Wearable devices in cardiology

320: Pitfalls of an Electronic Medical Record In Emergency Department Patients With Elevated Blood Pressure

Patients with undiagnosed hypertension: hiding in plain sight.

Digital health: Present conundrum, future hope or hype?

Access to novel cancer medicines in Europe: inequities across countries and their drivers

Team-based care is an effective strategy to improve BP in primary care.1, 2 The most recent meta-analysis evaluated 39 randomized controlled trials in 14,224 patients and found pharmacist interventions reduced systolic BP 7.6 mm Hg (95% CI:−9.0 to −6.3 mm Hg) compared to usual care.3 The authors concluded that pharmacist interventions were highly effective but that additional studies are still needed to determine the most efficient methods of implementation.3 Nearly all previous studies were efficacy studies conducted under optimal conditions. The National Heart, Lung, and Blood Institute has committed extensive funding to evaluate if interventions known to be effective in efficacy studies conducted under optimal conditions will be implemented in usual care scenarios.

Heart failure (HF) is the fastest growing cardiovascular condition globally; associated management costs and hospitalizations place an immense burden on healthcare systems. Wearable electronic devices (WEDs) may be useful tools to enhance HF management and mitigate negative health outcomes. We aimed to perform a systematic review to examine the potential of WEDs to support HF self-care in ambulatory patients at home. Five databases were searched for studies published between 2007 and May 2022, including OVID MEDLINE, EMBASE (OVID), APA PsycINFO (OVID), Cochrane Central Register of Controlled Trials (OVID), and CINAHL Plus with Full Text (Ebsco). After 6210 duplicates were removed, 4045 records were screened and 6 were included for review (2 conference abstracts and 4 full-text citations). All studies used WEDs as 1 component of a larger intervention. Outcome measures included quality of life, physical activity, self-efficacy, self-care, functional status, time to readmission, social isolation, and mood. Studies were of moderate to high quality and mixed findings were reported. Enhanced exercise habits and motivational behavior to exercise, as well as decreased adverse symptoms of fatigue and dyspnea, were identified in 2 studies. However, improvements in exercise capacity and increased motivational behavior did not lead to exercise adherence in another 2 studies. The findings from this review suggest that WEDs may be a viable health behavior improvement strategy for patients with HF. However, studies of higher quality, with the primary intervention being a WED, and consistent outcome measures are needed to replicate the positive findings of studies identified in this review.

Background: New technology and healthcare delivery approaches may help improve blood pressure (BP) control. Randomized controlled trials (RCTs) can demonstrate effectiveness of these emerging approaches, both overall and especially within underserved populations, but RCTs are expensive. Our objective is to establish a national platform to support BP control surveillance and efficient RCTs. Methods: The PCORnet BP Control Laboratory, designed and launched in partnership with the American Heart Association (AHA) and the American Medical Association (AMA), leverages electronic health record (EHR) systems throughout the US, the National Patient-Centered Outcomes Research Network (PCORnet), and the NIH-funded Eureka Research Platform, which enables direct-to-participant research including collection of patient-reported outcomes and mHealth data from wearable devices and smartphones. We will use these resources to 1) Conduct national surveillance through quarterly EHR data queries to calculate and track institution- and clinic-level BP control metrics across 23 PCORnet institutions, overall and within key subgroups, and support participation in the AHA/AMA’s Target:BP recognition program (BP Track); 2) Compare effectiveness of a Full Support versus Self-Guided version of the AMA’s Measure Accurately, Act Rapidly, and Partner with Patients (MAP) program at improving BP control in a cluster randomized trial of 24 safety net clinics (BP MAP); and 3) Compare effectiveness of Smartphone-linked versus standard home BP monitoring at reducing systolic BP in an individual-level, direct-to-participant RCT of 2000 patients with uncontrolled BP (BP Home). Results: Preliminary BP Track queries demonstrate an overall BP control rate of 56%, lower control in Black patients (51%), substantial heterogeneity in clinic-level metrics (e.g., 33% vs. 64% BP control), and low rates of medication intensification (9% prescribed a new medication class when BP was high). BP Track will launch PCORnet-wide queries in June; BP MAP in May; and BP Home in August 2019. Conclusions: Feasibility testing is underway to determine if the PCORnet BP Control Laboratory will be useful for investigators interested in conducting efficient RCTs of BP control interventions.

This paper proposes the application of Near Field Communication (NFC) for patient monitoring. The present paper proposes a NFC based architecture to implement patient record much faster. Different patient monitoring NFC based modules have been proposed in the paper pertaining to patients admitted to hospitals, self-care patients, patients suffering from memory loss diseases like Alzheimer, etc. With advances in medicine and technology, the focus is on creating better healthcare systems. With NFC technology, hospitals can better track patient information and update doctors' notes thus improving patient monitoring. Wearable health-related devices, ranging from heart monitors to biosensors that read body temperature, blood pressure etc. transmit critical information in real time to the patient's NFC tag. The doctor can then easily tap his/her device at the tag and then obtain the data. NFC is used to implement Electronic Medical Records (EMR) which aims at simplifying the process of keeping medical records. The specialized software stores patient history including digitized copies of x-rays, lab results and prescriptions. With the help of NFC tags, the patient's EMR can be synchronized and stored temporarily at the hospital for easy access by the physician. Further the patient's records and doctor's prescriptions for that day can also be updated.

