Computer Reminder Research Articles

Analisa Pencarian Data *.Doc pada Komputer Menerapkan Metode Sequensial With Sentinel

In the development of computers often encounter problems about how to get a data in a large data set and various types of data. In its need to find that data, there are various search algorithms, namely the sequential with Sentinel method. Searching is data search by searching where the data is searched. The place for searching the data can be an array in memory, it can also be in a file in external storage. When the amount of data is already so large, a method is needed to get the data needed. Several methods of organizing data have made the process of finding data more efficient. In the problem that often occurs a lot of lost doc data dimension or forget the name of the stored data and therefore applied how to find doc document data that is on the computer. A data contained in the storage media with this search method is created using a search algorithm that uses successive method so that the data sought knows its whereabouts. in overcoming the problem is applied The method of doc data extension can be done in two ways, namely internal search (internal searching) and external search (external searching). In an internal search, all records that are known to be in a computer reminder are on an external search, not all records that are known to be in a computer reminder.

Child Health Improvement through Computer Automation: the CHICA system.

Clinical guidelines are prevalent but frequently not used. Computer reminder systems can improve adherence to guidelines but have not been widely adopted. We present a computer-based decision support system that combines these elements: 1) pediatric preventive care guidelines encoded in Arden Syntax; 2) a dynamic, scannable paper user interface; and 3) a HL7-compliant interface to existing electronic medical record systems. The result is a system that both delivers "just in time" patient-relevant guidelines to physicians during the clinical encounter and accurately captures structured data from all who interact with the system. The system performs these tasks while remaining sensitive to the workflow constraints of a busy outpatient pediatric practice.

A computer reminder reduces catheter-associated urinary tract infections in hospitalized patients

A computer reminder reduces catheter-associated urinary tract infections in hospitalized patients

The effectiveness of a computer reminder system for laboratory monitoring of metabolic syndrome in schizophrenic outpatients using second-generation antipsychotics.

A computer reminder system (CRS) may help psychiatrists follow guidelines and monitor patients at risk of metabolic syndrome. This study explores the effectiveness of a CRS for outpatients with schizophrenia. The study data were collected from July 2004 to July 2008. A CRS was implemented in July 2006. The intervention group was patients taking either clozapine, olanzapine, risperidone, or quetiapine with a CRS. The control group was patients taking either sulpiride or zotepine without a CRS. We defined a qualified patient visit (QPV) as a visit in which metabolic monitoring adhered to established guidelines when the patient visit was within 6 months of performing the recommended laboratory examinations. We compared the percentage difference in QPVs between the 2 study groups. The percentage of QPVs in the intervention group was significantly higher than the control group (OR=3.51, 95% CI=1.83~6.73, P=0.0002) after adjusting potential confounding factors. The intervention group was divided into a high metabolic risk (clozapine and olanzapine) subgroup and an intermediate metabolic risk (risperidone and quetiapine) subgroup and compared with the control group. The percentage of QPVs in the high risk subgroup was significantly higher than the intermediate risk subgroup (OR=4.27, 95% CI=2.71~6.75, p<0.0001) and control group (OR=6.99, 95% CI=3.48~14.07, p<0.0001). The percentage of QPVs in the intervention group was higher than the control group and the different metabolic risk of SGAs also influenced the performance of laboratory examinations. Further studies are needed to confirm the results of our studies.

Trust is the Basis for Effective Suicide Risk Screening and Assessment in Veterans

