representations. Data from different EHR systems are first mapped to RDF data with source semantics, and then converted to representations with harmonized domain semantics where domain ontologies and terminologies are used to improve reusability. It is also possible to further convert data to application semantics and store the converted results in clinical research databases, e.g. i2b2, OMOP, to support different clinical research settings. Semantic conversions between different representations are explicitly expressed using N3 rules and executed by an N3 Reasoner (EYE), which can also generate proofs of the conversion processes. The solution presented in this paper has been applied to real-world applications that process large scale EHR data. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Modeling healthcare authorization and claim submissions using the openEHR dual-model approach

    Directory of Open Access Journals (Sweden)

    Freire Sergio M

    2011-10-01

    Full Text Available Abstract Background The TISS standard is a set of mandatory forms and electronic messages for healthcare authorization and claim submissions among healthcare plans and providers in Brazil. It is not based on formal models as the new generation of health informatics standards suggests. The objective of this paper is to model the TISS in terms of the openEHR archetype-based approach and integrate it into a patient-centered EHR architecture. Methods Three approaches were adopted to model TISS. In the first approach, a set of archetypes was designed using ENTRY subclasses. In the second one, a set of archetypes was designed using exclusively ADMIN_ENTRY and CLUSTERs as their root classes. In the third approach, the openEHR ADMIN_ENTRY is extended with classes designed for authorization and claim submissions, and an ISM_TRANSITION attribute is added to the COMPOSITION class. Another set of archetypes was designed based on this model. For all three approaches, templates were designed to represent the TISS forms. Results The archetypes based on the openEHR RM (Reference Model can represent all TISS data structures. The extended model adds subclasses and an attribute to the COMPOSITION class to represent information on authorization and claim submissions. The archetypes based on all three approaches have similar structures, although rooted in different classes. The extended openEHR RM model is more semantically aligned with the concepts involved in a claim submission, but may disrupt interoperability with other systems and the current tools must be adapted to deal with it. Conclusions Modeling the TISS standard by means of the openEHR approach makes it aligned with ISO recommendations and provides a solid foundation on which the TISS can evolve. Although there are few administrative archetypes available, the openEHR RM is expressive enough to represent the TISS standard. This paper focuses on the TISS but its results may be extended to other billing

  17. The Electronic Healthcare Record for Clinical Research (EHR4CR) information model and terminology.

    Science.gov (United States)

    Ouagne, David; Hussain, Sajjad; Sadou, Eric; Jaulent, Marie-Christine; Daniel, Christel

    2012-01-01

    A major barrier to repurposing routinely collected data for clinical research is the heterogeneity of healthcare information systems. Electronic Healthcare Record for Clinical Research (EHR4CR) is a European platform designed to improve the efficiency of conducting clinical trials. In this paper, we propose an initial architecture of the EHR4CR Semantic Interoperability Framework. We used a model-driven engineering approach to build a reference HL7-based multidimensional model bound to a set of reference clinical terminologies acting as a global as view model. We then conducted an evaluation of its expressiveness for patient eligibility. The EHR4CR information model consists in one fact table dedicated to clinical statement and 4 dimensions. The EHR4CR terminology integrates reference terminologies used in patient care (e.g LOINC, ICD-10, SNOMED CT, etc). We used the Object Constraint Language (OCL) to represent patterns of eligibility criteria as constraints on the EHR4CR model to be further transformed in SQL statements executed on different clinical data warehouses.

  18. Validation and Refinement of a Pain Information Model from EHR Flowsheet Data.

    Science.gov (United States)

    Westra, Bonnie L; Johnson, Steven G; Ali, Samira; Bavuso, Karen M; Cruz, Christopher A; Collins, Sarah; Furukawa, Meg; Hook, Mary L; LaFlamme, Anne; Lytle, Kay; Pruinelli, Lisiane; Rajchel, Tari; Settergren, Theresa Tess; Westman, Kathryn F; Whittenburg, Luann

    2018-01-01

    Secondary use of electronic health record (EHR) data can reduce costs of research and quality reporting. However, EHR data must be consistent within and across organizations. Flowsheet data provide a rich source of interprofessional data and represents a high volume of documentation; however, content is not standardized. Health care organizations design and implement customized content for different care areas creating duplicative data that is noncomparable. In a prior study, 10 information models (IMs) were derived from an EHR that included 2.4 million patients. There was a need to evaluate the generalizability of the models across organizations. The pain IM was selected for evaluation and refinement because pain is a commonly occurring problem associated with high costs for pain management. The purpose of our study was to validate and further refine a pain IM from EHR flowsheet data that standardizes pain concepts, definitions, and associated value sets for assessments, goals, interventions, and outcomes. A retrospective observational study was conducted using an iterative consensus-based approach to map, analyze, and evaluate data from 10 organizations. The aggregated metadata from the EHRs of 8 large health care organizations and the design build in 2 additional organizations represented flowsheet data from 6.6 million patients, 27 million encounters, and 683 million observations. The final pain IM has 30 concepts, 4 panels (classes), and 396 value set items. Results are built on Logical Observation Identifiers Names and Codes (LOINC) pain assessment terms and extend the need for additional terms to support interoperability. The resulting pain IM is a consensus model based on actual EHR documentation in the participating health systems. The IM captures the most important concepts related to pain. Schattauer GmbH Stuttgart.

  19. Exploiting Temporal Constraints of Clinical Guidelines by Applying OpenEHR Archetypes.

    Science.gov (United States)

    Cintho, Lilian Mie Mukai; Garcia, Diego; da Silva Santos, Bruno Henrique; Sacchi, Lucia; Quaglini, Silvana; Moro, Claudia Maria Cabral

    2017-01-01

    Studies describing Computer-Interpretable Clinical Guidelines (CIG) with temporal constrains (TC) generally have not addressed issues related to their integration into Electronic Health Record (EHR) systems. This study aimed to represent TCs contained in clinical guidelines by applying archetypes and Guideline Definition Language (GDL) to incorporate decision support into EHRs. An example of each TC class in the clinical guideline for management of Atrial Fibrillation was represented using archetypes and GDL.

  20. Implementing a Social Knowledge Networking (SKN) system to enable meaningful use of an EHR medication reconciliation system.

    Science.gov (United States)

    Rangachari, Pavani

    2018-01-01

    Despite the regulatory impetus toward meaningful use of electronic health record (EHR) Medication Reconciliation (MedRec) to prevent medication errors during care transitions, hospital adherence has lagged for one chief reason: low physician engagement, stemming from lack of consensus about which physician is responsible for managing a patient's medication list. In October 2016, Augusta University received a 2-year grant from the Agency for Healthcare Research and Quality to implement a Social Knowledge Networking (SKN) system for enabling its health system (AU Health) to progress from "limited use" of EHR MedRec technology to "meaningful use." The hypothesis is that SKN would bring together a diverse group of practitioners, to facilitate tacit knowledge exchange on issues related to EHR MedRec, which in turn is expected to increase practitioners' engagement in addressing those issues and enable meaningful use of EHR. The specific aims are to examine: 1) user-engagement in the SKN system, and 2) associations between "SKN use" and "meaningful use" of EHR. The 2-year project uses an exploratory mixed-method design and consists of three phases: 1) development; 2) SKN implementation; and 3) analysis. Phase 1, completed in May 2017, sought to identify a comprehensive set of issues related to EHR MedRec from practitioners directly involved in the MedRec process. This process facilitated development of a "Reporting Tool" on issues related to EHR MedRec, which, along with an existing "SKN/Discussion Tool," was integrated into the EHR at AU Health. Phase 2 (launched in June 2017) involves implementing the EHR-integrated SKN system over a 52-week period in inpatient and outpatient medicine units. The prospective implementation design is expected to generate context-sensitive strategies for meaningful use and successful implementation of EHR MedRec and thereby make substantial contributions to the patient safety and risk management literature. From a health care policy

  1. Using nationwide ‘big data’ from linked electronic health records to help improve outcomes in cardiovascular diseases:33 studies using methods from epidemiology, informatics, economics and social science in the ClinicAl disease research using LInked Bespoke studies and Electronic health Records (CALIBER) programme

    OpenAIRE

    Hemingway, Harry; Feder, Gene; Fitzpatrick, Natalie; Denaxas, Spiros; Shah, Amit; Timmis, A D

    2017-01-01

    BACKGROUND:Electronic health records (EHRs), when linked across primary and secondary care and curated for research use, have the potential to improve our understanding of care quality and outcomes.OBJECTIVE:To evaluate new opportunities arising from linked EHRs for improving quality of care and outcomes for patients at risk of or with coronary disease across the patient journey.DESIGN:Epidemiological cohort, health informatics, health economics and ethnographic approaches were used.SETTING:2...

  2. The Karyotype of Alstroemeria diluta Ehr. Bayer subsp. chrysantha (Alstroemeriaceae Karyotype of Alstroemeria diluta Ehr. Bayer subsp. chrysantha (Alstroemeriaceae

    Directory of Open Access Journals (Sweden)

    Carlos M Baeza

    2010-12-01

    Full Text Available The karyotype of Alstroemeria diluta subsp. chrysantha Ehr. Bayer from Chile was examined. The species has 2n = 2x = 16 chromosomes, with 4m + 4sm + 2st-sat + 4t + 2t-sat. The reported karyotype is very asymmetrical (AsK % = 71.4 and Syi = 40.0%. This karyotype is similar to that published previously for Alstroemeria graminea Phil.Alstroemeria diluta subsp. chrysantha Ehr. Bayer (Alstroemeriaceae fue examinada citológicamente. Esta especie presenta un número cromosómico somático de 2n = 2x = 16 cromosomas, con una fórmula haploide constituida por 4m + 4sm + 2st-sat + 4t + 2t-sat cromosomas. El cariotipo es muy asimétrico, con valores de AsK % = 71,4 y Syi = 40,0%. Estos resultados se compararon con los de Alstroemeria graminea Phil., especie que presenta un cariotipo muy similar.

  3. Electronic Health Records: Applying Diffusion of Innovation Theory to the Relationship between Multifactor Authentication and EHR Adoption

    Science.gov (United States)

    Lockett, Daeron C.

    2014-01-01

    Electronic Health Record (EHR) systems are increasingly becoming accepted as future direction of medical record management systems. Programs such as the American Recovery and Reinvestment Act have provided incentives to hospitals that adopt EHR systems. In spite of these incentives, the perception of EHR adoption is that is has not achieved the…

  4. Developing an electronic health record (EHR) for methadone treatment recording and decision support.

    LENUS (Irish Health Repository)

    Xiao, Liang

    2011-02-01

    In this paper, we give an overview of methadone treatment in Ireland and outline the rationale for designing an electronic health record (EHR) with extensibility, interoperability and decision support functionality. Incorporating several international standards, a conceptual model applying a problem orientated approach in a hierarchical structure has been proposed for building the EHR.

  5. The good, the bad and the early adopters: providers' attitudes about a common, commercial EHR.

    Science.gov (United States)

    Makam, Anil N; Lanham, Holly J; Batchelor, Kim; Moran, Brett; Howell-Stampley, Temple; Kirk, Lynne; Cherukuri, Manjula; Samal, Lipika; Santini, Noel; Leykum, Luci K; Halm, Ethan A

    2014-02-01

    To describe primary care providers' (PCP) attitudes about the impact of a mature, commercial electronic health records (EHR) on clinical practice in settings with experience using the system and to evaluate whether a provider's propensity to adopt new technologies is associated with more favourable perceptions. We surveyed PCPs in 11 practices affiliated with three health systems in Texas. Most practices had greater than 5 years of experience with the Epic EHR. The effect of early adopter of technology status was evaluated using logistic regression. One hundred forty-six PCPs responded (70%). Most thought the EHR had a positive impact on routine tasks, such as prescription refills (94%), whereas fewer agreed for complex tasks, such as delivery of guideline-concordant care for chronic illnesses (51%). Two-thirds (62%) thought it interfered with eye contact with patients, and 40% reported that it interfered with in-visit communication. Early adopters of technology reported greater positive effects of the EHR, even after adjusting for age, ranging from 2% to 15% higher on satisfaction ratings. PCPs practicing in settings with considerable experience using a common commercial EHR identified many positive effects, as well as two key areas for improvement - patient centredness and intelligent decision support. Providers with a propensity to adopt new technologies have more favourable perceptions of the EHR. © 2013 John Wiley & Sons, Ltd.

  6. Transformation of standardized clinical models based on OWL technologies: from CEM to OpenEHR archetypes.

    Science.gov (United States)

    Legaz-García, María del Carmen; Menárguez-Tortosa, Marcos; Fernández-Breis, Jesualdo Tomás; Chute, Christopher G; Tao, Cui

    2015-05-01

    The semantic interoperability of electronic healthcare records (EHRs) systems is a major challenge in the medical informatics area. International initiatives pursue the use of semantically interoperable clinical models, and ontologies have frequently been used in semantic interoperability efforts. The objective of this paper is to propose a generic, ontology-based, flexible approach for supporting the automatic transformation of clinical models, which is illustrated for the transformation of Clinical Element Models (CEMs) into openEHR archetypes. Our transformation method exploits the fact that the information models of the most relevant EHR specifications are available in the Web Ontology Language (OWL). The transformation approach is based on defining mappings between those ontological structures. We propose a way in which CEM entities can be transformed into openEHR by using transformation templates and OWL as common representation formalism. The transformation architecture exploits the reasoning and inferencing capabilities of OWL technologies. We have devised a generic, flexible approach for the transformation of clinical models, implemented for the unidirectional transformation from CEM to openEHR, a series of reusable transformation templates, a proof-of-concept implementation, and a set of openEHR archetypes that validate the methodological approach. We have been able to transform CEM into archetypes in an automatic, flexible, reusable transformation approach that could be extended to other clinical model specifications. We exploit the potential of OWL technologies for supporting the transformation process. We believe that our approach could be useful for international efforts in the area of semantic interoperability of EHR systems. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  7. A qualitative analysis of an electronic health record (EHR implementation in an academic ambulatory setting

    Directory of Open Access Journals (Sweden)

    Kahyun Yoon-Flannery

    2008-12-01

    Conclusions Achieving the benefits of EHRs identified by our interviewees depends on successful implementation and use. Further identification of best implementation practices for EHRs is required, given the financial and clinical consequences of poor implementation.

  8. Integration of an OWL-DL knowledge base with an EHR prototype and providing customized information.

    Science.gov (United States)

    Jing, Xia; Kay, Stephen; Marley, Tom; Hardiker, Nicholas R

    2014-09-01

    When clinicians use electronic health record (EHR) systems, their ability to obtain general knowledge is often an important contribution to their ability to make more informed decisions. In this paper we describe a method by which an external, formal representation of clinical and molecular genetic knowledge can be integrated into an EHR such that customized knowledge can be delivered to clinicians in a context-appropriate manner.Web Ontology Language-Description Logic (OWL-DL) is a formal knowledge representation language that is widely used for creating, organizing and managing biomedical knowledge through the use of explicit definitions, consistent structure and a computer-processable format, particularly in biomedical fields. In this paper we describe: 1) integration of an OWL-DL knowledge base with a standards-based EHR prototype, 2) presentation of customized information from the knowledge base via the EHR interface, and 3) lessons learned via the process. The integration was achieved through a combination of manual and automatic methods. Our method has advantages for scaling up to and maintaining knowledge bases of any size, with the goal of assisting clinicians and other EHR users in making better informed health care decisions.

  9. Expressing clinical data sets with openEHR archetypes: a solid basis for ubiquitous computing.

    Science.gov (United States)

    Garde, Sebastian; Hovenga, Evelyn; Buck, Jasmin; Knaup, Petra

    2007-12-01

    The purpose of this paper is to analyse the feasibility and usefulness of expressing clinical data sets (CDSs) as openEHR archetypes. For this, we present an approach to transform CDS into archetypes, and outline typical problems with CDS and analyse whether some of these problems can be overcome by the use of archetypes. Literature review and analysis of a selection of existing Australian, German, other European and international CDSs; transfer of a CDS for Paediatric Oncology into openEHR archetypes; implementation of CDSs in application systems. To explore the feasibility of expressing CDS as archetypes an approach to transform existing CDSs into archetypes is presented in this paper. In case of the Paediatric Oncology CDS (which consists of 260 data items) this lead to the definition of 48 openEHR archetypes. To analyse the usefulness of expressing CDS as archetypes, we identified nine problems with CDS that currently remain unsolved without a common model underpinning the CDS. Typical problems include incompatible basic data types and overlapping and incompatible definitions of clinical content. A solution to most of these problems based on openEHR archetypes is motivated. With regard to integrity constraints, further research is required. While openEHR cannot overcome all barriers to Ubiquitous Computing, it can provide the common basis for ubiquitous presence of meaningful and computer-processable knowledge and information, which we believe is a basic requirement for Ubiquitous Computing. Expressing CDSs as openEHR archetypes is feasible and advantageous as it fosters semantic interoperability, supports ubiquitous computing, and helps to develop archetypes that are arguably of better quality than the original CDS.

  10. Using OpenEHR in SICTI an electronic health record system for critical medicine

    International Nuclear Information System (INIS)

    Filgueira, R; Odriazola, A; Simini, F

    2007-01-01

    SICTI is a software tool for registering health records in critical medicine environments. Version 1.0 has been in use since 2003. The Biomedical Engineering Group (Nucleo de Ingenieria Biomedica), with support from the Technological Development Programme (Programa de Desarrollo Tecnologico), decided to develop a new version, to provide an aid for more critical medicine processes, based on a framework which would make the application domain change oriented. The team analyzed three alternatives: to develop an original product based on new research, to base the development on OpenEHR framework, or to use HL7 RIM as the reference model for SICTI. The team opted for OpenEHR. This work describes the use of OpenEHR, its strong and weak points, and states future work perspectives

  11. Considerations for the analysis of longitudinal electronic health records linked to claims data to study the effectiveness and safety of drugs.

    Science.gov (United States)

    Lin, K J; Schneeweiss, S

    2016-08-01

    Health insurance claims and electronic health records (EHR) databases have been considered the preferred data sources with which to study drug safety and effectiveness in routine care. Linking claims data to EHR allows researchers to leverage the complementary advantages of each data source to enhance study validity. We propose a framework to evaluate the need for supplementing claims data with EHR and vice versa to optimize outcome ascertainment, exposure assessment, and confounding adjustment. © 2016 American Society for Clinical Pharmacology and Therapeutics.

  12. Case Study: Applying OpenEHR Archetypes to a Clinical Data Repository in a Chinese Hospital.

    Science.gov (United States)

    Min, Lingtong; Wang, Li; Lu, Xudong; Duan, Huilong

    2015-01-01

    openEHR is a flexible and scalable modeling methodology for clinical information and has been widely adopted in Europe and Australia. Due to the reasons of differences in clinical process and management, there are few research projects involving openEHR in China. To investigate the feasibility of openEHR methodology for clinical information modelling in China, this paper carries out a case study to apply openEHR archetypes to Clinical Data Repository (CDR) in a Chinese hospital. The results show that a set of 26 archetypes are found to cover all the concepts used in the CDR. Of all these, 9 (34.6%) are reused without change, 10 are modified and/or extended, and 7 are newly defined. The reasons for modification, extension and newly definition have been discussed, including granularity of archetype, metadata-level versus data-level modelling, and the representation of relationships between archetypes.

  13. SemEHR: A general-purpose semantic search system to surface semantic data from clinical notes for tailored care, trial recruitment, and clinical research.

    Science.gov (United States)

    Wu, Honghan; Toti, Giulia; Morley, Katherine I; Ibrahim, Zina M; Folarin, Amos; Jackson, Richard; Kartoglu, Ismail; Agrawal, Asha; Stringer, Clive; Gale, Darren; Gorrell, Genevieve; Roberts, Angus; Broadbent, Matthew; Stewart, Robert; Dobson, Richard J B

    2018-05-01

    Unlocking the data contained within both structured and unstructured components of electronic health records (EHRs) has the potential to provide a step change in data available for secondary research use, generation of actionable medical insights, hospital management, and trial recruitment. To achieve this, we implemented SemEHR, an open source semantic search and analytics tool for EHRs. SemEHR implements a generic information extraction (IE) and retrieval infrastructure by identifying contextualized mentions of a wide range of biomedical concepts within EHRs. Natural language processing annotations are further assembled at the patient level and extended with EHR-specific knowledge to generate a timeline for each patient. The semantic data are serviced via ontology-based search and analytics interfaces. SemEHR has been deployed at a number of UK hospitals, including the Clinical Record Interactive Search, an anonymized replica of the EHR of the UK South London and Maudsley National Health Service Foundation Trust, one of Europe's largest providers of mental health services. In 2 Clinical Record Interactive Search-based studies, SemEHR achieved 93% (hepatitis C) and 99% (HIV) F-measure results in identifying true positive patients. At King's College Hospital in London, as part of the CogStack program (github.com/cogstack), SemEHR is being used to recruit patients into the UK Department of Health 100 000 Genomes Project (genomicsengland.co.uk). The validation study suggests that the tool can validate previously recruited cases and is very fast at searching phenotypes; time for recruitment criteria checking was reduced from days to minutes. Validated on open intensive care EHR data, Medical Information Mart for Intensive Care III, the vital signs extracted by SemEHR can achieve around 97% accuracy. Results from the multiple case studies demonstrate SemEHR's efficiency: weeks or months of work can be done within hours or minutes in some cases. SemEHR provides a more

  14. Using OpenEHR in SICTI an electronic health record system for critical medicine

    Science.gov (United States)

    Filgueira, R.; Odriazola, A.; Simini, F.

    2007-11-01

    SICTI is a software tool for registering health records in critical medicine environments. Version 1.0 has been in use since 2003. The Biomedical Engineering Group (Núcleo de Ingeniería Biomédica), with support from the Technological Development Programme (Programa de Desarrollo Tecnológico), decided to develop a new version, to provide an aid for more critical medicine processes, based on a framework which would make the application domain change oriented. The team analyzed three alternatives: to develop an original product based on new research, to base the development on OpenEHR framework, or to use HL7 RIM as the reference model for SICTI. The team opted for OpenEHR. This work describes the use of OpenEHR, its strong and weak points, and states future work perspectives.

  15. Security challenges in integration of a PHR-S into a standards based national EHR.

    Science.gov (United States)

    Mense, Alexander; Hoheiser Pförtner, Franz; Sauermann, Stefan

    2014-01-01

    Health related data provided by patients themselves is expected to play a major role in future healthcare. Data from personal health devices, vaccination records, health diaries or observations of daily living, for instance, is stored in personal health records (PHR) which are maintained by personal health record systems (PHR-S). Combining this information with medical records provided by healthcare providers in electronic health records (EHR) is one of the next steps towards "personal care". Austria currently sets up a nationwide EHR system that incorporates all healthcare providers and is technically based on international standards (IHE, HL7, OASIS, ...). Looking at the expected potential of merging PHR and EHR data it is worth to analyse integration approaches. Although knowing that an integration requires the coordination of processes, information models and technical architectures, this paper specifically focuses on security issues by evaluating general security requirements for a PHR-S (based on HL7 PHR-S FM), comparing them with the information security specifications for the Austrian's national EHR (based on ISO/IES 27000 series) and identifying the main challenges as well as possible approaches.

  16. Electronic health records and patient safety: co-occurrence of early EHR implementation with patient safety practices in primary care settings.

    Science.gov (United States)

    Tanner, C; Gans, D; White, J; Nath, R; Pohl, J

    2015-01-01

    The role of electronic health records (EHR) in enhancing patient safety, while substantiated in many studies, is still debated. This paper examines early EHR adopters in primary care to understand the extent to which EHR implementation is associated with the workflows, policies and practices that promote patient safety, as compared to practices with paper records. Early adoption is defined as those who were using EHR prior to implementation of the Meaningful Use program. We utilized the Physician Practice Patient Safety Assessment (PPPSA) to compare primary care practices with fully implemented EHR to those utilizing paper records. The PPPSA measures the extent of adoption of patient safety practices in the domains: medication management, handoffs and transition, personnel qualifications and competencies, practice management and culture, and patient communication. Data from 209 primary care practices responding between 2006-2010 were included in the analysis: 117 practices used paper medical records and 92 used an EHR. Results showed that, within all domains, EHR settings showed significantly higher rates of having workflows, policies and practices that promote patient safety than paper record settings. While these results were expected in the area of medication management, EHR use was also associated with adoption of patient safety practices in areas in which the researchers had no a priori expectations of association. Sociotechnical models of EHR use point to complex interactions between technology and other aspects of the environment related to human resources, workflow, policy, culture, among others. This study identifies that among primary care practices in the national PPPSA database, having an EHR was strongly empirically associated with the workflow, policy, communication and cultural practices recommended for safe patient care in ambulatory settings.

  17. Developing an electronic health record (EHR) for methadone treatment recording and decision support

    Science.gov (United States)

    2011-01-01

    Background In this paper, we give an overview of methadone treatment in Ireland and outline the rationale for designing an electronic health record (EHR) with extensibility, interoperability and decision support functionality. Incorporating several international standards, a conceptual model applying a problem orientated approach in a hierarchical structure has been proposed for building the EHR. Methods A set of archetypes has been designed in line with the current best practice and clinical guidelines which guide the information-gathering process. A web-based data entry system has been implemented, incorporating elements of the paper-based prescription form, while at the same time facilitating the decision support function. Results The use of archetypes was found to capture the ever changing requirements in the healthcare domain and externalises them in constrained data structures. The solution is extensible enabling the EHR to cover medicine management in general as per the programme of the HRB Centre for Primary Care Research. Conclusions The data collected via this Irish system can be aggregated into a larger dataset, if necessary, for analysis and evidence-gathering, since we adopted the openEHR standard. It will be later extended to include the functionalities of prescribing drugs other than methadone along with the research agenda at the HRB Centre for Primary Care Research in Ireland. PMID:21284849

  18. Developing an electronic health record (EHR) for methadone treatment recording and decision support

    LENUS (Irish Health Repository)

    Xiao, Liang

    2011-02-01

    Abstract Background In this paper, we give an overview of methadone treatment in Ireland and outline the rationale for designing an electronic health record (EHR) with extensibility, interoperability and decision support functionality. Incorporating several international standards, a conceptual model applying a problem orientated approach in a hierarchical structure has been proposed for building the EHR. Methods A set of archetypes has been designed in line with the current best practice and clinical guidelines which guide the information-gathering process. A web-based data entry system has been implemented, incorporating elements of the paper-based prescription form, while at the same time facilitating the decision support function. Results The use of archetypes was found to capture the ever changing requirements in the healthcare domain and externalises them in constrained data structures. The solution is extensible enabling the EHR to cover medicine management in general as per the programme of the HRB Centre for Primary Care Research. Conclusions The data collected via this Irish system can be aggregated into a larger dataset, if necessary, for analysis and evidence-gathering, since we adopted the openEHR standard. It will be later extended to include the functionalities of prescribing drugs other than methadone along with the research agenda at the HRB Centre for Primary Care Research in Ireland.

  19. Comparison of EHR-based diagnosis documentation locations to a gold standard for risk stratification in patients with multiple chronic conditions.

    Science.gov (United States)

    Martin, Shelby; Wagner, Jesse; Lupulescu-Mann, Nicoleta; Ramsey, Katrina; Cohen, Aaron; Graven, Peter; Weiskopf, Nicole G; Dorr, David A

    2017-08-02

    To measure variation among four different Electronic Health Record (EHR) system documentation locations versus 'gold standard' manual chart review for risk stratification in patients with multiple chronic illnesses. Adults seen in primary care with EHR evidence of at least one of 13 conditions were included. EHRs were manually reviewed to determine presence of active diagnoses, and risk scores were calculated using three different methodologies and five EHR documentation locations. Claims data were used to assess cost and utilization for the following year. Descriptive and diagnostic statistics were calculated for each EHR location. Criterion validity testing compared the gold standard verified diagnoses versus other EHR locations and risk scores in predicting future cost and utilization. Nine hundred patients had 2,179 probable diagnoses. About 70% of the diagnoses from the EHR were verified by gold standard. For a subset of patients having baseline and prediction year data (n=750), modeling showed that the gold standard was the best predictor of outcomes on average for a subset of patients that had these data. However, combining all data sources together had nearly equivalent performance for prediction as the gold standard. EHR data locations were inaccurate 30% of the time, leading to improvement in overall modeling from a gold standard from chart review for individual diagnoses. However, the impact on identification of the highest risk patients was minor, and combining data from different EHR locations was equivalent to gold standard performance. The reviewer's ability to identify a diagnosis as correct was influenced by a variety of factors, including completeness, temporality, and perceived accuracy of chart data.

  20. Automated population of an i2b2 clinical data warehouse from an openEHR-based data repository.

    Science.gov (United States)

    Haarbrandt, Birger; Tute, Erik; Marschollek, Michael

    2016-10-01

    Detailed Clinical Model (DCM) approaches have recently seen wider adoption. More specifically, openEHR-based application systems are now used in production in several countries, serving diverse fields of application such as health information exchange, clinical registries and electronic medical record systems. However, approaches to efficiently provide openEHR data to researchers for secondary use have not yet been investigated or established. We developed an approach to automatically load openEHR data instances into the open source clinical data warehouse i2b2. We evaluated query capabilities and the performance of this approach in the context of the Hanover Medical School Translational Research Framework (HaMSTR), an openEHR-based data repository. Automated creation of i2b2 ontologies from archetypes and templates and the integration of openEHR data instances from 903 patients of a paediatric intensive care unit has been achieved. In total, it took an average of ∼2527s to create 2.311.624 facts from 141.917 XML documents. Using the imported data, we conducted sample queries to compare the performance with two openEHR systems and to investigate if this representation of data is feasible to support cohort identification and record level data extraction. We found the automated population of an i2b2 clinical data warehouse to be a feasible approach to make openEHR data instances available for secondary use. Such an approach can facilitate timely provision of clinical data to researchers. It complements analytics based on the Archetype Query Language by allowing querying on both, legacy clinical data sources and openEHR data instances at the same time and by providing an easy-to-use query interface. However, due to different levels of expressiveness in the data models, not all semantics could be preserved during the ETL process. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. 45 CFR 170.450 - EHR module testing and certification.

    Science.gov (United States)

    2010-10-01

    ... Section 170.450 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH INFORMATION TECHNOLOGY HEALTH INFORMATION TECHNOLOGY STANDARDS, IMPLEMENTATION SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Temporary Certification Program for HIT § 170.450 EHR...

  2. Using electronic health records for clinical research: the case of the EHR4CR project.

    Science.gov (United States)

    De Moor, Georges; Sundgren, Mats; Kalra, Dipak; Schmidt, Andreas; Dugas, Martin; Claerhout, Brecht; Karakoyun, Töresin; Ohmann, Christian; Lastic, Pierre-Yves; Ammour, Nadir; Kush, Rebecca; Dupont, Danielle; Cuggia, Marc; Daniel, Christel; Thienpont, Geert; Coorevits, Pascal

    2015-02-01

    To describe the IMI EHR4CR project which is designing and developing, and aims to demonstrate, a scalable, widely acceptable and efficient approach to interoperability between EHR systems and clinical research systems. The IMI EHR4CR project is combining and extending several previously isolated state-of-the-art technical components through a new approach to develop a platform for reusing EHR data to support medical research. This will be achieved through multiple but unified initiatives across different major disease areas (e.g. cardiovascular, cancer) and clinical research use cases (protocol feasibility, patient identification and recruitment, clinical trial execution and serious adverse event reporting), with various local and national stakeholders across several countries and therefore under various legal frameworks. An initial instance of the platform has been built, providing communication, security and terminology services to the eleven participating hospitals and ten pharmaceutical companies located in seven European countries. Proof-of-concept demonstrators have been built and evaluated for the protocol feasibility and patient recruitment scenarios. The specifications of the clinical trial execution and the adverse event reporting scenarios have been documented and reviewed. Through a combination of a consortium that brings collectively many years of experience from previous relevant EU projects and of the global conduct of clinical trials, of an approach to ethics that engages many important stakeholders across Europe to ensure acceptability, of a robust iterative design methodology for the platform services that is anchored on requirements of an underlying Service Oriented Architecture that has been designed to be scalable and adaptable, EHR4CR could be well placed to deliver a sound, useful and well accepted pan-European solution for the reuse of hospital EHR data to support clinical research studies. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Analysis of cloud-based solutions on EHRs systems in different scenarios.

    Science.gov (United States)

    Fernández-Cardeñosa, Gonzalo; de la Torre-Díez, Isabel; López-Coronado, Miguel; Rodrigues, Joel J P C

    2012-12-01

    Nowadays with the growing of the wireless connections people can access all the resources hosted in the Cloud almost everywhere. In this context, organisms can take advantage of this fact, in terms of e-Health, deploying Cloud-based solutions on e-Health services. In this paper two Cloud-based solutions for different scenarios of Electronic Health Records (EHRs) management system are proposed. We have researched articles published between the years 2005 and 2011 about the implementation of e-Health services based on the Cloud in Medline. In order to analyze the best scenario for the deployment of Cloud Computing two solutions for a large Hospital and a network of Primary Care Health centers have been studied. Economic estimation of the cost of the implementation for both scenarios has been done via the Amazon calculator tool. As a result of this analysis two solutions are suggested depending on the scenario: To deploy a Cloud solution for a large Hospital a typical Cloud solution in which are hired just the needed services has been assumed. On the other hand to work with several Primary Care Centers it's suggested the implementation of a network, which interconnects these centers with just one Cloud environment. Finally it's considered the fact of deploying a hybrid solution: in which EHRs with images will be hosted in the Hospital or Primary Care Centers and the rest of them will be migrated to the Cloud.

  4. Restructuring an EHR system and the Medical Markup Language (MML) standard to improve interoperability by archetype technology.

    Science.gov (United States)

    Kobayashi, Shinji; Kume, Naoto; Yoshihara, Hiroyuki

    2015-01-01

    In 2001, we developed an EHR system for regional healthcare information inter-exchange and to provide individual patient data to patients. This system was adopted in three regions in Japan. We also developed a Medical Markup Language (MML) standard for inter- and intra-hospital communications. The system was built on a legacy platform, however, and had not been appropriately maintained or updated to meet clinical requirements. To improve future maintenance costs, we reconstructed the EHR system using archetype technology on the Ruby on Rails platform, and generated MML equivalent forms from archetypes. The system was deployed as a cloud-based system for preliminary use as a regional EHR. The system now has the capability to catch up with new requirements, maintaining semantic interoperability with archetype technology. It is also more flexible than the legacy EHR system.

  5. Physician Order Entry Clerical Support Improves Physician Satisfaction and Productivity.

    Science.gov (United States)

    Contratto, Erin; Romp, Katherine; Estrada, Carlos A; Agne, April; Willett, Lisa L

    2017-05-01

    To examine the impact of clerical support personnel for physician order entry on physician satisfaction, productivity, timeliness with electronic health record (EHR) documentation, and physician attitudes. All seven part-time physicians at an academic general internal medicine practice were included in this quasi-experimental (single group, pre- and postintervention) mixed-methods study. One full-time clerical support staff member was trained and hired to enter physician orders in the EHR and conduct previsit planning. Physician satisfaction, productivity, timeliness with EHR documentation, and physician attitudes toward the intervention were measured. Four months after the intervention, physicians reported improvements in overall quality of life (good quality, 71%-100%), personal balance (43%-71%), and burnout (weekly, 43%-14%; callousness, 14%-0%). Matched for quarter, productivity increased: work relative value unit (wRVU) per session increased by 20.5% (before, April-June 2014; after, April-June 2015; range -9.2% to 27.5%). Physicians reported feeling more supported, more focused on patient care, and less stressed and fatigued after the intervention. This study supports the use of physician order entry clerical personnel as a simple, cost-effective intervention to improve the work lives of primary care physicians.

  6. An approach for the semantic interoperability of ISO EN 13606 and OpenEHR archetypes.

    Science.gov (United States)

    Martínez-Costa, Catalina; Menárguez-Tortosa, Marcos; Fernández-Breis, Jesualdo Tomás

    2010-10-01

    The communication between health information systems of hospitals and primary care organizations is currently an important challenge to improve the quality of clinical practice and patient safety. However, clinical information is usually distributed among several independent systems that may be syntactically or semantically incompatible. This fact prevents healthcare professionals from accessing clinical information of patients in an understandable and normalized way. In this work, we address the semantic interoperability of two EHR standards: OpenEHR and ISO EN 13606. Both standards follow the dual model approach which distinguishes information and knowledge, this being represented through archetypes. The solution presented here is capable of transforming OpenEHR archetypes into ISO EN 13606 and vice versa by combining Semantic Web and Model-driven Engineering technologies. The resulting software implementation has been tested using publicly available collections of archetypes for both standards.

  7. Beyond the Archive: Thinking CSCW into EHRs for Home Care

    DEFF Research Database (Denmark)

    Corry, Aino Vonge; Ingstrup, Mads; Larsen, Simon Bo

    2006-01-01

    The current electronic health records (EHR) are not build to adequately support pervasive healthcare, but overcoming certain challenges could change that. In this paper we explicate that point by presenting results of applying participatory design to two scenarios: treating diabetic foot ulcers...... at home, and providing support for women during their pregnancy. In particular, the contributions of this paper are: (1) to explicate the diversity of the domain, and how this leads to complex issues in practice, (2) to present four particular issues that need to be addressed in the design of EHRs...... as found through application of participatory design in our two scenarios, (3) to establish promising approaches to handling those four issues, and (4) to present the core of a software architecture that supports these approaches...

  8. Creating a foundation for implementing an electronic health records (EHR)-integrated Social Knowledge Networking (SKN) system on medication reconciliation.

    Science.gov (United States)

    Rangachari, P; Dellsperger, K C; Fallaw, D; Davis, I; Sumner, M; Ray, W; Fiedler, S; Nguyen, T; Rethemeyer, R

    2018-04-01

    In fall 2016, Augusta University received a two-year grant from AHRQ, to implement a Social Knowledge Networking (SKN) system for enabling its health system, AU-Health, to progress from "limited use" of EHR Medication Reconciliation (MedRec) Technology, to "meaningful use." Phase 1 sought to identify a comprehensive set of issues related to EHR MedRec encountered by practitioners at AU-Health. These efforts helped develop a Reporting Tool , which, along with a Discussion Tool , was incorporated into the AU-Health EHR, at the end of Phase 1. Phase 2 (currently underway), comprises a 52-week pilot of the EHR-integrated SKN system in outpatient and inpatient medicine units. The purpose of this paper is to describe the methods and results of Phase 1. Phase 1 utilized an exploratory mixed-method approach, involving two rounds of data collection. This included 15 individual interviews followed by a survey of 200 practitioners, i.e., physicians, nurses, and pharmacists, based in the outpatient and inpatient medicine service at AU Health. Thematic analysis of interviews identified 55 issue-items related to EHR MedRec under 9 issue-categories. The survey sought practitioners' importance-rating of all issue-items identified from interviews. A total of 127 (63%) survey responses were received. Factor analysis served to validate the following 6 of the 9 issue-categories, all of which, were rated "Important" or higher (on average), by over 70% of all respondents: 1) Care-Coordination (CCI); 2) Patient-Education (PEI); 3) Ownership-and-Accountability (OAI); 4) Processes-of-Care (PCI); 5) IT-Related (ITRI); and 6) Workforce-Training (WTI). Significance-testing of importance-rating by professional affiliation revealed no statistically significant differences for CCI and PEI; and some statistically significant differences for OAI, PCI, ITRI, and WTI. There were two key gleanings from the issues related to EHR MedRec unearthed by this study: 1) there was an absence of shared

  9. A business case for HIT adoption: effects of "meaningful use" EHR financial incentives on clinic revenue.

    Science.gov (United States)

    Behkami, Nima A; Dorr, David A; Morrice, Stuart

    2010-01-01

    The goal of this study is to describe a framework that allows decision makers to efficiently evaluate factors that affect Electronic Health Record (EHR) adoption and test suitable interventions; specifically financial incentives. The United States healthcare delivery system is experiencing a transformation to improve population health. There is strong agreement that "meaningful use" of Health Information Technology (HIT) is a major enabler in this effort. However it's also understood that the high cost of implementing an EHR is an obstacle for adoption. To help understand these complexities we developed a simulation model designed to capture the dynamic nature of policy interventions that affect the adoption of EHR. We found that "Effective" use of HIT approaches break-even-point and larger clinic revenue many times faster that "average" or "poor" use of HIT. This study uses a systems perspective to the evaluate EHR adoption process through the "meaningful use" redesign as proposed in the American Reinvestment and Recovery Act 2009 in the United States healthcare industry by utilizing the System Dynamics methodology and Scenario Analysis.

  10. The relationship between hospital and ehr vendor market dynamics on health information organization presence and participation.

    Science.gov (United States)

    Lin, Sunny C; Adler-Milstein, Julia

    2018-05-08

    Health Information Organizations (HIOs) are third party organizations that facilitate electronic health information exchange (HIE) between providers in a geographic area. Despite benefits from HIE, HIOs have struggled to form and subsequently gain broad provider participation. We sought to assess whether market-level hospital and EHR vendor dynamics are associated with presence and level of hospital participation in HIOs. 2014 data on 4523 hospitals and their EHR vendors were aggregated to the market level. We used multivariate OLS regression to analyze the relationship between hospital and vendor dynamics and (1) probability of HIO presence and (2) percent of hospitals participating in an HIO. 298 of 469 markets (64%) had HIO presence, and in those markets, 47% of hospitals participated in an HIO on average. In multivariate analysis, four characteristics were associated with HIO presence. Markets with more hospitals, markets with more EHR vendors, and markets with an EHR vendor-led HIE approach were more likely to have an HIO. Compared to markets with low hospital competition, markets with high hospital competition had a 25 percentage point lower probability of HIO presence. Two characteristics were associated with level of hospital HIO participation. Markets with more hospitals as well as markets with high vendor competition (compared to low competition) had lower participation. Both hospital and EHR vendor dynamics are associated with whether a market has an HIO as well as the level of hospital participation in HIOs.

  11. EHRs Connect Research and Practice: Where Predictive Modeling, Artificial Intelligence, and Clinical Decision Support Intersect

    OpenAIRE

    Bennett, Casey; Doub, Tom; Selove, Rebecca

    2012-01-01

    Objectives: Electronic health records (EHRs) are only a first step in capturing and utilizing health-related data - the challenge is turning that data into useful information. Furthermore, EHRs are increasingly likely to include data relating to patient outcomes, functionality such as clinical decision support, and genetic information as well, and, as such, can be seen as repositories of increasingly valuable information about patients' health conditions and responses to treatment over time. ...

  12. Querying Archetype-Based Electronic Health Records Using Hadoop and Dewey Encoding of openEHR Models.

    Science.gov (United States)

    Sundvall, Erik; Wei-Kleiner, Fang; Freire, Sergio M; Lambrix, Patrick

    2017-01-01

    Archetype-based Electronic Health Record (EHR) systems using generic reference models from e.g. openEHR, ISO 13606 or CIMI should be easy to update and reconfigure with new types (or versions) of data models or entries, ideally with very limited programming or manual database tweaking. Exploratory research (e.g. epidemiology) leading to ad-hoc querying on a population-wide scale can be a challenge in such environments. This publication describes implementation and test of an archetype-aware Dewey encoding optimization that can be used to produce such systems in environments supporting relational operations, e.g. RDBMs and distributed map-reduce frameworks like Hadoop. Initial testing was done using a nine-node 2.2 GHz quad-core Hadoop cluster querying a dataset consisting of targeted extracts from 4+ million real patient EHRs, query results with sub-minute response time were obtained.

  13. Design and Testing of an EHR-Integrated, Busulfan Pharmacokinetic Decision Support Tool for the Point-of-Care Clinician.

    Directory of Open Access Journals (Sweden)

    Susan M. Abdel-Rahman

    2016-03-01

    Full Text Available BACKGROUND: Busulfan demonstrates a narrow therapeutic index for which clinicians routinely employ therapeutic drug monitoring (TDM. However, operationalizing TDM can be fraught with inefficiency. We developed and tested software encoding a clinical decision support tool (DST that is embedded into our electronic health record (EHR and designed to streamline the TDM process for our oncology partners. METHODS: Our development strategy was modeled based on the features associated with successful DSTs. An initial Requirements Analysis was performed to characterize tasks, information flow, user needs, and system requirements to enable push/pull from the EHR. Back-end development was coded based on the algorithm used when manually performing busulfan TDM. The code was independently validated in MATLAB using 10,000 simulated patient profiles. A 296-item heuristic checklist was used to guide design of the front-end user interface. Content experts and end-users (n=28 were recruited to participate in traditional usability testing under an IRB approved protocol. RESULTS: Decision support software was developed to systematically walk the point-of-care clinician through the TDM process. The system is accessed through the EHR which transparently imports all of the requisite patient data. Data are visually inspected and then curve fit using a model-dependent approach. Quantitative goodness-of-fit are converted to single tachometer where green alerts the user that the model is strong, yellow signals caution and red indicates that there may be a problem with the fitting. Override features are embedded to permit application of a model-independent approach where appropriate. Simulations are performed to target a desired exposure or dose as entered by the clinician and the DST pushes the user approved recommendation back into the EHR. Usability testers were highly satisfied with our DST and quickly became proficient with the software.CONCLUSIONS: With early and

  14. De-identifying an EHR Database

    DEFF Research Database (Denmark)

    Lauesen, Søren; Pantazos, Kostas; Lippert, Søren

    2011-01-01

    -identified a Danish EHR database with 437,164 patients. The goal was to generate a version with real medical records, but related to artificial persons. We developed a de-identification algorithm that uses lists of named entities, simple language analysis, and special rules. Our algorithm consists of 3 steps: collect...... lists of identifiers from the database and external resources, define a replacement for each identifier, and replace identifiers in structured data and free text. Some patient records could not be safely de-identified, so the de-identified database has 323,122 patient records with an acceptable degree...... of anonymity, readability and correctness (F-measure of 95%). The algorithm has to be adjusted for each culture, language and database....

  15. Effect of EHR user interface changes on internal prescription discrepancies.

    Science.gov (United States)

    Turchin, A; Sawarkar, A; Dementieva, Y A; Breydo, E; Ramelson, H

    2014-01-01

    To determine whether specific design interventions (changes in the user interface (UI)) of an electronic health record (EHR) medication module are associated with an increase or decrease in the incidence of contradictions between the structured and narrative components of electronic prescriptions (internal prescription discrepancies). We performed a retrospective analysis of 960,000 randomly selected electronic prescriptions generated in a single EHR between 01/2004 and 12/2011. Internal prescription discrepancies were identified using a validated natural language processing tool with recall of 76% and precision of 84%. A multivariable autoregressive integrated moving average (ARIMA) model was used to evaluate the effect of five UI changes in the EHR medication module on incidence of internal prescription discrepancies. Over the study period 175,725 (18.4%) prescriptions were found to have internal discrepancies. The highest rate of prescription discrepancies was observed in March 2006 (22.5%) and the lowest in March 2009 (15.0%). Addition of "as directed" option to the dropdown decreased prescription discrepancies by 195 / month (p = 0.0004). An non-interruptive alert that reminded providers to ensure that structured and narrative components did not contradict each other decreased prescription discrepancies by 145 / month (p = 0.03). Addition of a "Renew / Sign" button to the Medication module (a negative control) did not have an effect in prescription discrepancies. Several UI changes in the electronic medication module were effective in reducing the incidence of internal prescription discrepancies. Further research is needed to identify interventions that can completely eliminate this type of prescription error and their effects on patient outcomes.

  16. The challenge of electronic health records (EHRs design and implementation: responses of health workers to drawing a 'big and rich picture' of a future EHR programme using animated tools

    Directory of Open Access Journals (Sweden)

    Neil Jenkings

    2007-06-01

    Conclusion We illustrate that use of the animator in focus groups is one means to raise understanding about a proposed EHR development. The animator provided a visual 'probe' to support a more proactive and discursive localised approach to end-user concerns, which could be part of an effective stakeholder engagement and communication strategy crucial in any EHR or health informatics implementation programme. The results of the focus groups were to raise salient issues and concerns, many of which anticipated those that have emerged in the current NHS Connecting for Health Care Records programme in England. Potentially, animator- type technologies may facilitate the user ownership which other forms of dissemination appear to be failing to achieve.

  17. Physicians' perceptions of the impact of the EHR on the collection and retrieval of psychosocial information in outpatient diabetes care.

    Science.gov (United States)

    Senteio, Charles; Veinot, Tiffany; Adler-Milstein, Julia; Richardson, Caroline

    2018-05-01

    Psychosocial information informs clinical decisions by providing crucial context for patients' barriers to recommended self-care; this is especially important in outpatient diabetes care because outcomes are largely dependent upon self-care behavior. Little is known about provider perceptions of use of psychosocial information. Further, while EHRs have dramatically changed how providers interact with patient health information, the EHRs' role in collection and retrieval of psychosocial information is not understood. We designed a qualitative study. We used semi-structured interviews to investigate physicians' (N = 17) perspectives on the impact of EHR for psychosocial information use for outpatient Type II diabetes care decisions. We selected the constant comparative method to analyze the data. Psychosocial information is perceived as dissimilar from other clinical information such as HbA1c and prescribed medications. Its narrative form conveys the patient's story, which elucidates barriers to following self-care recommendations. The narrative is abstract, and requires interpretation of patterns. Psychosocial information is also circumstantial; hence, the patients' context determines influence on self-care. Furthermore, EHRs can impair the collection of psychosocial information because the designs of EHR tools make it difficult to document, search for, and retrieve it. Templates do not enable users from collecting the patient's 'story', and using free text fields is time consuming. Providers therefore had low use of, and confidence in, the accuracy of psychosocial information in the EHR. Workflows and EHR tools should be re-designed to better support psychosocial information collection and retrieval. Tools should enable recording and summarization of the patient's story, and the rationale for treatment decisions. Copyright © 2018 Elsevier B.V. All rights reserved.

  18. Business analysis for a sustainable, multi-stakeholder ecosystem for leveraging the Electronic Health Records for Clinical Research (EHR4CR) platform in Europe.

    Science.gov (United States)

    Dupont, Danielle; Beresniak, Ariel; Sundgren, Mats; Schmidt, Andreas; Ainsworth, John; Coorevits, Pascal; Kalra, Dipak; Dewispelaere, Marc; De Moor, Georges

    2017-01-01

    The Electronic Health Records for Clinical Research (EHR4CR) technological platform has been developed to enable the trustworthy reuse of hospital electronic health records data for clinical research. The EHR4CR platform can enhance and speed up clinical research scenarios: protocol feasibility assessment, patient identification for recruitment in clinical trials, and clinical data exchange, including for reporting serious adverse events. Our objective was to seed a multi-stakeholder ecosystem to enable the scalable exploitation of the EHR4CR platform in Europe, and to assess its economic sustainability. Market analyses were conducted by a multidisciplinary task force to define an EHR4CR emerging ecosystem and multi-stakeholder value chain. This involved mapping stakeholder groups and defining their unmet needs, incentives, potential barriers for adopting innovative solutions, roles and interdependencies. A comprehensive business model, value propositions, and sustainability strategies were developed accordingly. Using simulation modelling (including Monte Carlo simulations) and a 5-year horizon, the potential financial outcomes of the business model were forecasted from the perspective of an EHR4CR service provider. A business ecosystem was defined to leverage the EHR4CR multi-stakeholder value chain. Value propositions were developed describing the expected benefits of EHR4CR solutions for all stakeholders. From an EHR4CR service provider's viewpoint, the business model simulation estimated that a profitability ratio of up to 1.8 could be achieved at year 1, with potential for growth in subsequent years depending on projected market uptake. By enhancing and speeding up existing processes, EHR4CR solutions promise to transform the clinical research landscape. The ecosystem defined provides the organisational framework for optimising the value and benefits for all stakeholders involved, in a sustainable manner. Our study suggests that the exploitation of EHR4CR

  19. Evaluation of a comprehensive EHR based on the DeLone and McLean model for IS success: approach, results, and success factors.

    Science.gov (United States)

    Bossen, Claus; Jensen, Lotte Groth; Udsen, Flemming Witt

    2013-10-01

    The article describes the methodological approach to, and results of an evaluation of a comprehensive electronic health record (EHR) in the shake down phase, shortly after its implementation at a regional hospital in Denmark. A formative evaluation based on a mixed-methods case study, designed to be interactive and concurrent was conducted at two hospital departments based on the updated DeLone and McLean framework for evaluating information systems success. To ascertain user assessments of the EHR, we distributed a questionnaire two months after implementation to four groups of staff (physicians, nurses, medical secretaries, and physiotherapists; n=244), and at the same time we conducted thirteen individual, semi-structured interviews with representatives from these four groups. Subsequently, seven follow-up focus group interviews were conducted with the four above-mentioned groups, in order to go deeper into specific user assessments. Simultaneously, focus group interviews with two IT departments and the implementation team were conducted, to gain insight into system provider assessments of the implementation process and the EHR. Before, during, and after implementation, 88 h of ethnographic observation were carried out, to give the researchers an understanding of the daily routine of staff, and their use of health records. Finally, daily system performance data were obtained, to gather factual information on system response and downtime. Overall, staff had positive experiences with the EHR and its operational reliability, response time, login and support. Performance was acceptable. Medical secretaries found the use of the patient administration module cumbersome, and physicians found the establishment of the overview of professionally relevant data challenging. There were demands for improvements to these and other functionalities, and for the EHR to be integrated with other systems and databases. Evaluations immediately following implementation are inherently

  20. User Satisfaction Evaluation of the EHR4CR Query Builder: A Multisite Patient Count Cohort System

    Directory of Open Access Journals (Sweden)

    Iñaki Soto-Rey

    2015-01-01

    Full Text Available The Electronic Health Records for Clinical Research (EHR4CR project aims to develop services and technology for the leverage reuse of Electronic Health Records with the purpose of improving the efficiency of clinical research processes. A pilot program was implemented to generate evidence of the value of using the EHR4CR platform. The user acceptance of the platform is a key success factor in driving the adoption of the EHR4CR platform; thus, it was decided to evaluate the user satisfaction. In this paper, we present the results of a user satisfaction evaluation for the EHR4CR multisite patient count cohort system. This study examined the ability of testers (n=22 and n=16 from 5 countries to perform three main tasks (around 20 minutes per task, after a 30-minute period of self-training. The System Usability Scale score obtained was 55.83 (SD: 15.37, indicating a moderate user satisfaction. The responses to an additional satisfaction questionnaire were positive about the design of the interface and the required procedure to design a query. Nevertheless, the most complex of the three tasks proposed in this test was rated as difficult, indicating a need to improve the system regarding complicated queries.

  1. Effect of EHR User Interface Changes on Internal Prescription Discrepancies

    Science.gov (United States)

    Sawarkar, A.; Dementieva, Y.A.; Breydo, E.; Ramelson, H.

    2014-01-01

    Summary Objective To determine whether specific design interventions (changes in the user interface (UI)) of an electronic health record (EHR) medication module are associated with an increase or decrease in the incidence of contradictions between the structured and narrative components of electronic prescriptions (internal prescription discrepancies). Materials and Methods We performed a retrospective analysis of 960,000 randomly selected electronic prescriptions generated in a single EHR between 01/2004 and 12/2011. Internal prescription discrepancies were identified using a validated natural language processing tool with recall of 76% and precision of 84%. A multivariable autoregressive integrated moving average (ARIMA) model was used to evaluate the effect of five UI changes in the EHR medication module on incidence of internal prescription discrepancies. Results Over the study period 175,725 (18.4%) prescriptions were found to have internal discrepancies. The highest rate of prescription discrepancies was observed in March 2006 (22.5%) and the lowest in March 2009 (15.0%). Addition of „as directed“ option to the dropdown decreased prescription discrepancies by 195 / month (p = 0.0004). An non-interruptive alert that reminded providers to ensure that structured and narrative components did not contradict each other decreased prescription discrepancies by 145 / month (p = 0.03). Addition of a „Renew / Sign“ button to the Medication module (a negative control) did not have an effect in prescription discrepancies. Conclusions Several UI changes in the electronic medication module were effective in reducing the incidence of internal prescription discrepancies. Further research is needed to identify interventions that can completely eliminate this type of prescription error and their effects on patient outcomes. PMID:25298811

  2. Mapping a Nursing Terminology Subset to openEHR Archetypes. A Case Study of the International Classification for Nursing Practice.

    Science.gov (United States)

    Nogueira, J R M; Cook, T W; Cavalini, L T

    2015-01-01

    Healthcare information technologies have the potential to transform nursing care. However, healthcare information systems based on conventional software architecture are not semantically interoperable and have high maintenance costs. Health informatics standards, such as controlled terminologies, have been proposed to improve healthcare information systems, but their implementation in conventional software has not been enough to overcome the current challenge. Such obstacles could be removed by adopting a multilevel model-driven approach, such as the openEHR specifications, in nursing information systems. To create an openEHR archetype model for the Functional Status concepts as published in Nursing Outcome Indicators Catalog of the International Classification for Nursing Practice (NOIC-ICNP). Four methodological steps were followed: 1) extraction of terms from the NOIC-ICNP terminology; 2) identification of previously published openEHR archetypes; 3) assessment of the adequacy of those openEHR archetypes to represent the terms; and 4) development of new openEHR archetypes when required. The "Barthel Index" archetype was retrieved and mapped to the 68 NOIC-ICNP Functional Status terms. There were 19 exact matches between a term and the correspondent archetype node and 23 archetype nodes that matched to one or more NOIC-INCP. No matches were found between the archetype and 14 of the NOIC-ICNP terms, and nine archetype nodes did not match any of the NOIC-ICNP terms. The openEHR model was sufficient to represent the semantics of the Functional Status concept according to the NOIC-ICNP, but there were differences in data granularity between the terminology and the archetype, thus producing a significantly complex mapping, which could be difficult to implement in real healthcare information systems. However, despite the technological complexity, the present study demonstrated the feasibility of mapping nursing terminologies to openEHR archetypes, which emphasizes the

  3. Development of a tripolar model of technology acceptance: Hospital-based physicians' perspective on EHR.

    Science.gov (United States)

    Beglaryan, Mher; Petrosyan, Varduhi; Bunker, Edward

    2017-06-01

    In health care, information technologies (IT) hold a promise to harness an ever-increasing flow of health related information and bring significant benefits including improved quality of care, efficiency, and cost containment. One of the main tools for collecting and utilizing health data is the Electronic Health Record (EHR). EHRs implementation can face numerous barriers to acceptance including attitudes and perceptions of potential users, required effort attributed to their implementation and usage, and resistance to change. Various theories explicate different aspects of technology deployment, implementation, and acceptance. One of the common theories is the Technology Acceptance Model (TAM), which helps to study the implementation of different healthcare IT applications. The objectives of this study are: to understand the barriers of EHR implementation from the perspective of physicians; to identify major determinants of physicians' acceptance of technology; and develop a model that explains better how EHRs (and technologies in general) are accepted by physicians. The proposed model derives from a cross-sectional survey of physicians selected through multi-stage cluster sampling from the hospitals of Yerevan, Armenia. The study team designed the survey instrument based on a literature review on barriers of EHR implementation. The analysis employed exploratory structural equation modeling (ESEM) with a robust weighted least squares (WLSMV) estimator for categorical indicators. The analysis progressed in two steps: appraisal of the measurement model and testing of the structural model. The derived model identifies the following factors as direct determinants of behavioral intention to use a novel technology: projected collective usefulness; personal innovativeness; patient influence; and resistance to change. Other factors (e.g., organizational change, professional relationships, administrative monitoring, organizational support and computer anxiety) exert their

  4. Measuring interoperable EHR adoption and maturity: a Canadian example.

    Science.gov (United States)

    Gheorghiu, Bobby; Hagens, Simon

    2016-01-25

    An interoperable electronic health record is a secure consolidated record of an individual's health history and care, designed to facilitate authorized information sharing across the care continuum.  Each Canadian province and territory has implemented such a system and for all, measuring adoption is essential to understanding progress and optimizing use in order to realize intended benefits. About 250,000 health professionals-approximately half of Canada's anticipated potential physician, nurse, pharmacist, and administrative users-indicated that they electronically access data, such as those found in provincial/territorial lab or drug information systems, in 2015.  Trends suggest further growth as maturity of use increases. There is strong interest in health information exchange through the iEHR in Canada, and continued growth in adoption is expected. Central to managing the evolution of digital health is access to robust data about who is using solutions, how they are used, where and when.  Stakeholders such as government, program leads, and health system administrators must critically assess progress and achievement of benefits, to inform future strategic and operational decisions.

  5. Are three methods better than one? A comparative assessment of usability evaluation methods in an EHR.

    Science.gov (United States)

    Walji, Muhammad F; Kalenderian, Elsbeth; Piotrowski, Mark; Tran, Duong; Kookal, Krishna K; Tokede, Oluwabunmi; White, Joel M; Vaderhobli, Ram; Ramoni, Rachel; Stark, Paul C; Kimmes, Nicole S; Lagerweij, Maxim; Patel, Vimla L

    2014-05-01

    To comparatively evaluate the effectiveness of three different methods involving end-users for detecting usability problems in an EHR: user testing, semi-structured interviews and surveys. Data were collected at two major urban dental schools from faculty, residents and dental students to assess the usability of a dental EHR for developing a treatment plan. These included user testing (N=32), semi-structured interviews (N=36), and surveys (N=35). The three methods together identified a total of 187 usability violations: 54% via user testing, 28% via the semi-structured interview and 18% from the survey method, with modest overlap. These usability problems were classified into 24 problem themes in 3 broad categories. User testing covered the broadest range of themes (83%), followed by the interview (63%) and survey (29%) methods. Multiple evaluation methods provide a comprehensive approach to identifying EHR usability challenges and specific problems. The three methods were found to be complementary, and thus each can provide unique insights for software enhancement. Interview and survey methods were found not to be sufficient by themselves, but when used in conjunction with the user testing method, they provided a comprehensive evaluation of the EHR. We recommend using a multi-method approach when testing the usability of health information technology because it provides a more comprehensive picture of usability challenges. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  6. Too Much or Too Little? How Much Control Should Patients Have Over EHR Data?

