Electronic Information Management Research Articles

An Assessment of Participant-Described Interprofessional Oral Health Referral Systems Across Rurality.

As a means to identify and quantify oral health interprofessional collaborative practice (IPP), we examined participant-described medical-to-dental (M2D) referral networks and how they function across rurality. We conducted a cross-sectional survey on the appraisal of IPP referral systems in 2016. Secondarily, we examined if rural health clinics (RHCs) have different experiences with M2D referrals compared to other practice types. Independent variables included geographic and organizational indicators, referral system attributes, and respondent characteristics. Data were coded by Census region and state Medicaid expansion status. Bivariable and multivariable analyses were conducted using SAS. A convenience cohort (n = 559) from 44 states was examined. Nearly, half (48.7%) reported dependable M2D referral systems. In bivariate analysis, all independent variables were significant except for state Medicaid expansion status. In multivariable analysis, Census region retained significance (P = .0093). Organization type and practice issues with no shows/missed appointments continued to have significance (P < .001 and .002, respectively). Accountable care organizations were over 5 times (5.72, P = .001) more likely than RHCs to report dependable M2D referral systems. Federally qualified health clinics were slightly over 3 times more likely than RHCs to report dependable M2D referral (3.04, P < .001). No differences between RHCs and other private practices were observed. The importance of IPP continues to be promoted in the current health care environment. Our study demonstrates that, in this motivated study population, M2D referrals can work well, even in rural areas. Organization type, directionality of referral, broken appointment rates, and electronic health information management were all found to significantly impact the respondents' rating on the dependability of an M2D referral process.

Nursing Care and Documentation Assistant with an Electronic Nursing Management System in Neonatal Intensive Care Unit

Background: All nursing cares require decision-making, and the ability to make the best decisions impact upon the quality of nursing care. Moreover, authenticity and accuracy of the best cares may be questioned if not recorded and reported properly and in a standard manner. We aimed to design and implement an electronic nursing managementsystem and then evaluate satisfaction of nurses with the designed electronic system.Methods: This technical action research was conducted in four phases of a) designing an electronic nursing process decision support system, b) designing an electronic nursing care documentation system, c) integrating these two systems and developing an electronic nursing information management system, and d) implementing the system and system satisfaction evaluation using quantitative methods (satisfaction questionnaire).Results: The results of this project led to design and development of an electronic nursing information management system for neonatal intensive care units, which enables nurses to carry out standard care and documentation with high level of nursing satisfaction.Conclusion: In order for an electronic system to support nurses in their care process, it must be accepted by nurses. If nurses are satisfied with the performance and nature of this system, they are much less likely to develop workaround solutions and much more likely to spend their efforts focusing on the professional aspects of nursing care.

Using High-Technology Simulators to Prepare Anesthesia Providers Before Implementation of a New Electronic Health Record Module: A Technical Report.

Learning to use a new electronic anesthesia information management system can be challenging. Documenting anesthetic events, medication administration, and airway management in an unfamiliar system while simultaneously caring for a patient with the vigilance required for safe anesthesia can be distracting and risky. This technical report describes a vendor-agnostic approach to training using a high-technology manikin in a simulated clinical scenario. Training was feasible and valued by participants but required a combination of electronic and manual components. Further exploration may reveal simulated patient care training that provides the greatest benefit to participants as well as feedback to inform electronic health record improvements.

An enterprise architecture framework for electronic requirements information management

Managing information about client requirements effectively can contribute to improve the quality of built facilities, and their related services. However, the process has been challenging to construction project management often resulting in failed projects. This necessitates an overwhelming need for a better approach. This paper presents a novel enterprise architecture framework for managing information about client requirements across all phases of a construction project and through-life of a built facility. The Integrated electronic Requirements Information Management Framework (eRIM) defines an information-centric, and process and service-oriented enterprise architecture approach to requirements management. It also describes how Information and Communication Technology (ICT)/Information Systems (IS) can support this information management. In developing the framework, findings from three case study projects were collated through observations, a questionnaire and interviews of construction practitioners. It is concluded that when implemented and incorporated in the management of construction projects, the eRIM architecture framework can potentially contribute towards improved and more efficient and effective management of client requirements across all stages of a project. Further work is outlined to operationalize the framework.

Arranging blood for elective thyroid surgeries: dilemma continues in the developing world

BackgroundCross matched blood is frequently ordered based on a subjective anticipation of blood loss for a procedure. Excessive blood arrangement and wastage overburdens the blood bank in terms of work load and storage of blood, increases cost of medical care and results in injudicious use of a limited resource. The aim of this short report is to assess the current practice for arranging cross matched blood in elective thyroid surgeries by comparing cross match to blood transfused ratio.FindingsMedical records for all patients from January 2009 to December 2014 undergoing thyroid surgery were retrieved and reviewed through electronic health information management system (HIMS). A total of 91 patients were included in the study, out of which 18 (19.7%) were male and 73 (80.2%) were female. A total of 107 units of blood were arranged and only 9 were transfused. 47 patients underwent a total thyroidectomy, while 44 underwent a hemithyroidectomy. The cross match to transfusion ratio came out to be 11.88.ConclusionsRoutine arrangement of cross matched blood is not required in elective thyroid surgeries. All institutions should have a maximum blood ordering schedule planned for elective procedures, and blood products should be arranged accordingly to avoid unnecessary cross matching.