To reduce suicides among Veterans, the Department of Veterans Affairs (VA) has designated suicide risk assessments for Veterans who screen positive for depression or post-traumatic stress disorder as a national performance goal. Many VA Medical Centers (VAMCs) are using brief suicidal ideation screens, administered in non-mental health ambulatory care settings, as the first step in the assessment process. To explore Veterans' perceptions of the suicide screening and risk assessment process, the barriers and facilitators to disclosing suicidal thoughts, and perceptions of possible consequences of revealing suicidal thoughts. Investigators recorded one semi-structured interview with each Veteran. Transcripts were analyzed using a modified grounded theory approach. Thirty-four Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans who screened positive for suicidal ideation in non-mental health ambulatory care settings in 2009 and 2010. Veterans accepted the need to assess suicide risk. They increasingly experienced attempts to suppress and avoid thoughts of suicide as burdensome and exhausting. Despite this, Veterans often failed to disclose severe and pervasive suicidal thoughts when screened because: (1) they considered suicidal thoughts as shameful and a sign of weakness; (2) they believed suicidal thoughts were private and not to be divulged to strangers; (3) they worried that disclosure would lead to unwanted hospitalization or medication recommendations; and (4) the templated computer reminder process was perceived as perfunctory and disrespectful. In contrast, admitting and discussing thoughts of suicide with a health provider who focused on building a relationship, demonstrated genuineness and empathy, offered information on the rationale for suicide risk assessment, and used straightforward and understandable language, all promoted trust that resulted in more honest disclosure of suicidal thoughts. In ambulatory care settings, both provider behaviors and system modifications may lead to more honest disclosure of suicidal thoughts.

A Cloud-Based Electronic Medical Record for Scheduling, Tracking, and Documenting Examinations and Treatment of Retinopathy of Prematurity

Screening by neonatologists and staging by ophthalmologists is a cost-effective intervention, but inadvertent missed examinations create a high liability. Paper tracking, bedside schedule reminders, and a computer scheduling and reminder program were compared for speed of input and retrospective missed examination rate. A neonatal intensive care unit (NICU) process was then programmed for cloud-based distribution for inpatient and outpatient retinopathy of prematurity monitoring. Over 11 years, 367 premature infants in one NICU were prospectively monitored. The initial paper system missed 11% of potential examinations, the Windows server-based system missed 2%, and the current cloud-based system missed 0% of potential inpatient and outpatient examinations. Computer input of examinations took the same or less time than paper recording. A computer application with a deliberate NICU process improved the proportion of eligible neonates getting their scheduled eye examinations in a timely manner.

The Use of a Computer Reminder System in an Emergency Department Universal HIV Screening Program

We describe electronic medical record use in automated eligibility determination for an emergency department (ED)-based nontargeted HIV screening program. We reviewed the electronic medical record system at an urban, inner-city ED from March 17 to April 14, 2008. During that period, patient eligibility for HIV screening was electronically determined according to preprogrammed criteria: (1) age between 18 and 64 years; (2) no known history of HIV disease; and (3) no known HIV screening in the previous year. This populated an electronic work list used by HIV testing counselors. Of 8,489 ED patients during the study period, the electronic medical record system determined 5,794 (68.3%) as eligible. Of 1,484 (25.6%) patients approached for screening, 1,121 (75.5%) consented, and 5 received confirmed positive results (0.4%). Reasons for ineligibility, as determined by the electronic medical record system, were previous screening 1,125 (41.7%), age 890 (33.0%), known HIV 111 (4.1%), and reason unknown 569 (21.1%). Clinical informatics solutions can provide automated delineation of ED subpopulations eligible for HIV screening, according to predetermined criteria, which could increase program efficiency and might accelerate integration of HIV screening into clinical practice.

Integrating Tobacco Treatment Into Mental Health Settings

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The effects of on-screen, point of care computer reminders on processes and outcomes of care