    Science.gov (United States)

    Bhuyan, Soumitra Sudip; Bailey-DeLeeuw, Sandra; Wyant, David K; Chang, Cyril F

    2016-07-01

    Electronic health records (EHRs) have been promoted as a mechanism to overcome the fragmented healthcare system in the United States. The challenge that is being discussed is the rights of the patient to control the access to their EHRs' data and the needs of healthcare professionals to know health data to make the best treatment decisions for their patients. The Federal Trade Commission has asked those who store consumer information to comply with the Fair Information Practice Principles. In the EHR context, these principles give the rights to the patient to control who can see their health data and what components of the data are restricted from view. Control is not limited to patients, as it also includes parents of adolescent children. We suggest that the ongoing policy discussion include consideration of the precise questions patients will be asked when a need for data sharing arises. Further, patients should understand the relative risks that they face, and the degree to which their decisions will (or will not) significantly reduce the risk of a data breach. As various approaches are considered, it is important to address the relative resource requirements and the associated costs of each option.

  7. The EHR-ARCHE project: Satisfying clinical information needs in a Shared Electronic Health Record System based on IHE XDS and Archetypes☆

    Science.gov (United States)

    Duftschmid, Georg; Rinner, Christoph; Kohler, Michael; Huebner-Bloder, Gudrun; Saboor, Samrend; Ammenwerth, Elske

    2013-01-01

    Purpose While contributing to an improved continuity of care, Shared Electronic Health Record (EHR) systems may also lead to information overload of healthcare providers. Document-oriented architectures, such as the commonly employed IHE XDS profile, which only support information retrieval at the level of documents, are particularly susceptible for this problem. The objective of the EHR-ARCHE project was to develop a methodology and a prototype to efficiently satisfy healthcare providers’ information needs when accessing a patient's Shared EHR during a treatment situation. We especially aimed to investigate whether this objective can be reached by integrating EHR Archetypes into an IHE XDS environment. Methods Using methodical triangulation, we first analysed the information needs of healthcare providers, focusing on the treatment of diabetes patients as an exemplary application domain. We then designed ISO/EN 13606 Archetypes covering the identified information needs. To support a content-based search for fine-grained information items within EHR documents, we extended the IHE XDS environment with two additional actors. Finally, we conducted a formative and summative evaluation of our approach within a controlled study. Results We identified 446 frequently needed diabetes-specific information items, representing typical information needs of healthcare providers. We then created 128 Archetypes and 120 EHR documents for two fictive patients. All seven diabetes experts, who evaluated our approach, preferred the content-based search to a conventional XDS search. Success rates of finding relevant information was higher for the content-based search (100% versus 80%) and the latter was also more time-efficient (8–14 min versus 20 min or more). Conclusions Our results show that for an efficient satisfaction of health care providers’ information needs, a content-based search that rests upon the integration of Archetypes into an IHE XDS-based Shared EHR system is

  8. The EHR-ARCHE project: satisfying clinical information needs in a Shared Electronic Health Record system based on IHE XDS and Archetypes.

    Science.gov (United States)

    Duftschmid, Georg; Rinner, Christoph; Kohler, Michael; Huebner-Bloder, Gudrun; Saboor, Samrend; Ammenwerth, Elske

    2013-12-01

    While contributing to an improved continuity of care, Shared Electronic Health Record (EHR) systems may also lead to information overload of healthcare providers. Document-oriented architectures, such as the commonly employed IHE XDS profile, which only support information retrieval at the level of documents, are particularly susceptible for this problem. The objective of the EHR-ARCHE project was to develop a methodology and a prototype to efficiently satisfy healthcare providers' information needs when accessing a patient's Shared EHR during a treatment situation. We especially aimed to investigate whether this objective can be reached by integrating EHR Archetypes into an IHE XDS environment. Using methodical triangulation, we first analysed the information needs of healthcare providers, focusing on the treatment of diabetes patients as an exemplary application domain. We then designed ISO/EN 13606 Archetypes covering the identified information needs. To support a content-based search for fine-grained information items within EHR documents, we extended the IHE XDS environment with two additional actors. Finally, we conducted a formative and summative evaluation of our approach within a controlled study. We identified 446 frequently needed diabetes-specific information items, representing typical information needs of healthcare providers. We then created 128 Archetypes and 120 EHR documents for two fictive patients. All seven diabetes experts, who evaluated our approach, preferred the content-based search to a conventional XDS search. Success rates of finding relevant information was higher for the content-based search (100% versus 80%) and the latter was also more time-efficient (8-14min versus 20min or more). Our results show that for an efficient satisfaction of health care providers' information needs, a content-based search that rests upon the integration of Archetypes into an IHE XDS-based Shared EHR system is superior to a conventional metadata-based XDS

  9. Foraging for Information in the EHR: The Search for Adherence Related Information by Mental Health Clinicians.

    Science.gov (United States)

    Gibson, Bryan; Butler, Jorie; Zirkle, Maryan; Hammond, Kenric; Weir, Charlene

    2016-01-01

    In this project we sought to qualitatively describe clinician's search for information related to the complex construct of adherence. Nineteen think aloud observations and semi-structured interviews were conducted with mental health providers as they prepared for a patient visit. The transcripts were coded according to constructs from information foraging theory (information goal, patch, scent, enrichment, and opportunity cost). The search strategies uncovered were complicated: provider's searches were sometimes multi-staged (e.g. a search of the EHR led to further enquiry when interviewing the patient), and involved multiple 'patches' (i.e. data from the EHR, the patient and other providers were all sought out). In addition, some information that providers considered relevant to understand adherence related questions was non-obvious (e.g. the absence of specific information was considered a useful cue). Providers' information search strategies for complex constructs are at times non-intuitive; implications for the design of EHR summarization tools are discussed.

  10. A virtual platform for electronic health record (EHR) education for nursing students: moving from in-house solutions to the cloud.

    Science.gov (United States)

    Kushniruk, Andre W; Kuo, Mu-Hsing; Parapini, Eric; Borycki, Elizabeth M

    2014-01-01

    There is a need to develop cost effective ways to bring hands-on education about essential information technologies, such as electronic health record (EHR) systems to nursing students, nursing faculty and practitioners. This is especially the case as worldwide there is an increased deployment of these systems and they are transforming the practice of healthcare. However, due to technical, financial and knowledge limitations, many nursing schools and programs do not have an adequate way to bring such technology into their classes and curricula. In this paper we describe an approach to developing Web-based EHR education that allows students from any Web-accessible location to access and work with real EHR systems remotely over the Internet for learning purposes. In this paper we describe our work in moving this approach to a cloud-based solution to allow access to EHRs for educational purposes from any location with Web access and to do so in a way that is both educationally sound and cost effective.

  11. Design of cloud security in the EHR for Indian healthcare services

    Directory of Open Access Journals (Sweden)

    Pradeep Deshmukh

    2017-07-01

    Full Text Available An ease of data or record sharing at will has compelled most of the physicians to adopt EHR (Electronic Health Record for record-keeping of patients. It also makes convenient to the other stake holders of healthcare ecosystem such as nurses, specialists and patient. Due to lower costs and scalability of application, the cloud is becoming the infrastructure for most of the EHR but without comprising the privacy of data. In this paper we have proposed a frame work for storing the health records and accessing them by patients and physicians as authorized by key-control scheme. The scenarios we have considered here are of rural and urban health care centers and hence more appropriate for Indian health care services. The proposed scheme has double data security by introducing isolation between encryption schemes of transmitted data and stored data. The experimental result shows that it has a capability of scaling in number of patients and also no of elements in health record.

  12. 77 FR 8217 - Evaluating the Usability of Electronic Health Record (EHR) Systems

    Science.gov (United States)

    2012-02-14

    ... usability of health information technology (HIT) systems, EHRs in particular, and performance-oriented user... the usability of health information technology (HIT) systems. NIST research is designed to: (1... DEPARTMENT OF COMMERCE National Institute of Standards and Technology [Docket No. 120123059-2058...

  13. Bridging data models and terminologies to support adverse drug event reporting using EHR data.

    Science.gov (United States)

    Declerck, G; Hussain, S; Daniel, C; Yuksel, M; Laleci, G B; Twagirumukiza, M; Jaulent, M-C

    2015-01-01

    This article is part of the Focus Theme of METHODs of Information in Medicine on "Managing Interoperability and Complexity in Health Systems". SALUS project aims at building an interoperability platform and a dedicated toolkit to enable secondary use of electronic health records (EHR) data for post marketing drug surveillance. An important component of this toolkit is a drug-related adverse events (AE) reporting system designed to facilitate and accelerate the reporting process using automatic prepopulation mechanisms. To demonstrate SALUS approach for establishing syntactic and semantic interoperability for AE reporting. Standard (e.g. HL7 CDA-CCD) and proprietary EHR data models are mapped to the E2B(R2) data model via SALUS Common Information Model. Terminology mapping and terminology reasoning services are designed to ensure the automatic conversion of source EHR terminologies (e.g. ICD-9-CM, ICD-10, LOINC or SNOMED-CT) to the target terminology MedDRA which is expected in AE reporting forms. A validated set of terminology mappings is used to ensure the reliability of the reasoning mechanisms. The percentage of data elements of a standard E2B report that can be completed automatically has been estimated for two pilot sites. In the best scenario (i.e. the available fields in the EHR have actually been filled), only 36% (pilot site 1) and 38% (pilot site 2) of E2B data elements remain to be filled manually. In addition, most of these data elements shall not be filled in each report. SALUS platform's interoperability solutions enable partial automation of the AE reporting process, which could contribute to improve current spontaneous reporting practices and reduce under-reporting, which is currently one major obstacle in the process of acquisition of pharmacovigilance data.

  14. EHR-based disease registries to support integrated care in a health neighbourhood: an ontology-based methodology.

    Science.gov (United States)

    Liaw, Siaw-Teng; Taggart, Jane; Yu, Hairong

    2014-01-01

    Disease registries derived from Electronic Health Records (EHRs) are widely used for chronic disease management. We approached registries from the perspective of integrated care in a health neighbourhood, considering data quality issues such as semantic interoperability (consistency), accuracy, completeness and duplication. Our proposition is that a realist ontological approach is required to accurately identify patients in an EHR or data repository, assess data quality and fitness for use by the multidisciplinary integrated care team. We report on this approach with routinely collected data in a practice based research network in Australia.

  15. A Natural Language Processing System That Links Medical Terms in Electronic Health Record Notes to Lay Definitions: System Development Using Physician Reviews.

    Science.gov (United States)

    Chen, Jinying; Druhl, Emily; Polepalli Ramesh, Balaji; Houston, Thomas K; Brandt, Cynthia A; Zulman, Donna M; Vimalananda, Varsha G; Malkani, Samir; Yu, Hong

    2018-01-22

    Many health care systems now allow patients to access their electronic health record (EHR) notes online through patient portals. Medical jargon in EHR notes can confuse patients, which may interfere with potential benefits of patient access to EHR notes. The aim of this study was to develop and evaluate the usability and content quality of NoteAid, a Web-based natural language processing system that links medical terms in EHR notes to lay definitions, that is, definitions easily understood by lay people. NoteAid incorporates two core components: CoDeMed, a lexical resource of lay definitions for medical terms, and MedLink, a computational unit that links medical terms to lay definitions. We developed innovative computational methods, including an adapted distant supervision algorithm to prioritize medical terms important for EHR comprehension to facilitate the effort of building CoDeMed. Ten physician domain experts evaluated the user interface and content quality of NoteAid. The evaluation protocol included a cognitive walkthrough session and a postsession questionnaire. Physician feedback sessions were audio-recorded. We used standard content analysis methods to analyze qualitative data from these sessions. Physician feedback was mixed. Positive feedback on NoteAid included (1) Easy to use, (2) Good visual display, (3) Satisfactory system speed, and (4) Adequate lay definitions. Opportunities for improvement arising from evaluation sessions and feedback included (1) improving the display of definitions for partially matched terms, (2) including more medical terms in CoDeMed, (3) improving the handling of terms whose definitions vary depending on different contexts, and (4) standardizing the scope of definitions for medicines. On the basis of these results, we have improved NoteAid's user interface and a number of definitions, and added 4502 more definitions in CoDeMed. Physician evaluation yielded useful feedback for content validation and refinement of this

  16. Patient and public views about the security and privacy of Electronic Health Records (EHRs) in the UK: results from a mixed methods study.

    Science.gov (United States)

    Papoutsi, Chrysanthi; Reed, Julie E; Marston, Cicely; Lewis, Ruth; Majeed, Azeem; Bell, Derek

    2015-10-14

    Although policy discourses frame integrated Electronic Health Records (EHRs) as essential for contemporary healthcare systems, increased information sharing often raises concerns among patients and the public. This paper examines patient and public views about the security and privacy of EHRs used for health provision, research and policy in the UK. Sequential mixed methods study with a cross-sectional survey (in 2011) followed by focus group discussions (in 2012-2013). Survey participants (N = 5331) were recruited from primary and secondary care settings in West London (UK). Complete data for 2761 (51.8 %) participants were included in the final analysis for this paper. The survey results were discussed in 13 focus groups with people living with a range of different health conditions, and in 4 mixed focus groups with patients, health professionals and researchers (total N = 120). Qualitative data were analysed thematically. In the survey, 79 % of participants reported that they would worry about the security of their record if this was part of a national EHR system and 71 % thought the National Health Service (NHS) was unable to guarantee EHR safety at the time this work was carried out. Almost half (47 %) responded that EHRs would be less secure compared with the way their health record was held at the time of the survey. Of those who reported being worried about EHR security, many would nevertheless support their development (55 %), while 12 % would not support national EHRs and a sizeable proportion (33 %) were undecided. There were also variations by age, ethnicity and education. In focus group discussions participants weighed up perceived benefits against potential security and privacy threats from wider sharing of information, as well as discussing other perceived risks: commercial exploitation, lack of accountability, data inaccuracies, prejudice and inequalities in health provision. Patient and public worries about the security risks associated

  17. Standardized headings as a foundation for semantic interoperability in EHR

    Directory of Open Access Journals (Sweden)

    Halilovic Amra

    2016-01-01

    Full Text Available The new Swedish Patient Act, which allows patients to choose health care in county councils other than their own, creates the need to be able to share health-related information contained in electronic health records [EHRs across county councils. This demands interoperability in terms of structured and standardized data. Headings in EHR could also be a part of structured and standardized data. The aim was to study to what extent terminology is shared and standardized across county councils in Sweden. Headings from three county councils were analyzed to see to what extent they were shared and to what extent they corresponded to concepts in SNOMED CT and the National Board of Health and Welfare’s term dictionary [NBHW’s TD. In total 41% of the headings were shared across two or three county councils. A third of the shared headings corresponded to concepts in SNOMED CT. Further, an eighth of the shared headings corresponded to concepts in NBHW’s TD. The results showed that the extent of shared and standardized terminology in terms of headings across the studied three county councils were negligible.

  18. Prototype of a Standards-Based EHR and Genetic Test Reporting Tool Coupled with HL7-Compliant Infobuttons

    Science.gov (United States)

    Crump, Jacob K.; Del Fiol, Guilherme; Williams, Marc S.; Freimuth, Robert R.

    2018-01-01

    Integration of genetic information is becoming increasingly important in clinical practice. However, genetic information is often ambiguous and difficult to understand, and clinicians have reported low-self-efficacy in integrating genetics into their care routine. The Health Level Seven (HL7) Infobutton standard helps to integrate online knowledge resources within Electronic Health Records (EHRs) and is required for EHR certification in the US. We implemented a prototype of a standards-based genetic reporting application coupled with infobuttons leveraging the Infobutton and Fast Healthcare Interoperability Resources (FHIR) Standards. Infobutton capabilities were provided by Open Infobutton, an open source package compliant with the HL7 Infobutton Standard. The resulting prototype demonstrates how standards-based reporting of genetic results, coupled with curated knowledge resources, can provide dynamic access to clinical knowledge on demand at the point of care. The proposed functionality can be enabled within any EHR system that has been certified through the US Meaningful Use program.

  19. Analysis of the process of representing clinical statements for decision-support applications: a comparison of openEHR archetypes and HL7 virtual medical record.

    Science.gov (United States)

    González-Ferrer, A; Peleg, M; Marcos, M; Maldonado, J A

    2016-07-01

    Delivering patient-specific decision-support based on computer-interpretable guidelines (CIGs) requires mapping CIG clinical statements (data items, clinical recommendations) into patients' data. This is most effectively done via intermediate data schemas, which enable querying the data according to the semantics of a shared standard intermediate schema. This study aims to evaluate the use of HL7 virtual medical record (vMR) and openEHR archetypes as intermediate schemas for capturing clinical statements from CIGs that are mappable to electronic health records (EHRs) containing patient data and patient-specific recommendations. Using qualitative research methods, we analyzed the encoding of ten representative clinical statements taken from two CIGs used in real decision-support systems into two health information models (openEHR archetypes and HL7 vMR instances) by four experienced informaticians. Discussion among the modelers about each case study example greatly increased our understanding of the capabilities of these standards, which we share in this educational paper. Differing in content and structure, the openEHR archetypes were found to contain a greater level of representational detail and structure while the vMR representations took fewer steps to complete. The use of openEHR in the encoding of CIG clinical statements could potentially facilitate applications other than decision-support, including intelligent data analysis and integration of additional properties of data items from existing EHRs. On the other hand, due to their smaller size and fewer details, the use of vMR potentially supports quicker mapping of EHR data into clinical statements.

  20. A qualitative evaluation of the crucial attributes of contextual information necessary in EHR design to support patient-centered medical home care.

    Science.gov (United States)

    Weir, Charlene R; Staggers, Nancy; Gibson, Bryan; Doing-Harris, Kristina; Barrus, Robyn; Dunlea, Robert

    2015-04-16

    Effective implementation of a Primary Care Medical Home model of care (PCMH) requires integration of patients' contextual information (physical, mental, social and financial status) into an easily retrievable information source for the healthcare team and clinical decision-making. This project explored clinicians' perceptions about important attributes of contextual information for clinical decision-making, how contextual information is expressed in CPRS clinical documentation as well as how clinicians in a highly computerized environment manage information flow related to these areas. A qualitative design using Cognitive Task Analyses and a modified Critical Incident Technique were used. The study was conducted in a large VA with a fully implemented EHR located in the western United States. Seventeen providers working in a PCMH model of care in Primary Care, Home Based Care and Geriatrics reported on a recent difficult transition requiring contextual information for decision-making. The transcribed interviews were qualitatively analyzed for thematic development related to contextual information using an iterative process and multiple reviewers with ATLAS@ti software. Six overarching themes emerged as attributes of contextual information: Informativeness, goal language, temporality, source attribution, retrieval effort, and information quality. These results indicate that specific attributes are needed to in order for contextual information to fully support clinical decision-making in a Medical Home care delivery environment. Improved EHR designs are needed for ease of contextual information access, displaying linkages across time and settings, and explicit linkages to both clinician and patient goals. Implications relevant to providers' information needs, team functioning and EHR design are discussed.

  1. Developing an Interface to Order and Document Health Education Videos in the Electronic Health Record.

    Science.gov (United States)

    Wojcik, Lauren

    2015-01-01

    Transitioning to electronic health records (EHRs) provides an opportunity for health care systems to integrate educational content available on interactive patient systems (IPS) with the medical documentation system. This column discusses how one hospital simplified providers' workflow by making it easier to order educational videos and ensure that completed education is documented within the medical record. Integrating the EHR and IPS streamlined the provision of patient education, improved documentation, and supported the organization in meeting core requirements for Meaningful Use.

  2. The value of EHR-based assessment of physician competency: An investigative effort with internal medicine physicians.

    Science.gov (United States)

    Venta, Kimberly; Baker, Erin; Fidopiastis, Cali; Stanney, Kay

    2017-12-01

    The purpose of this study was to investigate the potential of developing an EHR-based model of physician competency, named the Skill Deficiency Evaluation Toolkit for Eliminating Competency-loss Trends (Skill-DETECT), which presents the opportunity to use EHR-based models to inform selection of Continued Medical Education (CME) opportunities specifically targeted at maintaining proficiency. The IBM Explorys platform provided outpatient Electronic Health Records (EHRs) representing 76 physicians with over 5000 patients combined. These data were used to develop the Skill-DETECT model, a predictive hybrid model composed of a rule-based model, logistic regression model, and a thresholding model, which predicts cognitive clinical skill deficiencies in internal medicine physicians. A three-phase approach was then used to statistically validate the model performance. Subject Matter Expert (SME) panel reviews resulted in a 100% overall approval rate of the rule based model. Area under the receiver-operating characteristic curves calculated for each logistic regression curve resulted in values between 0.76 and 0.92, which indicated exceptional performance. Normality, skewness, and kurtosis were determined and confirmed that the distribution of values output from the thresholding model were unimodal and peaked, which confirmed effectiveness and generalizability. The validation has confirmed that the Skill-DETECT model has a strong ability to evaluate EHR data and support the identification of internal medicine cognitive clinical skills that are deficient or are of higher likelihood of becoming deficient and thus require remediation, which will allow both physician and medical organizations to fine tune training efforts. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Multi-octave analog photonic link with improved second- and third-order SFDRs

    Science.gov (United States)

    Tan, Qinggui; Gao, Yongsheng; Fan, Yangyu; He, You

    2018-03-01

    The second- and third-order spurious free dynamic ranges (SFDRs) are two key performance indicators for a multi-octave analogy photonic link (APL). The linearization methods for either second- or third-order intermodulation distortion (IMD2 or IMD3) have been intensively studied, but the simultaneous suppression for the both were merely reported. In this paper, we propose an APL with improved second- and third-order SFDRs for multi-octave applications based on two parallel DPMZM-based sub-APLs. The IMD3 in each sub-APL is suppressed by properly biasing the DPMZM, and the IMD2 is suppressed by balanced detecting the two sub-APLs. The experiment demonstrates significant suppression ratios for both the IMD2 and IMD3 after linearization in the proposed link, and the measured second- and third-order SFDRs with the operating frequency from 6 to 40 GHz are above 91 dB ṡHz 1 / 2 and 116 dB ṡHz 2 / 3, respectively.

  4. Developing a National-Level Concept Dictionary for EHR Implementations in Kenya.

    Science.gov (United States)

    Keny, Aggrey; Wanyee, Steven; Kwaro, Daniel; Mulwa, Edwin; Were, Martin C

    2015-01-01

    The increasing adoption of Electronic Health Records (EHR) by developing countries comes with the need to develop common terminology standards to assure semantic interoperability. In Kenya, where the Ministry of Health has rolled out an EHR at 646 sites, several challenges have emerged including variable dictionaries across implementations, inability to easily share data across systems, lack of expertise in dictionary management, lack of central coordination and custody of a terminology service, inadequately defined policies and processes, insufficient infrastructure, among others. A Concept Working Group was constituted to address these challenges. The country settled on a common Kenya data dictionary, initially derived as a subset of the Columbia International eHealth Laboratory (CIEL)/Millennium Villages Project (MVP) dictionary. The initial dictionary scope largely focuses on clinical needs. Processes and policies around dictionary management are being guided by the framework developed by Bakhshi-Raiez et al. Technical and infrastructure-based approaches are also underway to streamline workflow for dictionary management and distribution across implementations. Kenya's approach on comprehensive common dictionary can serve as a model for other countries in similar settings.

  5. CMS Medicare and Medicaid EHR Incentive Program, Electronic Health Record Products Used for Attestation

    Data.gov (United States)

    U.S. Department of Health & Human Services — Data set merges information about the Centers for Medicare and Medicaid Services, Medicare and Medicaid EHR Incentive Programs attestations with the Office of the...

  6. Implementing EHR in a developing country: potential challenges and benefits

    OpenAIRE

    Tanko, Abdulai

    2009-01-01

    Developing countries are slow adopters of new technologies, particularly with regards to the health services of these countries. This study explores the data collection and management challenges in a Ghanaian hospital using an interpretative case study approach and proposes implementing an Electronic Health Record (EHR) system as a solution to these challenges. The Technology Acceptance Model (TAM), Actor Network Theory (ANT) and Computer Supported Cooperative Work (CSCW) are used in discussi...

  7. A Repository of Semantic Open EHR Archetypes

    Directory of Open Access Journals (Sweden)

    Fernando Sánchez

    2015-03-01

    Full Text Available This paper describes a repository of openEHR archetypes that have been translated to OWL. In the work presented here, five different CKMs (Clinical Knowledge Managers have been downloaded and the archetypes have been translated to OWL. This translation is based on an existing translator that has been improved to solve programming problems with certain structures. As part of the repository a tool has been developed to keep it always up-to-date. So, any change in one of the CKMs (addition, elimination or even change of an archetype will involve translating the changed archetypes once more. The repository is accessible through a Web interface (http://www.openehr.es/.

  8. Evaluation of a Framework to Implement Electronic Health Record Systems Based on the openEHR Standard

    Science.gov (United States)

    Orellana, Diego A.; Salas, Alberto A.; Solarz, Pablo F.; Medina Ruiz, Luis; Rotger, Viviana I.

    2016-04-01

    The production of clinical information about each patient is constantly increasing, and it is noteworthy that the information is created in different formats and at diverse points of care, resulting in fragmented, incomplete, inaccurate and isolated, health information. The use of health information technology has been promoted as having a decisive impact to improve the efficiency, cost-effectiveness, quality and safety of medical care delivery. However in developing countries the utilization of health information technology is insufficient and lacking of standards among other situations. In the present work we evaluate the framework EHRGen, based on the openEHR standard, as mean to reach generation and availability of patient centered information. The framework has been evaluated through the provided tools for final users, that is, without intervention of computer experts. It makes easier to adopt the openEHR ideas and provides an open source basis with a set of services, although some limitations in its current state conspire against interoperability and usability. However, despite the described limitations respect to usability and semantic interoperability, EHRGen is, at least regionally, a considerable step toward EHR adoption and interoperability, so that it should be supported from academic and administrative institutions.

  9. Validating EHR documents: automatic schematron generation using archetypes.

    Science.gov (United States)

    Pfeiffer, Klaus; Duftschmid, Georg; Rinner, Christoph

    2014-01-01

    The goal of this study was to examine whether Schematron schemas can be generated from archetypes. The openEHR Java reference API was used to transform an archetype into an object model, which was then extended with context elements. The model was processed and the constraints were transformed into corresponding Schematron assertions. A prototype of the generator for the reference model HL7 v3 CDA R2 was developed and successfully tested. Preconditions for its reusability with other reference models were set. Our results indicate that an automated generation of Schematron schemas is possible with some limitations.

  10. A Framework for Usability Evaluation in EHR Procurement.

    Science.gov (United States)

    Tyllinen, Mari; Kaipio, Johanna; Lääveri, Tinja

    2018-01-01

    Usability should be considered already by the procuring organizations when selecting future systems. In this paper, we present a framework for usability evaluation during electronic health record (EHR) system procurement. We describe the objectives of the evaluation, the procedure, selected usability attributes and the evaluation methods to measure them. We also present the emphasis usability had in the selection process. We do not elaborate on the details of the results, the application of methods or gathering of data. Instead we focus on the components of the framework to inform and give an example to other similar procurement projects.

  11. Ubiquitous information for ubiquitous computing: expressing clinical data sets with openEHR archetypes.

    Science.gov (United States)

    Garde, Sebastian; Hovenga, Evelyn; Buck, Jasmin; Knaup, Petra

    2006-01-01

    Ubiquitous computing requires ubiquitous access to information and knowledge. With the release of openEHR Version 1.0 there is a common model available to solve some of the problems related to accessing information and knowledge by improving semantic interoperability between clinical systems. Considerable work has been undertaken by various bodies to standardise Clinical Data Sets. Notwithstanding their value, several problems remain unsolved with Clinical Data Sets without the use of a common model underpinning them. This paper outlines these problems like incompatible basic data types and overlapping and incompatible definitions of clinical content. A solution to this based on openEHR archetypes is motivated and an approach to transform existing Clinical Data Sets into archetypes is presented. To avoid significant overlaps and unnecessary effort during archetype development, archetype development needs to be coordinated nationwide and beyond and also across the various health professions in a formalized process.

  12. Incorporating personalized gene sequence variants, molecular genetics knowledge, and health knowledge into an EHR prototype based on the Continuity of Care Record standard

    Science.gov (United States)

    Jing, Xia; Kay, Stephen; Marley, Tom; Hardiker, Nicholas R.; Cimino, James J.

    2011-01-01

    Summary Objectives The current volume and complexity of genetic tests, and the molecular genetics knowledge and health knowledge related to interpretation of the results of those tests, are rapidly outstripping the ability of individual clinicians to recall, understand and convey to their patients information relevant to their care. The tailoring of molecular genetics knowledge and health knowledge in clinical settings is important both for the provision of personalized medicine and to reduce clinician information overload. In this paper we describe the incorporation, customization and demonstration of molecular genetic data (mainly sequence variants), molecular genetics knowledge and health knowledge into a standards-based electronic health record (EHR) prototype developed specifically for this study. Methods We extended the CCR (Continuity of Care Record), an existing EHR standard for representing clinical data, to include molecular genetic data. An EHR prototype was built based on the extended CCR and designed to display relevant molecular genetics knowledge and health knowledge from an existing knowledge base for cystic fibrosis (OntoKBCF). We reconstructed test records from published case reports and represented them in the CCR schema. We then used the EHR to dynamically filter molecular genetics knowledge and health knowledge from OntoKBCF using molecular genetic data and clinical data from the test cases. Results The molecular genetic data were successfully incorporated in the CCR by creating a category of laboratory results called “Molecular Genetics ” and specifying a particular class of test (“Gene Mutation Test”) in this category. Unlike other laboratory tests reported in the CCR, results of tests in this class required additional attributes (“Molecular Structure” and “Molecular Position”) to support interpretation by clinicians. These results, along with clinical data (age, sex, ethnicity, diagnostic procedures, and therapies) were used

  13. Can openEHR archetypes be used in a national context? The Danish archetype proof-of-concept project.

    Science.gov (United States)

    Bernstein, Knut; Tvede, Ida; Petersen, Jan; Bredegaard, Kirsten

    2009-01-01

    Semantic interoperability and secondary use of data are important informatics challenges in modern healthcare. Connected Digital Health Denmark is investigating if the openEHR reference model, archetypes and templates could be used for representing and exchanging clinical content specification and could become a candidate for a national logical infrastructure for semantic interoperability. The Danish archetype proof-of-concept project has tried out some elements of the openEHR methodology in cooperation with regions and vendors. The project has pointed out benefits and challenges using archetypes, and has identified barriers that need to be addressed in the next steps.

  14. Design and implementation of a web-based patient portal linked to an electronic health record designed to improve medication safety: the Patient Gateway medications module

    Directory of Open Access Journals (Sweden)

    Jeffrey Schnipper

    2008-07-01

    Full Text Available In this article we describe the background, design, and preliminary results of a medications module within Patient Gateway (PG, a patient portal linked to an electronic health record (EHR. The medications module is designed to improve the accuracy of medication lists within the EHR, reduce adverse drug events and improve patient_provider communication regarding medications and allergies in several primary care practices within a large integrated healthcare delivery network. This module allows patients to view and modify the list of medications and allergies from the EHR, report nonadherence, side effects and other medication-related problems and easily communicate this information to providers, who can verify the information and update the EHR as needed. Usage and satisfaction data indicate that patients found the module easy to use, felt that it led to their providers having more accurate information about them and enabled them to feel more prepared for their forthcoming visits. Further analyses will determine the effects of this module on important medication-related outcomes and identify further enhancements needed to improve on this approach.

  15. Clinical code set engineering for reusing EHR data for research: A review.

    Science.gov (United States)

    Williams, Richard; Kontopantelis, Evangelos; Buchan, Iain; Peek, Niels

    2017-06-01

    The construction of reliable, reusable clinical code sets is essential when re-using Electronic Health Record (EHR) data for research. Yet code set definitions are rarely transparent and their sharing is almost non-existent. There is a lack of methodological standards for the management (construction, sharing, revision and reuse) of clinical code sets which needs to be addressed to ensure the reliability and credibility of studies which use code sets. To review methodological literature on the management of sets of clinical codes used in research on clinical databases and to provide a list of best practice recommendations for future studies and software tools. We performed an exhaustive search for methodological papers about clinical code set engineering for re-using EHR data in research. This was supplemented with papers identified by snowball sampling. In addition, a list of e-phenotyping systems was constructed by merging references from several systematic reviews on this topic, and the processes adopted by those systems for code set management was reviewed. Thirty methodological papers were reviewed. Common approaches included: creating an initial list of synonyms for the condition of interest (n=20); making use of the hierarchical nature of coding terminologies during searching (n=23); reviewing sets with clinician input (n=20); and reusing and updating an existing code set (n=20). Several open source software tools (n=3) were discovered. There is a need for software tools that enable users to easily and quickly create, revise, extend, review and share code sets and we provide a list of recommendations for their design and implementation. Research re-using EHR data could be improved through the further development, more widespread use and routine reporting of the methods by which clinical codes were selected. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  16. A Stable-Matching-Based User Linking Method with User Preference Order

    Directory of Open Access Journals (Sweden)

    Xuzhong Wang

    2017-01-01

    Full Text Available With the development of social networks, more and more users choose to use multiple accounts from different networks to meet their needs. Linking a particular user’s multiple accounts not only can improve user’s experience of the net-services such as recommender system, but also plays a significant role in network security. However, multiple accounts of the same user are often not directly linked to each other, and further, the privacy policy provided by the service provider makes it harder to find accounts for a particular user. In this paper, we propose a stable-matching-based method with user preference order for the problem of low accuracy of user linking in cross-media sparse data. Different from the traditional way which just calculates the similarity of accounts, we take full account of the mutual influence among multiple accounts by regarding different networks as bilateral (multilateral market and user linking as a stable matching problem in such a market. Based on the combination of Game-Theoretic Machine Learning and Pairwise, a novel user linking method has been proposed. The experiment shows that our method has a 21.6% improvement in accuracy compared with the traditional linking method and a further increase of about 7.8% after adding the prior knowledge.

  17. Special Topic Interoperability and EHR: Combining openEHR, SNOMED, IHE, and Continua as approaches to interoperability on national eHealth.

    Science.gov (United States)

    Beštek, Mate; Stanimirović, Dalibor

    2017-08-09

    The main aims of the paper comprise the characterization and examination of the potential approaches regarding interoperability. This includes openEHR, SNOMED, IHE, and Continua as combined interoperability approaches, possibilities for their incorporation into the eHealth environment, and identification of the main success factors in the field, which are necessary for achieving required interoperability, and consequently, for the successful implementation of eHealth projects in general. The paper represents an in-depth analysis regarding the potential application of openEHR, SNOMED, IHE and Continua approaches in the development and implementation process of eHealth in Slovenia. The research method used is both exploratory and deductive in nature. The methodological framework is grounded on information retrieval with a special focus on research and charting of existing experience in the field, and sources, both electronic and written, which include interoperability concepts and related implementation issues. The paper will try to answer the following inquiries that are complementing each other: 1. Scrutiny of the potential approaches, which could alleviate the pertinent interoperability issues in the Slovenian eHealth context. 2. Analyzing the possibilities (requirements) for their inclusion in the construction process for individual eHealth solutions. 3. Identification and charting the main success factors in the interoperability field that critically influence development and implementation of eHealth projects in an efficient manner. Provided insights and identified success factors could serve as a constituent of the strategic starting points for continuous integration of interoperability principles into the healthcare domain. Moreover, the general implementation of the identified success factors could facilitate better penetration of ICT into the healthcare environment and enable the eHealth-based transformation of the health system especially in the countries

  18. Inter-organizational future proof EHR systems. A review of the security and privacy related issues.

    Science.gov (United States)

    van der Linden, Helma; Kalra, Dipak; Hasman, Arie; Talmon, Jan

    2009-03-01

    Identification and analysis of privacy and security related issues that occur when health information is exchanged between health care organizations. Based on a generic scenario questions were formulated to reveal the occurring issues. Possible answers were verified in literature. Ensuring secure health information exchange across organizations requires a standardization of security measures that goes beyond organizational boundaries, such as global definitions of professional roles, global standards for patient consent and semantic interoperable audit logs. As to be able to fully address the privacy and security issues in interoperable EHRs and the long-life virtual EHR it is necessary to realize a paradigm shift from storing all incoming information in a local system to retrieving information from external systems whenever that information is deemed necessary for the care of the patient.

  19. Rapid EHR development and implementation using web and cloud-based architecture in a large home health and hospice organization.

    Science.gov (United States)

    Weaver, Charlotte A; Teenier, Pamela

    2014-01-01

    Health care organizations have long been limited to a small number of major vendors in their selection of an electronic health record (EHR) system in the national and international marketplace. These major EHR vendors have in common base systems that are decades old, are built in antiquated programming languages, use outdated server architecture, and are based on inflexible data models [1,2]. The option to upgrade their technology to keep pace with the power of new web-based architecture, programming tools and cloud servers is not easily undertaken due to large client bases, development costs and risk [3]. This paper presents the decade-long efforts of a large national provider of home health and hospice care to select an EHR product, failing that to build their own and failing that initiative to go back into the market in 2012. The decade time delay had allowed new technologies and more nimble vendors to enter the market. Partnering with a new start-up company doing web and cloud based architecture for the home health and hospice market, made it possible to build, test and implement an operational and point of care system in 264 home health locations across 40 states and three time zones in the United States. This option of "starting over" with the new web and cloud technologies may be posing a next generation of new EHR vendors that retells the Blackberry replacement by iPhone story in healthcare.

  20. "Meaningful use" of EHR in dental school clinics: how to benefit from the U.S. HITECH Act's financial and quality improvement incentives.

    Science.gov (United States)

    Kalenderian, Elsbeth; Walji, Muhammad; Ramoni, Rachel B

    2013-04-01

    Through the 2009 HITECH (Health Information Technology for Economic and Clinical Health) Act, the U.S. government committed $27 billion to incentivize the adoption and "meaningful use" of certified electronic health records (EHRs) by providers, including dentists. Given their patient profiles, dental school clinics are in a position to benefit from this time-delimited commitment to support the adoption and use of certified EHR technology under the Medicaid-based incentive. The benefits are not merely financial: rather, the meaningful use objectives and clinical quality measures can drive quality improvement initiatives within dental practices and help develop a community of medical and dental professionals focused on quality. This article describes how dentists can qualify as eligible providers and the set of activities that must be undertaken and attested to in order to obtain this incentive. Two case studies describe the approaches that can be used to meet the Medicaid threshold necessary to be eligible for the incentive. Dentists can and have successfully applied for meaningful use incentive payments. Given the diverse set of patients who are treated at dental schools, these dental practices are among those most likely to benefit from the incentive programs.

  1. Using Linked Electronic Health Records to Estimate Healthcare Costs: Key Challenges and Opportunities.

    Science.gov (United States)

    Asaria, Miqdad; Grasic, Katja; Walker, Simon

    2016-02-01

    This paper discusses key challenges and opportunities that arise when using linked electronic health records (EHR) in health economics and outcomes research (HEOR), with a particular focus on estimating healthcare costs. These challenges and opportunities are framed in the context of a case study modelling the costs of stable coronary artery disease in England. The challenges and opportunities discussed fall broadly into the categories of (1) handling and organising data of this size and sensitivity; (2) extracting clinical endpoints from datasets that have not been designed and collected with such endpoints in mind; and (3) the principles and practice of costing resource use from routinely collected data. We find that there are a number of new challenges and opportunities that arise when working with EHR compared with more traditional sources of data for HEOR. These call for greater clinician involvement and intelligent use of sensitivity analysis.

  2. Validation of the openEHR archetype library by using OWL reasoning.

    Science.gov (United States)

    Menárguez-Tortosa, Marcos; Fernández-Breis, Jesualdo Tomás

    2011-01-01

    Electronic Health Record architectures based on the dual model architecture use archetypes for representing clinical knowledge. Therefore, ensuring their correctness and consistency is a fundamental research goal. In this work, we explore how an approach based on OWL technologies can be used for such purpose. This method has been applied to the openEHR archetype repository, which is the largest available one nowadays. The results of this validation are also reported in this study.

  3. Cost-benefit assessment of using electronic health records data for clinical research versus current practices: Contribution of the Electronic Health Records for Clinical Research (EHR4CR) European Project.

    Science.gov (United States)

    Beresniak, Ariel; Schmidt, Andreas; Proeve, Johann; Bolanos, Elena; Patel, Neelam; Ammour, Nadir; Sundgren, Mats; Ericson, Mats; Karakoyun, Töresin; Coorevits, Pascal; Kalra, Dipak; De Moor, Georges; Dupont, Danielle

    2016-01-01

    The widespread adoption of electronic health records (EHR) provides a new opportunity to improve the efficiency of clinical research. The European EHR4CR (Electronic Health Records for Clinical Research) 4-year project has developed an innovative technological platform to enable the re-use of EHR data for clinical research. The objective of this cost-benefit assessment (CBA) is to assess the value of EHR4CR solutions compared to current practices, from the perspective of sponsors of clinical trials. A CBA model was developed using an advanced modeling approach. The costs of performing three clinical research scenarios (S) applied to a hypothetical Phase II or III oncology clinical trial workflow (reference case) were estimated under current and EHR4CR conditions, namely protocol feasibility assessment (S1), patient identification for recruitment (S2), and clinical study execution (S3). The potential benefits were calculated considering that the estimated reduction in actual person-time and costs for performing EHR4CR S1, S2, and S3 would accelerate time to market (TTM). Probabilistic sensitivity analyses using Monte Carlo simulations were conducted to manage uncertainty. Should the estimated efficiency gains achieved with the EHR4CR platform translate into faster TTM, the expected benefits for the global pharmaceutical oncology sector were estimated at €161.5m (S1), €45.7m (S2), €204.5m (S1+S2), €1906m (S3), and up to €2121.8m (S1+S2+S3) when the scenarios were used sequentially. The results suggest that optimizing clinical trial design and execution with the EHR4CR platform would generate substantial added value for pharmaceutical industry, as main sponsors of clinical trials in Europe, and beyond. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Transfer function of radio over fiber multimode fiber optic links considering third-order dispersion.

    Science.gov (United States)

    Capmany, J; Gasulla, Ivana

    2007-08-20

    Although a considerable number of multimode fiber (MMF) links operate in a wavelength region around 850 nm where chromatic dispersion of a given modal group mu is described adequately by the second derivative beta(mu) (2) of the propagation constant beta(mu)(omega), there is also an increasing interest in MMF links transmitting in the second spectral window (@1300nm) where this second derivative vanishes being thus necessary to consider the third derivative beta(mu) (3) in the evaluation of the transfer function of the multimode fiber link. We present in this paper, for the first time to our knowledge, an analytical model for the transfer function of a multimode fiber (MMF) optic link taken into account the impact of third-order dispersion. The model extends the operation of a previously reported one for second-order dispersion. Our results show that the performance of broadband radio over fiber transmission through middle-reach distances can be improved by working at the minimum-dispersion wavelength as long as low-linewidth lasers are employed.

  5. Special topic interoperability and EHR: Combining openEHR, SNOMED, IHE, and continua as approaches to interoperability on national ehealth

    DEFF Research Database (Denmark)

    Bestek, M.; Stanimirovi, D.

    2017-01-01

    into the eHealth environment, and identification of the main success factors in the field, which are necessary for achieving required interoperability, and consequently, for the successful implementation of eHealth projects in general. Methods: The paper represents an in-depth analysis regarding...... the potential application of openEHR, SNOMED, IHE and Continua approaches in the development and implementation process of eHealth in Slovenia. The research method used is both exploratory and deductive in nature. The methodological framework is grounded on information retrieval with a special focus on research...... could alleviate the pertinent interoperability issues in the Slovenian eHealth context. 2. Analyzing the possibilities (requirements) for their inclusion in the construction process for individual eHealth solutions. 3. Identification and charting the main success factors in the interoperability field...

  6. Text Mining for Precision Medicine: Bringing structure to EHRs and biomedical literature to understand genes and health

    Science.gov (United States)

    Simmons, Michael; Singhal, Ayush; Lu, Zhiyong

    2018-01-01

    The key question of precision medicine is whether it is possible to find clinically actionable granularity in diagnosing disease and classifying patient risk. The advent of next generation sequencing and the widespread adoption of electronic health records (EHRs) have provided clinicians and researchers a wealth of data and made possible the precise characterization of individual patient genotypes and phenotypes. Unstructured text — found in biomedical publications and clinical notes — is an important component of genotype and phenotype knowledge. Publications in the biomedical literature provide essential information for interpreting genetic data. Likewise, clinical notes contain the richest source of phenotype information in EHRs. Text mining can render these texts computationally accessible and support information extraction and hypothesis generation. This chapter reviews the mechanics of text mining in precision medicine and discusses several specific use cases, including database curation for personalized cancer medicine, patient outcome prediction from EHR-derived cohorts, and pharmacogenomic research. Taken as a whole, these use cases demonstrate how text mining enables effective utilization of existing knowledge sources and thus promotes increased value for patients and healthcare systems. Text mining is an indispensable tool for translating genotype-phenotype data into effective clinical care that will undoubtedly play an important role in the eventual realization of precision medicine. PMID:27807747

  7. Text Mining for Precision Medicine: Bringing Structure to EHRs and Biomedical Literature to Understand Genes and Health.

    Science.gov (United States)

    Simmons, Michael; Singhal, Ayush; Lu, Zhiyong

    2016-01-01

    The key question of precision medicine is whether it is possible to find clinically actionable granularity in diagnosing disease and classifying patient risk. The advent of next-generation sequencing and the widespread adoption of electronic health records (EHRs) have provided clinicians and researchers a wealth of data and made possible the precise characterization of individual patient genotypes and phenotypes. Unstructured text-found in biomedical publications and clinical notes-is an important component of genotype and phenotype knowledge. Publications in the biomedical literature provide essential information for interpreting genetic data. Likewise, clinical notes contain the richest source of phenotype information in EHRs. Text mining can render these texts computationally accessible and support information extraction and hypothesis generation. This chapter reviews the mechanics of text mining in precision medicine and discusses several specific use cases, including database curation for personalized cancer medicine, patient outcome prediction from EHR-derived cohorts, and pharmacogenomic research. Taken as a whole, these use cases demonstrate how text mining enables effective utilization of existing knowledge sources and thus promotes increased value for patients and healthcare systems. Text mining is an indispensable tool for translating genotype-phenotype data into effective clinical care that will undoubtedly play an important role in the eventual realization of precision medicine.

  8. Using Electronic Health Records to Support Clinical Trials: A Report on Stakeholder Engagement for EHR4CR.

    Science.gov (United States)

    McCowan, Colin; Thomson, Elizabeth; Szmigielski, Cezary A; Kalra, Dipak; Sullivan, Frank M; Prokosch, Hans-Ulrich; Dugas, Martin; Ford, Ian

    2015-01-01

    The conduct of clinical trials is increasingly challenging due to greater complexity and governance requirements as well as difficulties with recruitment and retention. Electronic Health Records for Clinical Research (EHR4CR) aims at improving the conduct of trials by using existing routinely collected data, but little is known about stakeholder views on data availability, information governance, and acceptable working practices. Senior figures in healthcare organisations across Europe were provided with a description of the project and structured interviews were subsequently conducted to elicit their views. 37 structured interviewees in Germany, UK, Switzerland, and France indicated strong support for the proposed EHR4CR platform. All interviewees reported that using the platform for assessing feasibility would enhance the conduct of clinical trials and the majority also felt it would reduce workloads. Interviewees felt the platform could enhance trial recruitment and adverse event reporting but also felt it could raise either ethical or information governance concerns in their country. There was clear support for EHR4CR and a belief that it could reduce workloads and improve the conduct and quality of trials. However data security, privacy, and information governance issues would need to be carefully managed in the development of the platform.

  9. Using Electronic Health Records to Support Clinical Trials: A Report on Stakeholder Engagement for EHR4CR

    Directory of Open Access Journals (Sweden)

    Colin McCowan

    2015-01-01

    Full Text Available Background. The conduct of clinical trials is increasingly challenging due to greater complexity and governance requirements as well as difficulties with recruitment and retention. Electronic Health Records for Clinical Research (EHR4CR aims at improving the conduct of trials by using existing routinely collected data, but little is known about stakeholder views on data availability, information governance, and acceptable working practices. Methods. Senior figures in healthcare organisations across Europe were provided with a description of the project and structured interviews were subsequently conducted to elicit their views. Results. 37 structured interviewees in Germany, UK, Switzerland, and France indicated strong support for the proposed EHR4CR platform. All interviewees reported that using the platform for assessing feasibility would enhance the conduct of clinical trials and the majority also felt it would reduce workloads. Interviewees felt the platform could enhance trial recruitment and adverse event reporting but also felt it could raise either ethical or information governance concerns in their country. Conclusions. There was clear support for EHR4CR and a belief that it could reduce workloads and improve the conduct and quality of trials. However data security, privacy, and information governance issues would need to be carefully managed in the development of the platform.

  10. Developing EHR-driven heart failure risk prediction models using CPXR(Log) with the probabilistic loss function.

    Science.gov (United States)

    Taslimitehrani, Vahid; Dong, Guozhu; Pereira, Naveen L; Panahiazar, Maryam; Pathak, Jyotishman

    2016-04-01

    Computerized survival prediction in healthcare identifying the risk of disease mortality, helps healthcare providers to effectively manage their patients by providing appropriate treatment options. In this study, we propose to apply a classification algorithm, Contrast Pattern Aided Logistic Regression (CPXR(Log)) with the probabilistic loss function, to develop and validate prognostic risk models to predict 1, 2, and 5year survival in heart failure (HF) using data from electronic health records (EHRs) at Mayo Clinic. The CPXR(Log) constructs a pattern aided logistic regression model defined by several patterns and corresponding local logistic regression models. One of the models generated by CPXR(Log) achieved an AUC and accuracy of 0.94 and 0.91, respectively, and significantly outperformed prognostic models reported in prior studies. Data extracted from EHRs allowed incorporation of patient co-morbidities into our models which helped improve the performance of the CPXR(Log) models (15.9% AUC improvement), although did not improve the accuracy of the models built by other classifiers. We also propose a probabilistic loss function to determine the large error and small error instances. The new loss function used in the algorithm outperforms other functions used in the previous studies by 1% improvement in the AUC. This study revealed that using EHR data to build prediction models can be very challenging using existing classification methods due to the high dimensionality and complexity of EHR data. The risk models developed by CPXR(Log) also reveal that HF is a highly heterogeneous disease, i.e., different subgroups of HF patients require different types of considerations with their diagnosis and treatment. Our risk models provided two valuable insights for application of predictive modeling techniques in biomedicine: Logistic risk models often make systematic prediction errors, and it is prudent to use subgroup based prediction models such as those given by CPXR

  11. Dealing with the archetypes development process for a regional EHR system.

    Science.gov (United States)

    Santos, M R; Bax, M P; Kalra, D

    2012-01-01

    This paper aims to present the archetype modelling process used for the Health Department of Minas Gerais State, Brazil (SES/MG), to support building its regional EHR system, and the lessons learned during this process. This study was undertaken within the Minas Gerais project. The EHR system architecture was built assuming the reference model from the ISO 13606 norm. The whole archetype development process took about ten months, coordinated by a clinical team co-ordinated by three health professionals and one systems analyst from the SES/MG. They were supported by around 30 health professionals from the internal SES/MG areas, and 5 systems analysts from the PRODEMGE. Based on a bottom-up approach, the project team used technical interviews and brainstorming sessions to conduct the modelling process. The main steps of the archetype modelling process were identified and described, and 20 archetypes were created. -The set of principles established during the selection of PCS elements helped the clinical team to keep the focus in their objectives;-The initial focus on the archetype structural organization aspects was important;-The data elements identified were subjected to a rigorous analysis aimed at determining the most suitable clinical domain;-Levelling the concepts to accommodate them within the hierarchical levels in the reference model was definitely no easy task, and the use of a mind mapping tool facilitated the modelling process;-Part of the difficulty experienced by the clinical team was related to a view focused on the original forms previously used;-The use of worksheets facilitated the modelling process by health professionals;-It was important to have a health professional that knew about the domain tables and health classifications from the Brazilian Federal Government as member in the clinical team. The archetypes (referencing terminology, domain tables and term lists) provided a favorable condition for the use of a controlled vocabulary between the

  12. E-health in Switzerland: The laborious adoption of the federal law on electronic health records (EHR) and health information exchange (HIE) networks.

    Science.gov (United States)

    De Pietro, Carlo; Francetic, Igor

    2018-02-01

    Within the framework of a broader e-health strategy launched a decade ago, in 2015 Switzerland passed a new federal law on patients' electronic health records (EHR). The reform requires hospitals to adopt interoperable EHRs to facilitate data sharing and cooperation among healthcare providers, ultimately contributing to improvements in quality of care and efficiency in the health system. Adoption is voluntary for ambulatories and private practices, that may however be pushed towards EHRs by patients. The latter have complete discretion in the choice of the health information to share. Moreover, careful attention is given to data security issues. Despite good intentions, the high institutional and organisational fragmentation of the Swiss healthcare system, as well as the lack of full agreement with stakeholders on some critical points of the reform, slowed the process of adoption of the law. In particular, pilot projects made clear that the participation of ambulatories is doomed to be low unless appropriate incentives are put in place. Moreover, most stakeholders point at the strategy proposed to finance technical implementation and management of EHRs as a major drawback. After two years of intense preparatory work, the law entered into force in April 2017. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

  13. An e-consent-based shared EHR system architecture for integrated healthcare networks.

    Science.gov (United States)

    Bergmann, Joachim; Bott, Oliver J; Pretschner, Dietrich P; Haux, Reinhold

    2007-01-01

    Virtual integration of distributed patient data promises advantages over a consolidated health record, but raises questions mainly about practicability and authorization concepts. Our work aims on specification and development of a virtual shared health record architecture using a patient-centred integration and authorization model. A literature survey summarizes considerations of current architectural approaches. Complemented by a methodical analysis in two regional settings, a formal architecture model was specified and implemented. Results presented in this paper are a survey of architectural approaches for shared health records and an architecture model for a virtual shared EHR, which combines a patient-centred integration policy with provider-oriented document management. An electronic consent system assures, that access to the shared record remains under control of the patient. A corresponding system prototype has been developed and is currently being introduced and evaluated in a regional setting. The proposed architecture is capable of partly replacing message-based communications. Operating highly available provider repositories for the virtual shared EHR requires advanced technology and probably means additional costs for care providers. Acceptance of the proposed architecture depends on transparently embedding document validation and digital signature into the work processes. The paradigm shift from paper-based messaging to a "pull model" needs further evaluation.

  14. Linking mothers and infants within electronic health records: a comparison of deterministic and probabilistic algorithms.

    Science.gov (United States)

    Baldwin, Eric; Johnson, Karin; Berthoud, Heidi; Dublin, Sascha

    2015-01-01

    To compare probabilistic and deterministic algorithms for linking mothers and infants within electronic health records (EHRs) to support pregnancy outcomes research. The study population was women enrolled in Group Health (Washington State, USA) delivering a liveborn infant from 2001 through 2008 (N = 33,093 deliveries) and infant members born in these years. We linked women to infants by surname, address, and dates of birth and delivery using deterministic and probabilistic algorithms. In a subset previously linked using "gold standard" identifiers (N = 14,449), we assessed each approach's sensitivity and positive predictive value (PPV). For deliveries with no "gold standard" linkage (N = 18,644), we compared the algorithms' linkage proportions. We repeated our analyses in an independent test set of deliveries from 2009 through 2013. We reviewed medical records to validate a sample of pairs apparently linked by one algorithm but not the other (N = 51 or 1.4% of discordant pairs). In the 2001-2008 "gold standard" population, the probabilistic algorithm's sensitivity was 84.1% (95% CI, 83.5-84.7) and PPV 99.3% (99.1-99.4), while the deterministic algorithm had sensitivity 74.5% (73.8-75.2) and PPV 95.7% (95.4-96.0). In the test set, the probabilistic algorithm again had higher sensitivity and PPV. For deliveries in 2001-2008 with no "gold standard" linkage, the probabilistic algorithm found matched infants for 58.3% and the deterministic algorithm, 52.8%. On medical record review, 100% of linked pairs appeared valid. A probabilistic algorithm improved linkage proportion and accuracy compared to a deterministic algorithm. Better linkage methods can increase the value of EHRs for pregnancy outcomes research. Copyright © 2014 John Wiley & Sons, Ltd.

  15. A Correlational Analysis: Electronic Health Records (EHR) and Quality of Care in Critical Access Hospitals

    Science.gov (United States)

    Khan, Arshia A.

    2012-01-01

    Driven by the compulsion to improve the evident paucity in quality of care, especially in critical access hospitals in the United States, policy makers, healthcare providers, and administrators have taken the advise of researchers suggesting the integration of technology in healthcare. The Electronic Health Record (EHR) System composed of multiple…

  16. Mapping HL7 CDA R2 Formatted Mass Screening Data to OpenEHR Archetypes.

    Science.gov (United States)

    Kobayashi, Shinji; Kume, Naoto; Yoshihara, Hiroyuki

    2017-01-01

    Mass screening of adults was performed to manage employee healthcare. The screening service defined the data collection format as HL7 Clinical Document Architecture (CDA) R2. To capture mass screening data for nationwide electronic health records (her), we programmed a model within the CDA format and mapped the data items to the ISO13606/openEHR archetype for semantic interoperabiilty.

  17. Evaluation of a comprehensive EHR based on the DeLone and McLean model for IS success

    DEFF Research Database (Denmark)

    Bossen, Claus; Groth Jensen, Lotte; Udsen, Flemming Witt

    2013-01-01

    :Overall, staff had positive experiences with the EHR and its operational reliability, response time, login and support. Performance was acceptable. Medical secretaries found the use of the patient administration module cumbersome, and physicians found the establishment of the overview of professionally...

  18. A Document-Based EHR System That Controls the Disclosure of Clinical Documents Using an Access Control List File Based on the HL7 CDA Header.

    Science.gov (United States)

    Takeda, Toshihiro; Ueda, Kanayo; Nakagawa, Akito; Manabe, Shirou; Okada, Katsuki; Mihara, Naoki; Matsumura, Yasushi

    2017-01-01

    Electronic health record (EHR) systems are necessary for the sharing of medical information between care delivery organizations (CDOs). We developed a document-based EHR system in which all of the PDF documents that are stored in our electronic medical record system can be disclosed to selected target CDOs. An access control list (ACL) file was designed based on the HL7 CDA header to manage the information that is disclosed.

  19. Comparison of response times of a mobile-web EHRs system using PHP and JSP languages.

    Science.gov (United States)

    De la Torre-Díez, Isabel; Antón-Rodríguez, Míriam; Díaz-Pernas, Francisco Javier; Perozo-Rondón, Freddy José

    2012-12-01

    Performance evaluation is highly important in the Electronic Health Records (EHRs) system implementation. Response time's measurement can be considered as one manner to make that evaluation. In the e-health field, after the creation of EHRs available through different platforms such as Web and/or mobile, a performance evaluation is necessary. The operation of the system in the right way is essential. In this paper, a comparison of the response times for the MEHRmobile system is presented. The first version uses PHP language with a MySQL database and the second one employs JSP with an eXist database. Both versions have got the same functionalities. In addition to the technological aspects, a significant difference is the way the information is stored. The main goal of this paper is choosing the version which offers better response times. We have created a new benchmark to calculate the response times. Better results have been obtained for the PHP version. Nowadays, this version is being used for specialists from Fundación Intras, Spain.

  20. 2015 Edition Health Information Technology (Health IT) Certification Criteria, 2015 Edition Base Electronic Health Record (EHR) Definition, and ONC Health IT Certification Program Modifications. Final rule.

    Science.gov (United States)

    2015-10-16

    This final rule finalizes a new edition of certification criteria (the 2015 Edition health IT certification criteria or "2015 Edition'') and a new 2015 Edition Base Electronic Health Record (EHR) definition, while also modifying the ONC Health IT Certification Program to make it open and accessible to more types of health IT and health IT that supports various care and practice settings. The 2015 Edition establishes the capabilities and specifies the related standards and implementation specifications that Certified Electronic Health Record Technology (CEHRT) would need to include to, at a minimum, support the achievement of meaningful use by eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) under the Medicare and Medicaid EHR Incentive Programs (EHR Incentive Programs) when such edition is required for use under these programs.

  1. Telemedicine and EHR Integrated Approach for An Effective E-Governance Healthcare Framework

    Directory of Open Access Journals (Sweden)

    Alpana Kakkar

    2017-05-01

    Full Text Available In the recent years, people have been more inclined towards the use of technology to reduce human effort. Telemedicine is one such concept which has gained popularity among the people, providing them easy access to health care. Telemedicine refers to the concept of providing health care from a distance through an integrated approach using information and communication technology (ICT. India, being a geographically wide country has its difficulties when it comes to providing health care facilities to people belonging to the different regions. This is one of the few reasons why India is the best stage to introduce a concept like telemedicine. The use of this technology to counter the various challenges has been highly regarded and termed as something which can revolutionize the medical field. Integrating telemedicine with electronic health record (EHR, which is a digital document of a person’s medical history is said to be a perfect combination which can help improve clinical efficiency. The country has seen initiatives taken up by various organizations, with the main motive of connecting the rural to the urban. Through this paper, we have discussed the potential we have with this technology, and also propose an EHR integrated telemedicine model to make the best use of it in an emergency healthcare situation to help save lives. We have also touched a few factors which can help the government better the current health scenario.