Wearable devices are the significant ubiquitous technology of the Internet of Things in day-to-day life. The efficient data processing in various devices such as smart clothes, smart wristwear and medical wearables along with consumer-oriented service of the IoT technology becomes inevitable in smart healthcare systems. The wearable market is currently dominated by health, safety, interaction, tracker, identity, fitness etc. Wearables increase the convergence of physical and digital world which automatically bring people into the IoT. The popularity of wearable devices is growing exponentially since it entirely changes the way how the consumers interact with the environment. 74% people believe that the wearable sensors assist them in interacting with the physical objects around them. Henceforth, one out of three smartphone users will wear minimum 5 wearables in 2020. Moreover, 60% believe that wearables in the next five years will be used not only to track health related information, although it can be used to control objects, unlock doors, authenticate identity and transactions. Wearables must be evolved to cope with the future to meet the expectations of consumers, where the users will wear many devices that is connected with the internet to interact with the physical surroundings and receive data in a seamless secure way. By 2021, smartwatches are estimated to be sold to nearly 81 million units which signifies 16% sales of total wearable device. According to the latest figure of Gartner report, the global shipment of wearable devices are anticipated to raise by 25.8% every year to $225 million (GBP 176.3 million) in 2019. Researchers also forecasted that the usage of wearable devices by the end users will increase to $42 billion (GBP 32.9 million) in 2019. In recent years, the IoT based Smart Healthcare system has influenced greatly on growing demand of wearable devices. In fact, the Wearable IoT (WIoT) devices are generating huge volume of personal health data. Enabling technologies such as cloud computing, Fog computing and Big Data play vital role in leveraging WIoT services. These enabling services over the voluminous health data enhance clinical process at health care system at remote or local servers. The traditional remote healthcare information system involves data transfer, signal processing mechanism and naive machine learning models deployed on remote server to process the medical data of patients. This technique has several demerits like they are not suitable for resource constrained wearable IoT devices. The resources such as processing, memory, energy, networking capability are limited in WIoT devices. Traditional mechanism lacks optimization of resource usage, prediction of medical condition, and dynamic assessment based on available information. Further, the naive machine learning techniques does not perform knowledge generation, decision making and discover hidden valuable patterns from the available medical data. The integrated platform in which cloud computing serves as backend computing systems, Fog computing as edge computing and Big data as platform for data analysis, knowledge generation promise to provide valid solution to several issues of Wearable IoT devices. Next, the health data generated through WIoT devices are personal and sensitive. Hence, the security and privacy of such delicate data at all level of WIoT ecosystem is essential. This part of chapter will contribute towards understanding the recent research work, issues, challenges, and opportunities in applying enabling technologies for WIoT. Also, how well the security and privacy can be incorporated is also discussed.

Our healthcare information is trapped It is trapped in the proprietary data models of the electronic medical record and in our healthcare systems' data warehouses This reality has become strikingly clear as the COVID-19 pandemic has swept across the globe, killing more than 20,000 people in the United States alone We need answers but struggle to address even the simplest questions How many individuals are infected? Who is at highest risk for developing severe infection? What therapies are being used to treat hospitalized patients? This crisis is testing the limits of our public health and healthcare systems in many ways, including a "quarantined" health information system This perspective reviews several deficiencies in healthcare information technology that currently limit our ability to deal with the pandemic and suggests current solutions moving forward

An important goal of medical education is to teach students to use an electronic health record (EHR) safely and effectively. The purpose of this study is to examine medical student accounts of EHR use during their core inpatient clinical clerkships using a national sample. Paper health records (PHRs) are similarly examined. An online survey about health record use within the inpatient component of six core clerkships was administered to medical students after they completed Step 2 Clinical Knowledge of the United States Medical Licensing Examination. The sample included 17,202 U.S. medical students graduating between 2012 and 2016. Mean percentages of clerkships in which students engaged in various health record activities were computed, and analysis of variance was used to examine differences. The mean percentages of clerkships in which a student accessed or entered information into an EHR increased from 78% to 93% and 59% to 72%, respectively. For students who used an EHR, the mean percentage of clerkships in which they entered information remained constant at 76%. Students entered notes during the majority of their clerkships, with increases over time. However, students entered orders in less than a quarter of their clerkships, with decreases over time. The percentage of clerkships in which students used PHRs was lower and declining. Although students used an EHR in the majority of their inpatient core clerkships, they received limited educational experiences related to order and note writing, which could translate into a lack of preparedness for future training and practice.