The opportunity to improve care by delivering decision support to clinicians at the point of care represents one of the main incentives for implementing sophisticated clinical information systems. Previous reviews of computer reminder and decision support systems have reported mixed effects, possibly because they did not distinguish point of care computer reminders from e-mail alerts, computer-generated paper reminders, and other modes of delivering 'computer reminders'. To evaluate the effects on processes and outcomes of care attributable to on-screen computer reminders delivered to clinicians at the point of care. We searched the Cochrane EPOC Group Trials register, MEDLINE, EMBASE and CINAHL and CENTRAL to July 2008, and scanned bibliographies from key articles. Studies of a reminder delivered via a computer system routinely used by clinicians, with a randomised or quasi-randomised design and reporting at least one outcome involving a clinical endpoint or adherence to a recommended process of care. Two authors independently screened studies for eligibility and abstracted data. For each study, we calculated the median improvement in adherence to target processes of care and also identified the outcome with the largest such improvement. We then calculated the median absolute improvement in process adherence across all studies using both the median outcome from each study and the best outcome. Twenty-eight studies (reporting a total of thirty-two comparisons) were included. Computer reminders achieved a median improvement in process adherence of 4.2% (interquartile range (IQR): 0.8% to 18.8%) across all reported process outcomes, 3.3% (IQR: 0.5% to 10.6%) for medication ordering, 3.8% (IQR: 0.5% to 6.6%) for vaccinations, and 3.8% (IQR: 0.4% to 16.3%) for test ordering. In a sensitivity analysis using the best outcome from each study, the median improvement was 5.6% (IQR: 2.0% to 19.2%) across all process measures and 6.2% (IQR: 3.0% to 28.0%) across measures of medication ordering. In the eight comparisons that reported dichotomous clinical endpoints, intervention patients experienced a median absolute improvement of 2.5% (IQR: 1.3% to 4.2%). Blood pressure was the most commonly reported clinical endpoint, with intervention patients experiencing a median reduction in their systolic blood pressure of 1.0 mmHg (IQR: 2.3 mmHg reduction to 2.0 mmHg increase). Point of care computer reminders generally achieve small to modest improvements in provider behaviour. A minority of interventions showed larger effects, but no specific reminder or contextual features were significantly associated with effect magnitude. Further research must identify design features and contextual factors consistently associated with larger improvements in provider behaviour if computer reminders are to succeed on more than a trial and error basis.

Improving Sedative-Hypnotic Prescribing in Older Hospitalized Patients: Provider-Perceived Benefits and Barriers of a Computer-Based Reminder

BackgroundOlder adults are commonly prescribed sedative-hypnotic (SH) medications when hospitalized, yet these drugs are associated with important adverse effects such as falls and delirium.ObjectiveTo identify provider-perceived benefits or barriers of a computer-based reminder regarding appropriate use of SH medications.DesignQualitative study using semi-structured interviews.Participants and settingThirty-six house staff physicians at a university hospital.MeasurementsInformation was collected regarding the experiences of prescribing an SH using a computer order entry system with a reminder intervention. Clinicians were asked about their perceptions of the reminder and what they found most and least useful about it. Responses were analyzed using grounded theory methodology.ResultsThe 36 participants (including 29 interns) had prescribed an SH medication for a hospitalized patient over age 65 years. Three themes associated with benefits of a computer reminder were identified: increasing awareness of safety, including risk of delirium, falls, and general patient safety risks; usefulness of information technology; and the value of the educational content, including geriatric pharmacology review and nonpharmacologic treatment options. Barriers included the demands of the reminder with regard to time needed to read the reminder, the role of clinician experience with regard to preserving clinical autonomy, and the information content of the reminder, including its being too basic or not relevant for a particular patient. The mean satisfaction rating for the reminder was 8.5 (±0.9 SD), with 10 indicating high satisfaction.ConclusionsImproving decision support systems involves an understanding of how clinicians respond to real-time strategies encouraging better prescribing.

Feasibility and acceptability of a computerised system with automated reminders for prescribing behaviour in primary care

Objective To evaluate the feasibility and acceptability of a computer reminder system (CRS) to improve prescribing behaviour in general practice and to explore the strengths and weaknesses of a reminder system. One group of GPs received reminders on cholesterol lowering drugs, the other group on antibiotics, asthma and COPD drugs. Methods Process evaluation of the computer reminder system being used by 53 GPs in 20 practices, by means of an analysis of the research database of the CRS. In addition, a questionnaire and semi-structured face-to-face interview were conducted with all GP practices, two project leaders, and one technical consultant. Results The strategy was largely carried out as planned, although the development period for the CRS had to be extended. Nine percent of the GPs dropped out. We found a significant learning curve without extinguishing effect ( p = 0.03) for the antibiotics reminders. The questionnaire showed that, in general, GPs were satisfied with the user-friendliness and the content of the different types of reminders, but less satisfied with certain specific technical performance issues of the system. The GPs reported mixed feelings towards the CRS in the interviews. They were generally positive about the guidelines themselves, but negative regarding to the organisational context and the method of implementing the CRS. GPs stated that they sometimes manipulated the system to bypass reminders. Interviews with the project leaders and technical consultant revealed barriers to cooperation and miscommunication between the different parties, and technical problems with multiple updates of the GP information system and the operating system. Conclusions This process evaluation demonstrated that the implementation of the CRS was mainly carried out as planned, but the subjective experience of working with the CRS was not only positive. Participating GPs had mixed feelings, and quite a number of barriers need to be addressed to facilitate large-scale implementation of the CRS. Costs cannot be neglected, so it is important to analyse the balance between costs and effects.