  2. Nudging physician prescription decisions by partitioning the order set: results of a vignette-based study.

    Science.gov (United States)

    Tannenbaum, David; Doctor, Jason N; Persell, Stephen D; Friedberg, Mark W; Meeker, Daniella; Friesema, Elisha M; Goldstein, Noah J; Linder, Jeffrey A; Fox, Craig R

    2015-03-01

    Healthcare professionals are rapidly adopting electronic health records (EHRs). Within EHRs, seemingly innocuous menu design configurations can influence provider decisions for better or worse. The purpose of this study was to examine whether the grouping of menu items systematically affects prescribing practices among primary care providers. We surveyed 166 primary care providers in a research network of practices in the greater Chicago area, of whom 84 responded (51% response rate). Respondents and non-respondents were similar on all observable dimensions except that respondents were more likely to work in an academic setting. The questionnaire consisted of seven clinical vignettes. Each vignette described typical signs and symptoms for acute respiratory infections, and providers chose treatments from a menu of options. For each vignette, providers were randomly assigned to one of two menu partitions. For antibiotic-inappropriate vignettes, the treatment menu either listed over-the-counter (OTC) medications individually while grouping prescriptions together, or displayed the reverse partition. For antibiotic-appropriate vignettes, the treatment menu either listed narrow-spectrum antibiotics individually while grouping broad-spectrum antibiotics, or displayed the reverse partition. The main outcome was provider treatment choice. For antibiotic-inappropriate vignettes, we categorized responses as prescription drugs or OTC-only options. For antibiotic-appropriate vignettes, we categorized responses as broad- or narrow-spectrum antibiotics. Across vignettes, there was an 11.5 percentage point reduction in choosing aggressive treatment options (e.g., broad-spectrum antibiotics) when aggressive options were grouped compared to when those same options were listed individually (95% CI: 2.9 to 20.1%; p = .008). Provider treatment choice appears to be influenced by the grouping of menu options, suggesting that the layout of EHR order sets is not an arbitrary exercise

  3. Development of the quality assessment model of EHR software in family medicine practices: research based on user satisfaction

    Directory of Open Access Journals (Sweden)

    Damir Kralj

    2015-09-01

    Full Text Available Background Family medicine practices (FMPs make the basis for the Croatian health care system. Use of electronic health record (EHR software is mandatory and it plays an important role in running these practices, but important functional features still remain uneven and largely left to the will of the software developers.Objective The objective of this study was to develop a novel and comprehensive model for functional evaluation of the EHR software in FMPs, based on current world standards, models and projects, as well as on actual user satisfaction and requirements.Methods Based on previous theoretical and experimental research in this area, we made the initial framework model consisting of six basic categories as a base for online survey questionnaire. Family doctors assessed perceived software quality by using a five-point Likert-type scale. Using exploratory factor analysis and appropriate statistical methods over the collected data, the final optimal structure of the novel model was formed. Special attention was focused on the validity and quality of the novel model.Results The online survey collected a total of 384 cases. The obtained results indicate both the quality of the assessed software and the quality in use of the novel model. The intense ergonomic orientation of the novel measurement model was particularly emphasised.Conclusions The resulting novel model is multiple validated, comprehensive and universal. It could be used to assess the user-perceived quality of almost all forms of the ambulatory EHR software and therefore useful to all stakeholders in this area of the health care informatisation. 

  4. Development of the quality assessment model of EHR software in family medicine practices: research based on user satisfaction.

    Science.gov (United States)

    Kralj, Damir; Kern, Josipa; Tonkovic, Stanko; Koncar, Miroslav

    2015-09-09

    Family medicine practices (FMPs) make the basis for the Croatian health care system. Use of electronic health record (EHR) software is mandatory and it plays an important role in running these practices, but important functional features still remain uneven and largely left to the will of the software developers. The objective of this study was to develop a novel and comprehensive model for functional evaluation of the EHR software in FMPs, based on current world standards, models and projects, as well as on actual user satisfaction and requirements. Based on previous theoretical and experimental research in this area, we made the initial framework model consisting of six basic categories as a base for online survey questionnaire. Family doctors assessed perceived software quality by using a five-point Likert-type scale. Using exploratory factor analysis and appropriate statistical methods over the collected data, the final optimal structure of the novel model was formed. Special attention was focused on the validity and quality of the novel model. The online survey collected a total of 384 cases. The obtained results indicate both the quality of the assessed software and the quality in use of the novel model. The intense ergonomic orientation of the novel measurement model was particularly emphasised. The resulting novel model is multiple validated, comprehensive and universal. It could be used to assess the user-perceived quality of almost all forms of the ambulatory EHR software and therefore useful to all stakeholders in this area of the health care informatisation.

  5. Predicting frequent emergency department visits among children with asthma using EHR data.

    Science.gov (United States)

    Das, Lala T; Abramson, Erika L; Stone, Anne E; Kondrich, Janienne E; Kern, Lisa M; Grinspan, Zachary M

    2017-07-01

    For children with asthma, emergency department (ED) visits are common, expensive, and often avoidable. Though several factors are associated with ED use (demographics, comorbidities, insurance, medications), its predictability using electronic health record (EHR) data is understudied. We used a retrospective cohort study design and EHR data from one center to examine the relationship of patient factors in 1 year (2013) and the likelihood of frequent ED use (≥2 visits) in the following year (2014), using bivariate and multivariable statistics. We applied and compared several machine-learning algorithms to predict frequent ED use, then selected a model based on accuracy, parsimony, and interpretability. We identified 2691 children. In bivariate analyses, future frequent ED use was associated with demographics, co-morbidities, insurance status, medication history, and use of healthcare resources. Machine learning algorithms had very good AUC (area under the curve) values [0.66-0.87], though fair PPV (positive predictive value) [48-70%] and poor sensitivity [16-27%]. Our final multivariable logistic regression model contained two variables: insurance status and prior ED use. For publicly insured patients, the odds of frequent ED use were 3.1 [2.2-4.5] times that of privately insured patients. Publicly insured patients with 4+ ED visits and privately insured patients with 6+ ED visits in a year had ≥50% probability of frequent ED use the following year. The model had an AUC of 0.86, PPV of 56%, and sensitivity of 23%. Among children with asthma, prior frequent ED use and insurance status strongly predict future ED use. © 2017 Wiley Periodicals, Inc.

  6. Comparing lagged linear correlation, lagged regression, Granger causality, and vector autoregression for uncovering associations in EHR data.

    Science.gov (United States)

    Levine, Matthew E; Albers, David J; Hripcsak, George

    2016-01-01

    Time series analysis methods have been shown to reveal clinical and biological associations in data collected in the electronic health record. We wish to develop reliable high-throughput methods for identifying adverse drug effects that are easy to implement and produce readily interpretable results. To move toward this goal, we used univariate and multivariate lagged regression models to investigate associations between twenty pairs of drug orders and laboratory measurements. Multivariate lagged regression models exhibited higher sensitivity and specificity than univariate lagged regression in the 20 examples, and incorporating autoregressive terms for labs and drugs produced more robust signals in cases of known associations among the 20 example pairings. Moreover, including inpatient admission terms in the model attenuated the signals for some cases of unlikely associations, demonstrating how multivariate lagged regression models' explicit handling of context-based variables can provide a simple way to probe for health-care processes that confound analyses of EHR data.

  7. Claims-based studies of oral glucose-lowering medications can achieve balance in critical clinical variables only observed in electronic health records.

    Science.gov (United States)

    Patorno, Elisabetta; Gopalakrishnan, Chandrasekar; Franklin, Jessica M; Brodovicz, Kimberly G; Masso-Gonzalez, Elvira; Bartels, Dorothee B; Liu, Jun; Schneeweiss, Sebastian

    2018-04-01

    To evaluate the extent to which balance in unmeasured characteristics of patients with type 2 diabetes (T2DM) was achieved in claims data, by comparing against more detailed information from linked electronic health records (EHR) data. Within a large US commercial insurance database and using a cohort design, we identified patients with T2DM initiating linagliptin or a comparator agent within class (ie, another dipeptidyl peptidase-4 inhibitor) or outside class (ie, pioglitazone or a sulphonylurea) between May 2011 and December 2012. We focused on comparators used at a similar stage of diabetes to linagliptin. For each comparison, 1:1 propensity score (PS) matching was used to balance >100 baseline claims-based characteristics, including proxies of diabetes severity and duration. Additional clinical data from EHR were available for a subset of patients. We assessed representativeness of the claims-EHR-linked subset, evaluated the balance of claims- and EHR-based covariates before and after PS-matching via standardized differences (SDs), and quantified the potential bias associated with observed imbalances. From a claims-based study population of 166 613 patients with T2DM, 7219 (4.3%) patients were linked to their EHR data. Claims-based characteristics in the EHR-linked and EHR-unlinked patients were similar (SD balance of claims-based and EHR-based patient characteristics appeared to be reasonable before PS-matching and generally improved in the PS-matched population, to be SD balance in covariates typically unmeasured in administrative claims datasets, to the extent that residual confounding is unlikely. © 2017 John Wiley & Sons Ltd.

  8. Constructive eHealth evaluation: lessons from evaluation of EHR development in 4 Danish hospitals.

    Science.gov (United States)

    Høstgaard, Anna Marie Balling; Bertelsen, Pernille; Nøhr, Christian

    2017-04-20

    Information and communication sources in the healthcare sector are replaced with new eHealth technologies. This has led to problems arising from the lack of awareness of the importance of end-user involvement in eHealth development and of the difficulties caused by using traditional summative evaluation methods. The Constructive eHealth evaluation method (CeHEM) provides a solution to these problems by offering an evaluation framework for supporting and facilitating end-user involvement during all phases of eHealth development. The aim of this paper is to support this process by sharing experiences of the eHealth evaluation method used in the introduction of electronic health records (EHR) in the North Denmark Region of Denmark. It is the first time the fully developed method and the experiences on using the CeHEM in all five phases of a full lifecycle framework is presented. A case study evaluation of the EHR development process in the North Denmark Region was conducted from 2004 to 2010. The population consisted of clinicians, IT professionals, administrators, and vendors. The study involved 4 hospitals in the region. Data were collected using questionnaires, observations, interviews, and insight gathered from relevant documents. The evaluation showed a need for a) Early involvement of clinicians, b) The best possible representation of clinicians, and c) Workload reduction for those involved. The consequences of not providing this were a lack of ownership of decisions and negative attitudes towards the clinical benefits related to these decisions. Further, the result disclosed that by following the above recommendations, and by providing feedback to the 4 actor groups, the physicians' involvement was improved. As a result they took ownership of decisions and gained a positive attitude to the clinical benefits. The CeHEM has proven successful in formative evaluation of EHR development and can point at important issues that need to be taken care of by management

  9. Facilitating the openEHR approach - organizational structures for defining high-quality archetypes.

    Science.gov (United States)

    Kohl, Christian Dominik; Garde, Sebastian; Knaup, Petra

    2008-01-01

    Using openEHR archetypes to establish an electronic patient record promises rapid development and system interoperability by using or adopting existing archetypes. However, internationally accepted, high quality archetypes which enable a comprehensive semantic interoperability require adequate development and maintenance processes. Therefore, structures have to be created involving different health professions. In the following we present a model which facilitates and governs distributed but cooperative development and adoption of archetypes by different professionals including peer reviews. Our model consists of a hierarchical structure of professional committees and descriptions of the archetype development process considering these different committees.

  10. Defining disease phenotypes using national linked electronic health records: a case study of atrial fibrillation.

    Directory of Open Access Journals (Sweden)

    Katherine I Morley

    Full Text Available National electronic health records (EHR are increasingly used for research but identifying disease cases is challenging due to differences in information captured between sources (e.g. primary and secondary care. Our objective was to provide a transparent, reproducible model for integrating these data using atrial fibrillation (AF, a chronic condition diagnosed and managed in multiple ways in different healthcare settings, as a case study.Potentially relevant codes for AF screening, diagnosis, and management were identified in four coding systems: Read (primary care diagnoses and procedures, British National Formulary (BNF; primary care prescriptions, ICD-10 (secondary care diagnoses and OPCS-4 (secondary care procedures. From these we developed a phenotype algorithm via expert review and analysis of linked EHR data from 1998 to 2010 for a cohort of 2.14 million UK patients aged ≥ 30 years. The cohort was also used to evaluate the phenotype by examining associations between incident AF and known risk factors.The phenotype algorithm incorporated 286 codes: 201 Read, 63 BNF, 18 ICD-10, and four OPCS-4. Incident AF diagnoses were recorded for 72,793 patients, but only 39.6% (N = 28,795 were recorded in primary care and secondary care. An additional 7,468 potential cases were inferred from data on treatment and pre-existing conditions. The proportion of cases identified from each source differed by diagnosis age; inferred diagnoses contributed a greater proportion of younger cases (≤ 60 years, while older patients (≥ 80 years were mainly diagnosed in SC. Associations of risk factors (hypertension, myocardial infarction, heart failure with incident AF defined using different EHR sources were comparable in magnitude to those from traditional consented cohorts.A single EHR source is not sufficient to identify all patients, nor will it provide a representative sample. Combining multiple data sources and integrating information on treatment and

  11. Executing Complexity-Increasing Queries in Relational (MySQL) and NoSQL (MongoDB and EXist) Size-Growing ISO/EN 13606 Standardized EHR Databases.

    Science.gov (United States)

    Sánchez-de-Madariaga, Ricardo; Muñoz, Adolfo; Castro, Antonio L; Moreno, Oscar; Pascual, Mario

    2018-03-19

    This research shows a protocol to assess the computational complexity of querying relational and non-relational (NoSQL (not only Structured Query Language)) standardized electronic health record (EHR) medical information database systems (DBMS). It uses a set of three doubling-sized databases, i.e. databases storing 5000, 10,000 and 20,000 realistic standardized EHR extracts, in three different database management systems (DBMS): relational MySQL object-relational mapping (ORM), document-based NoSQL MongoDB, and native extensible markup language (XML) NoSQL eXist. The average response times to six complexity-increasing queries were computed, and the results showed a linear behavior in the NoSQL cases. In the NoSQL field, MongoDB presents a much flatter linear slope than eXist. NoSQL systems may also be more appropriate to maintain standardized medical information systems due to the special nature of the updating policies of medical information, which should not affect the consistency and efficiency of the data stored in NoSQL databases. One limitation of this protocol is the lack of direct results of improved relational systems such as archetype relational mapping (ARM) with the same data. However, the interpolation of doubling-size database results to those presented in the literature and other published results suggests that NoSQL systems might be more appropriate in many specific scenarios and problems to be solved. For example, NoSQL may be appropriate for document-based tasks such as EHR extracts used in clinical practice, or edition and visualization, or situations where the aim is not only to query medical information, but also to restore the EHR in exactly its original form.

  12. Executing Complexity-Increasing Queries in Relational (MySQL) and NoSQL (MongoDB and EXist) Size-Growing ISO/EN 13606 Standardized EHR Databases

    Science.gov (United States)

    Sánchez-de-Madariaga, Ricardo; Muñoz, Adolfo; Castro, Antonio L; Moreno, Oscar; Pascual, Mario

    2018-01-01

    This research shows a protocol to assess the computational complexity of querying relational and non-relational (NoSQL (not only Structured Query Language)) standardized electronic health record (EHR) medical information database systems (DBMS). It uses a set of three doubling-sized databases, i.e. databases storing 5000, 10,000 and 20,000 realistic standardized EHR extracts, in three different database management systems (DBMS): relational MySQL object-relational mapping (ORM), document-based NoSQL MongoDB, and native extensible markup language (XML) NoSQL eXist. The average response times to six complexity-increasing queries were computed, and the results showed a linear behavior in the NoSQL cases. In the NoSQL field, MongoDB presents a much flatter linear slope than eXist. NoSQL systems may also be more appropriate to maintain standardized medical information systems due to the special nature of the updating policies of medical information, which should not affect the consistency and efficiency of the data stored in NoSQL databases. One limitation of this protocol is the lack of direct results of improved relational systems such as archetype relational mapping (ARM) with the same data. However, the interpolation of doubling-size database results to those presented in the literature and other published results suggests that NoSQL systems might be more appropriate in many specific scenarios and problems to be solved. For example, NoSQL may be appropriate for document-based tasks such as EHR extracts used in clinical practice, or edition and visualization, or situations where the aim is not only to query medical information, but also to restore the EHR in exactly its original form. PMID:29608174

  13. Health behaviors and quality of life predictors for risk of hospitalization in an electronic health record-linked biobank

    Directory of Open Access Journals (Sweden)

    Takahashi PY

    2015-08-01

    Full Text Available Paul Y Takahashi,1,2 Euijung Ryu,3 Janet E Olson,3 Erin M Winkler,4 Matthew A Hathcock,3 Ruchi Gupta,3 Jeff A Sloan,3 Jyotishman Pathak,3 Suzette J Bielinski,3 James R Cerhan3 1Division of Primary Care Internal Medicine, 2Department of Internal Medicine, 3Department of Health Sciences Research, 4Center for Individualized Medicine, Mayo Clinic, Rochester, MN, USA Background: Hospital risk stratification models using electronic health records (EHRs often use age and comorbid health burden. Our primary aim was to determine if quality of life or health behaviors captured in an EHR-linked biobank can predict future risk of hospitalization. Methods: Participants in the Mayo Clinic Biobank completed self-administered questionnaires at enrollment that included quality of life and health behaviors. Participants enrolled as of December 31, 2010 were followed for one year to ascertain hospitalization. Data on comorbidities and hospitalization were derived from the Mayo Clinic EHR. Hazard ratios (HR and 95% confidence interval (CI were used, adjusted for age and sex. We used gradient boosting machines models to integrate multiple factors. Different models were compared using C-statistic. Results: Of the 8,927 eligible Mayo Clinic Biobank participants, 834 (9.3% were hospitalized. Self-perceived health status and alcohol use had the strongest associations with risk of hospitalization. Compared to participants with excellent self-perceived health, those reporting poor/fair health had higher risk of hospitalization (HR =3.66, 95% CI 2.74–4.88. Alcohol use was inversely associated with hospitalization (HR =0.57 95% CI 0.45–0.72. The gradient boosting machines model estimated self-perceived health as the most influential factor (relative influence =16%. The predictive ability of the model based on comorbidities was slightly higher than the one based on the self-perceived health (C-statistic =0.67 vs 0.65. Conclusion: This study demonstrates that self

  14. Novos registros do gênero Trachelomonas Ehr. (Euglenophyceae no Parque Estadual Delta do Jacuí e no Rio Grande do Sul, Brasil New records for the genus Trachelomonas Ehr. (Euglenophyceae in Jacuí Delta State Park, Rio Grande do Sul, Brazil

    Directory of Open Access Journals (Sweden)

    Sandra Maria Alves-da-Silva

    2007-06-01

    Full Text Available O levantamento do gênero Trachelomonas Ehr. (Euglenophyceae em 26 corpos d´água da área do Parque Estadual Delta do Jacuí, localizado a 29º 56' e 30º 03'S, 5lº l2' e 51º 25'W, resultou no registro de nove novas citações de espécies de Trachelomonas Ehr. para o Estado do Rio Grande do Sul, são elas: Trachelomonas abrupta Swir. emend. Defl. var. obesa (Playf. Defl. T. conica Playf., Trachelomonas duquei Conf. & Nudelman, Trachelomonas megalacantha Cunha var. crenulatocollis Bour. & Manguin, Trachelomonas verrucosa Stockes var. granulosa (Playf. Hub.-Pest., Trachelomonas zingeri Roll, três são ainda novos registros para o país: Trachelomonas cylindraceae f. cylindraceae (Playf. Pop., Trachelomonas helvetica Lemm. emend. Defl. e Trachelomonas splendidissima Middelhoek. São apresentadas descrições, ilustrações, comentários, distribuição geográfica e a amplitude de condições ambientais em que cada táxon foi encontrado.A study of the genus Trachelomonas Ehr. (Euglenophyceae in 26 water bodies at Jacuí Delta State Park near the state capital of Rio Grande do Sul (29º56', 30º03'S; 51º12', 51º18'W revealed nine new records of Trachelomonas species for this state, as follows: Trachelomonas abrupta Swir. emend. Defl. var. obesa (Playf. Defl., T. conica Playf., Trachelomonas duquei Conf. & Nudelman, Trachelomonas megalacantha Cunha var. crenulatocollis Bour. & Manguin, Trachelomonas verrucosa Stockes var. granulosa (Playf. Hub.-Pest., Trachelomonas zingeri Roll; three are new records for Brazil: Trachelomonas cylindraceae f. cylindraceae (Playf. Pop., Trachelomonas helvetica Lemm. emend. Defl. and Trachelomonas splendidissima Middelhoek. Descriptions, illustrations, comments, geographic distribution and the range of environmental conditions in which each taxon was found are presented.

  15. Bridging the gap between clinical practice and public health: Using EHR data to assess trends in the seasonality of blood-pressure control

    Directory of Open Access Journals (Sweden)

    Aurora O. Amoah

    2017-06-01

    Our findings identified cyclic trends in BP control and highlighted greater association with increased proportion of diabetic patients, therefore confirming the ability of the EHR as a tool for measuring population health outcomes.

  16. Structuring Legacy Pathology Reports by openEHR Archetypes to Enable Semantic Querying.

    Science.gov (United States)

    Kropf, Stefan; Krücken, Peter; Mueller, Wolf; Denecke, Kerstin

    2017-05-18

    Clinical information is often stored as free text, e.g. in discharge summaries or pathology reports. These documents are semi-structured using section headers, numbered lists, items and classification strings. However, it is still challenging to retrieve relevant documents since keyword searches applied on complete unstructured documents result in many false positive retrieval results. We are concentrating on the processing of pathology reports as an example for unstructured clinical documents. The objective is to transform reports semi-automatically into an information structure that enables an improved access and retrieval of relevant data. The data is expected to be stored in a standardized, structured way to make it accessible for queries that are applied to specific sections of a document (section-sensitive queries) and for information reuse. Our processing pipeline comprises information modelling, section boundary detection and section-sensitive queries. For enabling a focused search in unstructured data, documents are automatically structured and transformed into a patient information model specified through openEHR archetypes. The resulting XML-based pathology electronic health records (PEHRs) are queried by XQuery and visualized by XSLT in HTML. Pathology reports (PRs) can be reliably structured into sections by a keyword-based approach. The information modelling using openEHR allows saving time in the modelling process since many archetypes can be reused. The resulting standardized, structured PEHRs allow accessing relevant data by retrieving data matching user queries. Mapping unstructured reports into a standardized information model is a practical solution for a better access to data. Archetype-based XML enables section-sensitive retrieval and visualisation by well-established XML techniques. Focussing the retrieval to particular sections has the potential of saving retrieval time and improving the accuracy of the retrieval.

  17. Validating EHR clinical models using ontology patterns.

    Science.gov (United States)

    Martínez-Costa, Catalina; Schulz, Stefan

    2017-12-01

    Clinical models are artefacts that specify how information is structured in electronic health records (EHRs). However, the makeup of clinical models is not guided by any formal constraint beyond a semantically vague information model. We address this gap by advocating ontology design patterns as a mechanism that makes the semantics of clinical models explicit. This paper demonstrates how ontology design patterns can validate existing clinical models using SHACL. Based on the Clinical Information Modelling Initiative (CIMI), we show how ontology patterns detect both modeling and terminology binding errors in CIMI models. SHACL, a W3C constraint language for the validation of RDF graphs, builds on the concept of "Shape", a description of data in terms of expected cardinalities, datatypes and other restrictions. SHACL, as opposed to OWL, subscribes to the Closed World Assumption (CWA) and is therefore more suitable for the validation of clinical models. We have demonstrated the feasibility of the approach by manually describing the correspondences between six CIMI clinical models represented in RDF and two SHACL ontology design patterns. Using a Java-based SHACL implementation, we found at least eleven modeling and binding errors within these CIMI models. This demonstrates the usefulness of ontology design patterns not only as a modeling tool but also as a tool for validation. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Combining PubMed knowledge and EHR data to develop a weighted bayesian network for pancreatic cancer prediction.

    Science.gov (United States)

    Zhao, Di; Weng, Chunhua

    2011-10-01

    In this paper, we propose a novel method that combines PubMed knowledge and Electronic Health Records to develop a weighted Bayesian Network Inference (BNI) model for pancreatic cancer prediction. We selected 20 common risk factors associated with pancreatic cancer and used PubMed knowledge to weigh the risk factors. A keyword-based algorithm was developed to extract and classify PubMed abstracts into three categories that represented positive, negative, or neutral associations between each risk factor and pancreatic cancer. Then we designed a weighted BNI model by adding the normalized weights into a conventional BNI model. We used this model to extract the EHR values for patients with or without pancreatic cancer, which then enabled us to calculate the prior probabilities for the 20 risk factors in the BNI. The software iDiagnosis was designed to use this weighted BNI model for predicting pancreatic cancer. In an evaluation using a case-control dataset, the weighted BNI model significantly outperformed the conventional BNI and two other classifiers (k-Nearest Neighbor and Support Vector Machine). We conclude that the weighted BNI using PubMed knowledge and EHR data shows remarkable accuracy improvement over existing representative methods for pancreatic cancer prediction. Copyright © 2011 Elsevier Inc. All rights reserved.

  19. Practical choices for infobutton customization: experience from four sites.

    Science.gov (United States)

    Cimino, James J; Overby, Casey L; Devine, Emily B; Hulse, Nathan C; Jing, Xia; Maviglia, Saverio M; Del Fiol, Guilherme

    2013-01-01

    Context-aware links between electronic health records (EHRs) and online knowledge resources, commonly called "infobuttons" are being used increasingly as part of EHR "meaningful use" requirements. While an HL7 standard exists for specifying how the links should be constructed, there is no guidance on what links to construct. Collectively, the authors manage four infobutton systems that serve 16 institutions. The purpose of this paper is to publish our experience with linking various resources and specifying particular criteria that can be used by infobutton managers to select resources that are most relevant for a given situation. This experience can be used directly by those wishing to customize their own EHRs, for example by using the OpenInfobutton infobutton manager and its configuration tool, the Librarian Infobutton Tailoring Environment.

  20. Prospective validation of a near real-time EHR-integrated automated SOFA score calculator.

    Science.gov (United States)

    Aakre, Christopher; Franco, Pablo Moreno; Ferreyra, Micaela; Kitson, Jaben; Li, Man; Herasevich, Vitaly

    2017-07-01

    We created an algorithm for automated Sequential Organ Failure Assessment (SOFA) score calculation within the Electronic Health Record (EHR) to facilitate detection of sepsis based on the Third International Consensus Definitions for Sepsis and Septic Shock (SEPSIS-3) clinical definition. We evaluated the accuracy of near real-time and daily automated SOFA score calculation compared with manual score calculation. Automated SOFA scoring computer programs were developed using available EHR data sources and integrated into a critical care focused patient care dashboard at Mayo Clinic in Rochester, Minnesota. We prospectively compared the accuracy of automated versus manual calculation for a sample of patients admitted to the medical intensive care unit at Mayo Clinic Hospitals in Rochester, Minnesota and Jacksonville, Florida. Agreement was calculated with Cohen's kappa statistic. Reason for discrepancy was tabulated during manual review. Random spot check comparisons were performed 134 times on 27 unique patients, and daily SOFA score comparisons were performed for 215 patients over a total of 1206 patient days. Agreement between automatically scored and manually scored SOFA components for both random spot checks (696 pairs, κ=0.89) and daily calculation (5972 pairs, κ=0.89) was high. The most common discrepancies were in the respiratory component (inaccurate fraction of inspired oxygen retrieval; 200/1206) and creatinine (normal creatinine in patients with no urine output on dialysis; 128/1094). 147 patients were at risk of developing sepsis after intensive care unit admission, 10 later developed sepsis confirmed by chart review. All were identified before onset of sepsis with the ΔSOFA≥2 point criterion and 46 patients were false-positives. Near real-time automated SOFA scoring was found to have strong agreement with manual score calculation and may be useful for the detection of sepsis utilizing the new SEPSIS-3 definition. Copyright © 2017 Elsevier B.V. All

  1. The provision and impact of online patient access to their electronic health records (EHR) and transactional services on the quality and safety of health care: systematic review protocol.

    Science.gov (United States)

    Mold, Freda; Ellis, Beverley; de Lusignan, Simon; Sheikh, Aziz; Wyatt, Jeremy C; Cavill, Mary; Michalakidis, Georgios; Barker, Fiona; Majeed, Azeem; Quinn, Tom; Koczan, Phil; Avanitis, Theo; Gronlund, Toto Anne; Franco, Christina; McCarthy, Mary; Renton, Zoë; Chauhan, Umesh; Blakey, Hannah; Kataria, Neha; Jones, Simon; Rafi, Imran

    2012-01-01

    Innovators have piloted improvements in communication, changed patterns of practice and patient empowerment from online access to electronic health records (EHR). International studies of online services, such as prescription ordering, online appointment booking and secure communications with primary care, show good uptake of email consultations, accessing test results and booking appointments; when technologies and business process are in place. Online access and transactional services are due to be rolled out across England by 2015; this review seeks to explore the impact of online access to health records and other online services on the quality and safety of primary health care. To assess the factors that may affect the provision of online patient access to their EHR and transactional services, and the impact of such access on the quality and safety of health care. Two reviewers independently searched 11 international databases during the period 1999-2012. A range of papers including descriptive studies using qualitative or quantitative methods, hypothesis-testing studies and systematic reviews were included. A detailed eligibility criterion will be used to shape study inclusion. A team of experts will review these papers for eligibility, extract data using a customised extraction form and use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) instrument to determine the quality of the evidence and the strengths of any recommendation. Data will then be descriptively summarised and thematically synthesised. Where feasible, we will perform a quantitative meta-analysis. Prospero (International Prospective Register of Systematic Reviews) registration number: crd42012003091.

  2. A methodology based on openEHR archetypes and software agents for developing e-health applications reusing legacy systems.

    Science.gov (United States)

    Cardoso de Moraes, João Luís; de Souza, Wanderley Lopes; Pires, Luís Ferreira; do Prado, Antonio Francisco

    2016-10-01

    In Pervasive Healthcare, novel information and communication technologies are applied to support the provision of health services anywhere, at anytime and to anyone. Since health systems may offer their health records in different electronic formats, the openEHR Foundation prescribes the use of archetypes for describing clinical knowledge in order to achieve semantic interoperability between these systems. Software agents have been applied to simulate human skills in some healthcare procedures. This paper presents a methodology, based on the use of openEHR archetypes and agent technology, which aims to overcome the weaknesses typically found in legacy healthcare systems, thereby adding value to the systems. This methodology was applied in the design of an agent-based system, which was used in a realistic healthcare scenario in which a medical staff meeting to prepare a cardiac surgery has been supported. We conducted experiments with this system in a distributed environment composed by three cardiology clinics and a center of cardiac surgery, all located in the city of Marília (São Paulo, Brazil). We evaluated this system according to the Technology Acceptance Model. The case study confirmed the acceptance of our agent-based system by healthcare professionals and patients, who reacted positively with respect to the usefulness of this system in particular, and with respect to task delegation to software agents in general. The case study also showed that a software agent-based interface and a tools-based alternative must be provided to the end users, which should allow them to perform the tasks themselves or to delegate these tasks to other people. A Pervasive Healthcare model requires efficient and secure information exchange between healthcare providers. The proposed methodology allows designers to build communication systems for the message exchange among heterogeneous healthcare systems, and to shift from systems that rely on informal communication of actors to

  3. Development of the Precision Link Biobank at Boston Children’s Hospital: Challenges and Opportunities

    Directory of Open Access Journals (Sweden)

    Florence T. Bourgeois

    2017-12-01

    Full Text Available Increasingly, biobanks are being developed to support organized collections of biological specimens and associated clinical information on broadly consented, diverse patient populations. We describe the implementation of a pediatric biobank, comprised of a fully-informed patient cohort linking specimens to phenotypic data derived from electronic health records (EHR. The Biobank was launched after multiple stakeholders’ input and implemented initially in a pilot phase before hospital-wide expansion in 2016. In-person informed consent is obtained from all participants enrolling in the Biobank and provides permission to: (1 access EHR data for research; (2 collect and use residual specimens produced as by-products of routine care; and (3 share de-identified data and specimens outside of the institution. Participants are recruited throughout the hospital, across diverse clinical settings. We have enrolled 4900 patients to date, and 41% of these have an associated blood sample for DNA processing. Current efforts are focused on aligning the Biobank with other ongoing research efforts at our institution and extending our electronic consenting system to support remote enrollment. A number of pediatric-specific challenges and opportunities is reviewed, including the need to re-consent patients when they reach 18 years of age, the ability to enroll family members accompanying patients and alignment with disease-specific research efforts at our institution and other pediatric centers to increase cohort sizes, particularly for rare diseases.

  4. Implementation of a Novel Electronic Health Record-Embedded Physician Orders for Life-Sustaining Treatment System.

    Science.gov (United States)

    Zive, Dana M; Cook, Jennifer; Yang, Charissa; Sibell, David; Tolle, Susan W; Lieberman, Michael

    2016-11-01

    In April 2015, Oregon Health & Science University (OHSU) deployed a web-based, electronic medical record-embedded application created by third party vendor Vynca Inc. to allow real-time education, and completion of Physician Orders for Life Sustaining Treatment (POLST). Forms are automatically linked to the Epic Systems™ electronic health record (EHR) patient header and submitted to a state Registry, improving efficiency, accuracy, and rapid access to and retrieval of these important medical orders. POLST Forms, implemented in Oregon in 1992, are standardized portable medical orders used to document patient treatment goals for end-of-life care. In 2009, Oregon developed the first POLST-only statewide registry with a legislative mandate requiring POLST form signers to register the form unless the patient opts out. The Registry offers 24/7 emergency access to POLST Forms for Emergency Medical Services, Emergency Departments, and Acute Care Units. Because POLST is intended for those nearing end of life, immediate access to these forms at the time of an emergency is critical. Delays in registering a POLST Form may result in unwanted treatment if the paper form is not immediately available. An electronic POLST Form completion system (ePOLST) was implemented to support direct Registry submission. Other benefits of the system include single-sign-on, transmission of HL7 data for patient demographics and other relevant information, elimination of potential errors in form completion using internalized logic, built-in real-time video and text-based education materials for both patients and health care professionals, and mobile linkage for signature capture.

  5. An Analysis of the External Environmental and Internal Organizational Factors Associated with Adoption of the Electronic Health Record

    Science.gov (United States)

    Kruse, Clemens Scott

    2013-01-01

    Despite a Presidential Order in 2004 that launched national incentives for the use of health information technology, specifically the Electronic Health Record (EHR), adoption of the EHR has been slow. This study attempts to quantify factors associated with adoption of the EHR and Computerized Provider Order Entry (CPOE) by combining multiple…

  6. Overcoming challenges integrating patient-generated data into the clinical EHR: lessons from the CONtrolling Disease Using Inexpensive IT--Hypertension in Diabetes (CONDUIT-HID) Project.

    Science.gov (United States)

    Marquard, Jenna L; Garber, Lawrence; Saver, Barry; Amster, Brian; Kelleher, Michael; Preusse, Peggy

    2013-10-01

    The CONDUIT-HID intervention integrates patients' electronic blood pressure measurements directly into the clinical EHR using Microsoft HealthVault as an intermediary data store. The goal of this paper is to describe generalizable categories of patient and technical challenges encountered in the development and implementation of this inexpensive, commercial off-the-shelf consumer health informatics intervention, examples of challenges within each category, and how the example challenges were resolved prior to conducting an RCT of the intervention. The research team logged all challenges and mediation strategies during the technical development of the intervention, conducted home visits to observe patients using the intervention, and conducted telephone calls with patients to understand challenges they encountered. We then used these data to iteratively refine the intervention. The research team identified a variety of generalizable categories of challenges associated with patients uploading data from their homes, patients uploading data from clinics because they did not have or were not comfortable using home computers, and patients establishing the connection between HealthVault and the clinical EHR. Specific challenges within these categories arose because: (1) the research team had little control over the device and application design, (2) multiple vendors needed to coordinate their actions and design changes, (3) the intervention use cases were not anticipated by the device and application designers, (4) PHI accessed on clinic computers needed to be kept secure, (5) the research team wanted the data in the clinical EHR to be valid and reliable, (6) patients needed the ability to share only the data they wanted, and (7) the development of some EHR functionalities were new to the organization. While these challenges were varied and complex, the research team was able to successfully resolve each one prior to the start of the RCT. By identifying these

  7. A Digital Architecture for a Network-Based Learning Health System: Integrating Chronic Care Management, Quality Improvement, and Research.

    Science.gov (United States)

    Marsolo, Keith; Margolis, Peter A; Forrest, Christopher B; Colletti, Richard B; Hutton, John J

    2015-01-01

    We collaborated with the ImproveCareNow Network to create a proof-of-concept architecture for a network-based Learning Health System. This collaboration involved transitioning an existing registry to one that is linked to the electronic health record (EHR), enabling a "data in once" strategy. We sought to automate a series of reports that support care improvement while also demonstrating the use of observational registry data for comparative effectiveness research. We worked with three leading EHR vendors to create EHR-based data collection forms. We automated many of ImproveCareNow's analytic reports and developed an application for storing protected health information and tracking patient consent. Finally, we deployed a cohort identification tool to support feasibility studies and hypothesis generation. There is ongoing uptake of the system. To date, 31 centers have adopted the EHR-based forms and 21 centers are uploading data to the registry. Usage of the automated reports remains high and investigators have used the cohort identification tools to respond to several clinical trial requests. The current process for creating EHR-based data collection forms requires groups to work individually with each vendor. A vendor-agnostic model would allow for more rapid uptake. We believe that interfacing network-based registries with the EHR would allow them to serve as a source of decision support. Additional standards are needed in order for this vision to be achieved, however. We have successfully implemented a proof-of-concept Learning Health System while providing a foundation on which others can build. We have also highlighted opportunities where sponsors could help accelerate progress.

  8. Progress along developmental tracks for electronic health records implementation in the United States

    Directory of Open Access Journals (Sweden)

    Hollar David W

    2009-03-01

    Full Text Available Abstract The development and implementation of electronic health records (EHR have occurred slowly in the United States. To date, these approaches have, for the most part, followed four developmental tracks: (a Enhancement of immunization registries and linkage with other health records to produce Child Health Profiles (CHP, (b Regional Health Information Organization (RHIO demonstration projects to link together patient medical records, (c Insurance company projects linked to ICD-9 codes and patient records for cost-benefit assessments, and (d Consortia of EHR developers collaborating to model systems requirements and standards for data linkage. Until recently, these separate efforts have been conducted in the very silos that they had intended to eliminate, and there is still considerable debate concerning health professionals access to as well as commitment to using EHR if these systems are provided. This paper will describe these four developmental tracks, patient rights and the legal environment for EHR, international comparisons, and future projections for EHR expansion across health networks in the United States.

  9. Development of a multi-institutional cohort to facilitate cardiovascular disease biomarker validation using existing biorepository samples linked to electronic health records.

    Science.gov (United States)

    Cross, Deanna S; McCarty, Catherine A; Steinhubl, Steven R; Carey, David J; Erlich, Porat M

    2013-08-01

    Emerging biomarkers for acute myocardial infarction (AMI) may enhance conventional risk-prediction algorithms if they are informative and associated with risk independently of established predictors. In this study, we constructed a cohort for testing emerging biomarkers for AMI in managed-care populations using existing biospecimen repositories linked to electronic health records (EHR). Electronic health record-based biorepositories collected by healthcare systems can be federated to provide large, methodologically sound testing sets for biomarker validation. Subjects ages 40 to 80 years were selected from 2 existing population-based biospecimen repositories. Incident AMI status and covariates were ascertained from the EHR. An ad hoc model for AMI risk was parameterized and validated. Simulation was used to test incremental gains in performance due to the inclusion of biomarkers in this model. Gains in performance were assessed in terms of area under the receiver operating characteristic curve (ROC-AUC) and case reclassification. A total of 18 329 individuals (57% female) contributed 108 400 person-years of EHR follow-up. The crude AMI incidence was 10.8 and 5.0 per 1000 person-years among males and females, respectively. Compared with the model with risk factors alone, inclusion of a simulated biomarker yielded substantial gains in sensitivity without loss of specificity. Furthermore, a net ROC-AUC gain of 13.3% was observed, as well as correct reclassification of 9.8% of incident cases (79 of 806) that were otherwise not considered statin-indicated at baseline under the National Cholesterol Education Program Adult Treatment Panel III criteria. More research is needed to assess incremental contribution of emerging biomarkers for AMI prediction in managed-care populations. © 2013 Wiley Periodicals, Inc.

  10. The provision and impact of online patient access to their electronic health records (EHR and transactional services on the quality and safety of health care: systematic review protocol

    Directory of Open Access Journals (Sweden)

    Freda Mold

    2013-09-01

    Full Text Available Background Innovators have piloted improvements in communication, changed patterns of practice and patient empowerment from online access to electronic health records (EHR. International studies of online services, such as prescription ordering, online appointment booking and secure communications with primary care, show good uptake of email consultations, accessing test results and booking appointments; when technologies and business process are in place. Online access and transactional services are due to be rolled out across England by 2015; this review seeks to explore the impact of online access to health records and other online services on the quality and safety of primary health care.Objective To assess the factors that may affect the provision of online patient access to their EHR and transactional services, and the impact of such access on the quality and safety of health care.Method Two reviewers independently searched 11 international databases during the period 1999–2012. A range of papers including descriptive studies using qualitative or quantitative methods, hypothesis-testing studies and systematic reviews were included. A detailed eligibility criterion will be used to shape study inclusion .A team of experts will review these papers for eligibility, extract data using a customised extraction form and use the Grading of Recommendations Assessment, Development and Evaluation (GRADE instrument to determine the quality of the evidence and the strengths of any recommendation. Data will then be descriptively summarised and thematically synthesised. Where feasible, we will perform a quantitative meta-analysis.Prospero (International Prospective Register of Systematic Reviews registration number: crd42012003091.

  11. Technical Modification Within the Healthcare Industry: Improving Both the Efficacy of the National Drug Code Carrier and the Accessibility of Electronic Health Records to Reduce Adverse Drug Events

    Science.gov (United States)

    2013-06-01

    with an EHR .................................................. 97 C. SWOT ANALYSIS OF USING QR CODES WITH THE NDC AND WITH EHRS...96 Figure 41. SWOT analysis ................................................................................... 99 xiii LIST OF...having an EHR provides a more robust overall solution. C. SWOT ANALYSIS OF USING QR CODES WITH THE NDC AND WITH EHRS In order to conduct an

  12. Codifying unstructured data: A Natural Language Processing approach to extract rich data from clinical letters

    Directory of Open Access Journals (Sweden)

    Arron Lacey

    2017-04-01

    Clix Enrich can be used to accurately extract SNOMED concepts from clinical letters. The resulting datasets are readily available to link to existing EHRs, and can be linked to EHRs that adopt the SNOMED coding structure, or backward compatible hierarchies. Clix Enrich comes with out-of-the-box extraction methods but the optimum way to extract the correct information would be to build in custom queries, thus requiring clinical expertise to validate extraction.

  13. Understanding Productivity and Technostress for Oncology Nurses Using an Electronic Health Record (EHR) to Increase Safety, Quality, and Effectiveness of Care for Patients with Cancer

    Science.gov (United States)

    Evans, Elizabeth M. Wertz

    2013-01-01

    Health information technology has become more prevalent in hospitals, physician offices, clinics, and other areas of medical treatment, especially since the federal government passed legislation to offer incentive payments for the meaningful use of electronic health records (EHRs). Previous research demonstrated a decrease in medical errors as…

  14. Structured data quality reports to improve EHR data quality.

    Science.gov (United States)

    Taggart, Jane; Liaw, Siaw-Teng; Yu, Hairong

    2015-12-01

    To examine whether a structured data quality report (SDQR) and feedback sessions with practice principals and managers improve the quality of routinely collected data in EHRs. The intervention was conducted in four general practices participating in the Fairfield neighborhood electronic Practice Based Research Network (ePBRN). Data were extracted from their clinical information systems and summarised as a SDQR to guide feedback to practice principals and managers at 0, 4, 8 and 12 months. Data quality (DQ) metrics included completeness, correctness, consistency and duplication of patient records. Information on data recording practices, data quality improvement, and utility of SDQRs was collected at the feedback sessions at the practices. The main outcome measure was change in the recording of clinical information and level of meeting Royal Australian College of General Practice (RACGP) targets. Birth date was 100% and gender 99% complete at baseline and maintained. DQ of all variables measured improved significantly (pImprovement was greatest with allergies. There was no significant change in duplicate records. SDQRs and feedback sessions support general practitioners and practice managers to focus on improving the recording of patient information. However, improved practice DQ, was not sufficient to meet RACGP targets. Randomised controlled studies are required to evaluate strategies to improve data quality and any associated improved safety and quality of care. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  15. Tunability of Open-Shell Character, Charge Asymmetry, and Third-Order Nonlinear Optical Properties of Covalently Linked (Hetero)Phenalenyl Dimers.

    Science.gov (United States)

    Minamida, Yuka; Kishi, Ryohei; Fukuda, Kotaro; Matsui, Hiroshi; Takamuku, Shota; Yamane, Masaki; Tonami, Takayoshi; Nakano, Masayoshi

    2018-02-06

    Tunability of the open-shell character, charge asymmetry, and third-order nonlinear optical (NLO) properties of covalently linked (hetero)phenalenyl dimers are investigated by using the density functional theory method. By changing the molecular species X and substitution position (i, j) for the linker part, a variety of intermonomer distances R and relative alignments between the phenalenyl dimers can be realized from the geometry optimizations, resulting in a wide-range tuning of diradical character y and charge asymmetry. It is found that the static second hyperpolarizabilities along the stacking direction, γ yyyy , are one-order enhanced for phenalenyl dimer systems exhibiting intermediate y, a feature that is in good agreement with the "y-γ correlation". By replacing the central carbon atoms of the phenalenyl rings with a boron or a nitrogen, we have also designed covalently linked heterophenalenyl dimers. The introduction of such a charge asymmetry to the open-shell systems, which leads to closed-shell ionic ground states, is found to further enhance the γ yyyy values of the systems having longer intermonomer distance R with intermediate ionic character, that is, charge asymmetry. The present results demonstrate a promising potential of covalently linked NLO dimers with intermediate open-shell/ionic characters as a new building block of highly efficient NLO systems. © 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

  16. Developing the First Generally-Available openEHR Archetypes and Templates for Physiotherapy: An Example of Building Clinical Models and Modelling Capacity via Student-Led Academic-Industrial Collaboration.

    Science.gov (United States)

    Chihab, Jamila; Franke, Hildegard; McNicoll, Ian; Darlison, Matthew W

    2017-01-01

    We present the first public openEHR archetypes and templates for physiotherapy, and the context of multidisciplinary academic-industry partnership that has enabled their production by a team led by a clinically trained student on the UCL health informatics MSc programme.

  17. A Process for the Representation of openEHR ADL Archetypes in OWL Ontologies.

    Science.gov (United States)

    Porn, Alex Mateus; Peres, Leticia Mara; Didonet Del Fabro, Marcos

    2015-01-01

    ADL is a formal language to express archetypes, independent of standards or domain. However, its specification is not precise enough in relation to the specialization and semantic of archetypes, presenting difficulties in implementation and a few available tools. Archetypes may be implemented using other languages such as XML or OWL, increasing integration with Semantic Web tools. Exchanging and transforming data can be better implemented with semantics oriented models, for example using OWL which is a language to define and instantiate Web ontologies defined by W3C. OWL permits defining significant, detailed, precise and consistent distinctions among classes, properties and relations by the user, ensuring the consistency of knowledge than using ADL techniques. This paper presents a process of an openEHR ADL archetypes representation in OWL ontologies. This process consists of ADL archetypes conversion in OWL ontologies and validation of OWL resultant ontologies using the mutation test.

  18. Towards sophisticated learning from EHRs: increasing prediction specificity and accuracy using clinically meaningful risk criteria.

    Science.gov (United States)

    Vasiljeva, Ieva; Arandjelovic, Ognjen

    2016-08-01

    Computer based analysis of Electronic Health Records (EHRs) has the potential to provide major novel insights of benefit both to specific individuals in the context of personalized medicine, as well as on the level of population-wide health care and policy. The present paper introduces a novel algorithm that uses machine learning for the discovery of longitudinal patterns in the diagnoses of diseases. Two key technical novelties are introduced: one in the form of a novel learning paradigm which enables greater learning specificity, and another in the form of a risk driven identification of confounding diagnoses. We present a series of experiments which demonstrate the effectiveness of the proposed techniques, and which reveal novel insights regarding the most promising future research directions.

  19. Big biomedical data and cardiovascular disease research: opportunities and challenges.

    Science.gov (United States)

    Denaxas, Spiros C; Morley, Katherine I

    2015-07-01

    Electronic health records (EHRs), data generated and collected during normal clinical care, are increasingly being linked and used for translational cardiovascular disease research. Electronic health record data can be structured (e.g. coded diagnoses) or unstructured (e.g. clinical notes) and increasingly encapsulate medical imaging, genomic and patient-generated information. Large-scale EHR linkages enable researchers to conduct high-resolution observational and interventional clinical research at an unprecedented scale. A significant amount of preparatory work and research, however, is required to identify, obtain, and transform raw EHR data into research-ready variables that can be statistically analysed. This study critically reviews the opportunities and challenges that EHR data present in the field of cardiovascular disease clinical research and provides a series of recommendations for advancing and facilitating EHR research.

  20. Construction of a multisite DataLink using electronic health records for the identification, surveillance, prevention, and management of diabetes mellitus: the SUPREME-DM project.

    Science.gov (United States)

    Nichols, Gregory A; Desai, Jay; Elston Lafata, Jennifer; Lawrence, Jean M; O'Connor, Patrick J; Pathak, Ram D; Raebel, Marsha A; Reid, Robert J; Selby, Joseph V; Silverman, Barbara G; Steiner, John F; Stewart, W F; Vupputuri, Suma; Waitzfelder, Beth

    2012-01-01

    Electronic health record (EHR) data enhance opportunities for conducting surveillance of diabetes. The objective of this study was to identify the number of people with diabetes from a diabetes DataLink developed as part of the SUPREME-DM (SUrveillance, PREvention, and ManagEment of Diabetes Mellitus) project, a consortium of 11 integrated health systems that use comprehensive EHR data for research. We identified all members of 11 health care systems who had any enrollment from January 2005 through December 2009. For these members, we searched inpatient and outpatient diagnosis codes, laboratory test results, and pharmaceutical dispensings from January 2000 through December 2009 to create indicator variables that could potentially identify a person with diabetes. Using this information, we estimated the number of people with diabetes and among them, the number of incident cases, defined as indication of diabetes after at least 2 years of continuous health system enrollment. The 11 health systems contributed 15,765,529 unique members, of whom 1,085,947 (6.9%) met 1 or more study criteria for diabetes. The nonstandardized proportion meeting study criteria for diabetes ranged from 4.2% to 12.4% across sites. Most members with diabetes (88%) met multiple criteria. Of the members with diabetes, 428,349 (39.4%) were incident cases. The SUPREME-DM DataLink is a unique resource that provides an opportunity to conduct comparative effectiveness research, epidemiologic surveillance including longitudinal analyses, and population-based care management studies of people with diabetes. It also provides a useful data source for pragmatic clinical trials of prevention or treatment interventions.

  1. Early hospital readmission for gastrointestinal-related complications predicts long-term mortality after pancreatectomy.

    Science.gov (United States)

    Hicks, Caitlin W; Tosoian, Jeffrey J; Craig-Schapiro, Rebecca; Valero, Vicente; Cameron, John L; Eckhauser, Frederic E; Hirose, Kenzo; Makary, Martin A; Pawlik, Timothy M; Ahuja, Nita; Weiss, Matthew J; Wolfgang, Christopher L

    2015-10-01

    The purpose of this study was to investigate the prognostic significance of early (30-day) hospital readmission (EHR) on mortality after pancreatectomy. Using a prospectively collected institutional database linked with a statewide dataset, we evaluated the association between EHR and overall mortality in all patients undergoing pancreatectomy at our tertiary institution (2005 to 2010). Of 595 pancreatectomy patients, EHR occurred in 21.5%. Overall mortality was 29.4% (median follow-up 22.7 months). Patients with EHR had decreased survival compared with those who were not readmitted (P = .011). On multivariate analysis adjusting for baseline group differences, EHR for gastrointestinal-related complications was a significant independent predictor of mortality (hazard ratio 2.30, P = .001). In addition to known risk factors, 30-day readmission for gastrointestinal-related complications following pancreatectomy independently predicts increased mortality. Additional studies are necessary to identify surgical, medical, and social factors contributing to EHR, as well as interventions aimed at decreasing postpancreatectomy morbidity and mortality. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Linked Data Applications Through Ontology Based Data Access in Clinical Research.

    Science.gov (United States)

    Kock-Schoppenhauer, Ann-Kristin; Kamann, Christian; Ulrich, Hannes; Duhm-Harbeck, Petra; Ingenerf, Josef

    2017-01-01

    Clinical care and research data are widely dispersed in isolated systems based on heterogeneous data models. Biomedicine predominantly makes use of connected datasets based on the Semantic Web paradigm. Initiatives like Bio2RDF created Resource Description Framework (RDF) versions of Omics resources, enabling sophisticated Linked Data applications. In contrast, electronic healthcare records (EHR) data are generated and processed in diverse clinical subsystems within hospital information systems (HIS). Usually, each of them utilizes a relational database system with a different proprietary schema. Semantic integration and access to the data is hardly possible. This paper describes ways of using Ontology Based Data Access (OBDA) for bridging the semantic gap between existing raw data and user-oriented views supported by ontology-based queries. Based on mappings between entities of data schemas and ontologies data can be made available as materialized or virtualized RDF triples ready for querying and processing. Our experiments based on CentraXX for biobank and study management demonstrate the advantages of abstracting away from low level details and semantic mediation. Furthermore, it becomes clear that using a professional platform for Linked Data applications is recommended due to the inherent complexity, the inconvenience to confront end users with SPARQL, and scalability and performance issues.

  3. Generalized Modular Transformations in (3+1D Topologically Ordered Phases and Triple Linking Invariant of Loop Braiding

    Directory of Open Access Journals (Sweden)

    Shenghan Jiang

    2014-09-01

    Full Text Available In topologically ordered quantum states of matter in (2+1D (spacetime dimensions, the braiding statistics of anyonic quasiparticle excitations is a fundamental characterizing property that is directly related to global transformations of the ground-state wave functions on a torus (the modular transformations. On the other hand, there are theoretical descriptions of various topologically ordered states in (3+1D, which exhibit both pointlike and looplike excitations, but systematic understanding of the fundamental physical distinctions between phases, and how these distinctions are connected to quantum statistics of excitations, is still lacking. One main result of this work is that the three-dimensional generalization of modular transformations, when applied to topologically ordered ground states, is directly related to a certain braiding process of looplike excitations. This specific braiding surprisingly involves three loops simultaneously, and can distinguish different topologically ordered states. Our second main result is the identification of the three-loop braiding as a process in which the worldsheets of the three loops have a nontrivial triple linking number, which is a topological invariant characterizing closed two-dimensional surfaces in four dimensions. In this work, we consider realizations of topological order in (3+1D using cohomological gauge theory in which the loops have Abelian statistics and explicitly demonstrate our results on examples with Z_{2}×Z_{2} topological order.

  4. Determination of Minimum Data Set (MSD) in Echocardiography Reporting System to Exchange with Iran's Electronic Health Record (EHR) System.

    Science.gov (United States)

    Mahmoudvand, Zahra; Kamkar, Mehran; Shahmoradi, Leila; Nejad, Ahmadreza Farzaneh

    2016-04-01

    Determination of minimum data set (MDS) in echocardiography reports is necessary for documentation and putting information in a standard way, and leads to the enhancement of electrocardiographic studies through having access to precise and perfect reports and also to the development of a standard database for electrocardiographic reports. to determine the minimum data set of echocardiography reporting system to exchange with Iran's electronic health record (EHR) system. First, a list of minimum data set was prepared after reviewing texts and studying cardiac patients' records. Then, to determine the content validity of the prepared MDS, the expert views of 10 cardiologists and 10 health information management (HIM) specialists were obtained; to estimate the reliability of the set, test-retest method was employed. Finally, the data were analyzed using SPSS software. The highest degree of consensus was found for the following MDSs: patient's name and family name (5), accepting doctor's name and family name, familial death records due to cardiac disorders, the image identification code, mitral valve, aortic valve, tricuspid valve, pulmonary valve, left ventricle, hole, atrium valve, Doppler examination of ventricular and atrial movement models and diagnoses with an average of. To prepare a model of echocardiography reporting system to exchange with EHR system, creation a standard data set is the vital point. Therefore, based on the research findings, the minimum reporting system data to exchange with Iran's electronic health record system include information on entity, management, medical record, carried-out acts, and the main content of the echocardiography report, which the planners of reporting system should consider.

  5. Computerised Provider Order Entry Adoption Rates Favourably Impact Length of Stay

    Directory of Open Access Journals (Sweden)

    Richard Schreiber

    2016-04-01

    Full Text Available Background Research regarding return on investment for electronic health records (EHRs is sparse. Objective To extend previously established research and examine rigorously whether increasing the adoption of computer-based provider/prescriber order entry (CPOE leads to a decrease in length of stay (LOS, and to demonstrate that the two are inversely and bidirectionally proportional even while other efforts to decrease LOS are in place. Method The study assessed CPOE, LOS and case mix index (CMI data in a community hospital in the United States, using a mature and nearly fully deployed vendor product EHR. CPOE rates and LOS over 7 years were determined on a per-patient, per-visit and per-discipline basis and compared with concomitant CMI data. Results An inverse relationship of CPOE to LOS was correlated for 13 disciplines out of 19, and organisation wide for all disciplines combined during the first 5 years of study. During the subsequent 2 years, both CPOE and LOS plateaued, except in eight disciplines where CPOE rates at first declined and LOS concurrently rose slightly, and then returned to the baseline plateau levels. CMI increased during the entire period of evaluation. An inflection point at approximately 60% CPOE adoption predicted the greatest improvement in lowering of LOS. Conclusions Rising and falling rates of CPOE correlated with reductions and rises in LOS, respectively. CPOE appeared statistically to be an independent factor in affecting LOS, over and above other efforts to shorten LOS, thus contributing to lower costs and improved efficiency outcomes as measured by LOS, even as CMI rises.

  6. Construction of a Multisite DataLink Using Electronic Health Records for the Identification, Surveillance, Prevention, and Management of Diabetes Mellitus: The SUPREME-DM Project

    Science.gov (United States)

    Desai, Jay; Elston Lafata, Jennifer; Lawrence, Jean M.; O’Connor, Patrick J.; Pathak, Ram D.; Raebel, Marsha A.; Reid, Robert J.; Selby, Joseph V.; Silverman, Barbara G.; Steiner, John F.; Stewart, W.F.; Vupputuri, Suma; Waitzfelder, Beth

    2012-01-01

    Introduction Electronic health record (EHR) data enhance opportunities for conducting surveillance of diabetes. The objective of this study was to identify the number of people with diabetes from a diabetes DataLink developed as part of the SUPREME-DM (SUrveillance, PREvention, and ManagEment of Diabetes Mellitus) project, a consortium of 11 integrated health systems that use comprehensive EHR data for research. Methods We identified all members of 11 health care systems who had any enrollment from January 2005 through December 2009. For these members, we searched inpatient and outpatient diagnosis codes, laboratory test results, and pharmaceutical dispensings from January 2000 through December 2009 to create indicator variables that could potentially identify a person with diabetes. Using this information, we estimated the number of people with diabetes and among them, the number of incident cases, defined as indication of diabetes after at least 2 years of continuous health system enrollment. Results The 11 health systems contributed 15,765,529 unique members, of whom 1,085,947 (6.9%) met 1 or more study criteria for diabetes. The nonstandardized proportion meeting study criteria for diabetes ranged from 4.2% to 12.4% across sites. Most members with diabetes (88%) met multiple criteria. Of the members with diabetes, 428,349 (39.4%) were incident cases. Conclusion The SUPREME-DM DataLink is a unique resource that provides an opportunity to conduct comparative effectiveness research, epidemiologic surveillance including longitudinal analyses, and population-based care management studies of people with diabetes. It also provides a useful data source for pragmatic clinical trials of prevention or treatment interventions. PMID:22677160

  7. Orders on file but no labs drawn: investigation of machine and human errors caused by an interface idiosyncrasy.

    Science.gov (United States)

    Schreiber, Richard; Sittig, Dean F; Ash, Joan; Wright, Adam

    2017-09-01

    In this report, we describe 2 instances in which expert use of an electronic health record (EHR) system interfaced to an external clinical laboratory information system led to unintended consequences wherein 2 patients failed to have laboratory tests drawn in a timely manner. In both events, user actions combined with the lack of an acknowledgment message describing the order cancellation from the external clinical system were the root causes. In 1 case, rapid, near-simultaneous order entry was the culprit; in the second, astute order management by a clinician, unaware of the lack of proper 2-way interface messaging from the external clinical system, led to the confusion. Although testing had shown that the laboratory system would cancel duplicate laboratory orders, it was thought that duplicate alerting in the new order entry system would prevent such events. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  8. Ethics and the electronic health record in dental school clinics.

    Science.gov (United States)

    Cederberg, Robert A; Valenza, John A

    2012-05-01

    Electronic health records (EHRs) are a major development in the practice of dentistry, and dental schools and dental curricula have benefitted from this technology. Patient data entry, storage, retrieval, transmission, and archiving have been streamlined, and the potential for teledentistry and improvement in epidemiological research is beginning to be realized. However, maintaining patient health information in an electronic form has also changed the environment in dental education, setting up potential ethical dilemmas for students and faculty members. The purpose of this article is to explore some of the ethical issues related to EHRs, the advantages and concerns related to the use of computers in the dental operatory, the impact of the EHR on the doctor-patient relationship, the introduction of web-based EHRs, the link between technology and ethics, and potential solutions for the management of ethical concerns related to EHRs in dental schools.