Physician acceptance is critical to the widespread adoption of Electronic Medical Records (EMRs). The main objective of this research is to explore physicians’ perceptions of EMRs' function importance, anticipated usage, and their attitudes and opinions regarding EMRs in the sole organization that implemented EMRs in Kurdistan, Iraq. This cross-sectional study was conducted on 150 specialist physicians randomly selected from Faruk Medical City in Sulaimani City, Kurdistan, Iraq, using a self-administered questionnaire. The main findings of this study indicate that the greatest important functions were the display of lab results, clinical notes, and reports, as well as the display of time-trended clinical data and physician order entry (tests and medication orders) with a percentage of 100%. while the least important functions were the reporting of medical management & disease management, and nuclear medicine with percentages of (89.3%), and (72.7%) respectively. In addition, the results showed that the respondents used six out of 19 EMR functions at least weekly, agreed on the need for an EMR system implementation, and expressed overall support for EMRs. All the respondents (100%) perceived that EMRs would enhance the quality of care and reduce errors, improve the quality of practice (i.e., work-life), and have a positive impact on the cost and security of patients’ information. Most of the respondents (92.7%) also anticipated an increase in practice productivity with EMRs and recognized the necessity of spending time for training (94%). The study concluded that the respondents had a positive attitude toward EMRs. The main recommendation was to conduct a systematic examination of physician perceptions related to EMRs as both vendors and healthcare organizations can facilitate physician acceptance and ultimately the rate of adoption and utilization. This study would help them to design targeted education to demonstrate the advantages of EMRs and further improve physician perceptions toward EMRs. Keywords: Electronic Medical Records; physician acceptance; Use of medical record; Tertiary referral centers; Kurdistan Iraq.

he conventional measurement of blood pressure(BP) in the office or clinic has been the cornerstonefor hypertension management for decades. How-ever, because of the white-coat and the masked hyper-tension phenomena, out-of-office BP monitoring withambulatory or home measurements is often required [1].ExtensiveresearchonambulatoryBPmonitoringhasestab-lished its role as the most accurate tool for hypertensiondiagnosis [1–3].Onthecontrary,despitetheincreasinguseof home BP monitoring by hypertensive patients in thedaily management of their high BP condition, research inthisfield,inparticularwhenconsideringoutcometrials,hasbeen delayed as compared to ambulatory BP monitoring[4,5].

Meaningful Use and Electronic Medical Records for the Gastroenterology Practice

BackgroundHypertensive disorders, including preeclampsia, complicate 10% of all pregnancies, causing maternal and fetal morbidity and mortality. In Bangladesh, 24% of all maternal deaths are directly attributed to hypertensive disorders. Conventional antenatal care practices often delay or miss detecting hypertensive disorders in pregnancy, which may allow some women to become vulnerable to the adverse consequences of the hypertensive disorders. Regular self-monitoring of blood pressure and weight gain may improve maternal and fetal outcomes among pregnant women at risk of developing hypertensive disorders during pregnancy through early diagnosis, prompt referral, and timely clinical management; however, to undertake a randomized controlled trial of an intervention to reduce adverse consequences of hypertensive disorders in pregnancy, its feasibility must first be determined.ObjectiveThe objectives of this study are to evaluate the accuracy of a wearable blood pressure monitoring device (Health Gauge) in order to test the design and methods of a future definitive randomized controlled trial, and to examine the feasibility, acceptability, and fidelity of an intervention focusing on regular monitoring of weight gain and self-monitoring of blood pressure for pregnant women at risk of developing hypertensive disorders and their associated complications.MethodsThe study is located in Matlab, Bangladesh will be conducted in two phases. First, a wearable blood pressure device (Health Gauge) will be validated in accordance with the European Society of Hypertension International Protocol (revision 2010). Second, a prospective, two-arm, parallel, and nonblinded randomized controlled external pilot trial will be conducted. In the pilot trial, 70 eligible participants will be individually randomized to the intervention arm, in which pregnant women will self-monitor their blood pressure daily using a wearable device (Health Gauge) and be evaluated monthly by trained health workers for weight gain from 20 weeks of gestation until delivery, or the control arm, in which pregnant women will be assessed for weight gain every two months from 20 weeks of gestation until delivery (1:1 intervention to control allocation ratio using a permuted block randomization method with concealment). All women will receive standard antenatal care.ResultsA validation study of the wearable blood pressure device has successfully been conducted among the general adult population in Matlab, Bangladesh. As of September 2019, the pilot trial has completed enrollment of women who are pregnant (N=70; intervention: n=35; control: n=35) and follow-up of the participants is ongoing. Data analysis is expected to be completed by June 2020, and results are expected to be submitted for publication in August 2020.ConclusionsThe findings of this study will help us to design a comprehensive, full-scale randomized controlled trial to test the efficacy of regular self-monitoring of blood pressure and weight gain during pregnancy, a simple and inexpensive intervention to help to achieve optimal maternal and fetal outcomes in pregnant women at risk of developing hypertensive disorders and their associated complications during pregnancy.Trial RegistrationClinicalTrials.gov NCT03858595; https://clinicaltrials.gov/ct2/show/NCT03858595International Registered Report Identifier (IRRID)DERR1-10.2196/16676