The effect of computer reminders on GPs’ prescribing behaviour: A cluster-randomised trial

Objective It is difficult to control drug-prescribing behaviour in general practice, despite the development and distribution of guidelines. The purpose of this study was to assess the effect on drug-prescribing behaviour of implementing prescribing guidelines by means of a reactive computer reminder system (CRS). Design Cluster-randomised controlled trial with an incomplete block design in the south of the Netherlands: 25 GPs (7 GP practices) received reminders about antibiotics and asthma/COPD prescriptions, 28 GPs (7 GP practices) received reminders about cholesterol prescriptions. Prescription guidelines were integrated into the computerised GP information system. Measurements Both performance indicators and prescription volumes were calculated as the main outcome measures. Next to individual volume measure, sum scores were constructed on the volume measures per drug group (antibiotics, asthma/COPD and cholesterol). Results Variation between GPs turned out to be larger and more skewed than expected. No differences between groups were found for indicators and volumes related to recommendations advocating certain drugs. Although there was a tendency towards clinically relevant results for prescription volumes that were supposed to drop, the difference in sum score between the groups was not significant. For antibiotic prescriptions that were supposed to drop, the sum score for the intervention group was 28.2 (95% CI: 20.8–44.5) prescriptions per 1000 patients per GP, while this was 39.7 (95% CI: 29.7–64.1) for the control group ( p 0.2). For prescriptions asthma/COPD that were supposed to drop, the sum score for the intervention group was 1.1 (95% CI: 0.6–2.6) prescriptions per 1000 patients per GP, while this was 2.2 (95% CI: 1.4–4.3) for the control group ( p 0.1). On three specific recommendations (on quinolones for cystitis, corticosteroids for CPOD, and antibiotics for acute sore throat) significant differences were found. Conclusions This study turned out to be underpowered due to high inter doctor variation in prescribing behaviour. Nevertheless, computerised reminders sometimes have a favourable effect on restricting certain drugs that are not or no longer indicated in general practice.

Effective Administration of Influenza and Pneumococcal Vaccines in the Emergency Department Using a Computer Reminder System

Effective Administration of Influenza and Pneumococcal Vaccines in the Emergency Department Using a Computer Reminder System

Recordatorios informáticos: una estrategia más de vacunación antigripal en pacientes menores de 65 años

Objective To analyze the effect of introducing a computer reminder about influenza vaccination (vaccination flash) into the medical records of patients younger than 65 years with risk factors. Patients and methods A controlled non-randomized intervention study in two primary care centers of an urban area in Madrid (Spain) was performed between 2001 and 2002. A total of 1,522 patients (542 in the intervention group and 980 in the control group), aged between 6 months and 65 years with criteria for influenza vaccination were included. The intervention consisted of the introduction of a vaccination reminder flash into the medical record. The variables analyzed were age, sex, disease, vaccination flash and vaccination status in 2001 and in 2002. Results During the 2002 campaign, 20.8% of the control group and 41.5% of the intervention group were vaccinated (RR = 1.37; p < 0.001). There were no significant differences between groups in sex or underlying disease. In patients in the intervention group not immunized in 2001, the increase in vaccination coverage was more than two-fold (RR = 2.48; p < 0.0001). Conclusions The introduction of a vaccination flash intocomputerized medical records could be useful in increasing immunization coverage against influenza in patients aged less than 65 years old with risk factors. Coverage was higher in patients not previously immunized.