  9. Six switches solution for single-phase AC/DC/AC converter with capability of second-order power mitigation in DC-link capacitor

    DEFF Research Database (Denmark)

    Liu, Xiong; Wang, Peng; Loh, Poh Chiang

    2011-01-01

    This paper proposes an approach for DC-link second-order harmonic power cancellation in single-phase AC/DC/AC converter with reduced number of switches. The proposed six-switch converter has two bridges with three switches in each of them, where the middle switch in each bridge is shared by the A...

  10. Rate of electronic health record adoption in South Korea: A nation-wide survey.

    Science.gov (United States)

    Kim, Young-Gun; Jung, Kyoungwon; Park, Young-Taek; Shin, Dahye; Cho, Soo Yeon; Yoon, Dukyong; Park, Rae Woong

    2017-05-01

    The adoption rate of electronic health record (EHR) systems in South Korea has continuously increased. However, in contrast to the situation in the United States (US), where there has been a national effort to improve and standardize EHR interoperability, no consensus has been established in South Korea. The goal of this study was to determine the current status of EHR adoption in South Korean hospitals compared to that in the US. All general and tertiary teaching hospitals in South Korea were surveyed regarding their EHR status in 2015 with the same questionnaire as used previously. The survey form estimated the level of adoption of EHR systems according to 24 core functions in four categories (clinical documentation, result view, computerized provider order entry, and decision supports). The adoption level was classified into comprehensive and basic EHR systems according to their functionalities. EHRs and computerized physician order entry systems were used in 58.1% and 86.0% of South Korean hospitals, respectively. Decision support systems and problem list documentation were the functions most frequently missing from comprehensive and basic EHR systems. The main barriers cited to adoption of EHR systems were the cost of purchasing (48%) and the ongoing cost of maintenance (11%). The EHR adoption rate in Korean hospitals (37.2%) was higher than that in US hospitals in 2010 (15.1%), but this trend was reversed in 2015 (58.1% vs. 75.2%). The evidence suggests that these trends were influenced by the level of financial and political support provided to US hospitals after the HITECH Act was passed in 2009. The EHR adoption rate in Korea has increased, albeit more slowly than in the US. It is logical to suggest that increased funding and support tied to the HITECH Act in the US partly explains the difference in the adoption rates of EHRs in both countries. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. The influence of institutional pressures on hospital electronic health record presence.

    Science.gov (United States)

    Fareed, Naleef; Bazzoli, Gloria J; Farnsworth Mick, Stephen S; Harless, David W

    2015-05-01

    Electronic health records (EHR) are a promising form of health information technology that could help US hospitals improve on their quality of care and costs. During the study period explored (2005-2009), high expectations for EHR diffused across institutional stakeholders in the healthcare environment, which may have pressured hospitals to have EHR capabilities even in the presence of weak technical rationale for the technology. Using an extensive set of organizational theory-specific predictors, this study explored whether five factors - cause, constituents, content, context, and control - that reflect the nature of institutional pressures for EHR capabilities motivated hospitals to comply with these pressures. Using information from several national data bases, an ordered probit regression model was estimated. The resulting predicted probabilities of EHR capabilities from the empirical model's estimates were used to test the study's five hypotheses, of which three were supported. When the underlying cause, dependence on constituents, or influence of control were high and potential countervailing forces were low, hospitals were more likely to employ strategic responses that were compliant with the institutional pressures for EHR capabilities. In light of these pressures, hospitals may have acquiesced, by having comprehensive EHR capabilities, or compromised, by having intermediate EHR capabilities, in order to maintain legitimacy in their environment. The study underscores the importance of our assessment for theory and policy development, and provides suggestions for future research. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Determination of Minimum Data Set (MSD) in Echocardiography Reporting System to Exchange with Iran’s Electronic Health Record (EHR) System

    Science.gov (United States)

    Mahmoudvand, Zahra; Kamkar, Mehran; Shahmoradi, Leila; Nejad, Ahmadreza Farzaneh

    2016-01-01

    Background: Determination of minimum data set (MDS) in echocardiography reports is necessary for documentation and putting information in a standard way, and leads to the enhancement of electrocardiographic studies through having access to precise and perfect reports and also to the development of a standard database for electrocardiographic reports. Aim: to determine the minimum data set of echocardiography reporting system to exchange with Iran’s electronic health record (EHR) system. Methods: First, a list of minimum data set was prepared after reviewing texts and studying cardiac patients’ records. Then, to determine the content validity of the prepared MDS, the expert views of 10 cardiologists and 10 health information management (HIM) specialists were obtained; to estimate the reliability of the set, test-retest method was employed. Finally, the data were analyzed using SPSS software. Results: The highest degree of consensus was found for the following MDSs: patient’s name and family name (5), accepting doctor’s name and family name, familial death records due to cardiac disorders, the image identification code, mitral valve, aortic valve, tricuspid valve, pulmonary valve, left ventricle, hole, atrium valve, Doppler examination of ventricular and atrial movement models and diagnoses with an average of. Conclusions: To prepare a model of echocardiography reporting system to exchange with EHR system, creation a standard data set is the vital point. Therefore, based on the research findings, the minimum reporting system data to exchange with Iran’s electronic health record system include information on entity, management, medical record, carried-out acts, and the main content of the echocardiography report, which the planners of reporting system should consider. PMID:27147803

  13. The double-edged sword of electronic health records: implications for patient disclosure.

    Science.gov (United States)

    Campos-Castillo, Celeste; Anthony, Denise L

    2015-04-01

    Electronic health record (EHR) systems are linked to improvements in quality of care, yet also privacy and security risks. Results from research studies are mixed about whether patients withhold personal information from their providers to protect against the perceived EHR privacy and security risks. This study seeks to reconcile the mixed findings by focusing on whether accounting for patients' global ratings of care reveals a relationship between EHR provider-use and patient non-disclosure. A nationally representative sample from the 2012 Health Information National Trends Survey was analyzed using bivariate and multivariable logit regressions to examine whether global ratings of care suppress the relationship between EHR provider-use and patient non-disclosure. 13% of respondents reported having ever withheld information from a provider because of privacy/security concerns. Bivariate analysis showed that withholding information was unrelated to whether respondents' providers used an EHR. Multivariable analysis showed that accounting for respondents' global ratings of care revealed a positive relationship between having a provider who uses an EHR and withholding information. After accounting for global ratings of care, findings suggest that patients may non-disclose to providers to protect against the perceived EHR privacy and security risks. Despite evidence that EHRs inhibit patient disclosure, their advantages for promoting quality of care may outweigh the drawbacks. Clinicians should leverage the EHR's value in quality of care and discuss patients' privacy concerns during clinic visits, while policy makers should consider how to address the real and perceived privacy and security risks of EHRs. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  14. Energy-aware hybrid fruitfly optimization for load balancing in cloud environments for EHR applications

    Directory of Open Access Journals (Sweden)

    M. Lawanyashri

    Full Text Available Cloud computing has gained precise attention from the research community and management of IT, due to its scalable and dynamic capabilities. It is evolving as a vibrant technology to modernize and restructure healthcare organization to provide best services to the consumers. The rising demand for healthcare services and applications in cloud computing leads to the imbalance in resource usage and drastically increases the power consumption resulting in high operating cost. To achieve fast execution time and optimum utilization of the virtual machines, we propose a multi-objective hybrid fruitfly optimization technique based on simulated annealing to improve the convergence rate and optimization accuracy. The proposed approach is used to achieve the optimal resource utilization and reduces the energy consumption and cost in cloud computing environment. The result attained in our proposed technique provides an improved solution. The experimental results show that the proposed algorithm efficiently outperforms compared to the existing load balancing algorithms. Keywords: Cloud computing, Electronic Health Records (EHR, Load balancing, Fruitfly Optimization Algorithm (FOA, Simulated Annealing (SA, Energy consumption

  15. Querying archetype-based EHRs by search ontology-based XPath engineering.

    Science.gov (United States)

    Kropf, Stefan; Uciteli, Alexandr; Schierle, Katrin; Krücken, Peter; Denecke, Kerstin; Herre, Heinrich

    2018-05-11

    Legacy data and new structured data can be stored in a standardized format as XML-based EHRs on XML databases. Querying documents on these databases is crucial for answering research questions. Instead of using free text searches, that lead to false positive results, the precision can be increased by constraining the search to certain parts of documents. A search ontology-based specification of queries on XML documents defines search concepts and relates them to parts in the XML document structure. Such query specification method is practically introduced and evaluated by applying concrete research questions formulated in natural language on a data collection for information retrieval purposes. The search is performed by search ontology-based XPath engineering that reuses ontologies and XML-related W3C standards. The key result is that the specification of research questions can be supported by the usage of search ontology-based XPath engineering. A deeper recognition of entities and a semantic understanding of the content is necessary for a further improvement of precision and recall. Key limitation is that the application of the introduced process requires skills in ontology and software development. In future, the time consuming ontology development could be overcome by implementing a new clinical role: the clinical ontologist. The introduced Search Ontology XML extension connects Search Terms to certain parts in XML documents and enables an ontology-based definition of queries. Search ontology-based XPath engineering can support research question answering by the specification of complex XPath expressions without deep syntax knowledge about XPaths.

  16. 日本版EHR(Electronic Health Record)構築に向けて

    OpenAIRE

    水野, 正明; MIZUNO, Masaaki

    2011-01-01

    個人を基軸に国際レベルで医療・健康情報の共有を可能にしようとする仕組みがEHR(Electronic Health Record)である.我が国は先進諸国の一員としてこのEHRの整備を通して医療・健康の質の向上を目指すとともに,我が国におけるその成果を常に世界に発信していかなければならない.そのためには世界一と評価を受ける医療実績と医療の原点である信頼の上に立った優れたEHR基盤を整えなければならない.今,我が国の医療に適した日本版EHRの創出が求められている....

  17. Electronic health record innovations: Helping physicians - One less click at a time.

    Science.gov (United States)

    Guo, Uta; Chen, Lu; Mehta, Parag H

    2017-09-01

    Physician burnout is becoming an epidemic, due to the pressures of being productive, an imperfect electronic health record (EHR) system, and limited face-to-face time with patients. Poor usability in EHR-user interface can force users to go through more steps (i.e. more clicks on the computer) in accomplishing a task. This increased 'click burden' is a source of frustration for physicians. In the light of increased click burden and time due to meaningful use requirements, there is a need to improve the physician's experience by creating innovations in EHR. This case study describes an attempt by physicians at NewYork-Presbyterian Brooklyn Methodist Hospital to enhance the EHR experience with more efficient methods of documentation, chart review, ordering and patient safety. The EHR innovations trialled in this study were: a mobile documentation application; abnormal test results auto-populated into an EHR patient summary; physician alerts to reduce inappropriate test ordering; and a system of safety alerts on a dashboard. These innovations led to decreased click burden and allowed physicians to spend less time on the computer and more time with patients. Physician-driven changes to EHR systems have the potential to streamline virtual workflows and the management of health information and to improve patient safety, reduce physician burnout and increase physician job satisfaction.

  18. Using ISO 25040 standard for evaluating electronic health record systems.

    Science.gov (United States)

    Oliveira, Marília; Novaes, Magdala; Vasconcelos, Alexandre

    2013-01-01

    Quality of electronic health record systems (EHR-S) is one of the key points in the discussion about the safe use of this kind of system. It stimulates creation of technical standards and certifications in order to establish the minimum requirements expected for these systems. [1] In other side, EHR-S suppliers need to invest in evaluation of their products to provide systems according to these requirements. This work presents a proposal of use ISO 25040 standard, which focuses on the evaluation of software products, for define a model of evaluation of EHR-S in relation to Brazilian Certification for Electronic Health Record Systems - SBIS-CFM Certification. Proposal instantiates the process described in ISO 25040 standard using the set of requirements that is scope of the Brazilian certification. As first results, this research has produced an evaluation model and a scale for classify an EHR-S about its compliance level in relation to certification. This work in progress is part for the acquisition of the degree of master in Computer Science at the Federal University of Pernambuco.

  19. Development and evaluation of an electronic health record configuration and customization laboratory course for clinical informatics students.

    Science.gov (United States)

    Mohan, Vishnu; Hersh, William R

    2013-01-01

    There is a need for informatics educational programs to develop laboratory courses that facilitate hands-on access to an EHR, and allow students to learn and evaluate functionality and configuration options. This is particularly relevant given the diversity of backgrounds of informatics students. We implemented an EHR laboratory course that allowed students to explore an EHR in both inpatient and outpatient clinical environments. The course focused on specific elements of the EHR including order set development, customization, clinical decision support, ancillary services, and billing and coding functionality. Students were surveyed at the end of the course for their satisfaction with the learning experience. We detailed challenges as well as lessons learned after analyzing student evaluations of this course. Features that promote the successful offering of an online EHR course, include (1) using more than one EHR to allow students to compare functionalities, (2) ensuring appropriate course calibration, (3) countering issues specific to EHR usability, and (4) fostering a fertile environment for rich online conversations are discussed.

  20. Ordering phenomena in ABA triblock copolymer gels

    DEFF Research Database (Denmark)

    Reynders, K.; Mischenko, N.; Kleppinger, R.

    1997-01-01

    Temperature and concentration dependencies of the degree of order in ABA triblock copolymer gels are discussed. Two factors can influence the ordering phenomena: the conformation of the midblocks (links of the network) and the polydispersity of the endblock domains (nodes of the network). The lat......Temperature and concentration dependencies of the degree of order in ABA triblock copolymer gels are discussed. Two factors can influence the ordering phenomena: the conformation of the midblocks (links of the network) and the polydispersity of the endblock domains (nodes of the network...

  1. Patients’ online access to their electronic health records and linked online services: a systematic interpretative review

    Science.gov (United States)

    de Lusignan, Simon; Mold, Freda; Sheikh, Aziz; Majeed, Azeem; Wyatt, Jeremy C; Quinn, Tom; Cavill, Mary; Gronlund, Toto Anne; Franco, Christina; Chauhan, Umesh; Blakey, Hannah; Kataria, Neha; Barker, Fiona; Ellis, Beverley; Koczan, Phil; Arvanitis, Theodoros N; McCarthy, Mary; Jones, Simon; Rafi, Imran

    2014-01-01

    Objectives To investigate the effect of providing patients online access to their electronic health record (EHR) and linked transactional services on the provision, quality and safety of healthcare. The objectives are also to identify and understand: barriers and facilitators for providing online access to their records and services for primary care workers; and their association with organisational/IT system issues. Setting Primary care. Participants A total of 143 studies were included. 17 were experimental in design and subject to risk of bias assessment, which is reported in a separate paper. Detailed inclusion and exclusion criteria have also been published elsewhere in the protocol. Primary and secondary outcome measures Our primary outcome measure was change in quality or safety as a result of implementation or utilisation of online records/transactional services. Results No studies reported changes in health outcomes; though eight detected medication errors and seven reported improved uptake of preventative care. Professional concerns over privacy were reported in 14 studies. 18 studies reported concern over potential increased workload; with some showing an increase workload in email or online messaging; telephone contact remaining unchanged, and face-to face contact staying the same or falling. Owing to heterogeneity in reporting overall workload change was hard to predict. 10 studies reported how online access offered convenience, primarily for more advantaged patients, who were largely highly satisfied with the process when clinician responses were prompt. Conclusions Patient online access and services offer increased convenience and satisfaction. However, professionals were concerned about impact on workload and risk to privacy. Studies correcting medication errors may improve patient safety. There may need to be a redesign of the business process to engage health professionals in online access and of the EHR to make it friendlier and provide equity of

  2. Reducing Misses and Near Misses Related to Multitasking on the Electronic Health Record: Observational Study and Qualitative Analysis.

    Science.gov (United States)

    Ratanawongsa, Neda; Matta, George Y; Bohsali, Fuad B; Chisolm, Margaret S

    2018-02-06

    Clinicians' use of electronic health record (EHR) systems while multitasking may increase the risk of making errors, but silent EHR system use may lower patient satisfaction. Delaying EHR system use until after patient visits may increase clinicians' EHR workload, stress, and burnout. We aimed to describe the perspectives of clinicians, educators, administrators, and researchers about misses and near misses that they felt were related to clinician multitasking while using EHR systems. This observational study was a thematic analysis of perspectives elicited from 63 continuing medical education (CME) participants during 2 workshops and 1 interactive lecture about challenges and strategies for relationship-centered communication during clinician EHR system use. The workshop elicited reflection about memorable times when multitasking EHR use was associated with "misses" (errors that were not caught at the time) or "near misses" (mistakes that were caught before leading to errors). We conducted qualitative analysis using an editing analysis style to identify codes and then select representative themes and quotes. All workshop participants shared stories of misses or near misses in EHR system ordering and documentation or patient-clinician communication, wondering about "misses we don't even know about." Risk factors included the computer's position, EHR system usability, note content and style, information overload, problematic workflows, systems issues, and provider and patient communication behaviors and expectations. Strategies to reduce multitasking EHR system misses included clinician transparency when needing silent EHR system use (eg, for prescribing), narrating EHR system use, patient activation during EHR system use, adapting visit organization and workflow, improving EHR system design, and improving team support and systems. CME participants shared numerous stories of errors and near misses in EHR tasks and communication that they felt related to EHR

  3. Making electronic health records support quality management: A narrative review.

    Science.gov (United States)

    Triantafillou, Peter

    2017-08-01

    Since the 1990s many hospitals in the OECD countries have introduced electronic health record (EHR) systems. A number of studies have examined the factors impinging on EHR implementation. Others have studied the clinical efficacy of EHR. However, only few studies have explored the (intermediary) factors that make EHR systems conducive to quality management (QM). Undertake a narrative review of existing studies in order to identify and discuss the factors conducive to making EHR support three dimensions of QM: clinical outcomes, managerial monitoring and cost-effectiveness. A narrative review of Web of Science, Cochrane, EBSCO, ProQuest, Scopus and three Nordic research databases. most studies do not specify the type of EHR examined. 39 studies were identified for analysis. 10 factors were found to be conducive to make EHR support QM. However, the contribution of EHR to the three specific dimensions of QM varied substantially. Most studies (29) included clinical outcomes. However, only half of these reported EHR to have a positive impact. Almost all the studies (36) dealt with the ability of EHR to enhance managerial monitoring of clinical activities, the far majority of which showed a positive relationship. Finally, only five dealt with cost-effectiveness of which two found positive effects. The findings resonates well with previous reviews, though two factors making EHR support QM seem new, namely: political goals and strategies, and integration of guidelines for clinical conduct. Lacking EHR type specification and diversity in study method imply that there is a strong need for further research on the factors that may make EHR may support QM. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Ranking Medical Terms to Support Expansion of Lay Language Resources for Patient Comprehension of Electronic Health Record Notes: Adapted Distant Supervision Approach.

    Science.gov (United States)

    Chen, Jinying; Jagannatha, Abhyuday N; Fodeh, Samah J; Yu, Hong

    2017-10-31

    Medical terms are a major obstacle for patients to comprehend their electronic health record (EHR) notes. Clinical natural language processing (NLP) systems that link EHR terms to lay terms or definitions allow patients to easily access helpful information when reading through their EHR notes, and have shown to improve patient EHR comprehension. However, high-quality lay language resources for EHR terms are very limited in the public domain. Because expanding and curating such a resource is a costly process, it is beneficial and even necessary to identify terms important for patient EHR comprehension first. We aimed to develop an NLP system, called adapted distant supervision (ADS), to rank candidate terms mined from EHR corpora. We will give EHR terms ranked as high by ADS a higher priority for lay language annotation-that is, creating lay definitions for these terms. Adapted distant supervision uses distant supervision from consumer health vocabulary and transfer learning to adapt itself to solve the problem of ranking EHR terms in the target domain. We investigated 2 state-of-the-art transfer learning algorithms (ie, feature space augmentation and supervised distant supervision) and designed 5 types of learning features, including distributed word representations learned from large EHR data for ADS. For evaluating ADS, we asked domain experts to annotate 6038 candidate terms as important or nonimportant for EHR comprehension. We then randomly divided these data into the target-domain training data (1000 examples) and the evaluation data (5038 examples). We compared ADS with 2 strong baselines, including standard supervised learning, on the evaluation data. The ADS system using feature space augmentation achieved the best average precision, 0.850, on the evaluation set when using 1000 target-domain training examples. The ADS system using supervised distant supervision achieved the best average precision, 0.819, on the evaluation set when using only 100 target

  5. Benefits and drawbacks of electronic health record systems

    Directory of Open Access Journals (Sweden)

    Menachemi N

    2011-05-01

    Full Text Available Nir Menachemi¹, Taleah H Collum²¹Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA; ²Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USAAbstract: The Health Information Technology for Economic and Clinical Health (HITECH Act of 2009 that was signed into law as part of the "stimulus package" represents the largest US initiative to date that is designed to encourage widespread use of electronic health records (EHRs. In light of the changes anticipated from this policy initiative, the purpose of this paper is to review and summarize the literature on the benefits and drawbacks of EHR systems. Much of the literature has focused on key EHR functionalities, including clinical decision support systems, computerized order entry systems, and health information exchange. Our paper describes the potential benefits of EHRs that include clinical outcomes (eg, improved quality, reduced medical errors, organizational outcomes (eg, financial and operational benefits, and societal outcomes (eg, improved ability to conduct research, improved population health, reduced costs. Despite these benefits, studies in the literature highlight drawbacks associated with EHRs, which include the high upfront acquisition costs, ongoing maintenance costs, and disruptions to workflows that contribute to temporary losses in productivity that are the result of learning a new system. Moreover, EHRs are associated with potential perceived privacy concerns among patients, which are further addressed legislatively in the HITECH Act. Overall, experts and policymakers believe that significant benefits to patients and society can be realized when EHRs are widely adopted and used in a “meaningful” way.Keywords: EHR, health information technology, HITECH, computerized order entry, health information exchange 

  6. Applying an Archetype-Based Approach to Electroencephalography/Event-Related Potential Experiments in the EEGBase Resource.

    Science.gov (United States)

    Papež, Václav; Mouček, Roman

    2017-01-01

    The purpose of this study is to investigate the feasibility of applying openEHR (an archetype-based approach for electronic health records representation) to modeling data stored in EEGBase, a portal for experimental electroencephalography/event-related potential (EEG/ERP) data management. The study evaluates re-usage of existing openEHR archetypes and proposes a set of new archetypes together with the openEHR templates covering the domain. The main goals of the study are to (i) link existing EEGBase data/metadata and openEHR archetype structures and (ii) propose a new openEHR archetype set describing the EEG/ERP domain since this set of archetypes currently does not exist in public repositories. The main methodology is based on the determination of the concepts obtained from EEGBase experimental data and metadata that are expressible structurally by the openEHR reference model and semantically by openEHR archetypes. In addition, templates as the third openEHR resource allow us to define constraints over archetypes. Clinical Knowledge Manager (CKM), a public openEHR archetype repository, was searched for the archetypes matching the determined concepts. According to the search results, the archetypes already existing in CKM were applied and the archetypes not existing in the CKM were newly developed. openEHR archetypes support linkage to external terminologies. To increase semantic interoperability of the new archetypes, binding with the existing odML electrophysiological terminology was assured. Further, to increase structural interoperability, also other current solutions besides EEGBase were considered during the development phase. Finally, a set of templates using the selected archetypes was created to meet EEGBase requirements. A set of eleven archetypes that encompassed the domain of experimental EEG/ERP measurements were identified. Of these, six were reused without changes, one was extended, and four were newly created. All archetypes were arranged in the

  7. REDEN: Named Entity Linking in Digital Literary Editions Using Linked Data Sets

    Directory of Open Access Journals (Sweden)

    Carmen Brando

    2016-07-01

    Full Text Available This paper proposes a graph-based Named Entity Linking (NEL algorithm named REDEN for the disambiguation of authors’ names in French literary criticism texts and scientific essays from the 19th and early 20th centuries. The algorithm is described and evaluated according to the two phases of NEL as reported in current state of the art, namely, candidate retrieval and candidate selection. REDEN leverages knowledge from different Linked Data sources in order to select candidates for each author mention, subsequently crawls data from other Linked Data sets using equivalence links (e.g., owl:sameAs, and, finally, fuses graphs of homologous individuals into a non-redundant graph well-suited for graph centrality calculation; the resulting graph is used for choosing the best referent. The REDEN algorithm is distributed in open-source and follows current standards in digital editions (TEI and semantic Web (RDF. Its integration into an editorial workflow of digital editions in Digital humanities and cultural heritage projects is entirely plausible. Experiments are conducted along with the corresponding error analysis in order to test our approach and to help us to study the weaknesses and strengths of our algorithm, thereby to further improvements of REDEN.

  8. Electronic health records, adoption, quality of care, legal and privacy issues and their implementation in emergency departments.

    Science.gov (United States)

    Ben-Assuli, Ofir

    2015-03-01

    Recently, the healthcare sector has shown a growing interest in information technologies. Two popular health IT (HIT) products are the electronic health record (EHR) and health information exchange (HIE) networks. The introduction of these tools is believed to improve care, but has also raised some important questions and legal and privacy issues. The implementation of these systems has not gone smoothly, and still faces some considerable barriers. This article reviews EHR and HIE to address these obstacles, and analyzes the current state of development and adoption in various countries around the world. Moreover, legal and ethical concerns that may be encountered by EHR users and purchasers are reviewed. Finally, links and interrelations between EHR and HIE and several quality of care issues in today's healthcare domain are examined with a focus on EHR and HIE in the emergency department (ED), whose unique characteristics makes it an environment in which the implementation of such technology may be a major contributor to health, but also faces substantial challenges. The paper ends with a discussion of specific policy implications and recommendations based on an examination of the current limitations of these systems. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  9. 77 FR 60997 - Agency for Healthcare Research and Quality Agency Information Collection Activities: Proposed...

    Science.gov (United States)

    2012-10-05

    ... people in the United States. In order to fulfill the promise of EHRs for all patients, especially for... Information Rating System (HIRS), (2) create a library of patient health education materials, (3) review EHR's... reliable and valid rating system to assess the understandability and actionability of health education...

  10. A novel approach to leveraging electronic health record data to enhance pediatric surgical quality improvement bundle process compliance.

    Science.gov (United States)

    Fisher, Jason C; Godfried, David H; Lighter-Fisher, Jennifer; Pratko, Joseph; Sheldon, Mary Ellen; Diago, Thelma; Kuenzler, Keith A; Tomita, Sandra S; Ginsburg, Howard B

    2016-06-01

    Quality improvement (QI) bundles have been widely adopted to reduce surgical site infections (SSI). Improvement science suggests when organizations achieve high-reliability to QI processes, outcomes dramatically improve. However, measuring QI process compliance is poorly supported by electronic health record (EHR) systems. We developed a custom EHR tool to facilitate capture of process data for SSI prevention with the aim of increasing bundle compliance and reducing adverse events. Ten SSI prevention bundle processes were linked to EHR data elements that were then aggregated into a snapshot display superimposed on weekly case-log reports. The data aggregation and user interface facilitated efficient review of all SSI bundle elements, providing an exact bundle compliance rate without random sampling or chart review. Nine months after implementation of our custom EHR tool, we observed centerline shifts in median SSI bundle compliance (46% to 72%). Additionally, as predicted by high reliability principles, we began to see a trend toward improvement in SSI rates (1.68 to 0.87 per 100 operations), but a discrete centerline shift was not detected. Simple informatics solutions can facilitate extraction of QI process data from the EHR without relying on adjunctive systems. Analyses of these data may drive reductions in adverse events. Pediatric surgical departments should consider leveraging the EHR to enhance bundle compliance as they implement QI strategies. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Do service innovations influence the adoption of electronic health records in long-term care organizations? Results from the U.S. National Survey of Residential Care Facilities.

    Science.gov (United States)

    Bhuyan, Soumitra S; Zhu, He; Chandak, Aastha; Kim, Jungyoon; Stimpson, Jim P

    2014-12-01

    Healthcare organizations including residential care facilities (RCFs) are diversifying their services to meet market demands. Service innovations have been linked to the changes in the way that healthcare organizations organize their work. The objective of this study is to explore the relationship between organizational service innovations and Electronic Health Record (EHR) adoption in the RCFs. We used the data from the 2010 National Survey of Residential Care Facilities conducted by the Centers for Disease Control and Prevention. The outcome was whether an RCF adopted EHR or not, and the predictors were the organizational service innovations including provision of skilled nursing care and medication review. We also added facility characteristics as control variables. Weighted multivariate logistic regressions were used to estimate the relationship between service innovation factors and EHR adoption in the RCFs. In 2010, about 17.4% of the RCFs were estimated to use EHR. Multivariate analysis showed that RCFs employing service innovations were more likely to adopt EHR. The residential care facilities that provide skilled nursing services to their residents are more likely (OR: 1.42; 95% CI: 1.09-1.87) to adopt EHR. Similarly, RCFs with a provision of medication review were also more likely to adopt EHR (OR: 1.40; 95% CI: 1.00-1.95). Among the control variables, facility size, chain affiliation, ownership type, and Medicaid certification were significantly associated with EHR adoption. Our findings suggest that service innovations may drive EHR adoption in the RCFs in the United States. This can be viewed as a strategic attempt by RCFs to engage in a new business arrangement with hospitals and other health care organizations, where quality of care and interoperability of patients' records might play a vital role under the current healthcare reform. Future research could examine the relationship between service innovations and use of different EHR functionality in

  12. Adaptive laser link reconfiguration using constraint propagation

    Science.gov (United States)

    Crone, M. S.; Julich, P. M.; Cook, L. M.

    1993-01-01

    This paper describes Harris AI research performed on the Adaptive Link Reconfiguration (ALR) study for Rome Lab, and focuses on the application of constraint propagation to the problem of link reconfiguration for the proposed space based Strategic Defense System (SDS) Brilliant Pebbles (BP) communications system. According to the concept of operations at the time of the study, laser communications will exist between BP's and to ground entry points. Long-term links typical of RF transmission will not exist. This study addressed an initial implementation of BP's based on the Global Protection Against Limited Strikes (GPALS) SDI mission. The number of satellites and rings studied was representative of this problem. An orbital dynamics program was used to generate line-of-site data for the modeled architecture. This was input into a discrete event simulation implemented in the Harris developed COnstraint Propagation Expert System (COPES) Shell, developed initially on the Rome Lab BM/C3 study. Using a model of the network and several heuristics, the COPES shell was used to develop the Heuristic Adaptive Link Ordering (HALO) Algorithm to rank and order potential laser links according to probability of communication. A reduced set of links based on this ranking would then be used by a routing algorithm to select the next hop. This paper includes an overview of Constraint Propagation as an Artificial Intelligence technique and its embodiment in the COPES shell. It describes the design and implementation of both the simulation of the GPALS BP network and the HALO algorithm in COPES. This is described using a 59 Data Flow Diagram, State Transition Diagrams, and Structured English PDL. It describes a laser communications model and the heuristics involved in rank-ordering the potential communication links. The generation of simulation data is described along with its interface via COPES to the Harris developed View Net graphical tool for visual analysis of communications

  13. Wireless data link for FBTR

    International Nuclear Information System (INIS)

    Sundararajan, M.K.; Prabhakara Rao, G.; Ilango Sambasivan, S.; Swaminathan, P.; Ramakrishna, P.V.

    2004-01-01

    This paper deals with the design and development of a wireless data link for transmission of block pile signals at the Fast Breeder Test Reactor (FBTR) of Indira Gandhi Center for Atomic Research (IGCAR). This link is to establish wireless connectivity, typically at RS232C rates, over distances of the order of 50 m, and is expected to operate under electrically hostile conditions. (author)

  14. Interoperability of Electronic Health Records: A Physician-Driven Redesign.

    Science.gov (United States)

    Miller, Holly; Johns, Lucy

    2018-01-01

    PURPOSE: Electronic health records (EHRs), now used by hundreds of thousands of providers and encouraged by federal policy, have the potential to improve quality and decrease costs in health care. But interoperability, although technically feasible among different EHR systems, is the weak link in the chain of logic. Interoperability is inhibited by poor understanding, by suboptimal implementation, and at times by a disinclination to dilute market share or patient base on the part of vendors or providers, respectively. The intent of this project has been to develop a series of practicable recommendations that, if followed by EHR vendors and users, can promote and enhance interoperability, helping EHRs reach their potential. METHODOLOGY: A group of 11 physicians, one nurse, and one health policy consultant, practicing from California to Massachusetts, has developed a document titled "Feature and Function Recommendations To Optimize Clinician Usability of Direct Interoperability To Enhance Patient Care" that offers recommendations from the clinician point of view. This report introduces some of these recommendations and suggests their implications for policy and the "virtualization" of EHRs. CONCLUSION: Widespread adoption of even a few of these recommendations by designers and vendors would enable a major advance toward the "Triple Aim" of improving the patient experience, improving the health of populations, and reducing per capita costs.

  15. Teaching Inquiry with Linked Classes and Learning Communities

    Science.gov (United States)

    Piercey, Victor; Cullen, Roxanne

    2017-01-01

    In order to improve problem-solving dispositions, a section of an inquiry-based math sequence for first-year business students was linked with a section of our general education English sequence. We describe how the linked classes worked and compare some preliminary results from linked and unlinked sections of the math sequence.

  16. Readiness of the Belgian network of sentinel general practitioners to deliver electronic health record data for surveillance purposes: results of survey study.

    Science.gov (United States)

    Boffin, Nicole; Bossuyt, Nathalie; Vanthomme, Katrien; Van Casteren, Viviane

    2010-06-25

    In order to proceed from a paper based registration to a surveillance system that is based on extraction of electronic health records (EHR), knowledge is needed on the number and representativeness of sentinel GPs using a government-certified EHR system and the quality of EHR data for research, expressed in the compliance rate with three criteria: recording of home visits, use of prescription module and diagnostic subject headings. Data were collected by annual postal surveys between 2005 and 2009 among all sentinel GPs. We tested relations between four key GP characteristics (age, gender, language community, practice organisation) and use of a certified EHR system by multivariable logistic regression. The relation between EHR software package, GP characteristics and compliance with three quality criteria was equally measured by multivariable logistic regression. A response rate of 99% was obtained. Of 221 sentinel GPs, 55% participated in the surveillance without interruption from 2005 onwards, i.e. all five years, and 78% were participants in 2009. Sixteen certified EHR systems were used among 91% of the Dutch and 63% of the French speaking sentinel GPs. The EHR software package was strongly related to the community and only one EHR system was used by a comparable number of sentinel GPs in both communities. Overall, the prescription module was always used and home visits were usually recorded. Uniform subject headings were only sometimes used and the compliance with this quality criterion was almost exclusively related to the EHR software package in use. The challenge is to progress towards a sentinel network of GPs delivering care-based data that are (partly) extracted from well performing EHR systems and still representative for Belgian general practice.

  17. Utilidad de los arquetipos ISO 13606 para representar modelos clínicos detallados

    OpenAIRE

    Serrano, Pablo; Moner Cano, David; Sebastian, Tomás; Maldonado Segura, José Alberto; Navalón, Rafael; Robles Viejo, Montserrat; Gómez, Ángel

    2009-01-01

    Objetivo: Evaluar la utilidad de los Arquetipos ISO/CEN 13606 y openEHR en la representación de modelos clínicos detallados. Metodología: como editores de arquetipos se utilizaron LinkERH para ISO/CEN 13606 y los editores de Ocean Informatics y LiU para openEHR. Como caso de uso se representaron los conjuntos de datos identificados en los modelos locales de tres sistemas (hospital, UCI y atención primaria) en el dominio de la úlcera por decúbito, abarcando la observación, evalu...

  18. Patients' online access to their electronic health records and linked online services: a systematic interpretative review.

    Science.gov (United States)

    de Lusignan, Simon; Mold, Freda; Sheikh, Aziz; Majeed, Azeem; Wyatt, Jeremy C; Quinn, Tom; Cavill, Mary; Gronlund, Toto Anne; Franco, Christina; Chauhan, Umesh; Blakey, Hannah; Kataria, Neha; Barker, Fiona; Ellis, Beverley; Koczan, Phil; Arvanitis, Theodoros N; McCarthy, Mary; Jones, Simon; Rafi, Imran

    2014-09-08

    To investigate the effect of providing patients online access to their electronic health record (EHR) and linked transactional services on the provision, quality and safety of healthcare. The objectives are also to identify and understand: barriers and facilitators for providing online access to their records and services for primary care workers; and their association with organisational/IT system issues. Primary care. A total of 143 studies were included. 17 were experimental in design and subject to risk of bias assessment, which is reported in a separate paper. Detailed inclusion and exclusion criteria have also been published elsewhere in the protocol. Our primary outcome measure was change in quality or safety as a result of implementation or utilisation of online records/transactional services. No studies reported changes in health outcomes; though eight detected medication errors and seven reported improved uptake of preventative care. Professional concerns over privacy were reported in 14 studies. 18 studies reported concern over potential increased workload; with some showing an increase workload in email or online messaging; telephone contact remaining unchanged, and face-to face contact staying the same or falling. Owing to heterogeneity in reporting overall workload change was hard to predict. 10 studies reported how online access offered convenience, primarily for more advantaged patients, who were largely highly satisfied with the process when clinician responses were prompt. Patient online access and services offer increased convenience and satisfaction. However, professionals were concerned about impact on workload and risk to privacy. Studies correcting medication errors may improve patient safety. There may need to be a redesign of the business process to engage health professionals in online access and of the EHR to make it friendlier and provide equity of access to a wider group of patients. A1 SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO

  19. Using intranet-based order sets to standardize clinical care and prepare for computerized physician order entry.

    Science.gov (United States)

    Heffner, John E; Brower, Kathleen; Ellis, Rosemary; Brown, Shirley

    2004-07-01

    The high cost of computerized physician order entry (CPOE) and physician resistance to standardized care have delayed implementation. An intranet-based order set system can provide some of CPOE's benefits and offer opportunities to acculturate physicians toward standardized care. INTRANET CLINICIAN ORDER FORMS (COF): The COF system at the Medical University of South Carolina (MUSC) allows caregivers to enter and print orders through the intranet at points of care and to access decision support resources. Work on COF began in March 2000 with transfer of 25 MUSC paper-based order set forms to an intranet site. Physician groups developed additional order sets, which number more than 200. Web traffic increased progressively during a 24-month period, peaking at more than 6,400 hits per month to COF. Decision support tools improved compliance with Centers for Medicare & Medicaid Services core indicators. Clinicians demonstrated a willingness to develop and use order sets and decision support tools posted on the COF site. COF provides a low-cost method for preparing caregivers and institutions to adopt CPOE and standardization of care. The educational resources, relevant links to external resources, and communication alerts will all link to CPOE, thereby providing a head start in CPOE implementation.

  20. Link prediction via generalized coupled tensor factorisation

    DEFF Research Database (Denmark)

    Ermiş, Beyza; Evrim, Acar Ataman; Taylan Cemgil, A.

    2012-01-01

    and higher-order tensors. We propose to use an approach based on probabilistic interpretation of tensor factorisation models, i.e., Generalised Coupled Tensor Factorisation, which can simultaneously fit a large class of tensor models to higher-order tensors/matrices with com- mon latent factors using...... different loss functions. Numerical experiments demonstrate that joint analysis of data from multiple sources via coupled factorisation improves the link prediction performance and the selection of right loss function and tensor model is crucial for accurately predicting missing links....

  1. Number comparison and number ordering as predictors of arithmetic performance in adults: Exploring the link between the two skills, and investigating the question of domain-specificity.

    Science.gov (United States)

    Morsanyi, Kinga; O'Mahony, Eileen; McCormack, Teresa

    2017-12-01

    Recent evidence has highlighted the important role that number-ordering skills play in arithmetic abilities, both in children and adults. In the current study, we demonstrated that number comparison and ordering skills were both significantly related to arithmetic performance in adults, and the effect size was greater in the case of ordering skills. Additionally, we found that the effect of number comparison skills on arithmetic performance was mediated by number-ordering skills. Moreover, performance on comparison and ordering tasks involving the months of the year was also strongly correlated with arithmetic skills, and participants displayed similar (canonical or reverse) distance effects on the comparison and ordering tasks involving months as when the tasks included numbers. This suggests that the processes responsible for the link between comparison and ordering skills and arithmetic performance are not specific to the domain of numbers. Finally, a factor analysis indicated that performance on comparison and ordering tasks loaded on a factor that included performance on a number line task and self-reported spatial thinking styles. These results substantially extend previous research on the role of order processing abilities in mental arithmetic.

  2. Electronic Health Record-Related Safety Concerns: A Cross-Sectional Survey of Electronic Health Record Users

    Science.gov (United States)

    Pajunen, Tuuli; Saranto, Kaija; Lehtonen, Lasse

    2016-01-01

    systematic assessments of EHR risks before harmful events occur. An EHR training program should be compulsory for all EHR users in order to address EHR safety concerns resulting from the failure to use HIT appropriately. PMID:27154599

  3. A systematic literature review on security and privacy of electronic health record systems: technical perspectives.

    Science.gov (United States)

    Rezaeibagha, Fatemeh; Win, Khin Than; Susilo, Willy

    Even though many safeguards and policies for electronic health record (EHR) security have been implemented, barriers to the privacy and security protection of EHR systems persist. This article presents the results of a systematic literature review regarding frequently adopted security and privacy technical features of EHR systems. Our inclusion criteria were full articles that dealt with the security and privacy of technical implementations of EHR systems published in English in peer-reviewed journals and conference proceedings between 1998 and 2013; 55 selected studies were reviewed in detail. We analysed the review results using two International Organization for Standardization (ISO) standards (29100 and 27002) in order to consolidate the study findings. Using this process, we identified 13 features that are essential to security and privacy in EHRs. These included system and application access control, compliance with security requirements, interoperability, integration and sharing, consent and choice mechanism, policies and regulation, applicability and scalability and cryptography techniques. This review highlights the importance of technical features, including mandated access control policies and consent mechanisms, to provide patients' consent, scalability through proper architecture and frameworks, and interoperability of health information systems, to EHR security and privacy requirements.

  4. Euglenophyceae de ambientes lênticos na planície costeira do Rio Grande do Sul, Sul do Brasil: gêneros Euglena Ehr. e Lepocinclis Perty Euglenophyceae of lentic environments at the coastal plain of Rio Grande do Sul State, South of Brazil: genera Euglena Ehr. and Lepocinclis Perty

    Directory of Open Access Journals (Sweden)

    Sandra Maria Alves-da-Silva

    2006-06-01

    Full Text Available São apresentados 28 táxons específicos e infra-específicos dos gêneros Euglena Ehr. e Lepocinclis Perty como resultado do estudo do fitoplâncton e perifíton em ambientes lênticos (lagoas, açude e banhados da Lagoa do Casamento e ecossistemas associados (30º03'- 30º34'S e 50º25'- 50º47'W e ecossistemas próximos ao Butiazal de Tapes (30º23'- 30º38'S e 51º16'- 51º29'W na planície costeira do Rio Grande do Sul. As coletas abrangeram as estações de outono e primavera de 2003. As áreas úmidas (banhados associadas à Lagoa do Casamento na primavera de 2003 apresentaram maior riqueza específica destes dois gêneros. Lepocinclis salina Fritsch var. salina foi a espécie que se distinguiu quanto a distribuição por ter ocorrido em 41,2% do total de amostras analisadas. São novos registros para o estado do Rio Grande do Sul e país, L. playfairiana Defl. var. playfairiana e L. boseensis Xie, Qiu & Ling.Twenty eight specific and infra-specific taxa of the genera Euglena Ehr. and Lepocinclis Perty are presented as a result of phytoplankton and periphyton study in lentic systems next to Lagoa do Casamento (30º03'- 30º34'S and 50º25'- 50º47'W and Butiazal de Tapes (30º23'- 30º38'S and 51º16'- 51º29'W, coastal zone of Rio Grande do Sul State. Samples were collected in autumn and spring seasons in 2003. The swamps associated to Lagoa do Casamento in spring of 2003 presented more specific richness of these two genera. Lepocinclis salina Fritsch var. salina distinguished by its distribution, occuring in 41,2% of the analized samples. Two taxa are new records for the State and Brazil: L. playfairiana Defl. var. playfairiana and L. boseensis Xie, Qiu & Ling.

  5. Readiness of the Belgian network of sentinel general practitioners to deliver electronic health record data for surveillance purposes: results of survey study

    Directory of Open Access Journals (Sweden)

    Vanthomme Katrien

    2010-06-01

    Full Text Available Abstract Background In order to proceed from a paper based registration to a surveillance system that is based on extraction of electronic health records (EHR, knowledge is needed on the number and representativeness of sentinel GPs using a government-certified EHR system and the quality of EHR data for research, expressed in the compliance rate with three criteria: recording of home visits, use of prescription module and diagnostic subject headings. Methods Data were collected by annual postal surveys between 2005 and 2009 among all sentinel GPs. We tested relations between four key GP characteristics (age, gender, language community, practice organisation and use of a certified EHR system by multivariable logistic regression. The relation between EHR software package, GP characteristics and compliance with three quality criteria was equally measured by multivariable logistic regression. Results A response rate of 99% was obtained. Of 221 sentinel GPs, 55% participated in the surveillance without interruption from 2005 onwards, i.e. all five years, and 78% were participants in 2009. Sixteen certified EHR systems were used among 91% of the Dutch and 63% of the French speaking sentinel GPs. The EHR software package was strongly related to the community and only one EHR system was used by a comparable number of sentinel GPs in both communities. Overall, the prescription module was always used and home visits were usually recorded. Uniform subject headings were only sometimes used and the compliance with this quality criterion was almost exclusively related to the EHR software package in use. Conclusions The challenge is to progress towards a sentinel network of GPs delivering care-based data that are (partly extracted from well performing EHR systems and still representative for Belgian general practice.

  6. Studies of future readout links for the CMS experiment

    CERN Document Server

    Bukowiec, Sebastian

    2010-01-01

    This paper studies a possible replacement of the existing S-LINK64 implementation by an optical link, based on 10 Gigabit Ethernet. The new link will employ commercial protocols in order to be able to receive the data by standard hardware components like PCs or network switches. Currently prototypes using multiple Gigabit Ethernet links are being developed and tested. The paper summarizes the status of these studies.

  7. Spatial attention interacts with serial-order retrieval from verbal working memory.

    Science.gov (United States)

    van Dijck, Jean-Philippe; Abrahamse, Elger L; Majerus, Steve; Fias, Wim

    2013-09-01

    The ability to maintain the serial order of events is recognized as a major function of working memory. Although general models of working memory postulate a close link between working memory and attention, such a link has so far not been proposed specifically for serial-order working memory. The present study provided the first empirical demonstration of a direct link between serial order in verbal working memory and spatial selective attention. We show that the retrieval of later items of a sequence stored in working memory-compared with that of earlier items-produces covert attentional shifts toward the right. This observation suggests the conceptually surprising notion that serial-order working memory, even for nonspatially defined verbal items, draws on spatial attention.

  8. MedlinePlus Milestones: 1998-present

    Science.gov (United States)

    ... Connect , a service linking patients or providers in electronic health record (EHR) systems to related MedlinePlus information on conditions ... updates Subscribe to RSS Follow us Disclaimers Copyright Privacy Accessibility Quality Guidelines Viewers & Players MedlinePlus Connect for ...

  9. Trust in government and support for governmental regulation: the case of electronic health records.

    Science.gov (United States)

    Herian, Mitchel N; Shank, Nancy C; Abdel-Monem, Tarik L

    2014-12-01

    This paper presents results from a public engagement effort in Nebraska, USA, which measured public opinions about governmental involvement in encouraging the use of electronic health records (EHRs). We examine the role of trust in government in contributing to public support for government involvement in the development of EHR technologies. We hypothesize that trust in government will lead to support for federal and state governmental encouragement of the use of EHRs among doctors and insurance companies. Further, because individual experiences with health-care professionals will reduce perceptions of risk, we expect that support for governmental involvement will be tempered by greater personal experience with the health-care industry. Examining a small survey of individuals on the issue, we find general support for both of our hypotheses. The findings suggest that trust in government does have a positive relationship with support for government involvement in the policy domain, but that the frequency of personal experiences with health-care providers reduces the extent to which the public supports governmental involvement in the development of EHR technology. This inquiry contributes to our understanding of public attitudes towards government involvement in EHRs in the United States specifically and contributes to social science examining links between trust in government and support for governmental activity in the emerging policy domain regarding electronic health records systems. © 2012 John Wiley & Sons Ltd.

  10. Recommendation of standardized health learning contents using archetypes and semantic web technologies.

    Science.gov (United States)

    Legaz-García, María del Carmen; Martínez-Costa, Catalina; Menárguez-Tortosa, Marcos; Fernández-Breis, Jesualdo Tomás

    2012-01-01

    Linking Electronic Healthcare Records (EHR) content to educational materials has been considered a key international recommendation to enable clinical engagement and to promote patient safety. This would suggest citizens to access reliable information available on the web and to guide them properly. In this paper, we describe an approach in that direction, based on the use of dual model EHR standards and standardized educational contents. The recommendation method will be based on the semantic coverage of the learning content repository for a particular archetype, which will be calculated by applying semantic web technologies like ontologies and semantic annotations.

  11. Study of Euglenophyta in the Jacuí Delta State Park, Rio Grande do Sul, Brazil. 1. Euglena Ehr., Lepocinclis Perty Estudo de Euglenophyta no Parque Estadual Delta do Jacuí, Rio Grande do Sul, Brasil, 1. Euglena Ehr., Lepocinclis Perty

    Directory of Open Access Journals (Sweden)

    Sandra Maria Alves-da-Silva

    2004-03-01

    Full Text Available This paper is the result of the study of pigmented Euglenaceae performed within the area of the Jacuí Delta State Park, located between parallels 29º56' and 30º03'S and meridians 51º12'and 51º18'W, with qualitative samplings at 25 stations, distributed over 8 islands, 8 "sacos" (i.e. small bays, 4 river mouths, 2 stream mouths and 3 channels in December/1993 and January/1994, and from February/1998 to December/1999. One hundred and fifty taxa of the Euglenophyceae were identified in the area. Currently 23 specific and infraspecific taxa of genus Euglena and 12 taxa of Lepocinclis are presented. E. acus Ehr. var. acus, and L. salina Fritsch var. salina were the taxa best represented in the region since they occured in over 40% of the samples studied. E. bonettoi (Tell & Zaloc. Couté & Thérez., L. playfairiana Defl. var. striata Conf. and L. caudata (Cunha Conr. were recorded exclusively for South America; sixteen taxa identified have a cosmopolitan distribution. Ranges of some abiotic variables of the environments in which each taxon occurred in the study area are mentioned.Este trabalho é o resultado do estudo de Euglenaceae pigmentadas realizado na área do Parque Estadual Delta do Jacuí, localizado entre paralelos 29º56' e 30º03'S e os meridianos 51º12'e 51º18'W, com amostragens qualitativas em 25 estações de coletas distribuídas em 8 ilhas, 8 sacos, 6 desembocaduras de rios e 3 canais, em dezembro/1993 e janeiro/1994 e de fevereiro/1998 a dezembro/1999. Foram identificados na área cerca de 150 táxons de Euglenophyceae. São apresentados, neste trabalho, 23 táxons específicos e infra-específicos do gênero Euglena e 12 táxons de Lepocinclis. E. acus Ehr. var. acus e L. salina Fritsch var. salina foram os táxons melhor representados na área por ocorrerem em mais de 40% dos biótopos estudados. E. bonettoi (Tell & Zaloc. Couté & Thérez., L. playfairiana Defl. var. striata Conf. e L. caudata (Cunha Conr. foram

  12. Refinement of the localization of the X-linked ocular albinism gene

    NARCIS (Netherlands)

    Bergen, A. A.; Zijp, P.; Schuurman, E. J.; Bleeker-Wagemakers, E. M.; Apkarian, P.; van Ommen, G. J.

    1993-01-01

    Although physical and genetic mapping studies assigned the X-linked ocular albinism gene to Xp22.3, the exact gene order in this region is still unclear. We present additional genetic mapping data concerning X-linked ocular albinism that suggests the consensus order Xpter-STS-DXS237-KAL-(OA1,

  13. Patients' online access to their electronic health records and linked online services: a systematic review in primary care.

    Science.gov (United States)

    Mold, Freda; de Lusignan, Simon; Sheikh, Aziz; Majeed, Azeem; Wyatt, Jeremy C; Quinn, Tom; Cavill, Mary; Franco, Christina; Chauhan, Umesh; Blakey, Hannah; Kataria, Neha; Arvanitis, Theodoros N; Ellis, Beverley

    2015-03-01

    Online access to medical records by patients can potentially enhance provision of patient-centred care and improve satisfaction. However, online access and services may also prove to be an additional burden for the healthcare provider. To assess the impact of providing patients with access to their general practice electronic health records (EHR) and other EHR-linked online services on the provision, quality, and safety of health care. A systematic review was conducted that focused on all studies about online record access and transactional services in primary care. Data sources included MEDLINE, Embase, CINAHL, Cochrane Library, EPOC, DARE, King's Fund, Nuffield Health, PsycINFO, OpenGrey (1999-2012). The literature was independently screened against detailed inclusion and exclusion criteria; independent dual data extraction was conducted, the risk of bias (RoB) assessed, and a narrative synthesis of the evidence conducted. A total of 176 studies were identified, 17 of which were randomised controlled trials, cohort, or cluster studies. Patients reported improved satisfaction with online access and services compared with standard provision, improved self-care, and better communication and engagement with clinicians. Safety improvements were patient-led through identifying medication errors and facilitating more use of preventive services. Provision of online record access and services resulted in a moderate increase of e-mail, no change on telephone contact, but there were variable effects on face-to-face contact. However, other tasks were necessary to sustain these services, which impacted on clinician time. There were no reports of harm or breaches in privacy. While the RoB scores suggest many of the studies were of low quality, patients using online services reported increased convenience and satisfaction. These services positively impacted on patient safety, although there were variations of record access and use by specific ethnic and socioeconomic groups

  14. Patients’ online access to their electronic health records and linked online services: a systematic review in primary care

    Science.gov (United States)

    Mold, Freda; de Lusignan, Simon; Sheikh, Aziz; Majeed, Azeem; Wyatt, Jeremy C; Quinn, Tom; Cavill, Mary; Franco, Christina; Chauhan, Umesh; Blakey, Hannah; Kataria, Neha; Arvanitis, Theodoros N; Ellis, Beverley

    2015-01-01

    Background Online access to medical records by patients can potentially enhance provision of patient-centred care and improve satisfaction. However, online access and services may also prove to be an additional burden for the healthcare provider. Aim To assess the impact of providing patients with access to their general practice electronic health records (EHR) and other EHR-linked online services on the provision, quality, and safety of health care. Design and setting A systematic review was conducted that focused on all studies about online record access and transactional services in primary care. Method Data sources included MEDLINE, Embase, CINAHL, Cochrane Library, EPOC, DARE, King’s Fund, Nuffield Health, PsycINFO, OpenGrey (1999–2012). The literature was independently screened against detailed inclusion and exclusion criteria; independent dual data extraction was conducted, the risk of bias (RoB) assessed, and a narrative synthesis of the evidence conducted. Results A total of 176 studies were identified, 17 of which were randomised controlled trials, cohort, or cluster studies. Patients reported improved satisfaction with online access and services compared with standard provision, improved self-care, and better communication and engagement with clinicians. Safety improvements were patient-led through identifying medication errors and facilitating more use of preventive services. Provision of online record access and services resulted in a moderate increase of e-mail, no change on telephone contact, but there were variable effects on face-to-face contact. However, other tasks were necessary to sustain these services, which impacted on clinician time. There were no reports of harm or breaches in privacy. Conclusion While the RoB scores suggest many of the studies were of low quality, patients using online services reported increased convenience and satisfaction. These services positively impacted on patient safety, although there were variations of

  15. Awareness of the Care Team in Electronic Health Records

    Science.gov (United States)

    Vawdrey, D.K.; Wilcox, L.G.; Collins, S.; Feiner, S.; Mamykina, O.; Stein, D.M.; Bakken, S.; Fred, M.R.; Stetson, P.D.

    2011-01-01

    Objective To support collaboration and clinician-targeted decision support, electronic health records (EHRs) must contain accurate information about patients’ care providers. The objective of this study was to evaluate two approaches for care provider identification employed within a commercial EHR at a large academic medical center. Methods We performed a retrospective review of EHR data for 121 patients in two cardiology wards during a four-week period. System audit logs of chart accesses were analyzed to identify the clinicians who were likely participating in the patients’ hospital care. The audit log data were compared with two functions in the EHR for documenting care team membership: 1) a vendor-supplied module called “Care Providers”, and 2) a custom “Designate Provider” order that was created primarily to improve accuracy of the attending physician of record documentation. Results For patients with a 3–5 day hospital stay, an average of 30.8 clinicians accessed the electronic chart, including 10.2 nurses, 1.4 attending physicians, 2.3 residents, and 5.4 physician assistants. The Care Providers module identified 2.7 clinicians/patient (1.8 attending physicians and 0.9 nurses). The Designate Provider order identified 2.1 clinicians/patient (1.1 attending physicians, 0.2 resident physicians, and 0.8 physician assistants). Information about other members of patients’ care teams (social workers, dietitians, pharmacists, etc.) was absent. Conclusions The two methods for specifying care team information failed to identify numerous individuals involved in patients’ care, suggesting that commercial EHRs may not provide adequate tools for care team designation. Improvements to EHR tools could foster greater collaboration among care teams and reduce communication-related risks to patient safety. PMID:22574103

  16. Reducing Parental Uncertainty Around Childhood Cancer: Implementation Decisions and Design Trade-Offs in Developing an Electronic Health Record-Linked Mobile App.

    Science.gov (United States)

    Marsolo, Keith; Shuman, William; Nix, Jeremy; Morrison, Caroline F; Mullins, Larry L; Pai, Ahna Lh

    2017-06-26

    Parents of children newly diagnosed with cancer are confronted with multiple stressors that place them at risk for significant psychological distress. One strategy that has been shown to help reduce uncertainty is the provision of basic information; however, families of newly diagnosed cancer patients are often bombarded with educational material. Technology has the potential to help families manage their informational needs and move towards normalization. The aim of this study was to create a mobile app that pulls together data from both the electronic health record (EHR) and vetted external information resources to provide tailored information to parents of newly diagnosed children as one method to reduce the uncertainty around their child's illness. This app was developed to be used by families in a National Institutes of Health (NIH)-funded randomized controlled trial (RCT) aimed at decreasing uncertainty and the subsequent psychological distress. A 2-phase qualitative study was conducted to elicit the features and content of the mobile app based on the needs and experience of parents of children newly diagnosed with cancer and their providers. Example functions include the ability to view laboratory results, look up appointments, and to access educational material. Educational material was obtained from databases maintained by the National Cancer Institute (NCI) as well as from groups like the Children's Oncology Group (COG) and care teams within Cincinnati Children's Hospital Medical Center (CCHMC). The use of EHR-based Web services was explored to allow data like laboratory results to be retrieved in real-time. The ethnographic design process resulted in a framework that divided the content of the mobile app into the following 4 sections: (1) information about the patient's current treatment and other data from the EHR; (2) educational background material; (3) a calendar to view upcoming appointments at their medical center; and (4) a section where

  17. Electronic health record usability: analysis of the user-centered design processes of eleven electronic health record vendors.

    Science.gov (United States)

    Ratwani, Raj M; Fairbanks, Rollin J; Hettinger, A Zachary; Benda, Natalie C

    2015-11-01

    The usability of electronic health records (EHRs) continues to be a point of dissatisfaction for providers, despite certification requirements from the Office of the National Coordinator that require EHR vendors to employ a user-centered design (UCD) process. To better understand factors that contribute to poor usability, a research team visited 11 different EHR vendors in order to analyze their UCD processes and discover the specific challenges that vendors faced as they sought to integrate UCD with their EHR development. Our analysis demonstrates a diverse range of vendors' UCD practices that fall into 3 categories: well-developed UCD, basic UCD, and misconceptions of UCD. Specific challenges to practicing UCD include conducting contextually rich studies of clinical workflow, recruiting participants for usability studies, and having support from leadership within the vendor organization. The results of the study provide novel insights for how to improve usability practices of EHR vendors. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  18. For Developers

    Science.gov (United States)

    ... health IT providers to link patient portals and electronic health record (EHR) systems to content from MedlinePlus.gov. MedlinePlus ... updates Subscribe to RSS Follow us Disclaimers Copyright Privacy Accessibility Quality Guidelines Viewers & Players MedlinePlus Connect for ...

  19. MedlinePlus FAQ: What's the difference between MedlinePlus and MedlinePlus Connect?

    Science.gov (United States)

    ... MedlinePlus Connect is a free service that allows electronic health record (EHR) systems to easily link users to MedlinePlus, ... updates Subscribe to RSS Follow us Disclaimers Copyright Privacy Accessibility Quality Guidelines Viewers & Players MedlinePlus Connect for ...

  20. Drugs + HIV, Learn the Link

    Medline Plus

    Full Text Available ... and Drugs Publications Search Publications Orderable DrugFacts Research Reports Mind Over Matter Science of Addiction Funding Funding ... transmitting HIV/AIDS or other infectious diseases. Research Reports: HIV/AIDS : Explores the link between drug misuse ...