Patients and computers as reminders to screen for diabetes in family practice

In New Zealand, more than 5% of people aged 50 years and older have undiagnosed diabetes; most of them attend family practitioners (FPs) at least once a year. To test the effectiveness of patients or computers as reminders to screen for diabetes in patients attending FPs. A randomized-controlled trial compared screening rates in 4 intervention arms: patient reminders, computer reminders, both reminders, and usual care. The trial lasted 2 months. The patient reminder was a diabetes risk self-assessment sheet filled in by patients and given to the FP during the consultation. The computer reminder was an icon that flashed only for patients considered eligible for screening. One hundred and seven FPs. The primary outcome was whether each eligible patient, who attended during the trial, was or was not tested for blood glucose. Analysis was by intention to treat and allowed for clustering by FP. Patient reminders (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.21, 2.43), computer reminders (OR 2.55, 1.68, 3.88), and both reminders (OR 1.69, 1.11, 2.59) were all effective compared with usual care. Computer reminders were more effective than patient reminders (OR 1.49, 1.07, 2.07). Patients were more likely to be screened if they visited the FP repeatedly, if patients were non-European, if they were "regular" patients of the practice, and if their FP had a higher screening rate prior to the study. Patient and computer reminders were effective methods to increase screening for diabetes. However, the effects were not additive.

Prevention of Venous Thromboembolism Among Hospitalized Medical Patients

Case presentation : A 79-year-old woman was noted by staff at her skilled nursing facility to have increasing shortness of breath during the previous 24 to 48 hours. She had been receiving daily physical therapy, occupational therapy, and 6 prescription medications to manage underlying congestive heart failure with preserved systolic function. The woman was hospitalized. After being transferred to the emergency department, she underwent further workup, which showed no pulmonary embolism on chest CT scan. The chest x-ray, however, revealed a new right lobar infiltrate and consolidation, which are consistent with pneumonia. On examination, she was alert, with a respiratory rate of 24 per minute, heart rate of 96 bpm, blood pressure of 154/76 mm Hg, temperature of 38°C, distended neck veins, right lower lung zone posterior musical rales, regular heart rhythm, normal S1, single S2, and grade II/VI systolic murmur at the left lower sternal border. The diagnosis of pneumonia was made, and levofloxacin was initiated in the emergency department. Specific evaluation of her medical regimen, including furosemide, potassium chloride, metoprolol, candesartan, simvastatin, and baby aspirin, was recommended. Prevention of venous thromboembolism has been neglected in hospitalized patients with medical illnesses such as congestive heart failure, chronic lung disease, cancer, and infectious diseases. In the Medical Intensive Care Unit (MICU) at Brigham and Women’s Hospital, we found a combination of omitted and ineffective prophylaxis. When we performed venous ultrasound examinations on 100 patients admitted to the MICU with an anticipated stay of >48 hours, we detected deep vein thrombosis (DVT) in 33%.1 Almost 50% of the patients with DVT …

Introduction of screening guidelines for men who have sex with men at an STD clinic, the Melbourne Sexual Health Centre, Australia

A recent audit indicated that a substantial proportion of men who have sex with men (MSM) were not screened for rectal gonorrhoea and chlamydia at the Melbourne Sexual Health Clinic, Melbourne, Australia. In response, screening guidelines for MSM were introduced at the clinic using a computer reminder. The aim of this study was to evaluate the impact of the guidelines and alert on screening MSM for gonorrhoea and chlamydia. The medical records of MSM were reviewed for gonorrhoea and chlamydia screening by site (pharyngeal, urethral and rectal), four months before the implementation of the guidelines and alert (July to October 2002), and one year thereafter (beginning November 2002). After the introduction of the guidelines there was a significant increase in rectal chlamydia testing (55% to 67%, P < 0.001), and significant reduction in pharyngeal chlamydia and gonorrhoea testing (65% to 28%, P < 0.001, and 83% to 76%, P = 0.015 respectively). The proportion of tests that were positive by any site did not change (7% to 7%). The introduction of a computer reminder for new guidelines was temporally associated with screening that conformed more closely to clinical guidelines.