  1. The Influence of Big (Clinical) Data and Genomics on Precision Medicine and Drug Development.

    Science.gov (United States)

    Denny, Joshua C; Van Driest, Sara L; Wei, Wei-Qi; Roden, Dan M

    2018-03-01

    Drug development continues to be costly and slow, with medications failing due to lack of efficacy or presence of toxicity. The promise of pharmacogenomic discovery includes tailoring therapeutics based on an individual's genetic makeup, rational drug development, and repurposing medications. Rapid growth of large research cohorts, linked to electronic health record (EHR) data, fuels discovery of new genetic variants predicting drug action, supports Mendelian randomization experiments to show drug efficacy, and suggests new indications for existing medications. New biomedical informatics and machine-learning approaches advance the ability to interpret clinical information, enabling identification of complex phenotypes and subpopulations of patients. We review the recent history of use of "big data" from EHR-based cohorts and biobanks supporting these activities. Future studies using EHR data, other information sources, and new methods will promote a foundation for discovery to more rapidly advance precision medicine. © 2017 American Society for Clinical Pharmacology and Therapeutics.

  2. A federated semantic metadata registry framework for enabling interoperability across clinical research and care domains.

    Science.gov (United States)

    Sinaci, A Anil; Laleci Erturkmen, Gokce B

    2013-10-01

    In order to enable secondary use of Electronic Health Records (EHRs) by bridging the interoperability gap between clinical care and research domains, in this paper, a unified methodology and the supporting framework is introduced which brings together the power of metadata registries (MDR) and semantic web technologies. We introduce a federated semantic metadata registry framework by extending the ISO/IEC 11179 standard, and enable integration of data element registries through Linked Open Data (LOD) principles where each Common Data Element (CDE) can be uniquely referenced, queried and processed to enable the syntactic and semantic interoperability. Each CDE and their components are maintained as LOD resources enabling semantic links with other CDEs, terminology systems and with implementation dependent content models; hence facilitating semantic search, much effective reuse and semantic interoperability across different application domains. There are several important efforts addressing the semantic interoperability in healthcare domain such as IHE DEX profile proposal, CDISC SHARE and CDISC2RDF. Our architecture complements these by providing a framework to interlink existing data element registries and repositories for multiplying their potential for semantic interoperability to a greater extent. Open source implementation of the federated semantic MDR framework presented in this paper is the core of the semantic interoperability layer of the SALUS project which enables the execution of the post marketing safety analysis studies on top of existing EHR systems. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Drugs + HIV, Learn the Link

    Medline Plus

    Full Text Available ... Health Professionals Patients & Families Parents & Educators Children & Teens Search Connect with NIDA : Facebook LinkedIn Twitter YouTube Flickr ... Populations Treatment Trends & Statistics Women and Drugs Publications Search Publications Orderable DrugFacts Research Reports Mind Over Matter ...

  4. Enterprise Linked Data as Core Business Infrastructure

    Science.gov (United States)

    Harris, Steve; Ilube, Tom; Tuffield, Mischa

    This chapter describes Garlik's motivation, interest, and experiences of using Linked Data technologies in its online services. It describes the methodologies and approaches that were taken in order to deploy online services to hundreds of thousands of users, and describes the trade-offs inherent in our choice of these technologies for our production systems. In order to help illustrate and aid the arguments for the adoption of SemanticWeb technologies this chapter will focus on two of our customer facing products, DataPatrol, a consumer-centric personal information protection product, and QDOS a Linked Data service that is used to measure peoples' online activity

  5. Effectiveness Of Security Controls On Electronic Health Records

    Directory of Open Access Journals (Sweden)

    Everleen Wanyonyi

    2017-12-01

    Full Text Available Electronic Health Record EHR systems enhance efficiency and effectiveness in handling patients information in healthcare. This study focused on the EHR security by initially establishing the nature of threats affecting the system and reviewing the implemented security safeguards. The study was done at a referral hospital level 6 government facility in Kenya. Purposive sampling was used to select a sample of 196 out of 385 staff and a questionnaire designed for qualitative data collection. Data was analyzed using SPSS software. Correlations and binary logistic regression were obtained. Binary Logistic Regression BLR was used to establish the effect of the safeguards predictors on EHR security. It was established that physical security contributes more to the security of an information system than administrative controls and technical controls in that order. BLR helped in predicting effective safeguards to control EHR security threats in limited resourced public health facilities.

  6. "It's like texting at the dinner table": A qualitative analysis of the impact of electronic health records on patient-physician interaction in hospitals.

    Science.gov (United States)

    Pelland, Kimberly D; Baier, Rosa R; Gardner, Rebekah L

    2017-06-30

    nBACKGROUND: Electronic health records (EHRs) may reduce medical errors and improve care, but can complicate clinical encounters. To describe hospital-based physicians' perceptions of the impact of EHRs on patient-physician interactions and contrast these findings against office-based physicians' perceptionsMethods: We performed a qualitative analysis of comments submitted in response to the 2014 Rhode Island Health Information Technology Survey. Office- and hospital-based physicians licensed in Rhode Island, in active practice, and located in Rhode Island or neighboring states completed the survey about their Electronic Health Record use. The survey's response rate was 68.3% and 2,236 (87.1%) respondents had EHRs. Among survey respondents, 27.3% of hospital-based and 37.8% of office-based physicians with EHRs responded to the question about patient interaction. Five main themes emerged for hospital-based physicians, with respondents generally perceiving EHRs as negatively altering patient interactions. We noted the same five themes among office-based physicians, but the rank-order of the top two responses differed by setting: hospital-based physicians commented most frequently that they spend less time with patients because they have to spend more time on computers; office-based physicians commented most frequently on EHRs worsening the quality of their interactions and relationships with patients. In our analysis of a large sample of physicians, hospital-based physicians generally perceived EHRs as negatively altering patient interactions, although they emphasized different reasons than their office-based counterparts. These findings add to the prior literature, which focuses on outpatient physicians, and can shape interventions to improve how EHRs are used in inpatient settings.

  7. “It’s like texting at the dinner table”: A qualitative analysis of the impact of electronic health records on patient-physician interaction in hospitals

    Directory of Open Access Journals (Sweden)

    Kimberly D Pelland

    2017-06-01

    Full Text Available Background: Electronic health records (EHRs may reduce medical errors and improve care, but can complicate clinical encounters. Objective: To describe hospital-based physicians’ perceptions of the impact of EHRs on patient-physician interactions and contrast these findings against office-based physicians’ perceptions Methods: We performed a qualitative analysis of comments submitted in response to the 2014 Rhode Island Health Information Technology Survey. Office- and hospital-based physicians licensed in Rhode Island, in active practice, and located in Rhode Island or neighboring states completed the survey about their Electronic Health Record use. Results: The survey’s response rate was 68.3% and 2,236 (87.1% respondents had EHRs. Among survey respondents, 27.3% of hospital-based and 37.8% of office-based physicians with EHRs responded to the question about patient interaction. Five main themes emerged for hospital-based physicians, with respondents generally perceiving EHRs as negatively altering patient interactions. We noted the same five themes among office-based physicians, but the rank-order of the top two responses differed by setting: hospital-based physicians commented most frequently that they spend less time with patients because they have to spend more time on computers; office-based physicians commented most frequently on EHRs worsening the quality of their interactions and relationships with patients. Conclusion: In our analysis of a large sample of physicians, hospital-based physicians generally perceived EHRs as negatively altering patient interactions, although they emphasized different reasons than their office-based counterparts. These findings add to the prior literature, which focuses on outpatient physicians, and can shape interventions to improve how EHRs are used in inpatient settings.

  8. Developmental neurotoxicity and autism: A potential link between indoor neuroactive pollutants and the curious birth order risk factor.

    Science.gov (United States)

    Gray, Wesley A; Billock, Vincent A

    2017-11-01

    Epidemiological and demographic studies find an increased risk of autism among first-borns. Toxicological studies show that some semi-volatile substances found in infant products produce adverse effects in neural and endocrine systems of animals, including behavioral and developmental effects. Several factors elevate the exposure of human infants to these chemicals. The highest exposures found in infants are comparable to the exposures that induce neural toxicity in animals. A review of these literatures suggests a linking hypothesis that could bridge the epidemiological and toxicological lines of evidence: an infant's exposure to neuroactive compounds emitted by infant products is increased by product newness and abundance; exposure is likely maximized for first-born children in families that can afford new products. Exposure is reduced for subsequently-born children who reuse these now neuroactive-depleted products. The presence of neuroactive chemical emissions from infant products has implications for birth-order effects and for other curious risk factors in autism, including gender, socioeconomic status, and season-of-birth risk factors. Copyright © 2017 ISDN. Published by Elsevier Ltd. All rights reserved.

  9. Patient Electronic Health Records as a Means to Approach Genetic Research in Gastroenterology.

    Science.gov (United States)

    Ananthakrishnan, Ashwin N; Lieberman, David

    2015-10-01

    Electronic health records (EHRs) are being increasingly utilized and form a unique source of extensive data gathered during routine clinical care. Through use of codified and free text concepts identified using clinical informatics tools, disease labels can be assigned with a high degree of accuracy. Analysis linking such EHR-assigned disease labels to a biospecimen repository has demonstrated that genetic associations identified in prospective cohorts can be replicated with adequate statistical power and novel phenotypic associations identified. In addition, genetic discovery research can be performed utilizing clinical, laboratory, and procedure data obtained during care. Challenges with such research include the need to tackle variability in quality and quantity of EHR data and importance of maintaining patient privacy and data security. With appropriate safeguards, this novel and emerging field of research offers considerable promise and potential to further scientific research in gastroenterology efficiently, cost-effectively, and with engagement of patients and communities. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

  10. Concepts for a standard based cross-organisational information security management system in the context of a nationwide EHR.

    Science.gov (United States)

    Mense, Alexander; Hoheiser-Pförtner, Franz; Schmid, Martin; Wahl, Harald

    2013-01-01

    Working with health related data necessitates appropriate levels of security and privacy. Information security, meaning ensuring confidentiality, integrity, and availability, is more organizational, than technical in nature. It includes many organizational and management measures, is based on well-defined security roles, processes, and documents, and needs permanent adaption of security policies, continuously monitoring, and measures assessment. This big challenge for any organization leads to implementation of an information security management system (ISMS). In the context of establishing a regional or national electronic health record for integrated care (ICEHR), the situation is worse. Changing the medical information exchange from on-demand peer-to-peer connections to health information networks requires all organizations participating in the EHR system to have consistent security levels and to follow the same security guidelines and rules. Also, the implementation must be monitored and audited, establishing cross-organizational information security management systems (ISMS) based on international standards. This paper evaluates requirements and defines basic concepts for an ISO 27000 series-based cross-organizational ISMS in the healthcare domain and especially for the implementation of the nationwide electronic health record in Austria (ELGA).

  11. Linking numbers and variational method

    International Nuclear Information System (INIS)

    Oda, I.; Yahikozawa, S.

    1989-09-01

    The ordinary and generalized linking numbers for two surfaces of dimension p and n-p-1 in an n dimensional manifold are derived. We use a variational method based on the properties of topological quantum field theory in order to derive them. (author). 13 refs, 2 figs

  12. Zero tolerance. With health IT money up for grabs, many EHR vendors are offering financing deals to attract business. But, just like shopping for a car, experts warn about reading the fine print before buying.

    Science.gov (United States)

    Blesch, Gregg; Carlson, Joe

    2010-03-01

    The government, by way of federal stimulus incentives, wants to boost the use of electronic health records. However, physician practices must be careful about low or no-interest offers when buying an EHR system, experts say. "The ultimate power a buyer has--I use the analogy of buying a car--is the ability to say 'no thanks' and walk out of the showroom", says Steven Fox, left, a partner at Post & Schell.

  13. Limit-order book resiliency after effective market orders: spread, depth and intensity

    Science.gov (United States)

    Xu, Hai-Chuan; Chen, Wei; Xiong, Xiong; Zhang, Wei; Zhou, Wei-Xing; Stanley, H. Eugene

    2017-07-01

    In order-driven markets, limit-order book (LOB) resiliency is an important microscopic indicator of market quality when the order book is hit by a liquidity shock and plays an essential role in the design of optimal submission strategies of large orders. However, the evolutionary behavior of LOB resilience around liquidity shocks is not well understood empirically. Using order flow data sets of Chinese stocks, we quantify and compare the LOB dynamics characterized by the bid-ask spread, the LOB depth and the order intensity surrounding effective market orders with different aggressiveness. We find that traders are more likely to submit effective market orders when the spreads are relatively low, the same-side depth is high, and the opposite-side depth is low. Such phenomenon is especially significant when the initial spread is 1 tick. Although the resiliency patterns show obvious diversity after different types of market orders, the spread and depth can return to the sample average within 20 best limit updates. The price resiliency behavior is dominant following aggressive market buy orders, while the price continuation behavior is dominant following less-aggressive market sell orders. Moreover, the resiliency stimulus of buy-sell shock is asymmetrical. The intensities of limit sell orders after market buy orders’ shock are always higher than the intensities of limit buy orders after market sell orders’ shock. The resiliency behavior of spread and depth is linked to limit order intensity.

  14. Rationale, design, and implementation protocol of an electronic health record integrated clinical prediction rule (iCPR randomized trial in primary care

    Directory of Open Access Journals (Sweden)

    Wisnivesky Juan

    2011-09-01

    Full Text Available Abstract Background Clinical prediction rules (CPRs represent well-validated but underutilized evidence-based medicine tools at the point-of-care. To date, an inability to integrate these rules into an electronic health record (EHR has been a major limitation and we are not aware of a study demonstrating the use of CPR's in an ambulatory EHR setting. The integrated clinical prediction rule (iCPR trial integrates two CPR's in an EHR and assesses both the usability and the effect on evidence-based practice in the primary care setting. Methods A multi-disciplinary design team was assembled to develop a prototype iCPR for validated streptococcal pharyngitis and bacterial pneumonia CPRs. The iCPR tool was built as an active Clinical Decision Support (CDS tool that can be triggered by user action during typical workflow. Using the EHR CDS toolkit, the iCPR risk score calculator was linked to tailored ordered sets, documentation, and patient instructions. The team subsequently conducted two levels of 'real world' usability testing with eight providers per group. Usability data were used to refine and create a production tool. Participating primary care providers (n = 149 were randomized and intervention providers were trained in the use of the new iCPR tool. Rates of iCPR tool triggering in the intervention and control (simulated groups are monitored and subsequent use of the various components of the iCPR tool among intervention encounters is also tracked. The primary outcome is the difference in antibiotic prescribing rates (strep and pneumonia iCPR's encounters and chest x-rays (pneumonia iCPR only between intervention and control providers. Discussion Using iterative usability testing and development paired with provider training, the iCPR CDS tool leverages user-centered design principles to overcome pervasive underutilization of EBM and support evidence-based practice at the point-of-care. The ongoing trial will determine if this collaborative

  15. Fear of e-Health records implementation?

    Science.gov (United States)

    Laur, Audrey

    2015-03-01

    As our world is dominated by Information Communication and Technologies (ICT), governments of many leading countries have decided to implement ICT in their health systems. The first step is the digitalisation of medical records (e-Health Records or EHRs). In order to reduce concerns that health systems encountered, EHRs are supposed to prevent duplicated prescriptions and hospitalisations, ineffective transferability of medical records, lack of communication in clinical assessments, etc. They are also expected to improve the relationship between health providers and patients. At first sight, EHR seems to offer considerable potential for assisting health policies, enabling the development of new tools to facilitate coordination and cooperation among health professionals and promoting a new approach to sharing medical information. However, as discussed in this article, recent debates have shown that EHR presents pros and cons (technical, financial, social) that governments need to clarify urgently. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  16. Towards the Adoption of Open Source and Open Access Electronic Health Record Systems

    Directory of Open Access Journals (Sweden)

    Ilias Maglogiannis

    2012-01-01

    Full Text Available As the Electronic Health Record (EHR systems constantly expand to support more clinical activities and their implementations in healthcare organizations become more widespread, several communities have been working intensively for several years to develop open access and open source EHR software, aiming at reducing the costs of EHR deployment and maintenance. In this paper, we describe and evaluate the most popular open source electronic medical records such as openEMR, openMRS and patientOS, providing their technical features and potentials. These systems are considered quite important due to their prevalence. The article presents the key features of each system and outlines the advantages and problems of Open Source Software (OSS Systems through a review of the literature, in order to demonstrate the possibility of their adoption in modern electronic healthcare systems. Also discussed are the future trends of OS EHRs in the context of the Personal Health Records and mobile computing paradigm.

  17. Advances and current state of the security and privacy in electronic health records: survey from a social perspective.

    Science.gov (United States)

    Tejero, Antonio; de la Torre, Isabel

    2012-10-01

    E-Health systems are experiencing an impulse in these last years, when many medical agencies began to include digital solutions into their platforms. Electronic Health Records (EHRs) are one of the most important improvements, being in its most part a patient-oriented tool. To achieve a completely operational EHR platform, security and privacy problems have to be resolved, due to the importance of the data included within these records. But given all the different methods to address security and privacy, they still remain in most cases as an open issue. This paper studies existing and proposed solutions included in different scenarios, in order to offer an overview of the current state in EHR systems. Bibliographic material has been obtained mainly from MEDLINE and SCOPUS sources, and over 30 publications have been analyzed. Many EHR platforms are being developed, but most of them present weaknesses when they are opened to the public. These architectures gain significance when they cover all the requisites related to security and privacy.

  18. Congruency between educators' teaching beliefs and an electronic health record teaching strategy.

    Science.gov (United States)

    Bani-issa, Wegdan; Rempusheski, Veronica F

    2014-06-01

    Technology has changed healthcare institutions into automated settings with the potential to greatly enhance the quality of healthcare. Implementation of electronic health records (EHRs) to replace paper charting is one example of the influence of technology on healthcare worldwide. In the past decade nursing higher education has attempted to keep pace with technological changes by integrating EHRs into learning experiences. Little is known about educators' teaching beliefs and the use of EHRs as a teaching strategy. This study explores the composition of core teaching beliefs of nurse educators and their related teaching practices within the context of teaching with EHRs in the classroom. A collective case study and qualitative research approach was used to explore and describe teaching beliefs of seven nurse educators teaching with EHRs. Data collection included open-ended, audio-taped interviews and non-participant observation. Content analysis of transcribed interviews and observational field notes focused on identification of teaching belief themes and associated practices. Two contrasting collective case studies of teaching beliefs emerged. Constructivist beliefs were dominant, focused on experiential, student-centered, contextual and collaborative learning, and associated with expanded and a futuristic view of EHRs use. Objectivist beliefs focused on educators' control of the context of learning and were associated with a constrained, limited view of EHRs. Constructivist educators embrace technological change, an essential ingredient of educational reform. We encourage nurse educators to adopt a constructivist view to using technology in teaching in order to prepare nurses for a rapidly changing, technologically sophisticated practice. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Disassociation for electronic health record privacy.

    Science.gov (United States)

    Loukides, Grigorios; Liagouris, John; Gkoulalas-Divanis, Aris; Terrovitis, Manolis

    2014-08-01

    The dissemination of Electronic Health Record (EHR) data, beyond the originating healthcare institutions, can enable large-scale, low-cost medical studies that have the potential to improve public health. Thus, funding bodies, such as the National Institutes of Health (NIH) in the U.S., encourage or require the dissemination of EHR data, and a growing number of innovative medical investigations are being performed using such data. However, simply disseminating EHR data, after removing identifying information, may risk privacy, as patients can still be linked with their record, based on diagnosis codes. This paper proposes the first approach that prevents this type of data linkage using disassociation, an operation that transforms records by splitting them into carefully selected subsets. Our approach preserves privacy with significantly lower data utility loss than existing methods and does not require data owners to specify diagnosis codes that may lead to identity disclosure, as these methods do. Consequently, it can be employed when data need to be shared broadly and be used in studies, beyond the intended ones. Through extensive experiments using EHR data, we demonstrate that our method can construct data that are highly useful for supporting various types of clinical case count studies and general medical analysis tasks. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Buffer-Aided Relaying with Adaptive Link Selection

    DEFF Research Database (Denmark)

    Zlatanov, Nikola; Schober, Robert; Popovski, Petar

    2013-01-01

    In this paper, we consider a simple network consisting of a source, a half-duplex decode-and-forward relay, and a destination. We propose a new relaying protocol employing adaptive link selection, i.e., in any given time slot, based on the channel state information of the source-relay and the relay......-destination link a decision is made whether the source or the relay transmits. In order to avoid data loss at the relay, adaptive link selection requires the relay to be equipped with a buffer such that data can be queued until the relay-destination link is selected for transmission. We study both delay......-constrained and delay-unconstrained transmission. For the delay-unconstrained case, we characterize the optimal link selection policy, derive the corresponding throughput, and develop an optimal power allocation scheme. For the delay-constrained case, we propose to starve the buffer of the relay by choosing...

  1. Aperiodic order

    CERN Document Server

    Grimm, Uwe

    2017-01-01

    Quasicrystals are non-periodic solids that were discovered in 1982 by Dan Shechtman, Nobel Prize Laureate in Chemistry 2011. The mathematics that underlies this discovery or that proceeded from it, known as the theory of Aperiodic Order, is the subject of this comprehensive multi-volume series. This second volume begins to develop the theory in more depth. A collection of leading experts, among them Robert V. Moody, cover various aspects of crystallography, generalising appropriately from the classical case to the setting of aperiodically ordered structures. A strong focus is placed upon almost periodicity, a central concept of crystallography that captures the coherent repetition of local motifs or patterns, and its close links to Fourier analysis. The book opens with a foreword by Jeffrey C. Lagarias on the wider mathematical perspective and closes with an epilogue on the emergence of quasicrystals, written by Peter Kramer, one of the founders of the field.

  2. Analysis of Azari Language based on Parsing using Link Gram

    Directory of Open Access Journals (Sweden)

    Maryam Arabzadeh

    2014-09-01

    Full Text Available There are different classes of theories for the natural lanuguage syntactic parsing problem and for creating the related grammars .This paper presents a syntactic grammar developed in the link grammar formalism for Turkish which is an agglutinative language. In the link grammar formalism, the words of a sentence are linked with each other depending on their syntactic roles. Turkish has complex derivational and inflectional morphology, and derivational and inflection morphemes play important syntactic roles in the sentences. In order to develop a link grammar for Turkish, the lexical parts in the morphological representations of Turkish words are removed, and the links are created depending on the part of speech tags and inflectional morphemes in words. Furthermore, a derived word is separated at the derivational boundaries in order to treat each derivation morpheme as a special distinct word, and allow it to be linked with the rest of the sentence. The derivational morphemes of a word are also linked with each other with special links to indicate that they are parts of the same word. Finally the adapted unique link grammar formalism for Turkish provides flexibility for the linkage construction, and similar methods can be used for other languages with complex morphology. Finally, using the Delphi programming language, the link grammar related to the Azeri language was developed and implemented and then by selecting 250 random sentences, this grammar is evaluated and then tested. For 84.31% of the sentences, the result set of the parser contains the correct parse.

  3. Calculations of Financial Incentives for Providers in a Pay-for-Performance Program: Manual Review Versus Data From Structured Fields in Electronic Health Records.

    Science.gov (United States)

    Urech, Tracy H; Woodard, LeChauncy D; Virani, Salim S; Dudley, R Adams; Lutschg, Meghan Z; Petersen, Laura A

    2015-10-01

    Hospital report cards and financial incentives linked to performance require clinical data that are reliable, appropriate, timely, and cost-effective to process. Pay-for-performance plans are transitioning to automated electronic health record (EHR) data as an efficient method to generate data needed for these programs. To determine how well data from automated processing of structured fields in the electronic health record (AP-EHR) reflect data from manual chart review and the impact of these data on performance rewards. Cross-sectional analysis of performance measures used in a cluster randomized trial assessing the impact of financial incentives on guideline-recommended care for hypertension. A total of 2840 patients with hypertension assigned to participating physicians at 12 Veterans Affairs hospital-based outpatient clinics. Fifty-two physicians and 33 primary care personnel received incentive payments. Overall, positive and negative agreement indices and Cohen's kappa were calculated for assessments of guideline-recommended antihypertensive medication use, blood pressure (BP) control, and appropriate response to uncontrolled BP. Pearson's correlation coefficient was used to assess how similar participants' calculated earnings were between the data sources. By manual chart review data, 72.3% of patients were considered to have received guideline-recommended antihypertensive medications compared with 65.0% by AP-EHR review (κ=0.51). Manual review indicated 69.5% of patients had controlled BP compared with 66.8% by AP-EHR review (κ=0.87). Compared with 52.2% of patients per the manual review, 39.8% received an appropriate response by AP-EHR review (κ=0.28). Participants' incentive payments calculated using the 2 methods were highly correlated (r≥0.98). Using the AP-EHR data to calculate earnings, participants' payment changes ranged from a decrease of $91.00 (-30.3%) to an increase of $18.20 (+7.4%) for medication use (interquartile range, -14.4% to 0

  4. Spin ordering in three-leg ladders in Ludwigite systems

    International Nuclear Information System (INIS)

    Vallejo, E.; Avignon, M.

    2007-01-01

    We study the spin ordering in a three-leg ladder present in Ludwigite systems formed of localized spins interacting with an extra electron per rung. We also consider the competition with super exchange interactions resulting in a very rich phase diagram. Among the phases we find the possibility of ferromagnetic rungs ordered antiferromagnetically and a zigzag spin ordering linked to the formation of a charge ordering as observed

  5. INTELLIGENT FRACTIONAL ORDER ITERATIVE LEARNING CONTROL USING FEEDBACK LINEARIZATION FOR A SINGLE-LINK ROBOT

    Directory of Open Access Journals (Sweden)

    Iman Ghasemi

    2017-05-01

    Full Text Available In this paper, iterative learning control (ILC is combined with an optimal fractional order derivative (BBO-Da-type ILC and optimal fractional and proportional-derivative (BBO-PDa-type ILC. In the update law of Arimoto's derivative iterative learning control, a first order derivative of tracking error signal is used. In the proposed method, fractional order derivative of the error signal is stated in term of 'sa' where  to update iterative learning control law. Two types of fractional order iterative learning control namely PDa-type ILC and Da-type ILC are gained for different value of a. In order to improve the performance of closed-loop control system, coefficients of both  and  learning law i.e. proportional , derivative  and  are optimized using Biogeography-Based optimization algorithm (BBO. Outcome of the simulation results are compared with those of the conventional fractional order iterative learning control to verify effectiveness of BBO-Da-type ILC and BBO-PDa-type ILC

  6. Reducing wrong patient selection errors: exploring the design space of user interface techniques.

    Science.gov (United States)

    Sopan, Awalin; Plaisant, Catherine; Powsner, Seth; Shneiderman, Ben

    2014-01-01

    Wrong patient selection errors are a major issue for patient safety; from ordering medication to performing surgery, the stakes are high. Widespread adoption of Electronic Health Record (EHR) and Computerized Provider Order Entry (CPOE) systems makes patient selection using a computer screen a frequent task for clinicians. Careful design of the user interface can help mitigate the problem by helping providers recall their patients' identities, accurately select their names, and spot errors before orders are submitted. We propose a catalog of twenty seven distinct user interface techniques, organized according to a task analysis. An associated video demonstrates eighteen of those techniques. EHR designers who consider a wider range of human-computer interaction techniques could reduce selection errors, but verification of efficacy is still needed.

  7. Three-dimensional cross-linked carbon network wrapped with ordered polyaniline nanowires for high-performance pseudo-supercapacitors

    Science.gov (United States)

    Hu, Huan; Liu, Shuwu; Hanif, Muddasir; Chen, Shuiliang; Hou, Haoqing

    2014-12-01

    The polyaniline (PANI)-based pseudo-supercapacitor has been extensively studied due to its good conductivity, ease of synthesis, low-cost monomer, tunable properties and remarkable specific capacitance. In this work, a three-dimensional cross-linked carbon network (3D-CCN) was used as a contact-resistance-free substrate for PANI-based pseudo-supercapacitors. The ordered PANI nanowires (PaNWs) were grown on the 3D-CCN to form PaNWs/3D-CCN composites by in-situ polymerization. The PaNWs/3D-CCN composites exhibited a specific capacitance (Cs) of 1191.8 F g-1 at a current density of 0.5 A g-1 and a superior rate capability with 66.4% capacitance retention at 100.0 A g-1. The high specific capacitance is attributed to the thin PaNW coating and the spaced PANI nanowire array, which ensure a higher utilization of PANI due to the ease of diffusion of protons through/on the PANI nanowires. In addition, the unique 3D-CCN was used as a high-conductivity platform (or skeleton) with no contact resistance for fast electron transfer and facile charge transport within the composites. Therefore, the binder-free composites can process rapid gains or losses of electrons and ions, even at a high current density. As a result, the specific capacitance and rate capability of our composites are remarkably higher than those of other PANI composites.

  8. Optimisation of the link volume for weakest link failure prediction in NBG-18 nuclear graphite

    International Nuclear Information System (INIS)

    Hindley, Michael P.; Groenwold, Albert A.; Blaine, Deborah C.; Becker, Thorsten H.

    2014-01-01

    This paper describes the process for approximating the optimal size of a link volume required for weakest link failure calculation in nuclear graphite, with NBG-18 used as an example. As part of the failure methodology, the link volume is defined in terms of two grouping criteria. The first criterion is a factor of the maximum grain size and the second criterion is a function of an equivalent stress limit. A methodology for approximating these grouping criteria is presented. The failure methodology employs finite element analysis (FEA) in order to predict the failure load, at 50% probability of failure. The average experimental failure load, as determined for 26 test geometries, is used to evaluate the accuracy of the weakest link failure calculations. The influence of the two grouping criteria on the failure load prediction is evaluated by defining an error in prediction across all test cases. Mathematical optimisation is used to find the minimum error across a range of test case failure predictions. This minimum error is shown to deliver the most accurate failure prediction across a whole range of components, although some test cases in the range predict conservative failure load. The mathematical optimisation objective function is penalised to account for non-conservative prediction of the failure load for any test case. The optimisation is repeated and a link volume found for conservative failure prediction. The failure prediction for each test case is evaluated, in detail, for the proposed link volumes. Based on the analysis, link design volumes for NBG-18 are recommended for either accurate or conservative failure prediction

  9. Unintended adverse consequences of introducing electronic health records in residential aged care homes.

    Science.gov (United States)

    Yu, Ping; Zhang, Yiting; Gong, Yang; Zhang, Jiajie

    2013-09-01

    The aim of this study was to investigate the unintended adverse consequences of introducing electronic health records (EHR) in residential aged care homes (RACHs) and to examine the causes of these unintended adverse consequences. A qualitative interview study was conducted in nine RACHs belonging to three organisations in the Australian Capital Territory (ACT), New South Wales (NSW) and Queensland, Australia. A longitudinal investigation after the implementation of the aged care EHR systems was conducted at two data points: January 2009 to December 2009 and December 2010 to February 2011. Semi-structured interviews were conducted with 110 care staff members identified through convenience sampling, representing all levels of care staff who worked in these facilities. Data analysis was guided by DeLone and McLean Information Systems Success Model, in reference with the previous studies of unintended consequences for the introduction of computerised provider order entry systems in hospitals. Eight categories of unintended adverse consequences emerged from 266 data items mentioned by the interviewees. In descending order of the number and percentage of staff mentioning them, they are: inability/difficulty in data entry and information retrieval, end user resistance to using the system, increased complexity of information management, end user concerns about access, increased documentation burden, the reduction of communication, lack of space to place enough computers in the work place and increasing difficulties in delivering care services. The unintended consequences were caused by the initial conditions, the nature of the EHR system and the way the system was implemented and used by nursing staff members. Although the benefits of the EHR systems were obvious, as found by our previous study, introducing EHR systems in RACH can also cause adverse consequences of EHR avoidance, difficulty in access, increased complexity in information management, increased documentation

  10. One-particle many-body Green's function theory: Algebraic recursive definitions, linked-diagram theorem, irreducible-diagram theorem, and general-order algorithms.

    Science.gov (United States)

    Hirata, So; Doran, Alexander E; Knowles, Peter J; Ortiz, J V

    2017-07-28

    A thorough analytical and numerical characterization of the whole perturbation series of one-particle many-body Green's function (MBGF) theory is presented in a pedagogical manner. Three distinct but equivalent algebraic (first-quantized) recursive definitions of the perturbation series of the Green's function are derived, which can be combined with the well-known recursion for the self-energy. Six general-order algorithms of MBGF are developed, each implementing one of the three recursions, the ΔMPn method (where n is the perturbation order) [S. Hirata et al., J. Chem. Theory Comput. 11, 1595 (2015)], the automatic generation and interpretation of diagrams, or the numerical differentiation of the exact Green's function with a perturbation-scaled Hamiltonian. They all display the identical, nondivergent perturbation series except ΔMPn, which agrees with MBGF in the diagonal and frequency-independent approximations at 1≤n≤3 but converges at the full-configuration-interaction (FCI) limit at n=∞ (unless it diverges). Numerical data of the perturbation series are presented for Koopmans and non-Koopmans states to quantify the rate of convergence towards the FCI limit and the impact of the diagonal, frequency-independent, or ΔMPn approximation. The diagrammatic linkedness and thus size-consistency of the one-particle Green's function and self-energy are demonstrated at any perturbation order on the basis of the algebraic recursions in an entirely time-independent (frequency-domain) framework. The trimming of external lines in a one-particle Green's function to expose a self-energy diagram and the removal of reducible diagrams are also justified mathematically using the factorization theorem of Frantz and Mills. Equivalence of ΔMPn and MBGF in the diagonal and frequency-independent approximations at 1≤n≤3 is algebraically proven, also ascribing the differences at n = 4 to the so-called semi-reducible and linked-disconnected diagrams.

  11. Towards Noncommutative Linking Numbers via the Seiberg-Witten Map

    Directory of Open Access Journals (Sweden)

    H. García-Compeán

    2015-01-01

    Full Text Available Some geometric and topological implications of noncommutative Wilson loops are explored via the Seiberg-Witten map. In the abelian Chern-Simons theory on a three-dimensional manifold, it is shown that the effect of noncommutativity is the appearance of 6n new knots at the nth order of the Seiberg-Witten expansion. These knots are trivial homology cycles which are Poincaré dual to the higher-order Seiberg-Witten potentials. Moreover the linking number of a standard 1-cycle with the Poincaré dual of the gauge field is shown to be written as an expansion of the linking number of this 1-cycle with the Poincaré dual of the Seiberg-Witten gauge fields. In the process we explicitly compute the noncommutative “Jones-Witten” invariants up to first order in the noncommutative parameter. Finally in order to exhibit a physical example, we apply these ideas explicitly to the Aharonov-Bohm effect. It is explicitly displayed at first order in the noncommutative parameter; we also show the relation to the noncommutative Landau levels.

  12. The impact of an electronic health record on nurse sensitive patient outcomes: an interrupted time series analysis.

    Science.gov (United States)

    Dowding, Dawn W; Turley, Marianne; Garrido, Terhilda

    2012-01-01

    To evaluate the impact of electronic health record (EHR) implementation on nursing care processes and outcomes. Interrupted time series analysis, 2003-2009. A large US not-for-profit integrated health care organization. 29 hospitals in Northern and Southern California. An integrated EHR including computerized physician order entry, nursing documentation, risk assessment tools, and documentation tools. Percentage of patients with completed risk assessments for hospital acquired pressure ulcers (HAPUs) and falls (process measures) and rates of HAPU and falls (outcome measures). EHR implementation was significantly associated with an increase in documentation rates for HAPU risk (coefficient 2.21, 95% CI 0.67 to 3.75); the increase for fall risk was not statistically significant (0.36; -3.58 to 4.30). EHR implementation was associated with a 13% decrease in HAPU rates (coefficient -0.76, 95% CI -1.37 to -0.16) but no decrease in fall rates (-0.091; -0.29 to 0.11). Irrespective of EHR implementation, HAPU rates decreased significantly over time (-0.16; -0.20 to -0.13), while fall rates did not (0.0052; -0.01 to 0.02). Hospital region was a significant predictor of variation for both HAPU (0.72; 0.30 to 1.14) and fall rates (0.57; 0.41 to 0.72). The introduction of an integrated EHR was associated with a reduction in the number of HAPUs but not in patient fall rates. Other factors, such as changes over time and hospital region, were also associated with variation in outcomes. The findings suggest that EHR impact on nursing care processes and outcomes is dependent on a number of factors that should be further explored.

  13. Recognition and Evaluation of Clinical Section Headings in Clinical Documents Using Token-Based Formulation with Conditional Random Fields

    Directory of Open Access Journals (Sweden)

    Hong-Jie Dai

    2015-01-01

    Full Text Available Electronic health record (EHR is a digital data format that collects electronic health information about an individual patient or population. To enhance the meaningful use of EHRs, information extraction techniques have been developed to recognize clinical concepts mentioned in EHRs. Nevertheless, the clinical judgment of an EHR cannot be known solely based on the recognized concepts without considering its contextual information. In order to improve the readability and accessibility of EHRs, this work developed a section heading recognition system for clinical documents. In contrast to formulating the section heading recognition task as a sentence classification problem, this work proposed a token-based formulation with the conditional random field (CRF model. A standard section heading recognition corpus was compiled by annotators with clinical experience to evaluate the performance and compare it with sentence classification and dictionary-based approaches. The results of the experiments showed that the proposed method achieved a satisfactory F-score of 0.942, which outperformed the sentence-based approach and the best dictionary-based system by 0.087 and 0.096, respectively. One important advantage of our formulation over the sentence-based approach is that it presented an integrated solution without the need to develop additional heuristics rules for isolating the headings from the surrounding section contents.

  14. [Development of an ophthalmological clinical information system for inpatient eye clinics].

    Science.gov (United States)

    Kortüm, K U; Müller, M; Babenko, A; Kampik, A; Kreutzer, T C

    2015-12-01

    In times of increased digitalization in healthcare, departments of ophthalmology are faced with the challenge of introducing electronic clinical health records (EHR); however, specialized software for ophthalmology is not available with most major EHR sytems. The aim of this project was to create specific ophthalmological user interfaces for large inpatient eye care providers within a hospitalwide EHR. Additionally the integration of ophthalmic imaging systems, scheduling and surgical documentation should be achieved. The existing EHR i.s.h.med (Siemens, Germany) was modified using advanced business application programming (ABAP) language to create specific ophthalmological user interfaces for reproduction and moreover optimization of the clinical workflow. A user interface for documentation of ambulatory patients with eight tabs was designed. From June 2013 to October 2014 a total of 61,551 patient contact details were documented. For surgical documentation a separate user interface was set up. Digital clinical orders for documentation of registration and scheduling of operations user interfaces were also set up. A direct integration of ophthalmic imaging modalities could be established. An ophthalmologist-orientated EHR for outpatient and surgical documentation for inpatient clinics was created and successfully implemented. By incorporation of imaging procedures the foundation of future smart/big data analyses was created.

  15. Cross-linking of rubber in the presence of multi-functional cross-linking aids via thermoreversible Diels-Alder chemistry

    NARCIS (Netherlands)

    Polgar, L. M.; Fortunato, G.; Araya-Hermosilla, R.; van Duin, M.; Pucci, A.; Picchioni, F.

    Furan-functionalized polyketone (PK-FU) was added to a furan-functionalized ethylene-propylene rubber (EPM-FU). The mixture was subsequently cross-linked with a bismaleimide through Diels-Alder chemistry in order to improve the mechanical properties of the rubber. Infrared spectroscopy showed the

  16. Deployment of a multi-link flexible structure

    Science.gov (United States)

    Na, Kyung-Su; Kim, Ji-Hwan

    2006-06-01

    Deployment of a multi-link beam structure undergoing locking is analyzed in the Timoshenko beam theory. In the modeling of the system, dynamic forces are assumed to be torques and restoring forces due to the torsion spring at each joint. Hamilton's principle is used to determine the equations of motion and the finite element method is adopted to analyze the system. Newmark time integration and Newton-Raphson iteration methods are used to solve for the non-linear equations of motion at each time step. The locking at the joints of the multi-link flexible structure is analyzed by the momentum balance method. Numerical results are compared with the previous experimental data. The angles and angular velocities of each joint, tip displacement, and velocity of each link are investigated to study the motions of the links at each time step. To analyze the effect of thickness on the motion of the link, the angle and the tip displacement of each link are compared according to the various slenderness ratios. Additionally, in order to investigate the effect of shear, the tip displacements of a Timoshenko beam are compared with those of an Euler-Bernoulli beam.

  17. A mobile app for securely capturing and transferring clinical images to the electronic health record: description and preliminary usability study.

    Science.gov (United States)

    Landman, Adam; Emani, Srinivas; Carlile, Narath; Rosenthal, David I; Semakov, Simon; Pallin, Daniel J; Poon, Eric G

    2015-01-02

    Photographs are important tools to record, track, and communicate clinical findings. Mobile devices with high-resolution cameras are now ubiquitous, giving clinicians the opportunity to capture and share images from the bedside. However, secure and efficient ways to manage and share digital images are lacking. The aim of this study is to describe the implementation of a secure application for capturing and storing clinical images in the electronic health record (EHR), and to describe initial user experiences. We developed CliniCam, a secure Apple iOS (iPhone, iPad) application that allows for user authentication, patient selection, image capture, image annotation, and storage of images as a Portable Document Format (PDF) file in the EHR. We leveraged our organization's enterprise service-oriented architecture to transmit the image file from CliniCam to our enterprise clinical data repository. There is no permanent storage of protected health information on the mobile device. CliniCam also required connection to our organization's secure WiFi network. Resident physicians from emergency medicine, internal medicine, and dermatology used CliniCam in clinical practice for one month. They were then asked to complete a survey on their experience. We analyzed the survey results using descriptive statistics. Twenty-eight physicians participated and 19/28 (68%) completed the survey. Of the respondents who used CliniCam, 89% found it useful or very useful for clinical practice and easy to use, and wanted to continue using the app. Respondents provided constructive feedback on location of the photos in the EHR, preferring to have photos embedded in (or linked to) clinical notes instead of storing them as separate PDFs within the EHR. Some users experienced difficulty with WiFi connectivity which was addressed by enhancing CliniCam to check for connectivity on launch. CliniCam was implemented successfully and found to be easy to use and useful for clinical practice. CliniCam is

  18. Critical Care Health Informatics Collaborative (CCHIC): Data, tools and methods for reproducible research: A multi-centre UK intensive care database.

    Science.gov (United States)

    Harris, Steve; Shi, Sinan; Brealey, David; MacCallum, Niall S; Denaxas, Spiros; Perez-Suarez, David; Ercole, Ari; Watkinson, Peter; Jones, Andrew; Ashworth, Simon; Beale, Richard; Young, Duncan; Brett, Stephen; Singer, Mervyn

    2018-04-01

    To build and curate a linkable multi-centre database of high resolution longitudinal electronic health records (EHR) from adult Intensive Care Units (ICU). To develop a set of open-source tools to make these data 'research ready' while protecting patient's privacy with a particular focus on anonymisation. We developed a scalable EHR processing pipeline for extracting, linking, normalising and curating and anonymising EHR data. Patient and public involvement was sought from the outset, and approval to hold these data was granted by the NHS Health Research Authority's Confidentiality Advisory Group (CAG). The data are held in a certified Data Safe Haven. We followed sustainable software development principles throughout, and defined and populated a common data model that links to other clinical areas. Longitudinal EHR data were loaded into the CCHIC database from eleven adult ICUs at 5 UK teaching hospitals. From January 2014 to January 2017, this amounted to 21,930 and admissions (18,074 unique patients). Typical admissions have 70 data-items pertaining to admission and discharge, and a median of 1030 (IQR 481-2335) time-varying measures. Training datasets were made available through virtual machine images emulating the data processing environment. An open source R package, cleanEHR, was developed and released that transforms the data into a square table readily analysable by most statistical packages. A simple language agnostic configuration file will allow the user to select and clean variables, and impute missing data. An audit trail makes clear the provenance of the data at all times. Making health care data available for research is problematic. CCHIC is a unique multi-centre longitudinal and linkable resource that prioritises patient privacy through the highest standards of data security, but also provides tools to clean, organise, and anonymise the data. We believe the development of such tools are essential if we are to meet the twin requirements of

  19. Analysis of second order harmonic distortion due to transmitter non-linearity and chromatic and modal dispersion of optical OFDM SSB modulated signals in SMF-MMF fiber links

    Science.gov (United States)

    Patel, Dhananjay; Singh, Vinay Kumar; Dalal, U. D.

    2017-01-01

    Single mode fibers (SMF) are typically used in Wide Area Networks (WAN), Metropolitan Area Networks (MAN) and also find applications in Radio over Fiber (RoF) architectures supporting data transmission in Fiber to the Home (FTTH), Remote Antenna Units (RAUs), in-building networks etc. Multi-mode fibers (MMFs) with low cost, ease of installation and low maintenance are predominantly (85-90%) deployed in-building networks providing data access in local area networks (LANs). The transmission of millimeter wave signals through the SMF in WAN and MAN, along with the reuse of MMF in-building networks will not levy fiber reinstallation cost. The transmission of the millimeter waves experiences signal impairments due to the transmitter non-linearity and modal dispersion of the MMF. The MMF exhibiting large modal dispersion limits the bandwidth-length product of the fiber. The second and higher-order harmonics present in the optical signal fall within the system bandwidth. This causes degradation in the received signal and an unwanted radiation of power at the RAU. The power of these harmonics is proportional to the non-linearity of the transmitter and the modal dispersion of the MMF and should be maintained below the standard values as per the international norms. In this paper, a mathematical model is developed for Second-order Harmonic Distortion (HD2) generated due to non-linearity of the transmitter and chromatic-modal dispersion of the SMF-MMF optic link. This is also verified using a software simulation. The model consists of a Mach Zehnder Modulator (MZM) that generates two m-QAM OFDM Single Sideband (SSB) signals based on phase shift of the hybrid coupler (90° and 120°). Our results show that the SSB signal with 120° hybrid coupler has suppresses the higher-order harmonics and makes the system more robust against the HD2 in the SMF-MMF optic link.

  20. A Higher-Order Colon Translation

    DEFF Research Database (Denmark)

    Danvy, Olivier; Nielsen, Lasse Reichstein

    2001-01-01

    A lambda-encoding such as the CPS transformation gives rise to administrative redexes. In his seminal article ``Call-by-name, call-by-value and the lambda-calculus'', 25 years ago, Plotkin tackled administrative reductions using a so-called ``colon translation.'' 10 years ago, Danvy and Filinski...... integrated administrative reductions in the CPS transformation, making it operate in one pass. The technique applies to other lambda-encodings (e.g., variants of CPS), but we do not see it used in practice--instead, Plotkin's colon translation appears to be favored. Therefore, in an attempt to link both...... techniques, we recast Plotkin's proof of Indifference and Simulation to the higher-order specification of the one-pass CPS transformation. To this end, we extend his colon translation from first order to higher order...

  1. Analysis of credit linked demand in an inventory model with varying ordering cost.

    Science.gov (United States)

    Banu, Ateka; Mondal, Shyamal Kumar

    2016-01-01

    In this paper, we have considered an economic order quantity model for deteriorating items with two-level trade credit policy in which a delay in payment is offered by a supplier to a retailer and also an another delay in payment is offered by the retailer to his/her all customers. Here, it is proposed that the demand function is dependent on the length of the customer's credit period and also the duration of offering the credit period. In this article, it is considered that the retailer's ordering cost per order depends on the number of replenishment cycles. The objective of this model is to establish a deterministic EOQ model of deteriorating items for the retailer to decide the position of customers credit period and the number of replenishment cycles in finite time horizon such that the retailer gets the maximum profit. Also, the model is explained with the help of some numerical examples.

  2. Numerical kinematic transformation calculations for a parallel link manipulator

    International Nuclear Information System (INIS)

    Killough, S.M.

    1993-01-01

    Parallel link manipulators are often considered for particular robotic applications because of the unique advantages they provide. Unfortunately, they have significant disadvantages with respect to calculating the kinematic transformations because of the high-order equations that must be solved. Presented is a manipulator design that exploits the mechanical advantages of parallel links yet also has a corresponding numerical kinematic solution that can be solved in real time on common microcomputers

  3. Attitudes and behaviors related to introduction of Electronic Health Record (EHR among Shiraz University students in 2014

    Directory of Open Access Journals (Sweden)

    Mohtaram Nematollahi

    2015-07-01

    Full Text Available Introduction: Electronic Health Record contains all the information related to the health of citizens, from before birth to death have been consistently over time is electronically stored and will be available without regard to location or time all or part of it to authorized persons. The acceptance of EHR by citizens is important in successful implementation of it. The aim of this study was to determine the attitudes and behaviors related to the introduction of electronic health records among Shiraz university student. Method:The present study is a cross-sectional descriptive survey. The study population consisted of all Shiraz University students. The data gathering tool was a questionnaire and data were analyzed in SPSS v.16 software, using descriptive statistical tests. Also, the samples, i.e. 384 students, were selected through convenient sampling. Results: The results showed that most of the students kept their medical records at home to show them to a specialist and only 15% of them were familiar with the Electronic Health Records term. The use of Electronic Health Records for Maintenance of drug prescriptions was of the most importance. Conclusion: Among the students who are educated class and the source of change, the university students’ familiarity with Electronic Health Records is too low and most of them were not even familiar with its name and it is very important to implement this system familiarize the users on how to use it sufficiently

  4. Perturbative improvement of staggered fermions using fat links

    International Nuclear Information System (INIS)

    Lee, Weonjong

    2002-01-01

    We study the possibility of improving staggered fermions using various fat links in order to reduce perturbative corrections to the gauge-invariant staggered fermion operators. We prove five theorems on SU(3) projection, triviality in renormalization, multiple SU(3) projections, uniqueness, and equivalence. As a result of these theorems, we show that, at the one-loop level, the renormalization of staggered fermion operators is identical between SU(3) projected Fat7 links and hypercubic links, as long as the action and operators are constructed by imposing the same perturbative improvement condition. In addition, we propose a new view of SU(3) projection as a tool of tadpole improvement for the staggered fermion doublers. As a conclusion, we present alternative choices of constructing fat links to improve the staggered fermion action and operators, which deserve further investigation

  5. Monte Carlo simulations on marker grouping and ordering.

    Science.gov (United States)

    Wu, J; Jenkins, J; Zhu, J; McCarty, J; Watson, C

    2003-08-01

    Four global algorithms, maximum likelihood (ML), sum of adjacent LOD score (SALOD), sum of adjacent recombinant fractions (SARF) and product of adjacent recombinant fraction (PARF), and one approximation algorithm, seriation (SER), were used to compare the marker ordering efficiencies for correctly given linkage groups based on doubled haploid (DH) populations. The Monte Carlo simulation results indicated the marker ordering powers for the five methods were almost identical. High correlation coefficients were greater than 0.99 between grouping power and ordering power, indicating that all these methods for marker ordering were reliable. Therefore, the main problem for linkage analysis was how to improve the grouping power. Since the SER approach provided the advantage of speed without losing ordering power, this approach was used for detailed simulations. For more generality, multiple linkage groups were employed, and population size, linkage cutoff criterion, marker spacing pattern (even or uneven), and marker spacing distance (close or loose) were considered for obtaining acceptable grouping powers. Simulation results indicated that the grouping power was related to population size, marker spacing distance, and cutoff criterion. Generally, a large population size provided higher grouping power than small population size, and closely linked markers provided higher grouping power than loosely linked markers. The cutoff criterion range for achieving acceptable grouping power and ordering power differed for varying cases; however, combining all situations in this study, a cutoff criterion ranging from 50 cM to 60 cM was recommended for achieving acceptable grouping power and ordering power for different cases.

  6. Infrastructuring and Ordering Devices in Health Care

    DEFF Research Database (Denmark)

    Bossen, Claus; Markussen, Randi

    2010-01-01

    ) that is part of an electronic health record (EHR), carried out at an endocrinology department. The upgrade led to a temporary breakdown of the EMM, and a return to paper-based medication plans. The breakdown made visible and noticeable the taken-for-granted capabilities of medication plans in their paper......In this paper, we analyse physicians' and nurses' practices of prescribing and administering medication through the use of paper-based, and digitalized medication plans. Our point of departure is an ethnographic study of the implications of upgrading an electronic medication module (EMM......-based and digital versions, and the distribution of functionalities between medication plans and clinicians. We see the case as an opportunity to analyse infrastructuring in health care, the process by which medical practices and artefacts become parts of social and technological networks with longer reaches...

  7. Quantum field theory and link invariants

    International Nuclear Information System (INIS)

    Cotta-Ramusino, P.; Guadagnini, E.; Mintchev, M.; Martellini, M.

    1990-01-01

    A skein relation for the expectation values of Wilson line operators in three-dimensional SU(N) Chern-Simons gauge theory is derived at first order in the coupling constant. We use a variational method based on the properties of the three-dimensional field theory. The relationship between the above expectation values and the known link invariants is established. (orig.)

  8. Linking advanced fracture models to structural analysis

    Energy Technology Data Exchange (ETDEWEB)

    Chiesa, Matteo

    2001-07-01

    Shell structures with defects occur in many situations. The defects are usually introduced during the welding process necessary for joining different parts of the structure. Higher utilization of structural materials leads to a need for accurate numerical tools for reliable prediction of structural response. The direct discretization of the cracked shell structure with solid finite elements in order to perform an integrity assessment of the structure in question leads to large size problems, and makes such analysis infeasible in structural application. In this study a link between local material models and structural analysis is outlined. An ''ad hoc'' element formulation is used in order to connect complex material models to the finite element framework used for structural analysis. An improved elasto-plastic line spring finite element formulation, used in order to take cracks into account, is linked to shell elements which are further linked to beam elements. In this way one obtain a global model of the shell structure that also accounts for local flexibilities and fractures due to defects. An important advantage with such an approach is a direct fracture mechanics assessment e.g. via computed J-integral or CTOD. A recent development in this approach is the notion of two-parameter fracture assessment. This means that the crack tip stress tri-axiality (constraint) is employed in determining the corresponding fracture toughness, giving a much more realistic capacity of cracked structures. The present thesis is organized in six research articles and an introductory chapter that reviews important background literature related to this work. Paper I and II address the performance of shell and line spring finite elements as a cost effective tool for performing the numerical calculation needed to perform a fracture assessment. In Paper II a failure assessment, based on the testing of a constraint-corrected fracture mechanics specimen under tension, is

  9. Archetype-based data warehouse environment to enable the reuse of electronic health record data.

    Science.gov (United States)

    Marco-Ruiz, Luis; Moner, David; Maldonado, José A; Kolstrup, Nils; Bellika, Johan G

    2015-09-01

    The reuse of data captured during health care delivery is essential to satisfy the demands of clinical research and clinical decision support systems. A main barrier for the reuse is the existence of legacy formats of data and the high granularity of it when stored in an electronic health record (EHR) system. Thus, we need mechanisms to standardize, aggregate, and query data concealed in the EHRs, to allow their reuse whenever they are needed. To create a data warehouse infrastructure using archetype-based technologies, standards and query languages to enable the interoperability needed for data reuse. The work presented makes use of best of breed archetype-based data transformation and storage technologies to create a workflow for the modeling, extraction, transformation and load of EHR proprietary data into standardized data repositories. We converted legacy data and performed patient-centered aggregations via archetype-based transformations. Later, specific purpose aggregations were performed at a query level for particular use cases. Laboratory test results of a population of 230,000 patients belonging to Troms and Finnmark counties in Norway requested between January 2013 and November 2014 have been standardized. Test records normalization has been performed by defining transformation and aggregation functions between the laboratory records and an archetype. These mappings were used to automatically generate open EHR compliant data. These data were loaded into an archetype-based data warehouse. Once loaded, we defined indicators linked to the data in the warehouse to monitor test activity of Salmonella and Pertussis using the archetype query language. Archetype-based standards and technologies can be used to create a data warehouse environment that enables data from EHR systems to be reused in clinical research and decision support systems. With this approach, existing EHR data becomes available in a standardized and interoperable format, thus opening a world

  10. The Electronic Health Record Objective Structured Clinical Examination: Assessing Student Competency in Patient Interactions While Using the Electronic Health Record.

    Science.gov (United States)

    Biagioli, Frances E; Elliot, Diane L; Palmer, Ryan T; Graichen, Carla C; Rdesinski, Rebecca E; Ashok Kumar, Kaparaboyna; Galper, Ari B; Tysinger, James W

    2017-01-01

    Because many medical students do not have access to electronic health records (EHRs) in the clinical environment, simulated EHR training is necessary. Explicitly training medical students to use EHRs appropriately during patient encounters equips them to engage patients while also attending to the accuracy of the record and contributing to a culture of information safety. Faculty developed and successfully implemented an EHR objective structured clinical examination (EHR-OSCE) for clerkship students at two institutions. The EHR-OSCE objectives include assessing EHR-related communication and data management skills. The authors collected performance data for students (n = 71) at the first institution during academic years 2011-2013 and for students (n = 211) at the second institution during academic year 2013-2014. EHR-OSCE assessment checklist scores showed that students performed well in EHR-related communication tasks, such as maintaining eye contact and stopping all computer work when the patient expresses worry. Findings indicated student EHR skill deficiencies in the areas of EHR data management including medical history review, medication reconciliation, and allergy reconciliation. Most students' EHR skills failed to improve as the year progressed, suggesting that they did not gain the EHR training and experience they need in clinics and hospitals. Cross-institutional data comparisons will help determine whether differences in curricula affect students' EHR skills. National and institutional policies and faculty development are needed to ensure that students receive adequate EHR education, including hands-on experience in the clinic as well as simulated EHR practice.

  11. Interoperable Archetypes With a Three Folded Terminology Governance.

    Science.gov (United States)

    Pederson, Rune; Ellingsen, Gunnar

    2015-01-01

    The use of openEHR archetypes increases the interoperability of clinical terminology, and in doing so improves upon the availability of clinical terminology for both primary and secondary purposes. Where clinical terminology is employed in the EPR system, research reports conflicting a results for the use of structuring and standardization as measurements of success. In order to elucidate this concept, this paper focuses on the effort to establish a national repository for openEHR based archetypes in Norway where clinical terminology could be included with benefit for interoperability three folded.

  12. Alternative Design Concepts for Multi-Circuit HTS Link Systems

    CERN Document Server

    Ballarino, A

    2011-01-01

    Superconducting cables for power transmission usually contain two conductors for DC application, or three conductors for AC, with high voltage insulation. In contrast, for some applications related to accelerators it is convenient to transfer high currents via superconducting links feeding a number of circuits at relatively low voltage, of the order of a kilovolt, over distances of up to a few hundred meters. For power transmission applications based on cooling via sub-cooled liquid nitrogen, suitable HTS conductors are only available in the form of tape, and a multi-layer variant can be envisaged for the multi-circuit links. However, where cooling to temperatures of the order of 20 K is feasible, MgB2 conductor, available in the form of both tape and wire, can also be envisaged and in the latter case used to assemble round cables. There are, therefore, two distinct topologies - based on the use of wires or tapes - that can be envisaged for use in applications to multi-circuit link systems. In this paper the ...

  13. BIRTH ORDER AMONG NORTHERN INDIAN MEDICAL STUDENTS

    Directory of Open Access Journals (Sweden)

    Vinay Agarwal

    2011-12-01

    Full Text Available Background: Birth order is claimed to be linked with academic achievement. However, many scientists do not accept it. Objective: To assess the association of birth order in North Indian medical students with number of attempts to cross the competition bar. Study design: Cross sectional study. Setting and participation: M.B.B.S. 1st year students of L.L.R.M. Medical College, Meerut. Statistical analysis used: Chi Square test. Methods: Enquiry of Birth order and number of attempts to crack the medical entrance examination from responded 360 medical students among 494 students admitted during 2005 – 2010. Results: The study revealed insignificant relationship between ages of entrance in medical college in both sexes. of 360 students responded 37% students were of first Birth order. Among those admitted in first attempt, 67% students were of first birth order and proportion of success in first attempt reduced with increasing birth order. Conclusion: Birth Order strongly influences academic achievements.

  14. An analytical framework for linking biodiversity to poverty

    NARCIS (Netherlands)

    Hengsdijk, H.; Meijerink, G.W.; Tonneijck, A.E.G.; Bindraban, P.S.

    2005-01-01

    This report aims to develop a framework linking poverty reduction and biodiversity conservation in order to identify research questions and to contribute to improved policy formulation. A general overview of the subject, definitions and concepts of poverty and biodiversity are described.

  15. Concentration-dependent oligomerization of cross-linked complexes between ferredoxin and ferredoxin–NADP+ reductase

    International Nuclear Information System (INIS)

    Kimata-Ariga, Yoko; Kubota-Kawai, Hisako; Lee, Young-Ho; Muraki, Norifumi; Ikegami, Takahisa; Kurisu, Genji; Hase, Toshiharu

    2013-01-01

    Highlights: •Cross-linked complexes of ferredoxin (Fd) and Fd–NADP + reductase form oligomers. •In the crystal structures, Fd- and FNR moieties swap across the molecules. •The complexes exhibit concentration-dependent oligomerization at sub-milimolar order. -- Abstract: Ferredoxin–NADP + reductase (FNR) forms a 1:1 complex with ferredoxin (Fd), and catalyzes the electron transfer between Fd and NADP + . In our previous study, we prepared a series of site-specifically cross-linked complexes of Fd and FNR, which showed diverse electron transfer properties. Here, we show that X-ray crystal structures of the two different Fd–FNR cross-linked complexes form oligomers by swapping Fd and FNR moieties across the molecules; one complex is a dimer from, and the other is a successive multimeric form. In order to verify whether these oligomeric structures are formed only in crystal, we investigated the possibility of the oligomerization of these complexes in solution. The mean values of the particle size of these cross-linked complexes were shown to increase with the rise of protein concentration at sub-milimolar order, whereas the size of dissociable wild-type Fd:FNR complex was unchanged as analyzed by dynamic light scattering measurement. The oligomerization products were detected by SDS–PAGE after chemical cross-linking of these complexes at the sub-milimolar concentrations. The extent and concentration-dependent profile of the oligomerizaion were differentiated between the two cross-linked complexes. These results show that these Fd–FNR cross-linked complexes exhibit concentration-dependent oligomerization, possibly through swapping of Fd and FNR moieties also in solution. These findings lead to the possibility that some native multi-domain proteins may present similar phenomenon in vivo

  16. Preparation of Nanocellulose Reinforced Chitosan Films, Cross-Linked by Adipic Acid.

    Science.gov (United States)

    Falamarzpour, Pouria; Behzad, Tayebeh; Zamani, Akram

    2017-02-13

    Adipic acid, an abundant and nontoxic compound, was used to dissolve and cross-link chitosan. After the preparation of chitosan films through casting technique, the in situ amidation reaction was performed at 80-100 °C as verified by Fourier transform infrared (FT-IR). The reaction was accompanied by the release of water which was employed to investigate the reaction kinetics. Accordingly, the reaction rate followed the first-order model and Arrhenius equation, and the activation energy was calculated to be 18 kJ/mol. Furthermore, the mechanical properties of the chitosan films were comprehensively studied. First, optimal curing conditions (84 °C, 93 min) were introduced through a central composite design. In order to evaluate the effects of adipic acid, the mechanical properties of physically cross-linked (uncured), chemically cross-linked (cured), and uncross-linked (prepared by acetic acid) films were compared. The use of adipic acid improved the tensile strength of uncured and chemically cross-linked films more than 60% and 113%, respectively. Finally, the effect of cellulose nanofibrils (CNFs) on the mechanical performance of cured films, in the presence of glycerol as a plasticizer, was investigated. The plasticized chitosan films reinforced by 5 wt % CNFs showed superior properties as a promising material for the development of chitosan-based biomaterials.

  17. Entanglement entropy for (3+1)-dimensional topological order with excitations

    Science.gov (United States)

    Wen, Xueda; He, Huan; Tiwari, Apoorv; Zheng, Yunqin; Ye, Peng

    2018-02-01

    Excitations in (3+1)-dimensional [(3+1)D] topologically ordered phases have very rich structures. (3+1)D topological phases support both pointlike and stringlike excitations, and in particular the loop (closed string) excitations may admit knotted and linked structures. In this work, we ask the following question: How do different types of topological excitations contribute to the entanglement entropy or, alternatively, can we use the entanglement entropy to detect the structure of excitations, and further obtain the information of the underlying topological order? We are mainly interested in (3+1)D topological order that can be realized in Dijkgraaf-Witten (DW) gauge theories, which are labeled by a finite group G and its group 4-cocycle ω ∈H4[G ;U(1 ) ] up to group automorphisms. We find that each topological excitation contributes a universal constant lndi to the entanglement entropy, where di is the quantum dimension that depends on both the structure of the excitation and the data (G ,ω ) . The entanglement entropy of the excitations of the linked/unlinked topology can capture different information of the DW theory (G ,ω ) . In particular, the entanglement entropy introduced by Hopf-link loop excitations can distinguish certain group 4-cocycles ω from the others.

  18. Analog Fiber Optic Link with DC-100 MHz Bandwidth

    National Research Council Canada - National Science Library

    Sullivan, C. A; Girardi, P. G; Lohrmann, Dieter R

    2008-01-01

    An analog fiber optic link covering the frequency range from DC to 100 MHz was designed, constructed, and tested, in order to connect a 10 kA pulse current probe to oscilloscopes for oscillographing...

  19. Third-order nonlinear optical properties of open-shell supermolecular systems composed of acetylene linked phenalenyl radicals.

    Science.gov (United States)

    Nakano, Masayoshi; Kishi, Ryohei; Yoneda, Kyohei; Inoue, Yudai; Inui, Tomoya; Shigeta, Yasuteru; Kubo, Takashi; Champagne, Benoît

    2011-08-11

    The third-order nonlinear optical (NLO) properties, at the molecular level, the static second hyperpolarizabilities, γ, of supermolecular systems composed of phenalenyl and pyrene rings linked by acetylene units are investigated by employing the long-range corrected spin-unrestricted density functional theory, LC-UBLYP, method. The phenalenyl based superethylene, superallyl, and superbutadiene in their lowest spin states have intermediate diradical characters and exhibit larger γ values than the closed-shell pyrene based superpolyene systems. The introduction of a positive charge into the phenalenyl based superallyl radical changes the sign of γ and enhances its amplitude by a factor of 35. Although such sign inversion is also observed in the allyl radical and cation systems in their ground state equilibrium geometries, the relative amplitude of γ is much different, that is, |γ(regular allyl cation)/γ(regular allyl radical)| = 0.61 versus |γ(phenalenyl based superallyl cation)/γ(phenalenyl based superallyl radical)| = 35. In contrast, the model ethylene, allyl radical/cation, and butadiene systems with stretched carbon-carbon bond lengths (2.0 Å), having intermediate diradical characters, exhibit similar γ features to those of the phenalenyl based superpolyene systems. This exemplifies that the size dependence of γ as well as its sign change by introducing a positive charge on the phenalenyl based superpolyene systems originate from their intermediate diradical characters. In addition, the change from the lowest to the highest π-electron spin states significantly reduces the γ amplitudes of the neutral phenalenyl based superpolyene systems. For phenalenyl based superallyl cation, the sign inversion of γ (from negative to positive) is observed upon switching between the singlet and triplet states, which is predicted to be associated with a modification of the balance between the positive and negative contributions to γ. The present study paves the way

  20. What Information Does Your EHR Contain? Automatic Generation of a Clinical Metadata Warehouse (CMDW) to Support Identification and Data Access Within Distributed Clinical Research Networks.

    Science.gov (United States)

    Bruland, Philipp; Doods, Justin; Storck, Michael; Dugas, Martin

    2017-01-01

    Data dictionaries provide structural meta-information about data definitions in health information technology (HIT) systems. In this regard, reusing healthcare data for secondary purposes offers several advantages (e.g. reduce documentation times or increased data quality). Prerequisites for data reuse are its quality, availability and identical meaning of data. In diverse projects, research data warehouses serve as core components between heterogeneous clinical databases and various research applications. Given the complexity (high number of data elements) and dynamics (regular updates) of electronic health record (EHR) data structures, we propose a clinical metadata warehouse (CMDW) based on a metadata registry standard. Metadata of two large hospitals were automatically inserted into two CMDWs containing 16,230 forms and 310,519 data elements. Automatic updates of metadata are possible as well as semantic annotations. A CMDW allows metadata discovery, data quality assessment and similarity analyses. Common data models for distributed research networks can be established based on similarity analyses.

  1. Linking DC together with TRSL

    DEFF Research Database (Denmark)

    Haxthausen, Anne; Yong, Xia

    1999-01-01

    In this talk we present a method for linking the Duration Calculus together with the Timed RAISE Specification Language. Duration Calculus (DC) [ZHR91] is an interval-based real time logic, which can be used naturally in capturing and eliciting users' real time requirements in the form of constra......In this talk we present a method for linking the Duration Calculus together with the Timed RAISE Specification Language. Duration Calculus (DC) [ZHR91] is an interval-based real time logic, which can be used naturally in capturing and eliciting users' real time requirements in the form.......TRSL is a real-time extension of the RAISE Specification Language (RSL) [Rlg92] which together with its associated method [Rmg95]and tools has shown to be very useful in the industrial development of software systems. Therefore, a promising approach for the development of real-time systemscould be to use DC...... for high-level specifications of real-time requirementsand TRSL for specifying real-time implementations in the form of timed communicating concurrent processes.In order to link DC and TRSL together in a well-founded way, we formally define what it means for a TRSL process to satisfy a DC requirement...

  2. Electronic health records improve clinical note quality.

    Science.gov (United States)

    Burke, Harry B; Sessums, Laura L; Hoang, Albert; Becher, Dorothy A; Fontelo, Paul; Liu, Fang; Stephens, Mark; Pangaro, Louis N; O'Malley, Patrick G; Baxi, Nancy S; Bunt, Christopher W; Capaldi, Vincent F; Chen, Julie M; Cooper, Barbara A; Djuric, David A; Hodge, Joshua A; Kane, Shawn; Magee, Charles; Makary, Zizette R; Mallory, Renee M; Miller, Thomas; Saperstein, Adam; Servey, Jessica; Gimbel, Ronald W

    2015-01-01

    The clinical note documents the clinician's information collection, problem assessment, clinical management, and its used for administrative purposes. Electronic health records (EHRs) are being implemented in clinical practices throughout the USA yet it is not known whether they improve the quality of clinical notes. The goal in this study was to determine if EHRs improve the quality of outpatient clinical notes. A five and a half year longitudinal retrospective multicenter quantitative study comparing the quality of handwritten and electronic outpatient clinical visit notes for 100 patients with type 2 diabetes at three time points: 6 months prior to the introduction of the EHR (before-EHR), 6 months after the introduction of the EHR (after-EHR), and 5 years after the introduction of the EHR (5-year-EHR). QNOTE, a validated quantitative instrument, was used to assess the quality of outpatient clinical notes. Its scores can range from a low of 0 to a high of 100. Sixteen primary care physicians with active practices used QNOTE to determine the quality of the 300 patient notes. The before-EHR, after-EHR, and 5-year-EHR grand mean scores (SD) were 52.0 (18.4), 61.2 (16.3), and 80.4 (8.9), respectively, and the change in scores for before-EHR to after-EHR and before-EHR to 5-year-EHR were 18% (pquality scores significantly improved over the 5-year time interval. The EHR significantly improved the overall quality of the outpatient clinical note and the quality of all its elements, including the core and non-core elements. To our knowledge, this is the first study to demonstrate that the EHR significantly improves the quality of clinical notes. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association.

  3. Montreal Accord on Patient-Reported Outcomes (PROs) use series - Paper 8: patient-reported outcomes in electronic health records can inform clinical and policy decisions.

    Science.gov (United States)

    Ahmed, Sara; Ware, Patrick; Gardner, William; Witter, James; Bingham, Clifton O; Kairy, Dahlia; Bartlett, Susan J

    2017-09-01

    Given that the goal of health care systems is to improve and maintain the health of the populations they serve, the indicators of performance must include outcomes that are meaningful to patients. The growth of health technologies provides an unprecedented opportunity to integrate the patient voice into clinical care by linking electronic health records (EHRs) to patient-reported outcome (PRO) data collection. However, PRO data must be relevant, meaningful, and actionable for those who will have to invest the time and effort to collect it. In this study, we highlight opportunities to integrate PRO data collection into EHRs. We consider how stakeholder perspectives should influence the selection of PROs and ways to enhance engagement in and commitment to PRO implementation. We propose a research and policy agenda to address unanswered questions and facilitate the widespread adoption of PRO data collection into EHRs. Building a learning health care system that gathers PRO data in ways that can inform individual patient care, quality improvement, and comparative effectiveness research has the potential to accelerate the application of new evidence and knowledge to patient care. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Linking main-belt comets to asteroid families

    Science.gov (United States)

    Novakovic, B.; Hsieh, H. H.; Cellino, A.

    2012-09-01

    Here we present our results obtained by applying different methods in order to establish a firm link between the main-belt comets (MBCs) and colisionally-formed asteroid families (AFs), i.e, to possibly find additional line of evidence supporting the hypothesis that MBCs may be preferentially found among the members of young AFs.

  5. Factors associated with adoption of health information technology: a conceptual model based on a systematic review.

    Science.gov (United States)

    Kruse, Clemens Scott; DeShazo, Jonathan; Kim, Forest; Fulton, Lawrence

    2014-05-23

    The Health Information Technology for Economic and Clinical Health Act (HITECH) allocated $19.2 billion to incentivize adoption of the electronic health record (EHR). Since 2009, Meaningful Use Criteria have dominated information technology (IT) strategy. Health care organizations have struggled to meet expectations and avoid penalties to reimbursements from the Center for Medicare and Medicaid Services (CMS). Organizational theories attempt to explain factors that influence organizational change, and many theories address changes in organizational strategy. However, due to the complexities of the health care industry, existing organizational theories fall short of demonstrating association with significant health care IT implementations. There is no organizational theory for health care that identifies, groups, and analyzes both internal and external factors of influence for large health care IT implementations like adoption of the EHR. The purpose of this systematic review is to identify a full-spectrum of both internal organizational and external environmental factors associated with the adoption of health information technology (HIT), specifically the EHR. The result is a conceptual model that is commensurate with the complexity of with the health care sector. We performed a systematic literature search in PubMed (restricted to English), EBSCO Host, and Google Scholar for both empirical studies and theory-based writing from 1993-2013 that demonstrated association between influential factors and three modes of HIT: EHR, electronic medical record (EMR), and computerized provider order entry (CPOE). We also looked at published books on organizational theories. We made notes and noted trends on adoption factors. These factors were grouped as adoption factors associated with various versions of EHR adoption. The resulting conceptual model summarizes the diversity of independent variables (IVs) and dependent variables (DVs) used in articles, editorials, books, as

  6. Writing and reading in the electronic health record: an entirely new world

    Directory of Open Access Journals (Sweden)

    Lauri Lopp

    2013-02-01

    Full Text Available Background: Electronic health records (EHRs are structured, distributed documentation systems that differ from paper charts. These systems require skills not traditionally used to navigate a paper chart and to produce a written clinic note. Despite these differences, little attention has been given to physicians’ electronic health record (EHR-writing and -reading competence. Purposes: This study aims to investigate physicians’ self-assessed competence to document and to read EHR notes; writing and reading preferences in an EHR; and demographic characteristics associated with their perceived EHR ability and preference. Methods: Fourteen 5-point Likert scale items, based on EHR system characteristics and a literature review, were developed to measure EHR-writing and -reading competence and preference. Physicians in the midwest region of the United States were invited via e-mail to complete the survey online from February to April 2011. Factor analysis and reliability testing were conducted to provide validity and reliability of the instrument. Correlation and regression analysis were conducted to pursue answers to the research questions. Results: Ninety-one physicians (12.5%, from general and specialty fields, working in inpatient and outpatient settings, participated in the survey. Despite over 3 years of EHR experience, respondents perceived themselves to be incompetent in EHR writing and reading (Mean = 2.74, SD = 0.76. They preferred to read succinct, narrative notes in EHR systems. However, physicians with higher perceived EHR-writing and -reading competence had less preference toward reading succinct (r= − 0.33, p<0.001 and narrative (r= − 0.36, p<0.001 EHR notes than physicians with lower perceived EHR competence. Physicians’ perceived EHR-writing and -reading competence was strongly related to their EHR navigation skills (r=0.55, p<0.0001. Conclusions: Writing and reading EHR documentation is different for physicians. Maximizing

  7. Mixed-order phase transition in a one-dimensional model.

    Science.gov (United States)

    Bar, Amir; Mukamel, David

    2014-01-10

    We introduce and analyze an exactly soluble one-dimensional Ising model with long range interactions that exhibits a mixed-order transition, namely a phase transition in which the order parameter is discontinuous as in first order transitions while the correlation length diverges as in second order transitions. Such transitions are known to appear in a diverse classes of models that are seemingly unrelated. The model we present serves as a link between two classes of models that exhibit a mixed-order transition in one dimension, namely, spin models with a coupling constant that decays as the inverse distance squared and models of depinning transitions, thus making a step towards a unifying framework.

  8. Which components of health information technology will drive financial value?

    Science.gov (United States)

    Kern, Lisa M; Wilcox, Adam; Shapiro, Jason; Dhopeshwarkar, Rina V; Kaushal, Rainu

    2012-08-01

    The financial effects of electronic health records (EHRs) and health information exchange (HIE) are largely unknown, despite unprecedented federal incentives for their use. We sought to understand which components of EHRs and HIE are most likely to drive financial savings in the ambulatory, inpatient, and emergency department settings. Framework development and a national expert panel. We searched the literature to identify functionalities enabled by EHRs and HIE across the 3 healthcare settings. We rated each of 233 functionality-setting combinations on their likelihood of having a positive financial effect. We validated the top-scoring functionalities with a panel of 28 national experts, and we compared the high-scoring functionalities with Stage 1 meaningful use criteria. We identified 54 high-scoring functionality- setting combinations, 27 for EHRs and 27 for HIE. Examples of high-scoring functionalities included providing alerts for expensive medications, providing alerts for redundant lab orders, sending and receiving imaging reports, and enabling structured medication reconciliation. Of the 54 high-scoring functionalities, 25 (46%) are represented in Stage 1 meaningful use. Many of the functionalities not yet represented in meaningful use correspond with functionalities that focus directly on healthcare utilization and costs rather than on healthcare quality per se. This work can inform the development and selection of future meaningful use measures; inform implementation efforts, as clinicians and hospitals choose from among a "menu" of measures for meaningful use; and inform evaluation efforts, as investigators seek to measure the actual financial impact of EHRs and HIE.

  9. Physician capability to electronically exchange clinical information, 2011.

    Science.gov (United States)

    Patel, Vaishali; Swain, Matthew J; King, Jennifer; Furukawa, Michael F

    2013-10-01

    To provide national estimates of physician capability to electronically share clinical information with other providers and to describe variation in exchange capability across states and electronic health record (EHR) vendors using the 2011 National Ambulatory Medical Care Survey Electronic Medical Record Supplement. Survey of a nationally representative sample of nonfederal office-based physicians who provide direct patient care. The survey was administered by mail with telephone follow-up and had a 61% weighted response rate. The overall sample consisted of 4326 respondents. We calculated estimates of electronic exchange capability at the national and state levels, and applied multivariate analyses to examine the association between the capability to exchange different types of clinical information and physician and practice characteristics. In 2011, 55% of physicians had computerized capability to send prescriptions electronically; 67% had the capability to view lab results electronically; 42% were able to incorporate lab results into their EHR; 35% were able to send lab orders electronically; and, 31% exchanged patient clinical summaries with other providers. The strongest predictor of exchange capability is adoption of an EHR. However, substantial variation exists across geography and EHR vendors in exchange capability, especially electronic exchange of clinical summaries. In 2011, a majority of office-based physicians could exchange lab and medication data, and approximately one-third could exchange clinical summaries with patients or other providers. EHRs serve as a key mechanism by which physicians can exchange clinical data, though physicians' capability to exchange varies by vendor and by state.

  10. The impact of interoperability of electronic health records on ambulatory physician practices: a discrete-event simulation study

    Directory of Open Access Journals (Sweden)

    Yuan Zhou

    2014-02-01

    Full Text Available Background The effect of health information technology (HIT on efficiency and workload among clinical and nonclinical staff has been debated, with conflicting evidence about whether electronic health records (EHRs increase or decrease effort. None of this paper to date, however, examines the effect of interoperability quantitatively using discrete event simulation techniques.Objective To estimate the impact of EHR systems with various levels of interoperability on day-to-day tasks and operations of ambulatory physician offices.Methods Interviews and observations were used to collect workflow data from 12 adult primary and specialty practices. A discrete event simulation model was constructed to represent patient flows and clinical and administrative tasks of physicians and staff members.Results High levels of EHR interoperability were associated with reduced time spent by providers on four tasks: preparing lab reports, requesting lab orders, prescribing medications, and writing referrals. The implementation of an EHR was associated with less time spent by administrators but more time spent by physicians, compared with time spent at paper-based practices. In addition, the presence of EHRs and of interoperability did not significantly affect the time usage of registered nurses or the total visit time and waiting time of patients.Conclusion This paper suggests that the impact of using HIT on clinical and nonclinical staff work efficiency varies, however, overall it appears to improve time efficiency more for administrators than for physicians and nurses.

  11. IHE cross-enterprise document sharing for imaging: interoperability testing software

    Directory of Open Access Journals (Sweden)

    Renaud Bérubé

    2010-09-01

    Full Text Available Abstract Background With the deployments of Electronic Health Records (EHR, interoperability testing in healthcare is becoming crucial. EHR enables access to prior diagnostic information in order to assist in health decisions. It is a virtual system that results from the cooperation of several heterogeneous distributed systems. Interoperability between peers is therefore essential. Achieving interoperability requires various types of testing. Implementations need to be tested using software that simulates communication partners, and that provides test data and test plans. Results In this paper we describe a software that is used to test systems that are involved in sharing medical images within the EHR. Our software is used as part of the Integrating the Healthcare Enterprise (IHE testing process to test the Cross Enterprise Document Sharing for imaging (XDS-I integration profile. We describe its architecture and functionalities; we also expose the challenges encountered and discuss the elected design solutions. Conclusions EHR is being deployed in several countries. The EHR infrastructure will be continuously evolving to embrace advances in the information technology domain. Our software is built on a web framework to allow for an easy evolution with web technology. The testing software is publicly available; it can be used by system implementers to test their implementations. It can also be used by site integrators to verify and test the interoperability of systems, or by developers to understand specifications ambiguities, or to resolve implementations difficulties.

  12. An electronic health record-enabled obesity database

    Directory of Open Access Journals (Sweden)

    Wood G

    2012-05-01

    Full Text Available Abstract Background The effectiveness of weight loss therapies is commonly measured using body mass index and other obesity-related variables. Although these data are often stored in electronic health records (EHRs and potentially very accessible, few studies on obesity and weight loss have used data derived from EHRs. We developed processes for obtaining data from the EHR in order to construct a database on patients undergoing Roux-en-Y gastric bypass (RYGB surgery. Methods Clinical data obtained as part of standard of care in a bariatric surgery program at an integrated health delivery system were extracted from the EHR and deposited into a data warehouse. Data files were extracted, cleaned, and stored in research datasets. To illustrate the utility of the data, Kaplan-Meier analysis was used to estimate length of post-operative follow-up. Results Demographic, laboratory, medication, co-morbidity, and survey data were obtained from 2028 patients who had undergone RYGB at the same institution since 2004. Pre-and post-operative diagnostic and prescribing information were available on all patients, while survey laboratory data were available on a majority of patients. The number of patients with post-operative laboratory test results varied by test. Based on Kaplan-Meier estimates, over 74% of patients had post-operative weight data available at 4 years. Conclusion A variety of EHR-derived data related to obesity can be efficiently obtained and used to study important outcomes following RYGB.

  13. Barriers to Electronic Health Record Adoption: a Systematic Literature Review.

    Science.gov (United States)

    Kruse, Clemens Scott; Kristof, Caitlin; Jones, Beau; Mitchell, Erica; Martinez, Angelica

    2016-12-01

    Federal efforts and local initiatives to increase adoption and use of electronic health records (EHRs) continue, particularly since the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act. Roughly one in four hospitals not adopted even a basic EHR system. A review of the barriers may help in understanding the factors deterring certain healthcare organizations from implementation. We wanted to assemble an updated and comprehensive list of adoption barriers of EHR systems in the United States. Authors searched CINAHL, MEDLINE, and Google Scholar, and accepted only articles relevant to our primary objective. Reviewers independently assessed the works highlighted by our search and selected several for review. Through multiple consensus meetings, authors tapered articles to a final selection most germane to the topic (n = 27). Each article was thoroughly examined by multiple authors in order to achieve greater validity. Authors identified 39 barriers to EHR adoption within the literature selected for the review. These barriers appeared 125 times in the literature; the most frequently mentioned barriers were regarding cost, technical concerns, technical support, and resistance to change. Despite federal and local incentives, the initial cost of adopting an EHR is a common existing barrier. The other most commonly mentioned barriers include technical support, technical concerns, and maintenance/ongoing costs. Policy makers should consider incentives that continue to reduce implementation cost, possibly aimed more directly at organizations that are known to have lower adoption rates, such as small hospitals in rural areas.

  14. Preparation of Nanocellulose Reinforced Chitosan Films, Cross-Linked by Adipic Acid

    Directory of Open Access Journals (Sweden)

    Pouria Falamarzpour

    2017-02-01

    Full Text Available Adipic acid, an abundant and nontoxic compound, was used to dissolve and cross-link chitosan. After the preparation of chitosan films through casting technique, the in situ amidation reaction was performed at 80–100 °C as verified by Fourier transform infrared (FT-IR. The reaction was accompanied by the release of water which was employed to investigate the reaction kinetics. Accordingly, the reaction rate followed the first-order model and Arrhenius equation, and the activation energy was calculated to be 18 kJ/mol. Furthermore, the mechanical properties of the chitosan films were comprehensively studied. First, optimal curing conditions (84 °C, 93 min were introduced through a central composite design. In order to evaluate the effects of adipic acid, the mechanical properties of physically cross-linked (uncured, chemically cross-linked (cured, and uncross-linked (prepared by acetic acid films were compared. The use of adipic acid improved the tensile strength of uncured and chemically cross-linked films more than 60% and 113%, respectively. Finally, the effect of cellulose nanofibrils (CNFs on the mechanical performance of cured films, in the presence of glycerol as a plasticizer, was investigated. The plasticized chitosan films reinforced by 5 wt % CNFs showed superior properties as a promising material for the development of chitosan-based biomaterials.

  15. The Challenges of Data Quality Evaluation in a Joint Data Warehouse.

    Science.gov (United States)

    Bae, Charles J; Griffith, Sandra; Fan, Youran; Dunphy, Cheryl; Thompson, Nicolas; Urchek, John; Parchman, Alandra; Katzan, Irene L

    2015-01-01

    The use of clinically derived data from electronic health records (EHRs) and other electronic clinical systems can greatly facilitate clinical research as well as operational and quality initiatives. One approach for making these data available is to incorporate data from different sources into a joint data warehouse. When using such a data warehouse, it is important to understand the quality of the data. The primary objective of this study was to determine the completeness and concordance of common types of clinical data available in the Knowledge Program (KP) joint data warehouse, which contains feeds from several electronic systems including the EHR. A manual review was performed of specific data elements for 250 patients from an EHR, and these were compared with corresponding elements in the KP data warehouse. Completeness and concordance were calculated for five categories of data including demographics, vital signs, laboratory results, diagnoses, and medications. In general, data elements for demographics, vital signs, diagnoses, and laboratory results were present in more cases in the source EHR compared to the KP. When data elements were available in both sources, there was a high concordance. In contrast, the KP data warehouse documented a higher prevalence of deaths and medications compared to the EHR. Several factors contributed to the discrepancies between data in the KP and the EHR-including the start date and frequency of data feeds updates into the KP, inability to transfer data located in nonstructured formats (e.g., free text or scanned documents), as well as incomplete and missing data variables in the source EHR. When evaluating the quality of a data warehouse with multiple data sources, assessing completeness and concordance between data set and source data may be better than designating one to be a gold standard. This will allow the user to optimize the method and timing of data transfer in order to capture data with better accuracy.

  16. Electronic Health Record Systems and Intent to Apply for Meaningful Use Incentives among Office-based Physician ...

    Science.gov (United States)

    ... Order from the National Technical Information Service NCHS Electronic Health Record Systems and Intent to Apply for ... In 2011, 57% of office-based physicians used electronic medical record/electronic health record (EMR/EHR) systems, ...

  17. Stabilized Sulfonated Aromatic Polymers by in situ Solvothermal Cross-Linking

    Energy Technology Data Exchange (ETDEWEB)

    Di Vona, Maria Luisa, E-mail: divona@uniroma2.it; Sgreccia, Emanuela [Dipartimento di Scienze e Tecnologie Chimiche, Università di Roma Tor Vergata, Rome (Italy); Narducci, Riccardo; Pasquini, Luca [Dipartimento di Scienze e Tecnologie Chimiche, Università di Roma Tor Vergata, Rome (Italy); MAtériaux Divisés, Interfaces, Réactivité, ELectrochimie (MADIREL – UMR 7246), Aix Marseille Université, Marseille (France); Hou, Hongying [Faculty of Material and Engineering, Kunming University of Science and Technology, Kunming (China); Knauth, Philippe [MAtériaux Divisés, Interfaces, Réactivité, ELectrochimie (MADIREL – UMR 7246), Aix Marseille Université, Marseille (France)

    2014-10-10

    The cross-link reaction via sulfone bridges of sulfonated polyether ether ketone (SPEEK) by thermal treatment at 180°C in presence of dimethylsulfoxide is discussed. The modifications of properties subsequent to the cross-linking are presented. The mechanical strength as well as the hydrolytic stability increased with the thermal treatment time, i.e., with the degree of cross-linking. The proton conductivity was determined as function of temperature, IEC, degree of cross-linking, and hydration number. The memory effect, which is the membrane ability to “remember” the water uptake reached at high temperature also at lower temperature, is exploited in order to achieve high values of conductivity. Membranes swelled at 110°C can reach a conductivity of 0.14 S/cm at 80°C with a hydration number (λ) of 73.

  18. Measuring use of electronic health record functionality using system audit information.

    Science.gov (United States)

    Bowes, Watson A

    2010-01-01

    Meaningful and efficient methods for measuring Electronic Health Record (EHR) adoption and functional usage patterns have recently become important for hospitals, clinics, and health care networks in the United State due to recent government initiatives to increase EHR use. To date, surveys have been the method of choice to measure EHR adoption. This paper describes another method for measuring EHR adoption which capitalizes on audit logs, which are often common components of modern EHRs. An Audit Data Mart is described which identified EHR functionality within 836 Departments, within 22 Hospitals and 170 clinics at Intermountain Healthcare, a large integrated delivery system. The Audit Data Mart successfully identified important and differing EHR functional usage patterns. These patterns were useful in strategic planning, tracking EHR implementations, and will likely be utilized to assist in documentation of "Meaningful Use" of EHR functionality.

  19. The Use of Clinical Decision Support in Reducing Diagnosis of and Treatment of Asymptomatic Bacteriuria.

    Science.gov (United States)

    Keller, Sara C; Feldman, Leonard; Smith, Janessa; Pahwa, Amit; Cosgrove, Sara E; Chida, Natasha

    2018-06-01

    Clinical decision support (CDS) embedded within the electronic health record (EHR) is a potential antibiotic stewardship strategy for hospitalized patients. Reduction in urine testing and treating asymptomatic bacteriuria (ASB) is an important strategy to promote antibiotic stewardship. We created an intervention focused on reducing urine testing for asymptomatic patients at a large tertiary care center. The objective of this study was to design an intervention to reduce unnecessary urinalysis and urine culture (UC) orders as well as the treatment of ASB. We performed a quasiexperimental study among adult inpatients at a single academic institution. We implemented a bundled intervention, including information broadcast in newsletters, hospitalwide screensavers, and passive CDS messages in the EHR. We investigated the impact of this strategy on urinalysis, UC orders, and on the treatment of ASB by using an interrupted time series analysis. Our intervention led to reduced UC order as well as reduced antibiotic orders in response to urinalysis orders and UC results. This easily implementable bundle may play an important role as an antibiotic stewardship strategy. © 2018 Society of Hospital Medicine.

  20. The SAFER guides: empowering organizations to improve the safety and effectiveness of electronic health records.

    Science.gov (United States)

    Sittig, Dean F; Ash, Joan S; Singh, Hardeep

    2014-05-01

    Electronic health records (EHRs) have potential to improve quality and safety of healthcare. However, EHR users have experienced safety concerns from EHR design and usability features that are not optimally adapted for the complex work flow of real-world practice. Few strategies exist to address unintended consequences from implementation of EHRs and other health information technologies. We propose that organizations equipped with EHRs should consider the strategy of "proactive risk assessment" of their EHR-enabled healthcare system to identify and address EHR-related safety concerns. In this paper, we describe the conceptual underpinning of an EHR-related self-assessment strategy to provide institutions a foundation upon which they could build their safety efforts. With support from the Office of the National Coordinator for Health Information Technology (ONC), we used a rigorous, iterative process to develop a set of 9 self-assessment tools to optimize the safety and safe use of EHRs. These tools, referred to as the Safety Assurance Factors for EHR Resilience (SAFER) guides, could be used to self-assess safety and effectiveness of EHR implementations, identify specific areas of vulnerability, and create solutions and culture change to mitigate risks. A variety of audiences could conduct these assessments, including frontline clinicians or care teams in different practices, or clinical, quality, or administrative leaders within larger institutions. The guides use a multifaceted systems-based approach to assess risk and empower organizations to work with internal or external stakeholders (eg, EHR developers) on optimizing EHR functionality and using EHRs to drive improvements in the quality and safety of healthcare.

  1. Electronic Health Records and US Public Health: Current Realities and Future Promise

    Science.gov (United States)

    Parrish, R. Gibson; Ross, David A.

    2013-01-01

    Electronic health records (EHRs) could contribute to improving population health in the United States. Realizing this potential will require understanding what EHRs can realistically offer to efforts to improve population health, the requirements for obtaining useful information from EHRs, and a plan for addressing these requirements. Potential contributions of EHRs to improving population health include better understanding of the level and distribution of disease, function, and well-being within populations. Requirements are improved population coverage of EHRs, standardized EHR content and reporting methods, and adequate legal authority for using EHRs, particularly for population health. A collaborative national effort to address the most pressing prerequisites for and barriers to the use of EHRs for improving population health is needed to realize the EHR’s potential. PMID:23865646

  2. A TLBO based gradient descent learning-functional link higher order ANN: An efficient model for learning from non-linear data

    Directory of Open Access Journals (Sweden)

    Bighnaraj Naik

    2018-01-01

    Full Text Available All the higher order ANNs (HONNs including functional link ANN (FLANN are sensitive to random initialization of weight and rely on the learning algorithms adopted. Although a selection of efficient learning algorithms for HONNs helps to improve the performance, on the other hand, initialization of weights with optimized weights rather than random weights also play important roles on its efficiency. In this paper, the problem solving approach of the teaching learning based optimization (TLBO along with learning ability of the gradient descent learning (GDL is used to obtain the optimal set of weight of FLANN learning model. TLBO does not require any specific parameters rather it requires only some of the common independent parameters like number of populations, number of iterations and stopping criteria, thereby eliminating the intricacy in selection of algorithmic parameters for adjusting the set of weights of FLANN model. The proposed TLBO-FLANN is implemented in MATLAB and compared with GA-FLANN, PSO-FLANN and HS-FLANN. The TLBO-FLANN is tested on various 5-fold cross validated benchmark data sets from UCI machine learning repository and analyzed under the null-hypothesis by using Friedman test, Holm’s procedure and post hoc ANOVA statistical analysis (Tukey test & Dunnett test.

  3. Modest Associations Between Electronic Health Record Use and Acute Myocardial Infarction Quality of Care and Outcomes: Results From the National Cardiovascular Data Registry.

    Science.gov (United States)

    Enriquez, Jonathan R; de Lemos, James A; Parikh, Shailja V; Simon, DaJuanicia N; Thomas, Laine E; Wang, Tracy Y; Chan, Paul S; Spertus, John A; Das, Sandeep R

    2015-11-01

    In 2009, national legislation promoted wide-spread adoption of electronic health records (EHRs) across US hospitals; however, the association of EHR use with quality of care and outcomes after acute myocardial infarction (AMI) remains unclear. Data on EHR use were collected from the American Hospital Association Annual Surveys (2007-2010) and data on AMI care and outcomes from the National Cardiovascular Data Registry Acute Coronary Treatment and Interventions Outcomes Network Registry-Get With The Guidelines. Comparisons were made between patients treated at hospitals with fully implemented EHR (n=43 527), partially implemented EHR (n=72 029), and no EHR (n=9270). Overall EHR use increased from 82.1% (183/223) hospitals in 2007 to 99.3% (275/277) hospitals in 2010. Patients treated at hospitals with fully implemented EHRs had fewer heparin overdosing errors (45.7% versus 72.8%; P<0.01) and a higher likelihood of guideline-recommended care (adjusted odds ratio, 1.40 [confidence interval, 1.07-1.84]) compared with patients treated at hospitals with no EHR. In non-ST-segment-elevation AMI, fully implemented EHR use was associated with lower risk of major bleeding (adjusted odds ratio, 0.78 [confidence interval, 0.67-0.91]) and mortality (adjusted odds ratio, 0.82 [confidence interval, 0.69-0.97]) compared with no EHR. In ST-segment-elevation MI, outcomes did not significantly differ by EHR status. EHR use has risen to high levels among hospitals in the National Cardiovascular Data Registry. EHR use was associated with less frequent heparin overdosing and modestly greater adherence to acute MI guideline-recommended therapies. In non-ST-segment-elevation MI, slightly lower adjusted risk of major bleeding and mortality were seen in hospitals implemented with full EHRs; however, in ST-segment-elevation MI, differences in outcomes were not seen. © 2015 American Heart Association, Inc.

  4. Design and implementation of a privacy preserving electronic health record linkage tool in Chicago.

    Science.gov (United States)

    Kho, Abel N; Cashy, John P; Jackson, Kathryn L; Pah, Adam R; Goel, Satyender; Boehnke, Jörn; Humphries, John Eric; Kominers, Scott Duke; Hota, Bala N; Sims, Shannon A; Malin, Bradley A; French, Dustin D; Walunas, Theresa L; Meltzer, David O; Kaleba, Erin O; Jones, Roderick C; Galanter, William L

    2015-09-01

    To design and implement a tool that creates a secure, privacy preserving linkage of electronic health record (EHR) data across multiple sites in a large metropolitan area in the United States (Chicago, IL), for use in clinical research. The authors developed and distributed a software application that performs standardized data cleaning, preprocessing, and hashing of patient identifiers to remove all protected health information. The application creates seeded hash code combinations of patient identifiers using a Health Insurance Portability and Accountability Act compliant SHA-512 algorithm that minimizes re-identification risk. The authors subsequently linked individual records using a central honest broker with an algorithm that assigns weights to hash combinations in order to generate high specificity matches. The software application successfully linked and de-duplicated 7 million records across 6 institutions, resulting in a cohort of 5 million unique records. Using a manually reconciled set of 11 292 patients as a gold standard, the software achieved a sensitivity of 96% and a specificity of 100%, with a majority of the missed matches accounted for by patients with both a missing social security number and last name change. Using 3 disease examples, it is demonstrated that the software can reduce duplication of patient records across sites by as much as 28%. Software that standardizes the assignment of a unique seeded hash identifier merged through an agreed upon third-party honest broker can enable large-scale secure linkage of EHR data for epidemiologic and public health research. The software algorithm can improve future epidemiologic research by providing more comprehensive data given that patients may make use of multiple healthcare systems. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  5. Birth Order and Participation in School Sports and Other Extracurricular Activities

    Science.gov (United States)

    Rees, Daniel I.; Lopez, Elizabeth; Averett, Susan L.; Argys, Laura M.

    2008-01-01

    Argys, L.M., Rees, D.I., Averett S.L., & Witoonchart, B. (2006). Birth order and risky adolescent behavior. "Economic Inquiry", 44(2), 215-233 demonstrated that a strong link exists between birth order and adolescent risky behavior. Using data on 10th graders from the National Education Longitudinal Study of 1988, we extend the work of Argys et…

  6. Research on Shore-Ship Photonic Link Performance for Two- Frequency-Band Signals

    Science.gov (United States)

    Zuo, Yanqin; Cong, Bo

    2016-02-01

    Ka and Ku bands links for shore-ship communications suffer limited bandwidth and high loss. In this paper, photonics-based links are proposed and modeled. The principle of phase modulation (PM) is elaborated and analyzed. It is showed that PM can effectively suppress high-order inter-modulation distortion (IMD), reduce the insert loss and improve the reliability of the system.

  7. LRSim: A Linked-Reads Simulator Generating Insights for Better Genome Partitioning

    Directory of Open Access Journals (Sweden)

    Ruibang Luo

    Full Text Available Linked-read sequencing, using highly-multiplexed genome partitioning and barcoding, can span hundreds of kilobases to improve de novo assembly, haplotype phasing, and other applications. Based on our analysis of 14 datasets, we introduce LRSim that simulates linked-reads by emulating the library preparation and sequencing process with fine control over variants, linked-read characteristics, and the short-read profile. We conclude from the phasing and assembly of multiple datasets, recommendations on coverage, fragment length, and partitioning when sequencing genomes of different sizes and complexities. These optimizations improve results by orders of magnitude, and enable the development of novel methods. LRSim is available at https://github.com/aquaskyline/LRSIM. Keywords: Linked-read, Molecular barcoding, Reads partitioning, Phasing, Reads simulation, Genome assembly, 10X Genomics

  8. Too Many Links in the Horizon; What is Next? Linked Views and Linked History

    NARCIS (Netherlands)

    E. Liarou (Erietta); S. Idreos (Stratos)

    2011-01-01

    textabstractThe trend for more online linked data becomes stronger. Foreseeing a future where ``everything" will be online and linked, we ask the critical question; what is next? We envision that managing, querying and storing large amounts of links and data is far from yet another query

  9. Mean link versus average plaquette tadpoles in lattice NRQCD

    Science.gov (United States)

    Shakespeare, Norman H.; Trottier, Howard D.

    1999-03-01

    We compare mean-link and average plaquette tadpole renormalization schemes in the context of the quarkonium hyperfine splittings in lattice NRQCD. Simulations are done for the three quarkonium systems c overlinec, b overlinec, and b overlineb. The hyperfine splittings are computed both at leading and at next-to-leading order in the relativistic expansion. Results are obtained at a large number of lattice spacings. A number of features emerge, all of which favor tadpole renormalization using mean links. This includes much better scaling of the hyperfine splittings in the three quarkonium systems. We also find that relativistic corrections to the spin splittings are smaller with mean-link tadpoles, particularly for the c overlinec and b overlinec systems. We also see signs of a breakdown in the NRQCD expansion when the bare quark mass falls below about one in lattice units (with the bare quark masses turning out to be much larger with mean-link tadpoles).

  10. Mean link versus average plaquette tadpoles in lattice NRQCD

    International Nuclear Information System (INIS)

    Shakespeare, Norman H.; Trottier, Howard D.

    1999-01-01

    We compare mean-link and average plaquette tadpole renormalization schemes in the context of the quarkonium hyperfine splittings in lattice NRQCD. Simulations are done for the three quarkonium systems cc-bar, bc-bar, and bb-bar. The hyperfine splittings are computed both at leading and at next-to-leading order in the relativistic expansion. Results are obtained at a large number of lattice spacings. A number of features emerge, all of which favor tadpole renormalization using mean links. This includes much better scaling of the hyperfine splittings in the three quarkonium systems. We also find that relativistic corrections to the spin splittings are smaller with mean-link tadpoles, particularly for the cc-bar and bc-bar systems. We also see signs of a breakdown in the NRQCD expansion when the bare quark mass falls below about one in lattice units (with the bare quark masses turning out to be much larger with mean-link tadpoles)

  11. Mean link versus average plaquette tadpoles in lattice NRQCD

    Energy Technology Data Exchange (ETDEWEB)

    Shakespeare, Norman H.; Trottier, Howard D

    1999-03-01

    We compare mean-link and average plaquette tadpole renormalization schemes in the context of the quarkonium hyperfine splittings in lattice NRQCD. Simulations are done for the three quarkonium systems cc-bar, bc-bar, and bb-bar. The hyperfine splittings are computed both at leading and at next-to-leading order in the relativistic expansion. Results are obtained at a large number of lattice spacings. A number of features emerge, all of which favor tadpole renormalization using mean links. This includes much better scaling of the hyperfine splittings in the three quarkonium systems. We also find that relativistic corrections to the spin splittings are smaller with mean-link tadpoles, particularly for the cc-bar and bc-bar systems. We also see signs of a breakdown in the NRQCD expansion when the bare quark mass falls below about one in lattice units (with the bare quark masses turning out to be much larger with mean-link tadpoles)

  12. explICU: A web-based visualization and predictive modeling toolkit for mortality in intensive care patients.

    Science.gov (United States)

    Chen, Robert; Kumar, Vikas; Fitch, Natalie; Jagadish, Jitesh; Lifan Zhang; Dunn, William; Duen Horng Chau

    2015-01-01

    Preventing mortality in intensive care units (ICUs) has been a top priority in American hospitals. Predictive modeling has been shown to be effective in prediction of mortality based upon data from patients' past medical histories from electronic health records (EHRs). Furthermore, visualization of timeline events is imperative in the ICU setting in order to quickly identify trends in patient histories that may lead to mortality. With the increasing adoption of EHRs, a wealth of medical data is becoming increasingly available for secondary uses such as data exploration and predictive modeling. While data exploration and predictive modeling are useful for finding risk factors in ICU patients, the process is time consuming and requires a high level of computer programming ability. We propose explICU, a web service that hosts EHR data, displays timelines of patient events based upon user-specified preferences, performs predictive modeling in the back end, and displays results to the user via intuitive, interactive visualizations.

  13. Stabilized sulfonated aromatic polymers by in situ solvothermal cross-linking

    Directory of Open Access Journals (Sweden)

    Maria Luisa eDi Vona

    2014-10-01

    Full Text Available The cross-link reaction via sulfone bridges of sulfonated polyetheretherketone (SPEEK by thermal treatment at 180 °C in presence of dimethylsulfoxide (DMSO is discussed. The modifications of properties subsequent to the cross-linking are presented. The mechanical strength as well as the hydrolytic stability increased with the thermal treatment time, i.e., with the degree of cross-linking. The proton conductivity was determined as function of temperature, IEC, degree of cross-linking and hydration number. The memory effect, which is the membrane ability to remember the water uptake reached at high temperature also at lower temperature, is exploited in order to achieve high values of conductivity. Membranes swelled at 110 °C can reach a conductivity of 0.14 S/cm at 80°C with a hydration number ( of 73.

  14. Second-Order Assortative Mixing in Social Networks

    DEFF Research Database (Denmark)

    Zhou, Shi; Cox, Ingemar; Hansen, Lars Kai

    2017-01-01

    In a social network, the number of links of a node, or node degree, is often assumed as a proxy for the node’s importance or prominence within the network. It is known that social networks exhibit the (first-order) assortative mixing, i.e. if two nodes are connected, they tend to have similar node...... degrees, suggesting that people tend to mix with those of comparable prominence. In this paper, we report the second-order assortative mixing in social networks. If two nodes are connected, we measure the degree correlation between their most prominent neighbours, rather than between the two nodes...... themselves. We observe very strong second-order assortative mixing in social networks, often significantly stronger than the first-order assortative mixing. This suggests that if two people interact in a social network, then the importance of the most prominent person each knows is very likely to be the same...

  15. Effects of the steric hindrance of micropores in the hyper-cross-linked polymeric adsorbent on the adsorption of p-nitroaniline in aqueous solution

    International Nuclear Information System (INIS)

    Xiao, Guqing; Wen, Ruimin; Wei, Dongmei; Wu, Dan

    2014-01-01

    Graphical abstract: The hyper-cross-linked polymeric adsorbents (GQ-05 and GQ-03) with different steric hindrance of micropores were designed. The adsorption capacity and adsorption rate of PNA onto the two adsorbents followed the order GQ-05 > GQ-03. The steric hindrance of micropores was a crucial factor for the adsorption capacity and adsorption rate order. - Highlights: • Two adsorbents with different steric hindrance of micropores were designed. • The adsorption capacity and adsorption rate followed the order GQ-05 > GQ-03. • The steric hindrance of micropores was a crucial factor for the order. - Abstract: A hyper-cross-linked polymeric adsorbent with “-CH 2 -phenol-CH 2 -” as the cross-linked bridge (denoted GQ-05), and another hyper-cross-linked polymeric adsorbent with “-CH 2 -p-cresol-CH 2 -” as the cross-linked bridge (denoted GQ-03) were synthesized to reveal the effect of the steric hindrance of micropores in the hyper-cross-linked polymeric adsorbent on adsorption capacity and adsorption rate of p-nitroaniline (PNA) from aqueous solution. The results of adsorption kinetics indicated the order of the adsorption rate GQ-05 > GQ-03. The pseudo-first-order rate equation could describe the entire adsorption process of PNA onto GQ-05 while the equation characterized the adsorption process of GQ-03 in two stages. The order of the adsorption capacity GQ-05 > GQ-03 was demonstrated by thermodynamic analysis and dynamic adsorption. The steric hindrance of micropores in the hyper-cross-linked polymeric adsorbent was a crucial factor for the order of the adsorption capacity and adsorption rate

  16. Development of research activity support system. 3. Automatic link generation/maintenance on self-evolving database; Kenkyu katsudo shien system no kaihatsu. 3. Jiko zoshokugata database deno bunsho link no jido sakusei/shufuku

    Energy Technology Data Exchange (ETDEWEB)

    Shimada, T.; Futakata, A. [Central Research Institute of Electric Power Industry, Tokyo (Japan)

    1997-04-01

    For a coordinated task to be accomplished in an organization, documents, charts, and data produced by plural workers need to be shared by the plural workers. This information sharing setup will function more effectively when the meanings and purposes of documents, etc., are arranged in good order relative to the other documents and when they are managed as a group of documents organically linked with each other and properly updated as the task approaches completion. In the self-evolving databases proposed so far, five types of document links representing the relations between documents are automatically generated and the documents are unifiedly managed for the documents yielded by coordinated work to be arranged in a proper order. A procedure for automatically generating document links are established on the basis of information received from the document retrieval system and Lotus Notes application. In a self-evolving database, the document on either side of a link is apt to be lost due to users` moving or deleting documents. An automatic procedure is developed in this report which will enable such document links to correctly restore themselves without loss of semantic relations. 12 refs., 11 figs., 3 tabs.

  17. Donor cross-linking for keratoplasty: a laboratory evaluation.

    Science.gov (United States)

    Mukherjee, Achyut; Hayes, Sally; Aslanides, Ioannis; Lanchares, Elena; Meek, Keith M

    2015-12-01

    This laboratory-based investigation compares the topographic outcomes of conventional penetrating keratoplasty with that of a novel procedure in which donor corneas are cross-linked prior to keratoplasty. Penetrating keratoplasty procedures with continuous running sutures were carried out in a porcine whole globe model. Sixty eyes were randomly paired as 'donor' and 'host' tissue before being assigned to one of two groups. In the cross-linked group, donor corneas underwent riboflavin/UVA cross-linking prior to being trephined and sutured to untreated hosts. In the conventional keratoplasty group, both host and donor corneas remained untreated prior to keratoplasty. Topographic and corneal wavefront measurements were performed following surgery, and technical aspects of the procedure evaluated. Mean keratometric astigmatism was significantly lower in the cross-linked donor group at 3.67D (SD 1.8 D), vs. 8.43 D (SD 2.4 D) in the conventional keratoplasty group (p < 0.005). Mean wavefront astigmatism was also significantly reduced in the cross-linked donor group 4.71 D (SD 2.1) vs. 8.29D (SD 3.6) in the conventional keratoplasty group (p < 0.005). Mean RMS higher order aberration was significantly lower in the cross-linked donor group at 1.79 um (SD 0.98), vs. 3.05 um (SD 1.9) in the conventional keratoplasty group (P = 0.02). Qualitative analysis revealed less tissue distortion at the graft-host junction in the cross-linked group. Cross-linking of donor corneas prior to keratoplasty reduces intraoperative induced astigmatism and aberrations in an animal model. Further studies are indicated to evaluate the implications of this potential modification of keratoplasty surgery.

  18. Free Space Optics – Monitoring Setup for Experimental Link

    Directory of Open Access Journals (Sweden)

    Ján Tóth

    2015-12-01

    Full Text Available This paper deals with advanced Free Space Optics communication technology. Two FSO nodes are needed in order to make a connection. Laser diodes are used as light sources. Simple OOK modulation is involved in this technology. FSO system offers multiple advantages indeed. However, a direct visibility is required in order to set up a communication link. This fact yields perhaps the most significant weakness of this technology. Obviously, there is no a chance to fight the weather phenomena like fog, heavy rain, dust and many other particles which are naturally present in the atmosphere. That’s why there is a key task to find a suitable solution to keep FSO link working with high reliability and availability. It turns out that it’s necessary to have knowledge about weather situation when FSO link operates (liquid water content - LWC, geographical location, particle size distribution, average particle diameter, temperature, humidity, wind conditions, pressure and many other variable weather parameters. It’s obvious that having most of mentioned parameter’s values stored in database (implicitly in charts would be really beneficial. This paper presents some of mentioned indicators continuously gathered from several sensors located close to one of FSO nodes.

  19. Perioperative nurses' attitudes toward the electronic health record.

    Science.gov (United States)

    Yontz, Laura S; Zinn, Jennifer L; Schumacher, Edward J

    2015-02-01

    The adoption of an electronic health record (EHR) is mandated under current health care legislation reform. The EHR provides data that are patient centered and improves patient safety. There are limited data; however, regarding the attitudes of perioperative nurses toward the use of the EHR. The purpose of this project was to identify perioperative nurses' attitudes toward the use of the EHR. Quantitative descriptive survey was used to determine attitudes toward the electronic health record. Perioperative nurses in a southeastern health system completed an online survey to determine their attitudes toward the EHR in providing patient care. Overall, respondents felt the EHR was beneficial, did not add to the workload, improved documentation, and would not eliminate any nursing jobs. Nursing acceptance and the utilization of the EHR are necessary for the successful integration of an EHR and to support the goal of patient-centered care. Identification of attitudes and potential barriers of perioperative nurses in using the EHR will improve patient safety, communication, reduce costs, and empower those who implement an EHR. Copyright © 2015 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  20. Quality Requirements for Electronic Health Record Systems*. A Japanese-German Information Management Perspective.

    Science.gov (United States)

    Winter, Alfred; Takabayashi, Katsuhiko; Jahn, Franziska; Kimura, Eizen; Engelbrecht, Rolf; Haux, Reinhold; Honda, Masayuki; Hübner, Ursula H; Inoue, Sozo; Kohl, Christian D; Matsumoto, Takehiro; Matsumura, Yasushi; Miyo, Kengo; Nakashima, Naoki; Prokosch, Hans-Ulrich; Staemmler, Martin

    2017-08-07

    For more than 30 years, there has been close cooperation between Japanese and German scientists with regard to information systems in health care. Collaboration has been formalized by an agreement between the respective scientific associations. Following this agreement, two joint workshops took place to explore the similarities and differences of electronic health record systems (EHRS) against the background of the two national healthcare systems that share many commonalities. To establish a framework and requirements for the quality of EHRS that may also serve as a basis for comparing different EHRS. Donabedian's three dimensions of quality of medical care were adapted to the outcome, process, and structural quality of EHRS and their management. These quality dimensions were proposed before the first workshop of EHRS experts and enriched during the discussions. The Quality Requirements Framework of EHRS (QRF-EHRS) was defined and complemented by requirements for high quality EHRS. The framework integrates three quality dimensions (outcome, process, and structural quality), three layers of information systems (processes and data, applications, and physical tools) and three dimensions of information management (strategic, tactical, and operational information management). Describing and comparing the quality of EHRS is in fact a multidimensional problem as given by the QRF-EHRS framework. This framework will be utilized to compare Japanese and German EHRS, notably those that were presented at the second workshop.

  1. Protein cross-linking by chlorinated polyamines and transglutamylation stabilizes neutrophil extracellular traps.

    Science.gov (United States)

    Csomós, Krisztián; Kristóf, Endre; Jakob, Bernadett; Csomós, István; Kovács, György; Rotem, Omri; Hodrea, Judit; Bagoly, Zsuzsa; Muszbek, Laszlo; Balajthy, Zoltán; Csősz, Éva; Fésüs, László

    2016-08-11

    Neutrophil extracellular trap (NET) ejected from activated dying neutrophils is a highly ordered structure of DNA and selected proteins capable to eliminate pathogenic microorganisms. Biochemical determinants of the non-randomly formed stable NETs have not been revealed so far. Studying the formation of human NETs we have observed that polyamines were incorporated into the NET. Inhibition of myeloperoxidase, which is essential for NET formation and can generate reactive chlorinated polyamines through hypochlorous acid, decreased polyamine incorporation. Addition of exogenous primary amines that similarly to polyamines inhibit reactions catalyzed by the protein cross-linker transglutaminases (TGases) has similar effect. Proteomic analysis of the highly reproducible pattern of NET components revealed cross-linking of NET proteins through chlorinated polyamines and ɛ(γ-glutamyl)lysine as well as bis-γ-glutamyl polyamine bonds catalyzed by the TGases detected in neutrophils. Competitive inhibition of protein cross-linking by monoamines disturbed the cross-linking pattern of NET proteins, which resulted in the loss of the ordered structure of the NET and significantly reduced capacity to trap bacteria. Our findings provide explanation of how NETs are formed in a reproducible and ordered manner to efficiently neutralize microorganisms at the first defense line of the innate immune system.

  2. Link-topic model for biomedical abbreviation disambiguation.

    Science.gov (United States)

    Kim, Seonho; Yoon, Juntae

    2015-02-01

    The ambiguity of biomedical abbreviations is one of the challenges in biomedical text mining systems. In particular, the handling of term variants and abbreviations without nearby definitions is a critical issue. In this study, we adopt the concepts of topic of document and word link to disambiguate biomedical abbreviations. We newly suggest the link topic model inspired by the latent Dirichlet allocation model, in which each document is perceived as a random mixture of topics, where each topic is characterized by a distribution over words. Thus, the most probable expansions with respect to abbreviations of a given abstract are determined by word-topic, document-topic, and word-link distributions estimated from a document collection through the link topic model. The model allows two distinct modes of word generation to incorporate semantic dependencies among words, particularly long form words of abbreviations and their sentential co-occurring words; a word can be generated either dependently on the long form of the abbreviation or independently. The semantic dependency between two words is defined as a link and a new random parameter for the link is assigned to each word as well as a topic parameter. Because the link status indicates whether the word constitutes a link with a given specific long form, it has the effect of determining whether a word forms a unigram or a skipping/consecutive bigram with respect to the long form. Furthermore, we place a constraint on the model so that a word has the same topic as a specific long form if it is generated in reference to the long form. Consequently, documents are generated from the two hidden parameters, i.e. topic and link, and the most probable expansion of a specific abbreviation is estimated from the parameters. Our model relaxes the bag-of-words assumption of the standard topic model in which the word order is neglected, and it captures a richer structure of text than does the standard topic model by considering

  3. Order parameter analysis of synchronization transitions on star networks

    Science.gov (United States)

    Chen, Hong-Bin; Sun, Yu-Ting; Gao, Jian; Xu, Can; Zheng, Zhi-Gang

    2017-12-01

    The collective behaviors of populations of coupled oscillators have attracted significant attention in recent years. In this paper, an order parameter approach is proposed to study the low-dimensional dynamical mechanism of collective synchronizations, by adopting the star-topology of coupled oscillators as a prototype system. The order parameter equation of star-linked phase oscillators can be obtained in terms of the Watanabe-Strogatz transformation, Ott-Antonsen ansatz, and the ensemble order parameter approach. Different solutions of the order parameter equation correspond to the diverse collective states, and different bifurcations reveal various transitions among these collective states. The properties of various transitions in the star-network model are revealed by using tools of nonlinear dynamics such as time reversibility analysis and linear stability analysis.

  4. Linked data management

    CERN Document Server

    Hose, Katja; Schenkel, Ralf

    2014-01-01

    Linked Data Management presents techniques for querying and managing Linked Data that is available on today’s Web. The book shows how the abundance of Linked Data can serve as fertile ground for research and commercial applications. The text focuses on aspects of managing large-scale collections of Linked Data. It offers a detailed introduction to Linked Data and related standards, including the main principles distinguishing Linked Data from standard database technology. Chapters also describe how to generate links between datasets and explain the overall architecture of data integration systems based on Linked Data. A large part of the text is devoted to query processing in different setups. After presenting methods to publish relational data as Linked Data and efficient centralized processing, the book explores lookup-based, distributed, and parallel solutions. It then addresses advanced topics, such as reasoning, and discusses work related to read-write Linked Data for system interoperation. Desp...

  5. A novel approach to supporting relationship-centered care through electronic health record ergonomic training in preclerkship medical education.

    Science.gov (United States)

    Silverman, Howard; Ho, Yun-Xian; Kaib, Susan; Ellis, Wendy Danto; Moffitt, Marícela P; Chen, Qingxia; Nian, Hui; Gadd, Cynthia S

    2014-09-01

    How can physicians incorporate the electronic health record (EHR) into clinical practice in a relationship-enhancing fashion ("EHR ergonomics")? Three convenience samples of 40 second-year medical students with varying levels of EHR ergonomic training were compared in the 2012 spring semester. All participants first received basic EHR training and completed a presurvey. Two study groups were then instructed to use the EHR during the standardized patient (SP) encounter in each of four regularly scheduled Doctoring (clinical skills) course sessions. One group received additional ergonomic training in each session. Ergonomic assessment data were collected from students, faculty, and SPs in each session. A postsurvey was administered to all students, and data were compared across all three groups to assess the impact of EHR use and ergonomic training. There was a significant positive effect of EHR ergonomics skills training on students' relationship-centered EHR use (Pergonomic training sessions were needed to see an overall improvement in EHR use. In addition to replication of these results, further effectiveness studies of this educational intervention need to be carried out in GME, practice, and other environments.

  6. Bibliometric analysis of scientific production about Linked Data

    Directory of Open Access Journals (Sweden)

    Leandro Dal Pizzol

    2015-09-01

    Full Text Available Introduction: Since Tim Berners-Lee coined the term Linked Data in 2006, many studies have emerged based on this initiative. Whether in the form of information access initiatives, whether in applications based on this data type, the interest in this new way to publish and consume information on the Web is increasingly in focus. Objective: In this paper, we present a bibliometric review with the aim of contributing to a better understanding and clarification of concepts and terms associated with the area of Linked Data. Methodology: We have used the Web of Science (WoS, Scopus, EBSCO and IEEE scientific databases, in order to find the existing studies about Linked Data until October 2012. Results: We have mapped 148 scientific papers that address the above issue, written by 409 authors from 160 institutions from 30 different countries. Through the analysis of the articles, it was found that researches about Linked Data are concentrated in a small authors group, suggesting future research opportunities. Conclusions: Synthesizing the information related to the scientific publications in a given area allows building a theoretical background that supports the development of future researches.