Clinical effect of computer generated physician reminders in health screening in primary health care—a controlled clinical trial of preventive services among the elderly

Objectives: To apply and evaluate the effects of a program for computer generated physician reminders, integrated with an electronic patient record (EPR) system, for opportunistic health screening in elderly patients. Design: A pilot study designed as a 20-month clinical trial with a control group and a 20-month non-intervention follow-up using a computer reminder program that selects patients for screening in five intervention areas (diabetes, hypertension, cobalamin deficiency, hypothyroidism and anaemia). Setting: Four primary health care (PHC) centres in suburban Stockholm. Subjects: The intervention was designed for patients 70 years or older from one health care centre who visited a general practitioner (GP) during the first 20-month period. Patients from the three remaining centres served as controls. Main outcome measures: The number of patients who underwent the tests, who had pathological test results, new diagnoses and new pharmacological treatments in both patient groups. Results: In total, 602 patients underwent screening and 1989 were controls. There was a statistically significant, moderate or marked increase (13–75%) in the number of patients who were tested in all five intervention areas. An increase in pathological test results (1–8%) was found in two areas: hypertension and cobalamin deficiency. There was an increase in the number of patients with the diagnosis of cobalamin deficiency during the study. At follow-up a decrease in new diagnoses for anaemia was found. Conclusion: The system seems to be associated with a moderate to large increase in laboratory and manual screening tests for both established and new screening areas. The effect on clinical outcomes was found mainly in a not-yet-established screening area (cobalamin deficiency), indicating that the system may be clinically useful when introducing new screening services.

A PROCESS ANALYSIS OF COMPUTER-GENERATED PATIENT REMINDERS DELIVERED BY NURSING PERSONNEL

Purpose: To measure the extent to which health care reminders are offered by nursing personnel and accepted by patients, we performed a detailed process study of a computer-generated, patient-specific mammography reminder. Subjects: 25,971 consecutive visits by 2,814 women age 50 and older seen during an eight year period in an academic internal medicine practice. Methods: An implementation trial with historical controls was done in the Internal Medicine Clinic at the University of Nebraska Medical Center. We incorporated a computer reminder system into the nursing check-in process along with the standing orders for mammograms. The administration of the reminder, the patient response to the reminder, and subsequent follow-through with mammography were tracked during the intervention phase. Patients were considered "up-to-date" if a mammogram had been done within two years before the visit, or if one was obtained within 60 days after the visit. Results: The proportion of patients up-to-date increased from 48% during a four-year pre-intervention phase to 54% in the intervention phase. Process analysis showed that clinic personnel offered the reminder in 31% of eligible visits, 11% of reminded patients agreed, and 53% of patients who agreed had mammography done. One unsuspected carcinoma was diagnosed. Patient race, insurance coverage, and number of visits during the prior two years influenced whether patients agreed to mammography and whether they then had the test done.

A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting.

Computer-based reminder systems have the potential to change physician and patient behaviors and to improve patient outcomes. We performed a meta-analysis of published randomized controlled trials to assess the overall effectiveness of computer-based reminder systems in ambulatory settings directed at preventive care. Meta-analysis. Searches of the Medline (1966-1994), Nursing and Allied Health (1982-1994), and Health Planning and Administration (1975-1994) databases identified 16 randomized, controlled trials of computer-based reminder systems in ambulatory settings. A weighted mixed effects model regression analysis was used to estimate intervention effects for computer and manual reminder systems for six classes of preventive practices. Adjusted odds ratio for preventive practices. Computer reminders improved preventive practices compared with the control condition for vaccinations (adjusted odds ratio [OR] 3.09; 95% confidence interval [CI] 2.39-4.00), breast cancer screening (OR 1.88; 95% CI 1.44-2.45), colorectal cancer screening (OR 2.25; 95% CI 1.74-2.91), and cardiovascular risk reduction (OR 2.01; 95% CI 1.55-2.61) but not cervical cancer screening (OR 1.15; 95% CI 0.89-1.49) or other preventive care (OR 1.02; 95% CI 0.79-1.32). For all six classes of preventive practices combined the adjusted OR was 1.77 (95% CI 1.38-2.27). Evidence from randomized controlled studies supports the effectiveness of data-driven computer-based reminder systems to improve prevention services in the ambulatory care setting.