  7. S-LINK, a data link interface specification for the LHC era

    International Nuclear Information System (INIS)

    Bij, H.C. van der; McLaren, R.A.; Boyle, O.

    1996-01-01

    In the Technical Proposals for ATLAS, CMS and ALICE there is a requirement for several thousand data links. Although there is an obvious need for standardization, this seems difficult to achieve as the links run at different speeds, over different distances and have various constraints of power consumption, size and radiation hardness. An additional complication is that today we cannot decide which will be the most cost effective technology for the implementation of the final links. Furthermore, we must allow designers of boards at each end of the link, for example readout electronics and input buffers, to work in parallel with the development of the links. The S-LINK is a new concept which should provide the benefits of standardization without the limitations. The S-LINK specification defines, at both ends of the link, a simple FIFO-like user interface which remains independent of the technology used to implement the physical link. The physical link provides transfer of event data and control words, error detection, optional flow control and test facilities. This paper describes the S-LINK specification and gives examples of the use of the S-LINK, the physical links being designed, and the test equipment that is being developed

  8. Attitude Towards Health Information Privacy and Electronic Health Records Among Urban Sri Lankan Adults.

    Science.gov (United States)

    Tissera, Shaluni R; Silva, S N

    2016-01-01

    Sri Lanka is planning to move towards an Electronic Health Record (EHR) system. This research argues that the public preparedness should be considered in order to implement a functioning and an effective EHR system in a country. When asked about how concerned the participants were about the security of their health records, 40.5% stated they were concerned and 38.8% were very concerned. They were asked to rate the 'level of trust' they have on health institutes in Sri Lanka on a scale from 1 to 10 (1 lowest level of trust and 10 highest), 66.1% rated at level 5 or less.

  9. LinkED: A Novel Methodology for Publishing Linked Enterprise Data

    Directory of Open Access Journals (Sweden)

    Shreyas Suresh Rao

    2017-01-01

    Full Text Available Semantic Web technologies have redefined and strengthened the Enterprise-Web interoperability over the last decade. Linked Open Data (LOD refers to a set of best practices that empower enterprises to publish and interlink their data using existing ontologies on the World Wide Web. Current research in LOD focuses on expert search, the creation of unified information space and augmentation of core data from an enterprise context. However, existing approaches for publication of enterprise data as LOD are domain-specific, ad-hoc and suffer from lack of uniform representation across domains. The paper proposes a novel methodology called LinkED that contributes towards LOD literature in two ways: (a streamlines the publishing process through five stages of cleaning, triplification, interlinking, storage and visualization; (b addresses the latest challenges in LOD publication, namely: inadequate links, inconsistencies in the quality of the dataset and replicability of the LOD publication process. Further, the methodology is demonstrated via the publication of digital repository data as LOD in a university setting, which is evaluated based on two semantic standards: Five-Star model and data quality metrics. Overall, the paper provides a generic LOD publication process that is applicable across various domains such as healthcare, e-governance, banking, and tourism, to name a few.

  10. Macro influencers of electronic health records adoption.

    Science.gov (United States)

    Raghavan, Vijay V; Chinta, Ravi; Zhirkin, Nikita

    2015-01-01

    While adoption rates for electronic health records (EHRs) have improved, the reasons for significant geographical differences in EHR adoption within the USA have remained unclear. To understand the reasons for these variations across states, we have compiled from secondary sources a profile of different states within the USA, based on macroeconomic and macro health-environment factors. Regression analyses were performed using these indicator factors on EHR adoption. The results showed that internet usage and literacy are significantly associated with certain measures of EHR adoption. Income level was not significantly associated with EHR adoption. Per capita patient days (a proxy for healthcare need intensity within a state) is negatively correlated with EHR adoption rate. Health insurance coverage is positively correlated with EHR adoption rate. Older physicians (>60 years) tend to adopt EHR systems less than their younger counterparts. These findings have policy implications on formulating regionally focused incentive programs.

  11. Applying representational state transfer (REST) architecture to archetype-based electronic health record systems

    Science.gov (United States)

    2013-01-01

    Background The openEHR project and the closely related ISO 13606 standard have defined structures supporting the content of Electronic Health Records (EHRs). However, there is not yet any finalized openEHR specification of a service interface to aid application developers in creating, accessing, and storing the EHR content. The aim of this paper is to explore how the Representational State Transfer (REST) architectural style can be used as a basis for a platform-independent, HTTP-based openEHR service interface. Associated benefits and tradeoffs of such a design are also explored. Results The main contribution is the formalization of the openEHR storage, retrieval, and version-handling semantics and related services into an implementable HTTP-based service interface. The modular design makes it possible to prototype, test, replicate, distribute, cache, and load-balance the system using ordinary web technology. Other contributions are approaches to query and retrieval of the EHR content that takes caching, logging, and distribution into account. Triggering on EHR change events is also explored. A final contribution is an open source openEHR implementation using the above-mentioned approaches to create LiU EEE, an educational EHR environment intended to help newcomers and developers experiment with and learn about the archetype-based EHR approach and enable rapid prototyping. Conclusions Using REST addressed many architectural concerns in a successful way, but an additional messaging component was needed to address some architectural aspects. Many of our approaches are likely of value to other archetype-based EHR implementations and may contribute to associated service model specifications. PMID:23656624

  12. Link Analysis of High Throughput Spacecraft Communication Systems for Future Science Missions

    Science.gov (United States)

    Simons, Rainee N.

    2015-01-01

    NASA's plan to launch several spacecrafts into low Earth Orbit (LEO) to support science missions in the next ten years and beyond requires down link throughput on the order of several terabits per day. The ability to handle such a large volume of data far exceeds the capabilities of current systems. This paper proposes two solutions, first, a high data rate link between the LEO spacecraft and ground via relay satellites in geostationary orbit (GEO). Second, a high data rate direct to ground link from LEO. Next, the paper presents results from computer simulations carried out for both types of links taking into consideration spacecraft transmitter frequency, EIRP, and waveform; elevation angle dependent path loss through Earths atmosphere, and ground station receiver GT.

  13. Sex-linked dominant

    Science.gov (United States)

    Inheritance - sex-linked dominant; Genetics - sex-linked dominant; X-linked dominant; Y-linked dominant ... can be either an autosomal chromosome or a sex chromosome. It also depends on whether the trait ...

  14. Do family physicians electronic health records support meaningful use?

    Science.gov (United States)

    Peterson, Lars E; Blackburn, Brenna; Ivins, Douglas; Mitchell, Jason; Matson, Christine; Phillips, Robert L

    2015-03-01

    Spurred by government incentives, the use of electronic health records (EHRs) in the United States has increased; however, whether these EHRs have the functionality necessary to meet meaningful use (MU) criteria remains unknown. Our objective was to characterize family physician access to MU functionality when using a MU-certified EHR. Data were obtained from a convenience survey of family physicians accessing their American Board of Family Medicine online portfolio in 2011. A brief survey queried MU functionality. We used descriptive statistics to characterize the responses and bivariate statistics to test associations between MU and patient communication functions by presence of a MU-certified EHR. Out of 3855 respondents, 60% reported having an EHR that supports MU. Physicians with MU-certified EHRs were more likely than physicians without MU-certified EHRs to report patient registry activities (49.7% vs. 32.3%, p-valuevs. 56.4%, p-valuecommunication abilities were low regardless of EHR capabilities. Family physicians with MU-certified EHRs are more likely to report MU functionality; however, a sizeable minority does not report MU functions. Many family physicians with MU-certified EHRs may not successfully meet the successively stringent MU criteria and may face significant upgrade costs to do so. Cross sectional survey. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. "Meaningful use" of electronic health records and its relevance to laboratories and pathologists

    Directory of Open Access Journals (Sweden)

    Walter H Henricks

    2011-01-01

    Full Text Available Electronic health records (EHRs have emerged as a major topic in health care and are central to the federal government′s strategy for transforming healthcare delivery in the United States. Recent federal actions that aim to promote the use of EHRs promise to have significant implications for laboratories and for pathology practices. Under the HITECH (Health Information Technology Economic and Clinical Health Act, an EHR incentive program has been established through which individual physicians and hospitals can qualify to receive incentive payments if they achieve "meaningful use" of "certified" EHR technology. The rule also establishes payment penalties in future years for eligible providers who have not met the requirements for meaningful use of EHRs. Meaningful use must be achieved using EHR technology that has been certified in accordance with functional and technical criteria that are set forth a regulation that parallels the meaningful use criteria in the incentive program. These actions and regulations are important to laboratories and pathologists for a number of reasons. Several of the criteria and requirements in the meaningful use rules and EHR certification criteria relate directly or indirectly to laboratory testing and laboratory information management, and future stage requirements are expected to impact the laboratory as well. Furthermore, as EHR uptake expands, there will be greater expectations for electronic interchange of laboratory information and laboratory information system (LIS-EHR interfaces. Laboratories will need to be aware of the technical, operational, and business challenges that they may face as expectations for LIS-EHR increase. This paper reviews the important recent federal efforts aimed at accelerating EHR use, including the incentive program for EHR meaningful use, provider eligibility, and EHR certification criteria, from a perspective of their relevance for laboratories and pathology practices.

  16. Second Order Sliding Mode Controller Design for Pneumatic Artificial Muscle

    Directory of Open Access Journals (Sweden)

    Ammar Al-Jodah

    2018-01-01

    Full Text Available In this paper, first and second order sliding mode controllers are designed for a single link robotic arm actuated by two Pneumatic Artificial Muscles (PAMs. A new mathematical model for the arm has been developed based on the model of large scale pneumatic muscle actuator model. Uncertainty in parameters has been presented and tested for the two controllers. The simulation results of the second-order sliding mode controller proves to have a low tracking error and chattering effect as compared to the first order one. The verification has been done by using MATLAB and Simulink software.

  17. Lagrangian generic second order traffic flow models for node

    Directory of Open Access Journals (Sweden)

    Asma Khelifi

    2018-02-01

    Full Text Available This study sheds light on higher order macroscopic traffic flow modeling on road networks, thanks to the generic second order models (GSOM family which embeds a myriad of traffic models. It has been demonstrated that such higher order models are easily solved in Lagrangian coordinates which are compatible with both microscopic and macroscopic descriptions. The generalized GSOM model is reformulated in the Lagrangian coordinate system to develop a more efficient numerical method. The difficulty in applying this approach on networks basically resides in dealing with node dynamics. Traffic flow characteristics at node are different from that on homogeneous links. Different geometry features can lead to different critical research issues. For instance, discontinuity in traffic stream can be an important issue for traffic signal operations, while capacity drop may be crucial for lane-merges. The current paper aims to establish and analyze a new adapted node model for macroscopic traffic flow models by applying upstream and downstream boundary conditions on the Lagrangian coordinates in order to perform simulations on networks of roads, and accompanying numerical method. The internal node dynamics between upstream and downstream links are taken into account of the node model. Therefore, a numerical example is provided to underscore the efficiency of this approach. Simulations show that the discretized node model yields accurate results. Additional kinematic waves and contact discontinuities are induced by the variation of the driver attribute.

  18. Novel fat-link fermion actions for lattice QCD

    International Nuclear Information System (INIS)

    Zanotti, J.; Bilson-Thompson, S.; Bonnet, F.; Leinweber, D.; Melnitchouk, W.; Williams, A.

    2000-01-01

    Full text: We are currently exploring new ideas for lattice fermion actions. Naive implementations of fermion actions encounter the well known fermion-doubling problem. In order to solve this problem, Wilson introduced an irrelevant (energy) dimension-five operator (the so-called Wilson term) which explicitly breaks chiral symmetry. The scaling properties of this Wilson action can be improved by introducing any number of irrelevant operators of increasing dimension which also vanish in the continuum limit. In this manner, one can improve fermion actions at finite 'a' by combining operators to eliminate O(a) and perhaps O(a 2 ) errors etc. A popular formulation of a lattice fermion action that achieves this is the Clover action which removes the O(a) error introduced by the Wilson term by introducing an additional irrelevant dimension-five operator. The Clover action can be O(a) improved to all orders in the strong coupling 'g'. While the Clover action displays excellent scaling, it is responsible for revealing the exceptional configuration problem where the quark propagator encounters singular behaviour particularly as the quark mass becomes small. Moreover, its free dispersion relation between energy and momentum is unchanged from the standard Wilson action dispersion and shows a continuum like behaviour only for relatively small momenta [F. X. Lee and D. B. Leinweber, Phys. Rev. D59, 074504 (1999), hep-lat/9711044]. Finally, significant chiral symmetry breaking is apparent as the renormalised quark mass differs significantly from the bare mass of the theory. Hence we propose a different approach to fermion action improvement. One in which the additive renormalisations become small while expressing good chiral behaviour. This can be achieved through the consideration of 'fat-link' fermion actions [T. DeGrand (the MILC collaboration, Phys. Rev. D60, 094501 (1999)]. Fat links are created by averaging or smearing links on the lattice with their nearest neighbours in

  19. High speed radiation tolerant data links

    Energy Technology Data Exchange (ETDEWEB)

    Brewer, Forrest [Univ. of California, Santa Barbara, CA (United States); Incandela, Joseph [Univ. of California, Santa Barbara, CA (United States)

    2016-04-01

    This project was slated to design and develop Rad-Hard IP components for 1Gb/s links and supporting hardware designs such as PLL, SER/DES, pad drivers and receivers and custom protocol hardware for the 1Gb/s channel. Also included in the proposal was a study of a hardened memory to be used as a packet buffer for channel and data concentrator components to meet the 1 Gb/s specification. Over the course of the proposal, technology change and innovation of hardware designs lead us away from the 1 Gb/s goal to contemplate much higher performance link IP which, we believed better met the goals of physics experiments. Note that CERN microelectronics had managed to create a 4.7 Gb/s link designed to drive optical fibers and containing infrastructure for connecting much lower bandwidth front-end devices. Our own work to that point had shown the possibility of constructing a link with much lower power, lower physical overhead but of equivalent performance that could be designed to integrate directly onto the front-end ASIC (ADC and data encoding) designs. Substantial overall power savings and experimental simplicity could be achieved by eliminating data transmission to data concentrators and data concentrators and related hardened buffering themselves, with conversion to optical media at a removed distance from the experiment core. We had already developed and tested Rad-Hard SER/DES components (1Gb in 130nm standard cells) and redundant Pad Drivers/Receivers (3+ Gb/s designed and measured performance), and had a viable 1Gb/s link design based on redundant a stuttered clock receiver and classical PLL, so the basic goals of the proposal had been achieved. Below, in chronological order, are the products and tools we constructed, as well as our tests and publications.

  20. ECO TECH LINK: PT3 Grant Builds Technology Circles in the K-18 Community.

    Science.gov (United States)

    Klinger, Katie; Duckett, Jane; Medrano, Maria; Crow, Nedra; Stowers, Gwen

    Through the vehicle of the PT3 grant program, ECO TECH LINK has built a strong consortium to support technology circles of government, education and business in order to raise student achievement scores, shorten the time it takes to earn a teaching credential, and enhance the quality of teacher credential courses. The ECO TECH LINK grant enables…

  1. Establishing Interoperability of a Blog Archive through Linked Open Data

    DEFF Research Database (Denmark)

    Kalb, Hendrik; Lazaridou, Paraskevi; Trier, Matthias

    2013-01-01

    on archived data. However, interoperability among BlogForever archives, as well as with other digital libraries, is necessary in order to avoid silos of data. In this paper, we reveal some of our efforts to establish interoperability through the application of Linked Open data....

  2. Named Entity Linking Algorithm

    Directory of Open Access Journals (Sweden)

    M. F. Panteleev

    2017-01-01

    Full Text Available In the tasks of processing text in natural language, Named Entity Linking (NEL represents the task to define and link some entity, which is found in the text, with some entity in the knowledge base (for example, Dbpedia. Currently, there is a diversity of approaches to solve this problem, but two main classes can be identified: graph-based approaches and machine learning-based ones. Graph and Machine Learning approaches-based algorithm is proposed accordingly to the stated assumptions about the interrelations of named entities in a sentence and in general.In the case of graph-based approaches, it is necessary to solve the problem of identifying an optimal set of the related entities according to some metric that characterizes the distance between these entities in a graph built on some knowledge base. Due to limitations in processing power, to solve this task directly is impossible. Therefore, its modification is proposed. Based on the algorithms of machine learning, an independent solution cannot be built due to small volumes of training datasets relevant to NEL task. However, their use can contribute to improving the quality of the algorithm. The adaptation of the Latent Dirichlet Allocation model is proposed in order to obtain a measure of the compatibility of attributes of various entities encountered in one context.The efficiency of the proposed algorithm was experimentally tested. A test dataset was independently generated. On its basis the performance of the model was compared using the proposed algorithm with the open source product DBpedia Spotlight, which solves the NEL problem.The mockup, based on the proposed algorithm, showed a low speed as compared to DBpedia Spotlight. However, the fact that it has shown higher accuracy, stipulates the prospects for work in this direction.The main directions of development were proposed in order to increase the accuracy of the system and its productivity.

  3. Virial theorem and the Born-Oppenheimer approximation at different orders of perturbation

    International Nuclear Information System (INIS)

    Olivier, Gabriel; Weislinger, Edmond

    1977-01-01

    The link between the virial theorem and the adiabatic approximation is studied for a few orders of perturbation. It is shown that the total energy of the system is distributed between the mean values of kinetic and potential energy of the nuclei and the electrons in each order of perturbation. No static approximation connected with the Hellmann-Feynman theorem is made [fr

  4. Characteristics of Hospitals Associated with Complete and Partial Implementation of Electronic Health Records.

    Science.gov (United States)

    Bhounsule, Prajakta; Peterson, Andrew M

    2016-01-01

    (1) To determine the proportion of hospitals with and without implementation of electronic health records (EHRs). (2) To examine characteristics of hospitals that report implementation of EHRs partially or completely versus those that report no implementation. (3) To identify hospital characteristics associated with nonimplementation to help devise future policy initiatives. This was a retrospective cross-sectional study using the 2012 American Hospital Association Annual Survey Database. The outcome variable was the implementation of EHRs completely or partially. Independent variables were hospital characteristics, such as staffing, organization structure, accreditations, ownership, and services and facilities provided at the hospitals. Descriptive frequencies were determined, and multinomial logistic regression was used to determine variables independently associated with complete or partial implementation of EHRs. In this study, 12.6 percent of hospitals reported no implementation of EHRs, while 43.9 percent of hospitals implemented EHRs partially and 43.5 percent implemented EHRs completely. Overall characteristics of hospitals with complete and partial implementation were similar. The multinomial regression model revealed a positive association between the number of licensed beds and complete implementation of EHRs. A positive association was found between children's general medical, surgical, and heart hospitals and complete implementation of EHRs. Conversely, psychiatric and rehabilitation hospitals, limited service hospitals, hospitals participating in a network, service hospitals, government nonfederal hospitals, and nongovernment not-for-profit hospitals showed less likelihood of complete implementation of EHRs. Study findings suggest a disparity of EHR implementation between larger, for-profit hospitals and smaller, not-for-profit hospitals. Low rates of implementation were observed with psychiatric and rehabilitation hospitals. EHR policy initiatives

  5. Creating a Connected Community: Lessons Learned from the Western New York Beacon Community

    Science.gov (United States)

    Maloney, Nancy; Heider, Arvela R.; Rockwood, Amy; Singh, Ranjit

    2014-01-01

    Introduction: Secure exchange of clinical data among providers has the potential to improve quality, safety, efficiency, and reduce duplication. Many communities are experiencing challenges in building effective health information exchanges (HIEs). Previous studies have focused on financial and technical issues regarding HIE development. This paper describes the Western New York (WNY) HIE growth and lessons learned about accelerating progress to become a highly connected community. Methods: HEALTHeLINK, with funding from the Office of the National Coordinator for Health Information Technology (ONC) under the Beacon Community Program, expanded HIE usage in eight counties. The communitywide transformation process used three main drivers: (1) a communitywide Electronic Health Record (EHR) adoption program; (2) clinical transformation partners; and (3) HIE outreach and infrastructure development. Results: ONC Beacon Community funding allowed WNY to achieve a new level in the use of interoperable HIE. Electronic delivery of results into the EHR expanded from 23 practices in 2010 to 222 practices in 2013, a tenfold increase. There were more than 12.5 million results delivered electronically (HL7 messages) to 222 practices’ EHRs via the HIE in 2013. Use of a secure portal and Virtual Health Record (VHR) to access reports (those not delivered directly to the EHR) also increased significantly, from 13,344 report views in 2010 to over 600,000 in 2013. Discussion and Conclusion: The WNY Beacon successfully expanded the sharing of clinical information among different sources of data and providers, creating a highly connected community to improve the quality and continuity of care. Technical, organizational, and community lessons described in this paper should prove beneficial to others as they pursue efforts to create connected communities. PMID:25848618

  6. Archetype modeling methodology.

    Science.gov (United States)

    Moner, David; Maldonado, José Alberto; Robles, Montserrat

    2018-03-01

    Clinical Information Models (CIMs) expressed as archetypes play an essential role in the design and development of current Electronic Health Record (EHR) information structures. Although there exist many experiences about using archetypes in the literature, a comprehensive and formal methodology for archetype modeling does not exist. Having a modeling methodology is essential to develop quality archetypes, in order to guide the development of EHR systems and to allow the semantic interoperability of health data. In this work, an archetype modeling methodology is proposed. This paper describes its phases, the inputs and outputs of each phase, and the involved participants and tools. It also includes the description of the possible strategies to organize the modeling process. The proposed methodology is inspired by existing best practices of CIMs, software and ontology development. The methodology has been applied and evaluated in regional and national EHR projects. The application of the methodology provided useful feedback and improvements, and confirmed its advantages. The conclusion of this work is that having a formal methodology for archetype development facilitates the definition and adoption of interoperable archetypes, improves their quality, and facilitates their reuse among different information systems and EHR projects. Moreover, the proposed methodology can be also a reference for CIMs development using any other formalism. Copyright © 2018 Elsevier Inc. All rights reserved.

  7. Second Order Sliding Mode Controller Design for Pneumatic Artificial Muscle

    OpenAIRE

    Ammar Al-Jodah; Laith Khames

    2018-01-01

    In this paper, first and second order sliding mode controllers are designed for a single link robotic arm actuated by two Pneumatic Artificial Muscles (PAMs). A new mathematical model for the arm has been developed based on the model of large scale pneumatic muscle actuator model. Uncertainty in parameters has been presented and tested for the two controllers. The simulation results of the second-order sliding mode controller proves to have a low tracking error and chattering effect as compar...

  8. Publication, discovery and interoperability of Clinical Decision Support Systems: A Linked Data approach.

    Science.gov (United States)

    Marco-Ruiz, Luis; Pedrinaci, Carlos; Maldonado, J A; Panziera, Luca; Chen, Rong; Bellika, J Gustav

    2016-08-01

    The high costs involved in the development of Clinical Decision Support Systems (CDSS) make it necessary to share their functionality across different systems and organizations. Service Oriented Architectures (SOA) have been proposed to allow reusing CDSS by encapsulating them in a Web service. However, strong barriers in sharing CDS functionality are still present as a consequence of lack of expressiveness of services' interfaces. Linked Services are the evolution of the Semantic Web Services paradigm to process Linked Data. They aim to provide semantic descriptions over SOA implementations to overcome the limitations derived from the syntactic nature of Web services technologies. To facilitate the publication, discovery and interoperability of CDS services by evolving them into Linked Services that expose their interfaces as Linked Data. We developed methods and models to enhance CDS SOA as Linked Services that define a rich semantic layer based on machine interpretable ontologies that powers their interoperability and reuse. These ontologies provided unambiguous descriptions of CDS services properties to expose them to the Web of Data. We developed models compliant with Linked Data principles to create a semantic representation of the components that compose CDS services. To evaluate our approach we implemented a set of CDS Linked Services using a Web service definition ontology. The definitions of Web services were linked to the models developed in order to attach unambiguous semantics to the service components. All models were bound to SNOMED-CT and public ontologies (e.g. Dublin Core) in order to count on a lingua franca to explore them. Discovery and analysis of CDS services based on machine interpretable models was performed reasoning over the ontologies built. Linked Services can be used effectively to expose CDS services to the Web of Data by building on current CDS standards. This allows building shared Linked Knowledge Bases to provide machine

  9. Efficient dynamic simulation of flexible link manipulators with PID control

    NARCIS (Netherlands)

    Aarts, Ronald G.K.M.; Jonker, Jan B.; Mook, D.T.; Balachandran, B.

    2001-01-01

    For accurate simulations of the dynamic behavior of flexible manipulators the combination of a perturbation method and modal analysis is proposed. First, the vibrational motion is modeled as a first-order perturbation of a nominal rigid link motion. The vibrational motion is then described by a set

  10. 77 FR 50692 - Request for Information on Quality Measurement Enabled by Health IT-Extension Date for Responses

    Science.gov (United States)

    2012-08-22

    ... measure and report electronically enabled quality measures in order to facilitate improvements in the... role (e.g., provider, payer, government, vendor, quality measure developer, quality improvement... quality measures? 8. Many EHR, HIE, and other health IT vendors are developing software code to support...

  11. An effective approach for choosing an electronic health record.

    Science.gov (United States)

    Rowley, Robert

    2009-01-01

    With government stimulus money becoming available to encourage healthcare facilities to adopt electronic health record (EHR) systems, the decision to move forward with implementing an EHR system has taken on an urgency not previously seen. The EHR landscape is evolving rapidly and the underlying technology platform is becoming increasingly interconnected. One must make sure that an EHR decision does not lock oneself into technology obsolescence. The best approach for evaluating an EHR is on the basis of:usability, interoperability, and affordability.

  12. An improved method of inverse kinematics calculation for a six-link manipulator

    International Nuclear Information System (INIS)

    Sasaki, Shinobu

    1987-07-01

    As one method of solving the inverse problem related to a six-link manipulator, an improvement was made of previously proposed calculation algorithm based on a solution of an algebraic equation of the 24-th order. In this paper, the same type of a polynomial was derived in the form of the equation of 16-th order, i.e., the order reduced by 8, as compared to previous algorithm. The accuracy of solutions was identified to be much refined. (author)

  13. Exploring the business case for ambulatory electronic health record system adoption.

    Science.gov (United States)

    Song, Paula H; McAlearney, Ann Scheck; Robbins, Julie; McCullough, Jeffrey S

    2011-01-01

    Widespread implementation and use of electronic health record (EHR) systems has been recognized by healthcare leaders as a cornerstone strategy for systematically reducing medical errors and improving clinical quality. However, EHR adoption requires a significant capital investment for healthcare providers, and cost is often cited as a barrier. Despite the capital requirements, a true business case for EHR system adoption and implementation has not been made. This is of concern, as the lack of a business case can influence decision making about EHR investments. The purpose of this study was to examine the role of business case analysis in healthcare organizations' decisions to invest in ambulatory EHR systems, and to identify what factors organizations considered when justifying an ambulatory EHR. Using a qualitative case study approach, we explored how five organizations that are considered to have best practices in ambulatory EHR system implementation had evaluated the business case for EHR adoption. We found that although the rigor of formal business case analysis was highly variable, informants across these organizations consistently reported perceiving that a positive business case for EHR system adoption existed, especially when they considered both financial and non-financial benefits. While many consider EHR system adoption inevitable in healthcare, this viewpoint should not deter managers from conducting a business case analysis. Results of such an analysis can inform healthcare organizations' understanding about resource allocation needs, help clarify expectations about financial and clinical performance metrics to be monitored through EHR systems, and form the basis for ongoing organizational support to ensure successful system implementation.

  14. Diatomáceas de tanques do cactário do Jardim Botânico, Guanabara, Brasil

    Directory of Open Access Journals (Sweden)

    Luis Tavares de Lyra

    1974-01-01

    Full Text Available O autor analisou a microflora de três tanques situados no Cactário do Jardim Botânico, Rio de Janeiro, Guanabara. Tanque nº 1. Apresentou desenvolvimento muito intenso da microfibra nos mseses mais frios. As diatomáceas foram muito freqüentes. As espécies indicadoras de saprobidade foram as seguintes: Gomphonema gracile Ehr., pinnularia maior. (kutz Cleve, Gomphonema parvulum (kutz Grunow, Navicula mutica Kutz., Pinnularia borealis Ehr., Pinnularia microstauron (Ehr Cleve, Pinnularia acrospheria Breb., Hantzschia amphioxys (Ehr Grunow, Nitzschia palea Kutz., Eutonia pectinalis (Kutz Rabenh. Tanque nº 2. As diatomáceas indicadoras de águas contaminadas, anotamos como segue: Eutonia pectinalis (Kutz Rabenh., Gomphonema parvulum (kutz Grunow, Hanstzschia amphioxys (Ehr Grunow, Navicula mutica Kutz, Pinnularia borealis Ehr., Pinnularia maior (Kutz Cleve, Pinnularia microstauron (Ehr Cleve. Tanque nº 3. Foi bastante reduzida a freqüência da microflora. Comparando-o com os tanques nº 1 e 2, as diatomáceas e clorofícias observadas, mostraram-se diminuídas nos meses mais quentes. Encontramos as seguintes espécies oligosaprobias: Eunotia pectinalis (Kutz Rabenh., Gomphonema gracile ehr., Gomphonema parvulum (Kutz Grunow Hantzschia amphioxys (Ehr Grunow, Pinnularia borealis Ehr., Pinnularia maior (Kutz Cleve. Foram consideradas também as clorofíceas quanto ao regime de saprobidade do material estudado. Eutonia augusta f. crenulata Cleve-Euler e Eutonia veneris var. exsecta Clever-Euler encontradas em nossas amostras, são novas para o Brasil. Um total de 71 espécies foram determinadas de 21 coletas realizadas durante o período de 36 meses.The author analysed the microflorafrom three ponds situated in the Cactarium from the Botanical Garden of Rio de Janeiro, Guanabara. Pond nº 1 - This pond showed a very intensive development of the microflora in the coldermonths. The diatoms were very frequent. Those diatoms that indicate saprobic

  15. On the origin of higher braces and higher-order derivations

    Czech Academy of Sciences Publication Activity Database

    Markl, Martin

    2015-01-01

    Roč. 10, č. 3 (2015), s. 637-667 ISSN 2193-8407 Institutional support: RVO:67985840 Keywords : Koszul braces * Börjeseon braces * higher-order derivation Subject RIV: BA - General Mathematics Impact factor: 0.600, year: 2015 http://link.springer.com/article/10.1007/s40062-014-0079-2

  16. Development of Hospital-based Data Sets as a Vehicle for Implementation of a National Electronic Health Record.

    Science.gov (United States)

    Keikha, Leila; Farajollah, Seyede Sedigheh Seied; Safdari, Reza; Ghazisaeedi, Marjan; Mohammadzadeh, Niloofar

    2018-01-01

    In developing countries such as Iran, international standards offer good sources to survey and use for appropriate planning in the domain of electronic health records (EHRs). Therefore, in this study, HL7 and ASTM standards were considered as the main sources from which to extract EHR data. The objective of this study was to propose a hospital data set for a national EHR consisting of data classes and data elements by adjusting data sets extracted from the standards and paper-based records. This comparative study was carried out in 2017 by studying the contents of the paper-based records approved by the health ministry in Iran and the international ASTM and HL7 standards in order to extract a minimum hospital data set for a national EHR. As a result of studying the standards and paper-based records, a total of 526 data elements in 174 classes were extracted. An examination of the data indicated that the highest number of extracted data came from the free text elements, both in the paper-based records and in the standards related to the administrative data. The major sources of data extracted from ASTM and HL7 were the E1384 and Hl7V.x standards, respectively. In the paper-based records, data were extracted from 19 forms sporadically. By declaring the confidentiality of information, the ASTM standards acknowledge the issue of confidentiality of information as one of the main challenges of EHR development, and propose new types of admission, such as teleconference, tele-video, and home visit, which are inevitable with the advent of new technology for providing healthcare and treating diseases. Data related to finance and insurance, which were scattered in different categories by three organizations, emerged as the financial category. Documenting the role and responsibility of the provider by adding the authenticator/signature data element was deemed essential. Not only using well-defined and standardized data, but also adapting EHR systems to the local facilities and

  17. The impact of electronic health records on collaborative work routines: A narrative network analysis.

    Science.gov (United States)

    Chao, Chia-An

    2016-10-01

    This study examined collaborative work routines and changes after the implementation of a perinatal EHR. The change process and underlying drivers were analyzed to offer insight into why changes - intended or unintended - did or did not occur and their implications for EHR design and implementation. This mixed-method case study included both qualitative and quantitative information. Pre- and post-implementation observations took place over an 18-month period totaling 90h. Formal and informal interviews with administrative and clinical staff, pre- and post-implementation surveys, project meeting observations, and artifact review supplemented data gathered from the observations. Workflow and narrative network analyses of work routines were used to identify changes pre- and post-EHR and to represent different perspectives of work routines. EHR improved documentation efficiency and in- and out-patient information exchange, but increased variability in documentation. Some variabilities were institutionally sanctioned or tolerated, but other variabilities - while ingenious and emblematic of the generative nature of routines enabled by the EHR - were problematic. EHR's support for clinician communication and coordination was limited and its cognitive support insufficient. In some cases, EHR increased cognitive load as the unlocalized EHR scattered information, and the lengthy printouts contributed to information fragmentation and made information retrieval more difficult. The process of the EHR implementation and the changes observed was the confluence of three factors: resource constraint - in particular EHR expertise and experience - not uncommon in many community hospitals; the functional properties of the EHR focusing on information aggregation, storage, and retrieval; and the extant culture and practice of healthcare emphasizing autonomy and flexibility. While collaborative and communication changes were prompted by EHR implementation, the system played a minimal

  18. Electronic health record adoption in US hospitals: the emergence of a digital "advanced use" divide.

    Science.gov (United States)

    Adler-Milstein, Julia; Holmgren, A Jay; Kralovec, Peter; Worzala, Chantal; Searcy, Talisha; Patel, Vaishali

    2017-11-01

    While most hospitals have adopted electronic health records (EHRs), we know little about whether hospitals use EHRs in advanced ways that are critical to improving outcomes, and whether hospitals with fewer resources - small, rural, safety-net - are keeping up. Using 2008-2015 American Hospital Association Information Technology Supplement survey data, we measured "basic" and "comprehensive" EHR adoption among hospitals to provide the latest national numbers. We then used new supplement questions to assess advanced use of EHRs and EHR data for performance measurement and patient engagement functions. To assess a digital "advanced use" divide, we ran logistic regression models to identify hospital characteristics associated with high adoption in each advanced use domain. We found that 80.5% of hospitals adopted at least a basic EHR system, a 5.3 percentage point increase from 2014. Only 37.5% of hospitals adopted at least 8 (of 10) EHR data for performance measurement functions, and 41.7% of hospitals adopted at least 8 (of 10) patient engagement functions. Critical access hospitals were less likely to have adopted at least 8 performance measurement functions (odds ratio [OR] = 0.58; P functions (OR = 0.68; P = 0.02). While the Health Information Technology for Economic and Clinical Health Act resulted in widespread hospital EHR adoption, use of advanced EHR functions lags and a digital divide appears to be emerging, with critical-access hospitals in particular lagging behind. This is concerning, because EHR-enabled performance measurement and patient engagement are key contributors to improving hospital performance. Hospital EHR adoption is widespread and many hospitals are using EHRs to support performance measurement and patient engagement. However, this is not happening across all hospitals. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions

  19. Electronic Health Records: Then, Now, and in the Future

    Science.gov (United States)

    2016-01-01

    Summary Objectives Describe the state of Electronic Health Records (EHRs) in 1992 and their evolution by 2015 and where EHRs are expected to be in 25 years. Further to discuss the expectations for EHRs in 1992 and explore which of them were realized and what events accelerated or disrupted/derailed how EHRs evolved. Methods Literature search based on “Electronic Health Record”, “Medical Record”, and “Medical Chart” using Medline, Google, Wikipedia Medical, and Cochrane Libraries resulted in an initial review of 2,356 abstracts and other information in papers and books. Additional papers and books were identified through the review of references cited in the initial review. Results By 1992, hardware had become more affordable, powerful, and compact and the use of personal computers, local area networks, and the Internet provided faster and easier access to medical information. EHRs were initially developed and used at academic medical facilities but since most have been replaced by large vendor EHRs. While EHR use has increased and clinicians are being prepared to practice in an EHR-mediated world, technical issues have been overshadowed by procedural, professional, social, political, and especially ethical issues as well as the need for compliance with standards and information security. There have been enormous advancements that have taken place, but many of the early expectations for EHRs have not been realized and current EHRs still do not meet the needs of today’s rapidly changing healthcare environment. Conclusion The current use of EHRs initiated by new technology would have been hard to foresee. Current and new EHR technology will help to provide international standards for interoperable applications that use health, social, economic, behavioral, and environmental data to communicate, interpret, and act intelligently upon complex healthcare information to foster precision medicine and a learning health system. PMID:27199197

  20. Deploying Linked Open Vocabulary (LOV to Enhance Library Linked Data

    Directory of Open Access Journals (Sweden)

    Oh, Sam Gyun

    2015-06-01

    Full Text Available Since the advent of Linked Data (LD as a method for building webs of data, there have been many attempts to apply and implement LD in various settings. Efforts have been made to convert bibliographic data in libraries into Linked Data, thereby generating Library Linked Data (LLD. However, when memory institutions have tried to link their data with external sources based on principles suggested by Tim Berners-Lee, identifying appropriate vocabularies for use in describing their bibliographic data has proved challenging. The objective of this paper is to discuss the potential role of Linked Open Vocabularies (LOV in providing better access to various open datasets and facilitating effective linking. The paper will also examine the ways in which memory institutions can utilize LOV to enhance the quality of LLD and LLD-based ontology design.

  1. Transglutaminase catalyzed cross-linking of sodium caseinate improves oxidative stability of flaxseed oil emulsion.

    Science.gov (United States)

    Ma, Hairan; Forssell, Pirkko; Kylli, Petri; Lampi, Anna-Maija; Buchert, Johanna; Boer, Harry; Partanen, Riitta

    2012-06-20

    Sodium caseinate was modified by transglutaminase catalyzed cross-linking reaction prior to the emulsification process in order to study the effect of cross-linking on the oxidative stability of protein stabilized emulsions. The extent of the cross-linking catalyzed by different dosages of transglutaminase was investigated by following the ammonia production during the reaction and using SDS-PAGE gel. O/W emulsions prepared with the cross-linked and non-cross-linked sodium caseinates were stored for 30 days under the same conditions. Peroxide value measurement, oxygen consumption measurement, and headspace gas chromatography analysis were used to study the oxidative stability of the emulsions. The emulsion made of the cross-linked sodium caseinate showed an improved oxidative stability with reduced formation of fatty acid hydroperoxides and volatiles and a longer period of low rate oxygen consumption. The improving effect of transglutaminase catalyzed cross-linking could be most likely attributed to the enhanced physical stability of the interfacial protein layer against competitive adsorption by oil oxidation products.

  2. Revealing Word Order: Using Serial Position in Binomials to Predict Properties of the Speaker

    Science.gov (United States)

    Iliev, Rumen; Smirnova, Anastasia

    2016-01-01

    Three studies test the link between word order in binomials and psychological and demographic characteristics of a speaker. While linguists have already suggested that psychological, cultural and societal factors are important in choosing word order in binomials, the vast majority of relevant research was focused on general factors and on broadly…

  3. Decomposition of the Google pagerank and optimal linking strategy

    NARCIS (Netherlands)

    Avrachenkov, Konstatin; Litvak, Nelli

    2004-01-01

    We provide the analysis of the Google PageRank from the perspective of the Markov Chain Theory. First we study the Google PageRank for a Web that can be decomposed into several connected components which do not have any links to each other. We show that in order to determine the Google PageRank for

  4. How the provenance of electronic health record data matters for research: a case example using system mapping.

    Science.gov (United States)

    Johnson, Karin E; Kamineni, Aruna; Fuller, Sharon; Olmstead, Danielle; Wernli, Karen J

    2014-01-01

    The use of electronic health records (EHRs) for research is proceeding rapidly, driven by computational power, analytical techniques, and policy. However, EHR-based research is limited by the complexity of EHR data and a lack of understanding about data provenance, meaning the context under which the data were collected. This paper presents system flow mapping as a method to help researchers more fully understand the provenance of their EHR data as it relates to local workflow. We provide two specific examples of how this method can improve data identification, documentation, and processing. EHRs store clinical and administrative data, often in unstructured fields. Each clinical system has a unique and dynamic workflow, as well as an EHR customized for local use. The EHR customization may be influenced by a broader context such as documentation required for billing. We present a case study with two examples of using system flow mapping to characterize EHR data for a local colorectal cancer screening process. System flow mapping demonstrated that information entered into the EHR during clinical practice required interpretation and transformation before it could be accurately applied to research. We illustrate how system flow mapping shaped our knowledge of the quality and completeness of data in two examples: (1) determining colonoscopy indication as recorded in the EHR, and (2) discovering a specific EHR form that captured family history. Researchers who do not consider data provenance risk compiling data that are systematically incomplete or incorrect. For example, researchers who are not familiar with the clinical workflow under which data were entered might miss or misunderstand patient information or procedure and diagnostic codes. Data provenance is a fundamental characteristic of research data from EHRs. Given the diversity of EHR platforms and system workflows, researchers need tools for evaluating and reporting data availability, quality, and

  5. Examination of the Link Between Medication Adherence and Use of Mail-Order Pharmacies in Chronic Disease States.

    Science.gov (United States)

    Fernandez, Elena V; McDaniel, Jennifer A; Carroll, Norman V

    2016-11-01

    Higher medication adherence is associated with positive health outcomes, including reduction in hospitalizations and costs, and many interventions have been implemented to increase patient adherence. To determine whether patients experience higher medication adherence by using mail-order or retail pharmacies. Articles pertaining to retail and mail-order pharmacies and medication adherence were collected from 3 literature databases: MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and International Pharmaceutical Abstracts (IPA). Searches were created for each database and articles were compiled. Articles were screened for exclusion factors, and final articles (n=15) comparing medication adherence in patients utilizing mail and retail pharmacies were analyzed. For each study, various factors were identified including days supply, patients' out-of-pocket costs, prior adherence behavior, therapeutic class, measure of adherence, limitations, and results. Studies were then categorized by disease state, and relevant information from each study was compared and contrasted. The majority of studies-14 out of the 15 reviewed-supported higher adherence through the mail-order dispensing channel rather than through retail pharmacies. There are a number of reasons for the differences in adherence between the channels. Study patients who used mail-order pharmacies were more likely to have substantially higher prior adherence behavior, socioeconomic status, and days supply of medicines received and were likely to be offered financial incentives to use mail-order. The few studies that attempted to statistically control for these factors also found that patients using mail-order services were more adherent but the size of the differences was smaller. The extent to which these results indicate an inherent adherence advantage of mail-order pharmacy (as distinct from adherence benefits due to greater days supply, lower copays, or more adherent patients

  6. Adapting Nielsen’s Design Heuristics to Dual Processing for Clinical Decision Support

    Science.gov (United States)

    Taft, Teresa; Staes, Catherine; Slager, Stacey; Weir, Charlene

    2016-01-01

    The study objective was to improve the applicability of Nielson’s standard design heuristics for evaluating electronic health record (EHR) alerts and linked ordering support by integrating them with Dual Process theory. Through initial heuristic evaluation and a user study of 7 physicians, usability problems were identified. Through independent mapping of specific usability criteria to support for each of the Dual Cognitive processes (S1 and S2) and deliberation, agreement was reached on mapping criteria. Finally, usability errors from the heuristic and user study were mapped to S1 and S2. Adding a dual process perspective to specific heuristic analysis increases the applicability and relevance of computerized health information design evaluations. This mapping enables designers to measure that their systems are tailored to support attention allocation. System 1 will be supported by improving pattern recognition and saliency, and system 2 through efficiency and control of information access. PMID:28269915

  7. Adapting Nielsen's Design Heuristics to Dual Processing for Clinical Decision Support.

    Science.gov (United States)

    Taft, Teresa; Staes, Catherine; Slager, Stacey; Weir, Charlene

    2016-01-01

    The study objective was to improve the applicability of Nielson's standard design heuristics for evaluating electronic health record (EHR) alerts and linked ordering support by integrating them with Dual Process theory. Through initial heuristic evaluation and a user study of 7 physicians, usability problems were identified. Through independent mapping of specific usability criteria to support for each of the Dual Cognitive processes (S1 and S2) and deliberation, agreement was reached on mapping criteria. Finally, usability errors from the heuristic and user study were mapped to S1 and S2. Adding a dual process perspective to specific heuristic analysis increases the applicability and relevance of computerized health information design evaluations. This mapping enables designers to measure that their systems are tailored to support attention allocation. System 1 will be supported by improving pattern recognition and saliency, and system 2 through efficiency and control of information access.

  8. Satisfaction of health-care providers with electronic health records and perceived barriers to its implementation in the United Arab Emirates.

    Science.gov (United States)

    Bani-Issa, Wegdan; Al Yateem, Nabeel; Al Makhzoomy, Ibtihal Khalaf; Ibrahim, Ali

    2016-08-01

    The integration of electronic health records (EHRs) has shown promise in improving health-care quality. In the United Arab Emirates, EHRs have been recently adopted to improve the quality and safety of patient care. A cross-sectional survey of 680 health-care providers (HCPs) was conducted to assess the satisfaction of HCPs in the United Arab Emirates with EHRs' impact on access/viewing, documentation and medication administration and to explore the barriers encountered in their use. Data were collected over 6 months from April to September 2014. High overall satisfaction with EHRs was reported by HCPs, suggesting their acceptance. Physicians reported the greatest overall satisfaction with EHRs, although nurses showed significantly higher satisfaction with the impact on medication administration compared with other HCPs. The most significant barriers reported by nurses were lack of belief in the value of EHRs for patients and lack of adequate computer skills. Given the large investment in technology, additional research is necessary to promote the full utilization of EHRs. Nurses need to be aware of the value of EHRs for patient care and be involved in all stages of EHR implementations to maximize its meaningful use for better clinical outcomes. © 2016 John Wiley & Sons Australia, Ltd.

  9. Electronic Health Records Data and Metadata: Challenges for Big Data in the United States.

    Science.gov (United States)

    Sweet, Lauren E; Moulaison, Heather Lea

    2013-12-01

    This article, written by researchers studying metadata and standards, represents a fresh perspective on the challenges of electronic health records (EHRs) and serves as a primer for big data researchers new to health-related issues. Primarily, we argue for the importance of the systematic adoption of standards in EHR data and metadata as a way of promoting big data research and benefiting patients. EHRs have the potential to include a vast amount of longitudinal health data, and metadata provides the formal structures to govern that data. In the United States, electronic medical records (EMRs) are part of the larger EHR. EHR data is submitted by a variety of clinical data providers and potentially by the patients themselves. Because data input practices are not necessarily standardized, and because of the multiplicity of current standards, basic interoperability in EHRs is hindered. Some of the issues with EHR interoperability stem from the complexities of the data they include, which can be both structured and unstructured. A number of controlled vocabularies are available to data providers. The continuity of care document standard will provide interoperability in the United States between the EMR and the larger EHR, potentially making data input by providers directly available to other providers. The data involved is nonetheless messy. In particular, the use of competing vocabularies such as the Systematized Nomenclature of Medicine-Clinical Terms, MEDCIN, and locally created vocabularies inhibits large-scale interoperability for structured portions of the records, and unstructured portions, although potentially not machine readable, remain essential. Once EMRs for patients are brought together as EHRs, the EHRs must be managed and stored. Adequate documentation should be created and maintained to assure the secure and accurate use of EHR data. There are currently a few notable international standards initiatives for EHRs. Organizations such as Health Level Seven

  10. Link Investigation of IEEE 802.15.4 Wireless Sensor Networks in Forests.

    Science.gov (United States)

    Ding, Xingjian; Sun, Guodong; Yang, Gaoxiang; Shang, Xinna

    2016-06-27

    Wireless sensor networks are expected to automatically monitor the ecological evolution and wildlife habits in forests. Low-power links (transceivers) are often adopted in wireless sensor network applications, in order to save the precious sensor energy and then achieve long-term, unattended monitoring. Recent research has presented some performance characteristics of such low-power wireless links under laboratory or outdoor scenarios with less obstacles, and they have found that low-power wireless links are unreliable and prone to be affected by the target environment. However, there is still less understanding about how well the low-power wireless link performs in real-world forests and to what extent the complex in-forest surrounding environments affect the link performances. In this paper, we empirically evaluate the low-power links of wireless sensors in three typical different forest environments. Our experiment investigates the performance of the link layer compatible with the IEEE 802.15.4 standard and analyzes the variation patterns of the packet reception ratio (PRR), the received signal strength indicator (RSSI) and the link quality indicator (LQI) under diverse experimental settings. Some observations of this study are inconsistent with or even contradict prior results that are achieved in open fields or relatively clean environments and thus, provide new insights both into effectively evaluating the low-power wireless links and into efficiently deploying wireless sensor network systems in forest environments.

  11. High speed serial link for UA1 microprocessor network

    CERN Document Server

    Cittolin, S; Zurfluh, E

    1981-01-01

    The UA1 data acquisition system consists of a set of distributed microprocessor units. An interprocessor link, independent of the CAMAC data readout, has been developed in order to have continuous remote control and run-time data handling, e.g. transmission of calibration programs/parameters, equipment test/status and histogram accumulation. The data transmission system is designed to be used in a loop configuration equipped with transceivers for twisted pair cables (RS-422). As an economical system, it is running as an ancillary serial loop-link between microprocessors, like Data Acquisition Crate Controllers and systems with distributed intelligence. The software driver consists of a loop-controller package, which may run in a BAMBI Computer Language environment and a fully interrupt controlled program for all other secondary stations. A special single-character mode provides a handy link for remote debugging in a pseudo-full-duplex mode. The format is based on the HDLC protocol without sequence numbering. ...

  12. High speed serial link for UA1 microprocessor network

    CERN Document Server

    Cittolin, Sergio; Zurfluh, E

    1981-01-01

    The UA1 data acquisition system consists of a set of distributed microprocessor units. An interprocessor link, independent of the CAMAC data readout, has been developed in order to have continuous remote control and run-time data handling, e.g. transmission of calibration programs/parameters, equipment test/status and histogram accumulation. The data transmission system is designed to be used in a loop configuration equipped with transceivers for twisted pair cables (RS-422). As an economical system, it is running as an ancillary serial loop-link between microprocessors, like data acquisition crate controllers and systems with distributed intelligence. The software driver consists of a loop-controller package, which may run in a BAMBI computer language environment and a fully interrupt controlled program for all other secondary stations. A special single-character mode provides a handy link for remote debugging in a pseudo-full-duplex mode. The format is based on the HDLC protocol without sequence numbering. ...

  13. Electronic Health Record Use a Bitter Pill for Many Physicians.

    Science.gov (United States)

    Meigs, Stephen L; Solomon, Michael

    2016-01-01

    Electronic health record (EHR) adoption among office-based physician practices in the United States has increased significantly in the past decade. However, the challenges of using EHRs have resulted in growing dissatisfaction with the systems among many of these physicians. The purpose of this qualitative multiple-case study was to increase understanding of physician perceptions regarding the value of using EHR technology. Important findings included the belief among physicians that EHR systems need to be more user-friendly and adaptable to individual clinic workflow preferences, physician beliefs that lack of interoperability among EHRs is a major barrier to meaningful use of the systems, and physician beliefs that EHR use does not improve the quality of care provided to patients. These findings suggest that although government initiatives to encourage EHR adoption among office-based physician practices have produced positive results, additional support may be required in the future to maintain this momentum.

  14. Risk assessment of integrated electronic health records.

    Science.gov (United States)

    Bjornsson, Bjarni Thor; Sigurdardottir, Gudlaug; Stefansson, Stefan Orri

    2010-01-01

    The paper describes the security concerns related to Electronic Health Records (EHR) both in registration of data and integration of systems. A description of the current state of EHR systems in Iceland is provided, along with the Ministry of Health's future vision and plans. New legislation provides the opportunity for increased integration of EHRs and further collaboration between institutions. Integration of systems, along with greater availability and access to EHR data, requires increased security awareness since additional risks are introduced. The paper describes the core principles of information security as it applies to EHR systems and data. The concepts of confidentiality, integrity, availability, accountability and traceability are introduced and described. The paper discusses the legal requirements and importance of performing risk assessment for EHR data. Risk assessment methodology according to the ISO/IEC 27001 information security standard is described with examples on how it is applied to EHR systems.

  15. Synthesis and characterization of organically linked ZnO nanoparticles

    Energy Technology Data Exchange (ETDEWEB)

    Chory, Christine; Riedel, Ingo; Parisi, Juergen [Energy and Semiconductor Research Laboratory (EHF), University of Oldenburg, Carl-von Ossietzky-Strasse 9-11, 26129 Oldenburg (Germany); Kruska, Carsten; Heimbrodt, Wolfram [Department of Physics and Material Sciences Center, Philipps-University Marburg, Renthof 5, 35032 Marburg (Germany); Feser, Clemens [NEXT ENERGY - EWE Research Centre for Energy Technology e.V., Carl-von Ossietzky-Strasse 15, 26129 Oldenburg (Germany); Beenken, Wichard J.D. [Department of Theoretical Physics I, Ilmenau University of Technology, Weimarer Strasse 25, 98693 Ilmenau (Germany); Hoppe, Harald [Department of Experimental Physics I, Ilmenau University of Technology, Weimarer Strasse 32, 98693 Ilmenau (Germany)

    2012-11-15

    We report on the solution-based synthesis and characterization of three-dimensional networks of ZnO nanoparticles where the formation of structures is achieved by covalently linking the nanocrystals with bifunctional organic ligands. The colloidal synthesis will be presented with application of two ligands that vary in size and binding sites. Furthermore we report on structural characterization of dried powders and thin films by means of X-ray diffraction and electron microscopy in order to examine the regularity of the structures. We also present first investigations of the optical properties and electrical conductance behavior in lateral direction of the differently linked hybrid ZnO networks. (Copyright copyright 2012 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim)

  16. Synthesis and characterization of organically linked ZnO nanoparticles

    International Nuclear Information System (INIS)

    Chory, Christine; Riedel, Ingo; Parisi, Juergen; Kruska, Carsten; Heimbrodt, Wolfram; Feser, Clemens; Beenken, Wichard J.D.; Hoppe, Harald

    2012-01-01

    We report on the solution-based synthesis and characterization of three-dimensional networks of ZnO nanoparticles where the formation of structures is achieved by covalently linking the nanocrystals with bifunctional organic ligands. The colloidal synthesis will be presented with application of two ligands that vary in size and binding sites. Furthermore we report on structural characterization of dried powders and thin films by means of X-ray diffraction and electron microscopy in order to examine the regularity of the structures. We also present first investigations of the optical properties and electrical conductance behavior in lateral direction of the differently linked hybrid ZnO networks. (Copyright copyright 2012 WILEY-VCH Verlag GmbH and Co. KGaA, Weinheim)

  17. The Dominicans, The Third Order and a social order. Santafé de Bogotá. XVI-XIX centuries

    Directory of Open Access Journals (Sweden)

    William Elvis Plata

    2015-01-01

    Full Text Available Since their arrival in New Granada, the dominicans promoted the so called “Third Order”, which brought a number of lay organizations such as fraternities, sororities and devouts groups. This article analyzes such organizations as key nodes of colonial society, through a symbiotic relationship with the colonial elite, which continued until the dawn of republican era. This link were favored by institutions such as chaplaincies and pious deeds. It allowed, among other things, the provision of many of the new members of the order and endowed convents of movable and immovable property and capital necessary for its functioning, in exchange for ensuring social order and provide prestige for this life and salvation for the other. This successful model was torn apart with the advent of the Enlightenment and will fall precipitously shortly after Independence.

  18. Towards plug-and-play integration of archetypes into legacy electronic health record systems: the ArchiMed experience.

    Science.gov (United States)

    Duftschmid, Georg; Chaloupka, Judith; Rinner, Christoph

    2013-01-22

    The dual model approach represents a promising solution for achieving semantically interoperable standardized electronic health record (EHR) exchange. Its acceptance, however, will depend on the effort required for integrating archetypes into legacy EHR systems. We propose a corresponding approach that: (a) automatically generates entry forms in legacy EHR systems from archetypes; and (b) allows the immediate export of EHR documents that are recorded via the generated forms and stored in the EHR systems' internal format as standardized and archetype-compliant EHR extracts. As a prerequisite for applying our approach, we define a set of basic requirements for the EHR systems. We tested our approach with an EHR system called ArchiMed and were able to successfully integrate 15 archetypes from a test set of 27. For 12 archetypes, the form generation failed owing to a particular type of complex structure (multiple repeating subnodes), which was prescribed by the archetypes but not supported by ArchiMed's data model. Our experiences show that archetypes should be customized based on the planned application scenario before their integration. This would allow problematic structures to be dissolved and irrelevant optional archetype nodes to be removed. For customization of archetypes, openEHR templates or specialized archetypes may be employed. Gaps in the data types or terminological features supported by an EHR system will often not preclude integration of the relevant archetypes. More work needs to be done on the usability of the generated forms.

  19. Approaches and challenges to optimising primary care teams’ electronic health record usage

    Directory of Open Access Journals (Sweden)

    Nancy Pandhi

    2014-07-01

    Full Text Available Background Although the presence of an electronic health record (EHR alone does not ensure high quality, efficient care, few studies have focused on the work of those charged with optimising use of existing EHR functionality.Objective To examine the approaches used and challenges perceived by analysts supporting the optimisation of primary care teams’ EHR use at a large U.S. academic health care system.Methods A qualitative study was conducted. Optimisation analysts and their supervisor were interviewed and data were analysed for themes.Results Analysts needed to reconcile the tension created by organisational mandates focused on the standardisation of EHR processes with the primary care teams’ demand for EHR customisation. They gained an understanding of health information technology (HIT leadership’s and primary care team’s goals through attending meetings, reading meeting minutes and visiting with clinical teams. Within what was organisationally possible, EHR education could then be tailored to fit team needs. Major challenges were related to organisational attempts to standardise EHR use despite varied clinic contexts, personnel readiness and technical issues with the EHR platform. Forcing standardisation upon clinical needs that current EHR functionality could not satisfy was difficult.Conclusions Dedicated optimisation analysts can add value to health systems through playing a mediating role between HIT leadership and care teams. Our findings imply that EHR optimisation should be performed with an in-depth understanding of the workflow, cognitive and interactional activities in primary care.

  20. Attending Physician Remote Access of the Electronic Health Record and Implications for Resident Supervision: A Mixed Methods Study.

    Science.gov (United States)

    Martin, Shannon K; Tulla, Kiara; Meltzer, David O; Arora, Vineet M; Farnan, Jeanne M

    2017-12-01

    Advances in information technology have increased remote access to the electronic health record (EHR). Concurrently, standards defining appropriate resident supervision have evolved. How often and under what circumstances inpatient attending physicians remotely access the EHR for resident supervision is unknown. We described a model of attending remote EHR use for resident supervision, and quantified the frequency and magnitude of use. Using a mixed methods approach, general medicine inpatient attendings were surveyed and interviewed about their remote EHR use. Frequency of use and supervisory actions were quantitatively examined via survey. Transcripts from semistructured interviews were analyzed using grounded theory to identify codes and themes. A total of 83% (59 of 71) of attendings participated. Fifty-seven (97%) reported using the EHR remotely, with 54 (92%) reporting they discovered new clinical information not relayed by residents via remote EHR use. A majority (93%, 55 of 59) reported that this resulted in management changes, and 54% (32 of 59) reported making immediate changes by contacting cross-covering teams. Six major factors around remote EHR use emerged: resident, clinical, educational, personal, technical, and administrative. Attendings described resident and clinical factors as facilitating "backstage" supervision via remote EHR use. In our study to assess attending remote EHR use for resident supervision, attendings reported frequent remote use with resulting supervisory actions, describing a previously uncharacterized form of "backstage" oversight supervision. Future work should explore best practices in remote EHR use to provide effective supervision and ultimately improve patient safety.

  1. 77 FR 53967 - Medicare and Medicaid Programs; Electronic Health Record Incentive Program-Stage 2

    Science.gov (United States)

    2012-09-04

    ... Provider Order Entry CQM Clinical Quality Measure CY Calendar Year EHR Electronic Health Record EP Eligible... Measures b. Reporting on Clinical Quality Measures (CQMs) c. Payment Adjustments and Exceptions d... Multiple Practices/Locations (3) Discussion of the Reporting Requirements of the Measures Associated with...

  2. Performance of local information-based link prediction: a sampling perspective

    Science.gov (United States)

    Zhao, Jichang; Feng, Xu; Dong, Li; Liang, Xiao; Xu, Ke

    2012-08-01

    Link prediction is pervasively employed to uncover the missing links in the snapshots of real-world networks, which are usually obtained through different kinds of sampling methods. In the previous literature, in order to evaluate the performance of the prediction, known edges in the sampled snapshot are divided into the training set and the probe set randomly, without considering the underlying sampling approaches. However, different sampling methods might lead to different missing links, especially for the biased ways. For this reason, random partition-based evaluation of performance is no longer convincing if we take the sampling method into account. In this paper, we try to re-evaluate the performance of local information-based link predictions through sampling method governed division of the training set and the probe set. It is interesting that we find that for different sampling methods, each prediction approach performs unevenly. Moreover, most of these predictions perform weakly when the sampling method is biased, which indicates that the performance of these methods might have been overestimated in the prior works.

  3. Consensus of second-order multi-agent dynamic systems with quantized data

    Energy Technology Data Exchange (ETDEWEB)

    Guan, Zhi-Hong, E-mail: zhguan@mail.hust.edu.cn [Department of Control Science and Engineering, Huazhong University of Science and Technology, Wuhan, 430074 (China); Meng, Cheng [Department of Control Science and Engineering, Huazhong University of Science and Technology, Wuhan, 430074 (China); Liao, Rui-Quan [Petroleum Engineering College,Yangtze University, Jingzhou, 420400 (China); Zhang, Ding-Xue, E-mail: zdx7773@163.com [Petroleum Engineering College,Yangtze University, Jingzhou, 420400 (China)

    2012-01-09

    The consensus problem of second-order multi-agent systems with quantized link is investigated in this Letter. Some conditions are derived for the quantized consensus of the second-order multi-agent systems by the stability theory. Moreover, a result characterizing the relationship between the eigenvalues of the Laplacians matrix and the quantized consensus is obtained. Examples are given to illustrate the theoretical analysis. -- Highlights: ► A second-order multi-agent model with quantized data is proposed. ► Two sufficient and necessary conditions are obtained. ► The relationship between the eigenvalues of the Laplacians matrix and the quantized consensus is discovered.

  4. Analysis of the harmonic and intermodulation distortion in a multimode fiber optic link.

    Science.gov (United States)

    Gasulla, I; Capmany, J

    2007-07-23

    We present an analytical evaluation of the harmonic and the intermodulation distortion effects produced in the transmission of an analog signal composed of various RF tones through a multimode fiber link. It is based on the electric field propagation model previously published by the authors. Results show the possibility of implementing subcarrier multiplexing techniques (SCM) with Composite Second Order (CSO) values below -50 dBc over short and middle reach multimode fiber links.

  5. Testing the growth links of emerging economies: Croatia in a growing world economy

    NARCIS (Netherlands)

    Ziesemer, Thomas

    2017-01-01

    We estimate a dynamic simultaneous equation model for 16 variables of the Croatian economy in order to test the links of growth with education, R&D, trade, savings and FDI. In order to motivate the choice of variables we review the related theories of growth and look at the relevant data. Permanent

  6. Space Link Extension Protocol Emulation for High-Throughput, High-Latency Network Connections

    Science.gov (United States)

    Tchorowski, Nicole; Murawski, Robert

    2014-01-01

    New space missions require higher data rates and new protocols to meet these requirements. These high data rate space communication links push the limitations of not only the space communication links, but of the ground communication networks and protocols which forward user data to remote ground stations (GS) for transmission. The Consultative Committee for Space Data Systems, (CCSDS) Space Link Extension (SLE) standard protocol is one protocol that has been proposed for use by the NASA Space Network (SN) Ground Segment Sustainment (SGSS) program. New protocol implementations must be carefully tested to ensure that they provide the required functionality, especially because of the remote nature of spacecraft. The SLE protocol standard has been tested in the NASA Glenn Research Center's SCENIC Emulation Lab in order to observe its operation under realistic network delay conditions. More specifically, the delay between then NASA Integrated Services Network (NISN) and spacecraft has been emulated. The round trip time (RTT) delay for the continental NISN network has been shown to be up to 120ms; as such the SLE protocol was tested with network delays ranging from 0ms to 200ms. Both a base network condition and an SLE connection were tested with these RTT delays, and the reaction of both network tests to the delay conditions were recorded. Throughput for both of these links was set at 1.2Gbps. The results will show that, in the presence of realistic network delay, the SLE link throughput is significantly reduced while the base network throughput however remained at the 1.2Gbps specification. The decrease in SLE throughput has been attributed to the implementation's use of blocking calls. The decrease in throughput is not acceptable for high data rate links, as the link requires constant data a flow in order for spacecraft and ground radios to stay synchronized, unless significant data is queued a the ground station. In cases where queuing the data is not an option

  7. A Novel Approach toward Fuzzy Generalized Bi-Ideals in Ordered Semigroups

    Directory of Open Access Journals (Sweden)

    Faiz Muhammad Khan

    2014-01-01

    Full Text Available In several advanced fields like control engineering, computer science, fuzzy automata, finite state machine, and error correcting codes, the use of fuzzified algebraic structures especially ordered semigroups plays a central role. In this paper, we introduced a new and advanced generalization of fuzzy generalized bi-ideals of ordered semigroups. These new concepts are supported by suitable examples. These new notions are the generalizations of ordinary fuzzy generalized bi-ideals of ordered semigroups. Several fundamental theorems of ordered semigroups are investigated by the properties of these newly defined fuzzy generalized bi-ideals. Further, using level sets, ordinary fuzzy generalized bi-ideals are linked with these newly defined ideals which is the most significant part of this paper.

  8. The State of Open Source Electronic Health Record Projects: A Software Anthropology Study.

    Science.gov (United States)

    Alsaffar, Mona; Yellowlees, Peter; Odor, Alberto; Hogarth, Michael

    2017-02-24

    Electronic health records (EHR) are a key tool in managing and storing patients' information. Currently, there are over 50 open source EHR systems available. Functionality and usability are important factors for determining the success of any system. These factors are often a direct reflection of the domain knowledge and developers' motivations. However, few published studies have focused on the characteristics of free and open source software (F/OSS) EHR systems and none to date have discussed the motivation, knowledge background, and demographic characteristics of the developers involved in open source EHR projects. This study analyzed the characteristics of prevailing F/OSS EHR systems and aimed to provide an understanding of the motivation, knowledge background, and characteristics of the developers. This study identified F/OSS EHR projects on SourceForge and other websites from May to July 2014. Projects were classified and characterized by license type, downloads, programming languages, spoken languages, project age, development status, supporting materials, top downloads by country, and whether they were "certified" EHRs. Health care F/OSS developers were also surveyed using an online survey. At the time of the assessment, we uncovered 54 open source EHR projects, but only four of them had been successfully certified under the Office of the National Coordinator for Health Information Technology (ONC Health IT) Certification Program. In the majority of cases, the open source EHR software was downloaded by users in the United States (64.07%, 148,666/232,034), underscoring that there is a significant interest in EHR open source applications in the United States. A survey of EHR open source developers was conducted and a total of 103 developers responded to the online questionnaire. The majority of EHR F/OSS developers (65.3%, 66/101) are participating in F/OSS projects as part of a paid activity and only 25.7% (26/101) of EHR F/OSS developers are, or have been

  9. Hydroxyl radical induced cross-linking of cytosine and tyrosine in nucleohistone

    International Nuclear Information System (INIS)

    Gajewski, E.; Dizdaroglu, M.

    1990-01-01

    Hydroxyl radical induced formation of a DNA-protein cross-link involving cytosine and tyrosine in nucleohistone in buffered aqueous solution is reported. The technique of gas chromatography-mass spectrometry was used for this investigation. A γ-irradiated aqueous mixture of cytosine and tyrosine was first investigated in order to obtain gas chromatographic-mass spectrometric properties of possible cytosine-tyrosine cross-links. One cross-link was observed, and its structure was identified as the product from the formation of a covalent bond between carbon 6 of cytosine and carbon 3 of tyrosine. With the use of gas chromatography-mass spectrometry with selected-ion monitoring, this cytosine-tyrosine cross-link was identified in acidic hydrolysates of calf thymus nucleohistone γ-irradiated in N 2 O-saturated aqueous solution. The yield of this DNA-protein cross-link in nucleohistone was found to be a linear function of the radiation dose in the range of 100-500 Gy (J·kg -1 ). This yield amounted to 0.05 nmol·J -1 . Mechanisms underlying the formation of the cytosine-tyrosine cross-link in nucleohistone were proposed to involve radical-radical and/or radical addition reactions of hydroxyl adduct radicals of cytosine and tyrosine moieties, forming a covalent bond between carbon 6 of cytosine and carbon 3 of tyrosine. When oxygen was present in irradiated solutions, no cytosine-tyrosine cross-links were observed

  10. Operative Links

    DEFF Research Database (Denmark)

    Wistoft, Karen; Højlund, Holger

    2012-01-01

    educational goals, learning content, or value clarification. Health pedagogy is often a matter of retrospective rationalization rather than the starting point of planning. Health and risk behaviour approaches override health educational approaches. Conclusions: Operational links between health education......, health professionalism, and management strategies pose the foremost challenge. Operational links indicates cooperative levels that facilitate a creative and innovative effort across traditional professional boundaries. It is proposed that such links are supported by network structures, shared semantics...

  11. Link-N: The missing link towards intervertebral disc repair is species-specific.

    Directory of Open Access Journals (Sweden)

    Frances C Bach

    Full Text Available Degeneration of the intervertebral disc (IVD is a frequent cause for back pain in humans and dogs. Link-N stabilizes proteoglycan aggregates in cartilaginous tissues and exerts growth factor-like effects. The human variant of Link-N facilitates IVD regeneration in several species in vitro by inducing Smad1 signaling, but it is not clear whether this is species specific. Dogs with IVD disease could possibly benefit from Link-N treatment, but Link-N has not been tested on canine IVD cells. If Link-N appears to be effective in canines, this would facilitate translation of Link-N into the clinic using the dog as an in vivo large animal model for human IVD degeneration.This study's objective was to determine the effect of the human and canine variant of Link-N and short (s Link-N on canine chondrocyte-like cells (CLCs and compare this to those on already studied species, i.e. human and bovine CLCs. Extracellular matrix (ECM production was determined by measuring glycosaminoglycan (GAG content and histological evaluation. Additionally, the micro-aggregates' DNA content was measured. Phosphorylated (p Smad1 and -2 levels were determined using ELISA.Human (sLink-N induced GAG deposition in human and bovine CLCs, as expected. In contrast, canine (sLink-N did not affect ECM production in human CLCs, while it mainly induced collagen type I and II deposition in bovine CLCs. In canine CLCs, both canine and human (sLink-N induced negligible GAG deposition. Surprisingly, human and canine (sLink-N did not induce Smad signaling in human and bovine CLCs. Human and canine (sLink-N only mildly increased pSmad1 and Smad2 levels in canine CLCs.Human and canine (sLink-N exerted species-specific effects on CLCs from early degenerated IVDs. Both variants, however, lacked the potency as canine IVD regeneration agent. While these studies demonstrate the challenges of translational studies in large animal models, (sLink-N still holds a regenerative potential for humans.

  12. The business end of health information technology. Can a fully integrated electronic health record increase provider productivity in a large community practice?

    Science.gov (United States)

    De Leon, Samantha; Connelly-Flores, Alison; Mostashari, Farzad; Shih, Sarah C

    2010-01-01

    Electronic health records (EHRs) are expected to transform and improve the way medicine is practiced. However, providers perceive many barriers toward implementing new health information technology. Specifically, they are most concerned about the potentially negative impact on their practice finances and productivity. This study compares the productivity of 75 providers at a large urban primary care practice from January 2005 to February 2009, before and after implementing an EHR system, using longitudinal mixed model analyses. While decreases in productivity were observed at the time the EHR system was implemented, most providers quickly recovered, showing increases in productivity per month shortly after EHR implementation. Overall, providers had significant productivity increases of 1.7% per month per provider from pre- to post-EHR adoption. The majority of the productivity gains occurred after the practice instituted a pay-for-performance program, enabled by the data capture of the EHRs. Coupled with pay-for-performance, EHRs can spur rapid gains in provider productivity.

  13. Electronic health record case studies to advance environmental public health tracking.

    Science.gov (United States)

    Namulanda, Gonza; Qualters, Judith; Vaidyanathan, Ambarish; Roberts, Eric; Richardson, Max; Fraser, Alicia; McVeigh, Katharine H; Patterson, Scott

    2018-03-01

    Data from traditional public health surveillance systems can have some limitations, e.g., timeliness, geographic level, and amount of data accessible. Electronic health records (EHRs) could present an opportunity to supplement current sources of routinely collected surveillance data. The National Environmental Public Health Tracking Program (Tracking Program) sought to explore the use of EHRs for advancing environmental public health surveillance practices. The Tracking Program funded four state/local health departments to obtain and pilot the use of EHR data to address several issues including the challenges and technical requirements for accessing EHR data, and the core data elements required to integrate EHR data within their departments' Tracking Programs. The results of these pilot projects highlighted the potential of EHR data for public health surveillance of rare diseases that may lack comprehensive registries, and surveillance of prevalent health conditions or risk factors for health outcomes at a finer geographic level. EHRs therefore, may have potential to supplement traditional sources of public health surveillance data. Published by Elsevier Inc.

  14. Effective teaching: Linking teaching to learning functions | Grösser ...

    African Journals Online (AJOL)

    In this regard, it is important that teachers are able to link teaching to learning functions in order to facilitate the optimal realization of learning outcomes. In this study the extent to which teaching assists the development of learning functions was examined by means of a quantitative research project. The findings indicated ...

  15. Determination of Dacarbazine Φ‐Order Photokinetics, Quantum Yields, and Potential for Actinometry.

    OpenAIRE

    Maafi, Mounir; Lee, Lok Yan

    2015-01-01

    The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link. The characterization of drugs’ Photodegradation kinetics is more accurately achieved by means of the recently developed –order kinetics than by the 0th–, 1st– and/or 2nd–order classical treatments. The photodegradation of anti–cancer Dacarbazine (DBZ) in ethanol has been investigated and found to obey –order kinetics when subjected to continu...

  16. A Bayesian network model for predicting type 2 diabetes risk based on electronic health records

    Science.gov (United States)

    Xie, Jiang; Liu, Yan; Zeng, Xu; Zhang, Wu; Mei, Zhen

    2017-07-01

    An extensive, in-depth study of diabetes risk factors (DBRF) is of crucial importance to prevent (or reduce) the chance of suffering from type 2 diabetes (T2D). Accumulation of electronic health records (EHRs) makes it possible to build nonlinear relationships between risk factors and diabetes. However, the current DBRF researches mainly focus on qualitative analyses, and the inconformity of physical examination items makes the risk factors likely to be lost, which drives us to study the novel machine learning approach for risk model development. In this paper, we use Bayesian networks (BNs) to analyze the relationship between physical examination information and T2D, and to quantify the link between risk factors and T2D. Furthermore, with the quantitative analyses of DBRF, we adopt EHR and propose a machine learning approach based on BNs to predict the risk of T2D. The experiments demonstrate that our approach can lead to better predictive performance than the classical risk model.

  17. Validation of multisource electronic health record data: an application to blood transfusion data.

    Science.gov (United States)

    Hoeven, Loan R van; Bruijne, Martine C de; Kemper, Peter F; Koopman, Maria M W; Rondeel, Jan M M; Leyte, Anja; Koffijberg, Hendrik; Janssen, Mart P; Roes, Kit C B

    2017-07-14

    Although data from electronic health records (EHR) are often used for research purposes, systematic validation of these data prior to their use is not standard practice. Existing validation frameworks discuss validity concepts without translating these into practical implementation steps or addressing the potential influence of linking multiple sources. Therefore we developed a practical approach for validating routinely collected data from multiple sources and to apply it to a blood transfusion data warehouse to evaluate the usability in practice. The approach consists of identifying existing validation frameworks for EHR data or linked data, selecting validity concepts from these frameworks and establishing quantifiable validity outcomes for each concept. The approach distinguishes external validation concepts (e.g. concordance with external reports, previous literature and expert feedback) and internal consistency concepts which use expected associations within the dataset itself (e.g. completeness, uniformity and plausibility). In an example case, the selected concepts were applied to a transfusion dataset and specified in more detail. Application of the approach to a transfusion dataset resulted in a structured overview of data validity aspects. This allowed improvement of these aspects through further processing of the data and in some cases adjustment of the data extraction. For example, the proportion of transfused products that could not be linked to the corresponding issued products initially was 2.2% but could be improved by adjusting data extraction criteria to 0.17%. This stepwise approach for validating linked multisource data provides a basis for evaluating data quality and enhancing interpretation. When the process of data validation is adopted more broadly, this contributes to increased transparency and greater reliability of research based on routinely collected electronic health records.

  18. Electronic Health Record Impacts on Family Medicine Teachers: Survey of Third-Year Medical Student Clerkship Preceptors at an Academic Medical Center.

    Science.gov (United States)

    Curry, Elizabeth; Oser, Tamara K; Oser, Sean M

    2017-10-01

    Electronic Health Record (EHR) use in clinical practice has accelerated in recent years. While several aspects of EHR use have been extensively studied, there is little data on EHR impacts on medical student educators, especially those involved in outpatient family medicine. This study evaluated perceived impacts of EHR use on clinician teachers of outpatient family medicine. The study used a mixed methods survey of clinicians who teach third-year medical students during the required family and community medicine outpatient clerkship at a Mid-Atlantic medical school. Among 50 completed surveys, most respondents reported that the EHR had impacted their teaching (70% reported at least one negative effect; 84% reported at least one positive effect). Positive impacts included more easily viewing information, more effectively teaching evidence-based medicine, and teaching about EHR use itself. Negative impacts included less time teaching or interacting with students, and a perception that EHR use impedes development of students' critical thinking and clinical integration skills. Providers who have taught medical students both with and without EHR in place (>P=.024), those over 50 years old (>P=.019), and those with at least 5 years teaching experience (>P=.006) were more likely to report negative impacts. Most preceptors reported that EHR use had both positive and negative impacts on their teaching of medical students, though the negative effects were perceived by respondents as more substantial, consistent with a theme of decreased enthusiasm for teaching due to EHR use. These findings can be used to help inform faculty development and education initiatives.

  19. Financial position and adoption of electronic health records: a retrospective longitudinal study.

    Science.gov (United States)

    Shen, Jay J; Ginn, Gregory O

    2012-01-01

    Financial barriers are a major factor of slow electronic health record (EHR) adoption among US hospitals. All existing literature focuses on relationships between current or short-term financial position and EHR adoption. This study examines relationship between financial position in previous years and the current level of EHR adoption. Retrospective longitudinal data were extracted from (1) the 2009 American Hospital Association (AHA) EHR implementation survey; (2) the 2002 and 2006 Centers for Medicare & Medicaid Cost Reports; and (3) the 2002 and 2006 AHA Annual Survey containing organizational and operational data. The final sample was 2,701 acute care hospitals in the United States. General ordinal logistic regression was used for data analysis with a three-level dependent variable to measure adoption, five independent variables to measure financial position, and 11 control variables to measure structure and environment. For 2006, higher total margin was significantly and positively associated with EHR adoption, but higher asset turnover was significantly and negatively associated with EHR adoption. For 2002, higher total margin was significantly and positively associated with EHR adoption, but higher asset turnover and higher equity multiplier were both significantly and negatively associated with EHR adoption. In addition, lower net days revenue in accounts receivable was significantly and positively associated with EHR adoption. For both the 2002 and 2006 control variables, human resource intensity and bed size were significant and positively related to adoption, and percentage Medicare patients and investor ownership were significant and negatively related to adoption. Financial position does relate to EHR adoption in mid-term and long-term planning.

  20. Analytical model and figures of merit for filtered Microwave Photonic Links.

    Science.gov (United States)

    Gasulla, Ivana; Capmany, José

    2011-09-26

    The concept of filtered Microwave Photonic Links is proposed in order to provide the most general and versatile description of complex analog photonic systems. We develop a field propagation model where a global optical filter, characterized by its optical transfer function, embraces all the intermediate optical components in a linear link. We assume a non-monochromatic light source characterized by an arbitrary spectral distribution which has a finite linewidth spectrum and consider both intensity modulation and phase modulation with balanced and single detection. Expressions leading to the computation of the main figures of merit concerning the link gain, noise and intermodulation distortion are provided which, to our knowledge, are not available in the literature. The usefulness of this derivation resides in the capability to directly provide performance criteria results for complex links just by substituting in the overall closed-form formulas the numerical or measured optical transfer function characterizing the link. This theory is presented thus as a potential tool for a wide range of relevant microwave photonic application cases which is extendable to multiport radio over fiber systems. © 2011 Optical Society of America

  1. Multi-level analysis of electronic health record adoption by health care professionals: A study protocol

    Directory of Open Access Journals (Sweden)

    Labrecque Michel

    2010-04-01

    Full Text Available Abstract Background The electronic health record (EHR is an important application of information and communication technologies to the healthcare sector. EHR implementation is expected to produce benefits for patients, professionals, organisations, and the population as a whole. These benefits cannot be achieved without the adoption of EHR by healthcare professionals. Nevertheless, the influence of individual and organisational factors in determining EHR adoption is still unclear. This study aims to assess the unique contribution of individual and organisational factors on EHR adoption in healthcare settings, as well as possible interrelations between these factors. Methods A prospective study will be conducted. A stratified random sampling method will be used to select 50 healthcare organisations in the Quebec City Health Region (Canada. At the individual level, a sample of 15 to 30 health professionals will be chosen within each organisation depending on its size. A semi-structured questionnaire will be administered to two key informants in each organisation to collect organisational data. A composite adoption score of EHR adoption will be developed based on a Delphi process and will be used as the outcome variable. Twelve to eighteen months after the first contact, depending on the pace of EHR implementation, key informants and clinicians will be contacted once again to monitor the evolution of EHR adoption. A multilevel regression model will be applied to identify the organisational and individual determinants of EHR adoption in clinical settings. Alternative analytical models would be applied if necessary. Results The study will assess the contribution of organisational and individual factors, as well as their interactions, to the implementation of EHR in clinical settings. Conclusions These results will be very relevant for decision makers and managers who are facing the challenge of implementing EHR in the healthcare system. In addition

  2. Market effects on electronic health record adoption by physicians.

    Science.gov (United States)

    Abdolrasulnia, Maziar; Menachemi, Nir; Shewchuk, Richard M; Ginter, Peter M; Duncan, W Jack; Brooks, Robert G

    2008-01-01

    Despite the advantages of electronic health record (EHR) systems, the adoption of these systems has been slow among community-based physicians. Current studies have examined organizational and personal barriers to adoption; however, the influence of market characteristics has not been studied. The purpose of this study was to measure the effects of market characteristics on EHR adoption by physicians. Generalized hierarchal linear modeling was used to analyze EHR survey data from Florida which were combined with data from the Area Resource File and the Florida Office of Insurance Regulation. The main outcome variable was self-reported use of EHR by physicians. A total of 2,926 physicians from practice sizes of 20 or less were included in the sample. Twenty-one percent (n = 613) indicated that they personally and routinely use an EHR system in their practice. Physicians located in counties with higher physician concentration were found to be more likely to adopt EHRs. For every one-unit increase in nonfederal physicians per 10,000 in the county, there was a 2.0% increase in likelihood of EHR adoption by physicians (odds ratio = 1.02, confidence interval = 1.00-1.03). Health maintenance organization penetration rate and poverty level were not found to be significantly related to EHR adoption. However, practice size, years in practice, Medicare payer mix, and measures of technology readiness were found to independently influence physician adoption. Market factors play an important role in the diffusion of EHRs in small medical practices. Policy makers interested in furthering the adoption of EHRs must consider strategies that would enhance the confidence of users as well as provide financial support in areas with the highest concentration of small medical practices and Medicare beneficiaries. Health care leaders should be cognizant of the market forces that enable or constrain the adoption of EHR among their practices and those of their competitors.

  3. Capacity of cognitive radio under imperfect secondary and cross link channel state information

    KAUST Repository

    Sboui, Lokman

    2011-09-01

    In this paper, we study the ergodic capacity of secondary user channel in a spectrum sharing scenario in which the secondary transmitter is instantaneously aware of estimated versions of the cross link (between the secondary transmitter and the primary receiver) and the secondary link Channel State Information (CSI). The secondary link optimal power profile along with the ergodic capacity are derived for a class of fading channels, under an average power constraint and an instantaneous interference outage constraint. We also show that our framework is rather general as it encompasses several previously studied spectrum sharing settings as special cases. In order to gain some insights on the capacity behavior, numerical results are shown for independent Rayleigh fading channels where it is found for instance, that at low SNR regime, only the secondary channel estimation matters and that the cross link CSI has no effect on the ergodic capacity; whereas at high SNR regime, the capacity is rather driven by the cross link CSI. © 2011 IEEE.

  4. Annual survey on the level and extent of usage of electronic health records in government-related hospitals in Eastern Province, Saudi Arabia.

    Science.gov (United States)

    Bah, Sulaiman; Alharthi, Hana; El Mahalli, Azza Ali; Jabali, Abdelkaream; Al-Qahtani, Mona; Al-kahtani, Nouf

    2011-01-01

    This study aims to determine the level and extent of usage of electronic health records (EHRs) in government-related hospitals in Eastern Province, Saudi Arabia. Another aim is to develop a Web site to serve as a forum of exchange on the development of EHRs in Saudi Arabia. All government hospitals (n = 19) in the province were included. The information technology (IT) managers in those hospitals made up the target population. An online questionnaire was developed, and the IT managers in all 19 government hospitals were invited to participate in the survey. The responses from the online survey were downloaded and analyzed using descriptive statistics. Of the 19 hospitals, only three (15.8 percent) use EHRs. These hospitals were established in 1984, 1995, and 2005. All three of these hospitals have implemented the same EHR software and were using it successfully, and all three were using the three core features of laboratory, radiology, and pharmacy electronic modules. Some modules were present in the EHR system but were underutilized. Some of the main challenges faced by the IT managers in implementing EHRs in their hospitals were related to the uncooperative attitudes of some physicians and nurses toward EHRs. In fulfillment of the second aim of the study, a Web site, http://ehr2011.weebly.com, was developed to serve as a forum for exchange of information on the development of EHRs in Saudi Arabia. The government of Saudi Arabia has prioritized the development of eHealth (health information technology) and allocated committed funding for it during 2008-2011. During this period, some sectors of government made highly commendable efforts in developing eHealth services. Along these lines, we had hoped to see higher uptake of EHRs than the 15.8 percent found in this study. The rate of implementing EHRs in government hospitals should be accelerated. The aim should be on achieving some basic EHR functionality in these hospitals, and once this has been achieved

  5. Evaluation of an electronic health record-supported obesity management protocol implemented in a community health center: a cautionary note.

    Science.gov (United States)

    Steglitz, Jeremy; Sommers, Mary; Talen, Mary R; Thornton, Louise K; Spring, Bonnie

    2015-07-01

    Primary care clinicians are well-positioned to intervene in the obesity epidemic. We studied whether implementation of an obesity intake protocol and electronic health record (EHR) form to guide behavior modification would facilitate identification and management of adult obesity in a Federally Qualified Health Center serving low-income, Hispanic patients. In three studies, we examined clinician and patient outcomes before and after the addition of the weight management protocol and form. In the Clinician Study, 12 clinicians self-reported obesity management practices. In the Population Study, BMI and order data from 5000 patients and all 40 clinicians in the practice were extracted from the EHR preintervention and postintervention. In the Exposure Study, EHR-documented outcomes for a sub-sample of 46 patients actually exposed to the obesity management form were compared to matched controls. Clinicians reported that the intake protocol and form increased their performance of obesity-related assessments and their confidence in managing obesity. However, no improvement in obesity management practices or patient weight-loss was evident in EHR records for the overall clinic population. Further analysis revealed that only 55 patients were exposed to the form. Exposed patients were twice as likely to receive weight-loss counseling following the intervention, as compared to before, and more likely than matched controls. However, their obesity outcomes did not differ. Results suggest that an obesity intake protocol and EHR-based weight management form may facilitate clinician weight-loss counseling among those exposed to the form. Significant implementation barriers can limit exposure, however, and need to be addressed. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  6. The Long-term Impact of Birth Order on Health and Educational Attainment

    OpenAIRE

    Barclay, Kieron

    2014-01-01

    This doctoral thesis examines the long-term impact of birth order on health, and educational attainment. Swedish register data is used to link individuals to their siblings, thereby allowing members of the sibling group to be compared to one another. This thesis consists of an introductory chapter summarizing empirical research on the relationship between birth order and educational attainment, intelligence, health, and personality, as well the theoretical frameworks that have been developed ...

  7. Electronic health record in the internal medicine clinic of a Brazilian university hospital: Expectations and satisfaction of physicians and patients.

    Science.gov (United States)

    Duarte, Jurandir Godoy; Azevedo, Raymundo Soares

    2017-06-01

    To evaluate the satisfaction and expectations of patients and physicians before and after the implementation of an electronic health record (EHR) in the outpatient clinic of a university hospital. We conducted 389 interviews with patients and 151 with physicians before and after the implementation of a commercial EHR at the internal medicine clinic of Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (HC-FMUSP), Brazil. The physicians were identified by their connection to the outpatient clinic and categorized by their years since graduation: residents and preceptors (with 10 years or less of graduation) or assistants (with more than 10 years of graduation). The answers to the questionnaire given by the physicians were classified as favorable or against the use of EHR, before and after the implementation of this system in this clinic, receiving 1 or 0 points, respectively. The sum of these points generated a multiple regression score to determine which factors contribute to the acceptance of EHR by physicians. We also did a third survey, after the EHR was routinely established in the outpatient clinic. The degree of patient satisfaction was the same before and after implementation, with more than 90% positive evaluations. They noted the use of the computer during the consultation and valued such use. Resident (younger) physicians had more positive expectations than assistants (older physicians) before EHR implementation. This optimism was reduced after implementation. In the third evaluation the use of EHR was higher among resident physicians. Resident physicians perceived and valued the EHR more and used it more. In 28 of the 57 questions on performance of clinical tasks, resident physicians found it easier to use EHR than assistant physicians with significant differences (pclinical setting should be preceded by careful planning to improve physician's adherence to the use of EHR. Patients do not seem to notice much difference to the

  8. Effects of small-world connectivity on noise-induced temporal and spatial order in neural media

    International Nuclear Information System (INIS)

    Perc, Matjaz

    2007-01-01

    We present an overview of possible effects of small-world connectivity on noise-induced temporal and spatial order in a two-dimensional network of excitable neural media with FitzHugh-Nagumo local dynamics. Small-world networks are characterized by a given fraction of so-called long-range couplings or shortcut links that connect distant units of the system, while all other units are coupled in a diffusive-like manner. Interestingly, already a small fraction of these long-range couplings can have wide-ranging effects on the temporal as well as spatial noise-induced dynamics of the system. Here we present two main effects. First, we show that the temporal order, characterized by the autocorrelation of a firing-rate function, can be greatly enhanced by the introduction of small-world connectivity, whereby the effect increases with the increasing fraction of introduced shortcut links. Second, we show that the introduction of long-range couplings induces disorder of otherwise ordered, spiral-wave-like, noise-induced patterns that can be observed by exclusive diffusive connectivity of spatial units. Thereby, already a small fraction of shortcut links is sufficient to destroy coherent pattern formation in the media. Although the two results seem contradictive, we provide an explanation considering the inherent scale-free nature of small-world networks, which on one hand, facilitates signal transduction and thus temporal order in the system, whilst on the other hand, disrupts the internal spatial scale of the media thereby hindering the existence of coherent wave-like patterns. Additionally, the importance of spatially versus temporally ordered neural network functioning is discussed

  9. Light-induced cross-linking and post-cross-linking modification of polyglycidol.

    Science.gov (United States)

    Marquardt, F; Bruns, M; Keul, H; Yagci, Y; Möller, M

    2018-02-08

    The photoinduced radical generation process has received renewed interest due to its economic and ecological appeal. Herein the light-induced cross-linking of functional polyglycidol and its post-cross-linking modification are presented. Linear polyglycidol was first functionalized with a tertiary amine in a two-step reaction. Dimethylaminopropyl functional polyglycidol was cross-linked in a UV-light mediated reaction with camphorquinone as a type II photoinitiator. The cross-linked polyglycidol was further functionalized by quaternization with various organoiodine compounds. Aqueous dispersions of the cross-linked polymers were investigated by means of DLS and zeta potential measurements. Polymer films were evaluated by DSC and XPS.

  10. Capacitance estimation algorithm based on DC-link voltage harmonics using artificial neural network in three-phase motor drive systems

    DEFF Research Database (Denmark)

    Soliman, Hammam Abdelaal Hammam; Davari, Pooya; Wang, Huai

    2017-01-01

    to industry. In this digest, a condition monitoring methodology that estimates the capacitance value of the dc-link capacitor in a three phase Front-End diode bridge motor drive is proposed. The proposed software methodology is based on Artificial Neural Network (ANN) algorithm. The harmonics of the dc......-link voltage are used as training data to the Artificial Neural Network. Fast Fourier Transform (FFT) of the dc-link voltage is analysed in order to study the impact of capacitance variation on the harmonics order. Laboratory experiments are conducted to validate the proposed methodology and the error analysis......In modern design of power electronic converters, reliability of dc-link capacitors is one of the critical considered aspects. The industrial field have been attracted to the monitoring of their health condition and the estimation of their ageing process status. However, the existing condition...

  11. -Omic and Electronic Health Record Big Data Analytics for Precision Medicine.

    Science.gov (United States)

    Wu, Po-Yen; Cheng, Chih-Wen; Kaddi, Chanchala D; Venugopalan, Janani; Hoffman, Ryan; Wang, May D

    2017-02-01

    Rapid advances of high-throughput technologies and wide adoption of electronic health records (EHRs) have led to fast accumulation of -omic and EHR data. These voluminous complex data contain abundant information for precision medicine, and big data analytics can extract such knowledge to improve the quality of healthcare. In this paper, we present -omic and EHR data characteristics, associated challenges, and data analytics including data preprocessing, mining, and modeling. To demonstrate how big data analytics enables precision medicine, we provide two case studies, including identifying disease biomarkers from multi-omic data and incorporating -omic information into EHR. Big data analytics is able to address -omic and EHR data challenges for paradigm shift toward precision medicine. Big data analytics makes sense of -omic and EHR data to improve healthcare outcome. It has long lasting societal impact.

  12. Applied nursing informatics research - state-of-the-art methodologies using electronic health record data.

    Science.gov (United States)

    Park, Jung In; Pruinelli, Lisiane; Westra, Bonnie L; Delaney, Connie W

    2014-01-01

    With the pervasive implementation of electronic health records (EHR), new opportunities arise for nursing research through use of EHR data. Increasingly, comparative effectiveness research within and across health systems is conducted to identify the impact of nursing for improving health, health care, and lowering costs of care. Use of EHR data for this type of research requires use of national and internationally recognized nursing terminologies to normalize data. Research methods are evolving as large data sets become available through EHRs. Little is known about the types of research and analytic methods for applied to nursing research using EHR data normalized with nursing terminologies. The purpose of this paper is to report on a subset of a systematic review of peer reviewed studies related to applied nursing informatics research involving EHR data using standardized nursing terminologies.

  13. Health IT and inappropriate utilization of outpatient imaging: A cross-sectional study of U.S. hospitals.

    Science.gov (United States)

    Appari, Ajit; Johnson, M Eric; Anthony, Denise L

    2018-01-01

    To determine whether the use of information technology (IT), measured by Meaningful Use capability, is associated with lower rates of inappropriate utilization of imaging services in hospital outpatient settings. A retrospective cross-sectional analysis of 3332 nonfederal U.S. hospitals using data from: Hospital Compare (2011 outpatient imaging efficiency measures), HIMSS Analytics (2009 health IT), and Health Indicator Warehouse (market characteristics). Hospitals were categorized for their health IT infrastructure including EHR Stage-1 capability, and three advanced imaging functionalities/systems including integrated picture archiving and communication system, Web-based image distribution, and clinical decision support (CDS) with physician pathways. Three imaging efficiency measures suggesting inappropriate utilization during 2011 included: percentage of "combined" (with and without contrast) computed tomography (CT) studies out of all CT studies for abdomen and chest respectively, and percentage of magnetic resonance imaging (MRI) studies of lumbar spine without antecedent conservative therapy within 60days. For each measure, three separate regression models (GLM with gamma-log link function, and denominator of imaging measure as exposure) were estimated adjusting for hospital characteristics, market characteristics, and state fixed effects. Additionally, Heckman's Inverse Mills Ratio and propensity for Stage-1 EHR capability were used to account for selection bias. We find support for association of each of the four health IT capabilities with inappropriate utilization rates of one or more imaging modality. Stage-1 EHR capability is associated with lower inappropriate utilization rates for chest CT (incidence rate ratio IRR=0.72, p-value value value value value value value use of Stage-1 Meaningful Use capable EHR systems along with advanced imaging related functionalities could have a beneficial impact on reducing some of the inappropriate utilization of

  14. Myshkis type oscillation criteria for second-order linear delay differential equations

    Czech Academy of Sciences Publication Activity Database

    Opluštil, Z.; Šremr, Jiří

    2015-01-01

    Roč. 178, č. 1 (2015), s. 143-161 ISSN 0026-9255 Institutional support: RVO:67985840 Keywords : linear second-order delay differential equation * oscillation criteria Subject RIV: BA - General Mathematics Impact factor: 0.664, year: 2015 http://link.springer.com/article/10.1007%2Fs00605-014-0719-y

  15. Electronic health record use in an affluent region in India: Findings from a survey of Chandigarh hospitals.

    Science.gov (United States)

    Powell, Adam C; Ludhar, Jasmine K; Ostrovsky, Yuri

    2017-07-01

    To characterize the electronic health record (EHR) systems in use in an affluent region of India in order to understand the state-of-the-art within the Indian market. A survey on EHR features was created by combining an instrument developed by the Organisation for International Cooperation and Development and an instrument developed by an American team of researchers. An interviewer directly administered the survey to leaders from hospitals in greater Chandigarh which possessed electronic health information systems. Summary statistics from the survey are reported. 24 hospitals offering multi-specialty inpatient care were identified in greater Chandigarh. 18 of these hospitals had electronic health information systems, 17 of which were interviewed. Of the hospitals with systems, 17 (100%) could access patient demographic information internally, but 12 (71%) could not access vital sign, allergy, or immunization data internally. 11 (65%) of the systems were capable of sharing patient summaries internally, but 13 (76%) could not send electronic referrals internally. Among organizations which have adopted systems, major barriers tend to have been around financial and staff matters. Concerns over interoperability, privacy, and security were infrequently cited as barriers to adoption. EHRs are ubiquitous in at least one region of India. Systems are more likely to have capabilities for intra-organizational information sharing than for inter-organizational information sharing. The availability of EHR data may foster clinical research. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Links between nuclear medicine and radiopharmacy

    International Nuclear Information System (INIS)

    Pelegrin, M.; Francois-Joubert, A.; Chassel, M.L.; Desruet, M.D.; Bolot, C.; Lao, S.

    2010-01-01

    Radiopharmaceuticals are nowadays under the responsibility of the radio-pharmacist because of their medicinal product status. Radiopharmacy belongs to the hospital pharmacy department, nevertheless, interactions with nuclear medicine department are important: rooms are included or located near nuclear medicine departments in order to respect radiation protection rules, more over staff, a part of the material and some activities are shared between the two departments. Consequently, it seems essential to formalize links between the radiopharmacy and the nuclear medicine department, setting the goals to avoid conflicts and to ensure patients' security. Modalities chosen for this formalization will depend on the establishment's organization. (authors)

  17. Identification of requirements for intersatellite links

    Science.gov (United States)

    Puccio, A.; Saggese, E.; Soprano, C.

    1988-06-01

    An account is given of the results of ESA studies on the concept of intersatellite links (ISLs), with a view to the formulation of a reference scenario for satellite communications in the Eutelsat III-operational period of 1996-2005. A detailed system analysis has been undertaken of selected study cases, in order to ascertain requirements for the first ISL generation and to evaluate its optical implementation and economic viability. A first-generation, mm-wave ISL would be preferable for future business systems, while a second-generation optical ISL that would become operational after 2005 could extend the field of application.

  18. Use of link to mammography screening information and link sharing strategies

    DEFF Research Database (Denmark)

    Mukai, Thomas; Bro, Flemming; Olesen, Frede

    2011-01-01

    -43%) reported use of the link. The difference between the two strategies was 15% (95% CI: 8-22%) (Pused the link prior to the screening event, and 37% (95% CI: 30-43%) used the link afterwards. The difference was 9% (95% CI: 0-17%) (P=0.035). Among the GPs in group 1, 40% (95% CI......Introduction: The Internet is increasingly being used for disseminating knowledge in health care. Often this is done through a ‘Uniform Resource Locator’ (URL), better known as a link. There are three ways of sharing a link: verbally, in print or electronically. Furthermore, timing and exposure...... in Central Denmark Region, we constructed a website containing screening programme information for GPs. We inserted the link to this website in different media and divided the GPs into three groups: Group 1 received a letter prior to the screening event and an electronic test result after the screening...

  19. Wallops Low Elevation Link Analysis for the Constellation Launch/Ascent Links

    Science.gov (United States)

    Cheung, Keith; Ho, C.; Kantak, A.; Lee, C.; Tye, R.; Richards, E.; Sham, C.; Schlesinger, A.; Barritt, B.

    2011-01-01

    To execute the President's Vision for Space Exploration, the Constellation Program (CxP) was formed to build the next generation spacecraft Orion and launch vehicles Ares, to transport human and cargo to International Space Station (ISS), moon, and Mars. This paper focuses on the detailed link analysis for Orion/Ares s launch and ascent links with Wallops 11.3m antenna (1) Orion's Dissimilar Voice link: 10.24 Kbps, 2-way (2) Ares Developmental Flight Instrument link, 20 Mbps, downlink. Three launch trajectories are considered: TD7-E, F (Feb), and G (Aug). In certain launch scenarios, the critical events of main engine cutoff (MECO) and Separation occur during the low elevation regime of WFF s downrange -- less than 5 degree elevation angle. The goal of the study is to access if there is enough link margins for WFF to track the DV and DFI links.

  20. Inverse kinematics algorithm for a six-link manipulator using a polynomial expression

    International Nuclear Information System (INIS)

    Sasaki, Shinobu

    1987-01-01

    This report is concerned with the forward and inverse kinematics problem relevant to a six-link robot manipulator. In order to derive the kinematic relationships between links, the vector rotation operator was applied instead of the conventional homogeneous transformation. The exact algorithm for solving the inverse problem was obtained by transforming kinematics equations into a polynomial. As shown in test calculations, the accuracies of numerical solutions obtained by means of the present approach are found to be quite high. The algorithm proposed permits to find out all feasible solutions for the given inverse problem. (author)

  1. An auxiliary optimization method for complex public transit route network based on link prediction

    Science.gov (United States)

    Zhang, Lin; Lu, Jian; Yue, Xianfei; Zhou, Jialin; Li, Yunxuan; Wan, Qian

    2018-02-01

    Inspired by the missing (new) link prediction and the spurious existing link identification in link prediction theory, this paper establishes an auxiliary optimization method for public transit route network (PTRN) based on link prediction. First, link prediction applied to PTRN is described, and based on reviewing the previous studies, the summary indices set and its algorithms set are collected for the link prediction experiment. Second, through analyzing the topological properties of Jinan’s PTRN established by the Space R method, we found that this is a typical small-world network with a relatively large average clustering coefficient. This phenomenon indicates that the structural similarity-based link prediction will show a good performance in this network. Then, based on the link prediction experiment of the summary indices set, three indices with maximum accuracy are selected for auxiliary optimization of Jinan’s PTRN. Furthermore, these link prediction results show that the overall layout of Jinan’s PTRN is stable and orderly, except for a partial area that requires optimization and reconstruction. The above pattern conforms to the general pattern of the optimal development stage of PTRN in China. Finally, based on the missing (new) link prediction and the spurious existing link identification, we propose optimization schemes that can be used not only to optimize current PTRN but also to evaluate PTRN planning.

  2. Decomposition of the Google PageRank and Optimal Linking Strategy

    NARCIS (Netherlands)

    Avrachenkov, Konstatin; Litvak, Nelli

    We provide the analysis of the Google PageRank from the perspective of the Markov Chain Theory. First we study the Google PageRank for a Web that can be decomposed into several connected components which do not have any links to each other. We show that in order to determine the Google PageRank for

  3. Linking open vocabularies

    CERN Document Server

    Greifender, Elke; Seadle, Michael

    2013-01-01

    Linked Data (LD), Linked Open Data (LOD) and generating a web of data, present the new knowledge sharing frontier. In a philosophical context, LD is an evolving environment that reflects humankinds' desire to understand the world by drawing on the latest technologies and capabilities of the time. LD, while seemingly a new phenomenon did not emerge overnight; rather it represents the natural progression by which knowledge structures are developed, used, and shared. Linked Open Vocabularies is a significant trajectory of LD. Linked Open Vocabularies targets vocabularies that have traditionally b

  4. High speed serial link for UA1 microprocessor network

    International Nuclear Information System (INIS)

    Cittolin, S.; Loefstedt, B.; Zurfluh, E.

    1981-01-01

    The UA1 data acquisition system consists of a set of distributed microprocessor units. An interprocessor link, independent of the CAMAC data readout, has been developed in order to have continuous remote control and run-time data handling, e.g. transmission of calibration programs/parameters, equipment rest/status and histogram accumulation. The data transmission system is designed to be used in a loop configuration equipped with transceivers for twisted pair cables (RS-422). As an economical system it is running as an ancillary serial loop-link between microprocessors Like Data Acquisition Crate Controllers and systems with distributed intelligence. The software driver consists of a loop-controller package, which may run in a BAMBI Computer Language environment and a fully interrupt controlled program for all other secondary stations. A special single-character mode provides a handy link for remote debugging in a pseudo-full-duplex mode. The format is based on the HDLC protocol without sequence numbering. The Chip MC-6854 from Motorola, Inc. enables an implementation with few components. (orig.)

  5. Electronic Health Record Effects on Work-Life Balance and Burnout Within the I3 Population Collaborative.

    Science.gov (United States)

    Robertson, Sandy L; Robinson, Mark D; Reid, Alfred

    2017-08-01

    Physician burnout is a problem that often is attributed to the use of the electronic health record (EHR). To estimate the prevalence of burnout and work-life balance satisfaction in primary care residents and teaching physicians, and to examine the relationship between these outcomes, EHR use, and other practice and individual factors. Residents and faculty in 19 primary care programs were anonymously surveyed about burnout, work-life balance satisfaction, and EHR use. Additional items included practice size, specialty, EHR characteristics, and demographics. A logistic regression model identified independent factors associated with burnout and work-life balance satisfaction. In total, 585 of 866 surveys (68%) were completed, and 216 (37%) respondents indicated 1 or more symptoms of burnout, with 162 (75%) attributing burnout to the EHR. A total of 310 of 585 (53%) reported dissatisfaction with work-life balance, and 497 (85%) indicated that use of the EHR affected their work-life balance. Respondents who spent more than 6 hours weekly after hours in EHR work were 2.9 times (95% confidence interval [CI] 1.9-4.4) more likely to report burnout and 3.9 times (95% CI 1.9-8.2) more likely to attribute burnout to the EHR. They were 0.33 times (95% CI 0.22-0.49) as likely to report work-life balance satisfaction, and 3.7 times (95% CI 2.1-6.7) more likely to attribute their work-life balance satisfaction to the EHR. More after-hours time spent on the EHR was associated with burnout and less work-life satisfaction in primary care residents and faculty.

  6. The Borg scale as an important tool of self-monitoring and self-regulation of exercise prescription in heart failure patients during hydrotherapy. A randomized blinded controlled trial.

    Science.gov (United States)

    Carvalho, Vitor Oliveira; Bocchi, Edimar Alcides; Guimarães, Guilherme Veiga

    2009-10-01

    The Borg Scale may be a useful tool for heart failure patients to self-monitor and self-regulate exercise on land or in water (hydrotherapy) by maintaining the heart rate (HR) between the anaerobic threshold and respiratory compensation point. Patients performed a cardiopulmonary exercise test to determine their anaerobic threshold/respiratory compensation points. The percentage of the mean HR during the exercise session in relation to the anaerobic threshold HR (%EHR-AT), in relation to the respiratory compensation point (%EHR-RCP), in relation to the peak HR by the exercise test (%EHR-Peak) and in relation to the maximum predicted HR (%EHR-Predicted) was calculated. Next, patients were randomized into the land or water exercise group. One blinded investigator instructed the patients in each group to exercise at a level between "relatively easy and slightly tiring". The mean HR throughout the 30-min exercise session was recorded. The %EHR-AT and %EHR-predicted did not differ between the land and water exercise groups, but they differed in the %EHR-RCP (95 +/-7 to 86 +/-7, P<0.001) and in the %EHR-Peak (85 +/-8 to 78 +/-9, P=0.007). Exercise guided by the Borg scale maintains the patient's HR between the anaerobic threshold and respiratory compensation point (ie, in the exercise training zone).

  7. Effects of fourth-order dispersion in very high-speed optical time-division multiplexed transmission.

    Science.gov (United States)

    Capmany, J; Pastor, D; Sales, S; Ortega, B

    2002-06-01

    We present a closed-form expression for computation of the output pulse's rms time width in an optical fiber link with up to fourth-order dispersion (FOD) by use of an optical source with arbitrary linewidth and chirp parameters. We then specialize the expression to analyze the effect of FOD on the transmission of very high-speed linear optical time-division multiplexing systems. By suitable source chirping, FOD can be compensated for to an upper link-length limit above which other techniques must be employed. Finally, a design formula to estimate the maximum attainable bit rate limited by FOD as a function of the link length is also presented.

  8. Effect of Link Flexibility on tip position of a single link robotic arm

    Science.gov (United States)

    Madhusudan Raju, E.; Siva Rama Krishna, L.; Mouli, Y. Sharath Chandra; Nageswara Rao, V.

    2015-12-01

    The flexible robots are widely used in space applications due to their quick response, lower energy consumption, lower overall mass and operation at high speed compared to conventional industrial rigid link robots. These robots are inherently flexible, so that the kinematics of flexible robots can't be solved with rigid body assumptions. The flexibility in links and joints affects end-point positioning accuracy of the robot. It is important to model the link kinematics with precision which in turn simplifies modelling of dynamics of flexible robots. The main objective of this paper is to evaluate the effect of link flexibility on a tip position of a single link robotic arm for a given motion. The joint is assumed to be rigid and only link flexibility is considered. The kinematics of flexible link problem is evaluated by Assumed Modes Method (AMM) using MAT LAB Programming. To evaluate the effect of link flexibility (with and without payload) of robotic arm, the normalized tip deviation is found for flexible link with respect to a rigid link. Finally, the limiting inertia for payload mass is found if the allowable tip deviation is 5%.

  9. Impedance-based Analysis of DC Link Control in Voltage Source Rectifiers

    DEFF Research Database (Denmark)

    Lu, Dapeng; Wang, Xiongfei; Blaabjerg, Frede

    2018-01-01

    This paper analyzes the dynamics influences of the outer dc link control in the voltage source rectifiers based on the impedance model. The ac-dc interactions are firstly presented by means of full order small signal model in dq frame, which shows the input voltage and load condition are the two...

  10. Locating relevant patient information in electronic health record data using representations of clinical concepts and database structures.

    Science.gov (United States)

    Pan, Xuequn; Cimino, James J

    2014-01-01

    Clinicians and clinical researchers often seek information in electronic health records (EHRs) that are relevant to some concept of interest, such as a disease or finding. The heterogeneous nature of EHRs can complicate retrieval, risking incomplete results. We frame this problem as the presence of two gaps: 1) a gap between clinical concepts and their representations in EHR data and 2) a gap between data representations and their locations within EHR data structures. We bridge these gaps with a knowledge structure that comprises relationships among clinical concepts (including concepts of interest and concepts that may be instantiated in EHR data) and relationships between clinical concepts and the database structures. We make use of available knowledge resources to develop a reproducible, scalable process for creating a knowledge base that can support automated query expansion from a clinical concept to all relevant EHR data.

  11. The general practitioner in the Giant's web.

    Science.gov (United States)

    Heimly, Vigdis

    2011-01-01

    Most General Practitioners (GPs) in Norway use Electronic Health Record (EHR) systems to support their daily work processes. These systems were developed with basis in local needs. Electronic collaboration between the different actors has developed over time. Larger national projects like the ePrescription and the Core EHR are examples of projects that interact with the GPs EHR systems. The requirements from these projects need to be addressed by the vendors of the EHR systems. At the same time the GPs see a need for further development of their EHR systems to make them more suited as tools to support the daily work processes. This paper addresses the how GPs can influence on the design and development of their EHR systems in a situation with a preexisting installed base of systems and increasing requirements from many actors.

  12. How to integrate the electronic health record and patient-centered communication into the medical visit: a skills-based approach.

    Science.gov (United States)

    Duke, Pamela; Frankel, Richard M; Reis, Shmuel

    2013-01-01

    Implementation of the electronic health record (EHR) has changed the dynamics of doctor-patient communication. Physicians train to use EHRs from a technical standpoint, giving only minimal attention to integrating the human dimensions of the doctor-patient relationship into the computer-accompanied medical visit. This article reviews the literature and proposes a model to help clinicians, residents, and students improve physician-patient communication while using the EHR. We conducted a literature search on use of communication skills when interfacing with the EHR. We observed an instructional gap and developed a model using evidence-based communication skills. This model integrates patient-centered interview skills and aims to empower physicians to remain patient centered while effectively using EHRs. It may also serve as a template for future educational and practice interventions for use of the EHR in the examination room.

  13. Linked Ocean Data

    Science.gov (United States)

    Leadbetter, Adam; Arko, Robert; Chandler, Cynthia; Shepherd, Adam

    2014-05-01

    "Linked Data" is a term used in Computer Science to encapsulate a methodology for publishing data and metadata in a structured format so that links may be created and exploited between objects. Berners-Lee (2006) outlines the following four design principles of a Linked Data system: Use Uniform Resource Identifiers (URIs) as names for things. Use HyperText Transfer Protocol (HTTP) URIs so that people can look up those names. When someone looks up a URI, provide useful information, using the standards (Resource Description Framework [RDF] and the RDF query language [SPARQL]). Include links to other URIs so that they can discover more things. In 2010, Berners-Lee revisited his original design plan for Linked Data to encourage data owners along a path to "good Linked Data". This revision involved the creation of a five star rating system for Linked Data outlined below. One star: Available on the web (in any format). Two stars: Available as machine-readable structured data (e.g. An Excel spreadsheet instead of an image scan of a table). Three stars: As two stars plus the use of a non-proprietary format (e.g. Comma Separated Values instead of Excel). Four stars: As three stars plus the use of open standards from the World Wide Web Commission (W3C) (i.e. RDF and SPARQL) to identify things, so that people can point to your data and metadata. Five stars: All the above plus link your data to other people's data to provide context Here we present work building on the SeaDataNet common vocabularies served by the NERC Vocabulary Server, connecting projects such as the Rolling Deck to Repository (R2R) and the Biological and Chemical Oceanography Data Management Office (BCO-DMO) and other vocabularies such as the Marine Metadata Interoperability Ontology Register and Repository and the NASA Global Change Master Directory to create a Linked Ocean Data cloud. Publishing the vocabularies and metadata in standard RDF XML and exposing SPARQL endpoints renders them five-star Linked

  14. Visualisierung von typisierten Links in Linked Data

    Directory of Open Access Journals (Sweden)

    Georg Neubauer

    2017-09-01

    Full Text Available Das Themengebiet der Arbeit behandelt Visualisierungen von typisierten Links in Linked Data. Die wissenschaftlichen Gebiete, die im Allgemeinen den Inhalt des Beitrags abgrenzen, sind das Semantic Web, das Web of Data und Informationsvisualisierung. Das Semantic Web, das von Tim Berners Lee 2001 erfunden wurde, stellt eine Erweiterung zum World Wide Web (Web 2.0 dar. Aktuelle Forschungen beziehen sich auf die Verknüpfbarkeit von Informationen im World Wide Web. Um es zu ermöglichen, solche Verbindungen wahrnehmen und verarbeiten zu können sind Visualisierungen die wichtigsten Anforderungen als Hauptteil der Datenverarbeitung. Im Zusammenhang mit dem Sematic Web werden Repräsentationen von zuhammenhängenden Informationen anhand von Graphen gehandhabt. Der Grund des Entstehens dieser Arbeit ist in erster Linie die Beschreibung der Gestaltung von Linked Data-Visualisierungskonzepten, deren Prinzipien im Rahmen einer theoretischen Annäherung eingeführt werden. Anhand des Kontexts führt eine schrittweise Erweiterung der Informationen mit dem Ziel, praktische Richtlinien anzubieten, zur Vernetzung dieser ausgearbeiteten Gestaltungsrichtlinien. Indem die Entwürfe zweier alternativer Visualisierungen einer standardisierten Webapplikation beschrieben werden, die Linked Data als Netzwerk visualisiert, konnte ein Test durchgeführt werden, der deren Kompatibilität zum Inhalt hatte. Der praktische Teil behandelt daher die Designphase, die Resultate, und zukünftige Anforderungen des Projektes, die durch die Testung ausgearbeitet wurden.

  15. DC Link Current Estimation in Wind-Double Feed Induction Generator Power Conditioning System

    Directory of Open Access Journals (Sweden)

    MARIAN GAICEANU

    2010-12-01

    Full Text Available In this paper the implementation of the DC link current estimator in power conditioning system of the variable speed wind turbine is shown. The wind turbine is connected to double feed induction generator (DFIG. The variable electrical energy parameters delivered by DFIG are fitted with the electrical grid parameters through back-to-back power converter. The bidirectional AC-AC power converter covers a wide speed range from subsynchronous to supersynchronous speeds. The modern control of back-to-back power converter involves power balance concept, therefore its load power should be known in any instant. By using the power balance control, the DC link voltage variation at the load changes can be reduced. In this paper the load power is estimated from the dc link, indirectly, through a second order DC link current estimator. The load current estimator is based on the DC link voltage and on the dc link input current of the rotor side converter. This method presents certain advantages instead of using measured method, which requires a low pass filter: no time delay, the feedforward current component has no ripple, no additional hardware, and more fast control response. Through the numerical simulation the performances of the proposed DC link output current estimator scheme are demonstrated.

  16. LinkMind: Link Optimization in Swarming Mobile Sensor Networks

    DEFF Research Database (Denmark)

    Ngo, Trung Dung

    2012-01-01

    of the most advantageous properties of the swarming wireless sensor network is that mobile nodes can work cooperatively to organize an ad-hoc network and optimize the network link capacity to maximize the transmission of gathered data from a source to a target. This paper describes a new method of link...... optimization of swarming mobile sensor networks. The new method is based on combination of the artificial potential force guaranteeing connectivities of the mobile sensor nodes and the max-flow min-cut theorem of graph theory ensuring optimization of the network link capacity. The developed algorithm...

  17. Link Between the Seismic Events and the Different Seismic Precursor Phenomena

    Directory of Open Access Journals (Sweden)

    Mirela GHEORGHITA

    2009-12-01

    Full Text Available This article presents an analysis of the earthquake prediction methods, highlighting mainly the VLF and LF electromagnetic waves seismic precursors’ monitoring method and the correlation among these in order to obtain a more precise result. It is well known the fact that there are lots of links between the seismic events occurrence and different phenomena that predict their occurrence, such as theelectromagnetic field, Earth movement, gaseous content of radon and hydrogen within the soil, or within the underground waters. This paper aims to demonstrate the close link between the seismic events and the electromagnetic wave propagation anomalies, which are recorded before the advent of an earthquake.

  18. Investigation on silver complexes of novel 1,2,3-triazole linked ...

    Indian Academy of Sciences (India)

    Abstract. The novel derivatives of 1,2,3-triazole linked crown ethers were investigated towards silver(I) ion coordination. The NMR measurements in deuterated methanol in different ratios of ligand and silver cation were studied. The experiments were performed in order to examine the way of binding Ag(I) ion by the ...

  19. Electronic health records: a valuable tool for dental school strategic planning.

    Science.gov (United States)

    Filker, Phyllis J; Cook, Nicole; Kodish-Stav, Jodi

    2013-05-01

    The objective of this study was to investigate if electronic patient records have utility in dental school strategic planning. Electronic health records (EHRs) have been used by all predoctoral students and faculty members at Nova Southeastern University's College of Dental Medicine (NSU-CDM) since 2006. The study analyzed patient demographic and caries risk assessment data from October 2006 to May 2011 extracted from the axiUm EHR database. The purpose was to determine if there was a relationship between high oral health care needs and patient demographics, including gender, age, and median income of the zip code where they reside in order to support dental school strategic planning including the locations of future satellite clinics. The results showed that about 51 percent of patients serviced by the Broward County-based NSU-CDM oral health care facilities have high oral health care needs and that about 60 percent of this population resides in zip codes where the average income is below the median income for the county ($41,691). The results suggest that EHR data can be used adjunctively by dental schools when proposing potential sites for satellite clinics and planning for future oral health care programming.

  20. Public and physician's expectations and ethical concerns about electronic health record: Benefits outweigh risks except for information security.

    Science.gov (United States)

    Entzeridou, Eleni; Markopoulou, Evgenia; Mollaki, Vasiliki

    2018-02-01

    Electronic Health Record systems (EHRs) offer numerous benefits in health care but also pose certain risks. As we progress toward the implementation of EHRs, a more in-depth understanding of attitudes that influence overall levels of EHR support is required. To record public and physicians' awareness, expectations for, and ethical concerns about the use of EHRs. A convenience sample was surveyed for both the public and physicians. The Public's Questionnaire was distributed to the public in a printed and an online version. The Physicians' Questionnaire was distributed to physicians in an online version. The questionnaires requested demographic characteristics followed by close-ended questions enquiring about awareness, perceived impact, perceived risks, and ethical issues raised by EHR use. In total, 46% of the public and 91% of physicians were aware of EHRs. Physicians' and public opinions were comparable concerning the positive impact of EHRs on better, more effective, and faster decisions on the patients' health, on better coordination between hospitals/clinics and on quality and reduced cost of health care. However, physicians were concerned that an EHR system would be a burden for their finances, for their time concerning training on the system, for their everyday workload and workflow. The majority of the public generally agreed that they would worry about the possibility that a non-authorized, third party might gain access to their personal health information (48.8%), and that they would worry about future discriminations due to possible disclosure of their health information (48.8%). Most physicians disagreed that EHRs will disrupt the doctor-patient relationship (58.1%) but they would worry about the safety of their patients' information (53.1%). Overall, both the public and physicians were in favor of the implementation of an EHR system, evaluating that possible benefits are more important than possible risks. The majority of the public believed that