Hypocapnia measured by end-tidal carbon dioxide tension during anesthesia is associated with increased 30-day mortality rate

Study objectiveTo evaluate the relationship between intraoperative end-tidal carbon dioxide (etco2) values and clinical outcomes with special attention on 30-day postoperative mortality and secondarily on hospital length of stay (LOS). DesignRetrospective, observational study. SettingSurgical theaters of the University Hospital Center of Charleroi. PatientsFive thousand three hundred seventeen patients ASA I-IV undergoing various surgical procedures (except pediatric and cardiac surgery) under general anesthesia. InterventionsNo intervention on the patients. MeasurementsThe mean etco2 level measured during anesthesia was secondarily extracted from an electronic information management system. Patients were divided into 2 separate groups based on etco2 values less than or greater than or equal to 35 mm Hg. The primary end point was the in- and outhospital mortality in the 30-day period after surgery. The second was the LOS more than 6 days. Main resultsHypocapnia occurred in 66% of the patients. Mortality rate at 30-day was 84 of 3554 (2.4%) in the low etco2 group vs 15 of 1763 (0.9%) in the other (odds ratio, 2.99 [1.69-5.28]; P<.001). In multivariate analysis, age and ASA scores had significant independent associations with mortality rate. Adjusting for these factors had an effect on the relative odds ratio of etco2 on mortality of 1.99 ([1.11-3.56]; P<.001). Patients with low etco2 experienced higher LOS (14.1±9.4 vs 13.1±8.9 days; P<.001). Thirty five percent of the patients in the low etco2 group were still hospitalized more than 6 days compared with 30% in the other (P<.001). ConclusionLow etco2 level during anesthesia is associated with an increase in postoperative mortality rate and LOS. These results emphasize the importance of preventing hypocapnia during anesthesia to improve surgical outcomes.

Effectiveness research on network informatization postoperative pain management

Objective Through the network informatization management, postoperative pain assessment, nursing records, process the results into the network electronic medical records, more standardized postoperative pain management, improve the effectiveness of postoperative analgesia. Methods A total of 3 680 patients after the operation from November to December in 2015 were selected and divided into control group and observation group according to the operation time. In November for the traditional postoperative pain management in control group (1 850 cases), in December as observation group (1 830 cases), with Hospital Information System and Anesthesia Information System, all of the records in the postoperative pain management content network electronic information management, according to the degree of pain and analgesia method to select a different form, data sharing, wrong alarm to remind, handle in time. To establish a network of WeChat public platform to perform health education and information communication. The analgesia effect and patient's satisfaction were compared between two groups. Results The incidence of incomplete pain was 12.5%(231/1 850) in control group and 4.2% (77/1 830) in observation group, and there was significant difference between two groups(χ2= 82.22, P< 0.01). The satisfaction score was (5.9±3.7) points in observation group and (4.4±2.6) points in control group, and there was significant difference between two groups(t = 2.10, P<0.05). Conclusions Postoperative pain management network informatization can effectively improve the effect of postoperative analgesia, improve work efficiency. Key words: Network informatization; Electronic medical record; Postoperative analgesia; Management

Diagnostic validity of hematologic parameters in evaluation of massive pulmonary embolism.

The aim of this study was to determine the hematologic parameter with the highest diagnostic differentiation in the identification of massive acute pulmonary embolism (APE). A retrospective study was performed on patients diagnosing with APE between June 2014 and June 2016. All radiological and laboratory parameters of patients were scanned through the electronic information management system of the hospital. PLR was obtained from the ratio of platelet count to lymphocyte count, NLR was obtained from the ratio of neutrophil count to lymphocyte count, WMR was obtained from white blood cell in mean platelet volume ratio, MPR was obtained from the ratio of mean platelet volume to platelet count, and RPR was obtained from the ratio of red distribution width to platelet count. Six hundred and thirty-nine patients consisting of 292 males (45.7%) and 347 females (54.3%) were included in the research. Independent predictors of massive risk as compared to sub-massive group were; pulmonary arterial systolic pressure (PASP) (OR=1.40; P=.001), PLR (OR=1.59; P<.001), NLR (OR=2.22; P<.001), WMR (OR=1.22; P<.001), MPR (OR=0.33; P<.001), and RPR (OR=0.68; P<.001). Upon evaluation of the diagnostic differentiation of these risk factors for massive APE by employing receiver operating characteristic curve analysis, it was determined that PLR (AUC±SE=0.877±0.015; P<.001), and NLR (AUC±SE=0.893±0.013; P<.001) have similar diagnostic differentiation in diagnosing massive APE and these two parameters are superior over PASP, MPR, WMR, and RPR. We determined that the levels of NLR and PLR are superior to other parameters in the determination of clinical severity in APE cases.

Feasibility of Vascular Matching for Image Guided Pancreatic Stereotactic Body Radiation Therapy

Implanted fiducial markers (IFM) and biliary stents are established as targets for image-guidance during high dose stereotactic body RT (SBRT) in the treatment of pancreatic adenocarcinoma (PDAC). IFM are often well tolerated, but may delay treatment. Furthermore, the potential for IFM/stent migration may cause insufficient target volume coverage and normal tissue toxicity. This study evaluated the use of vascular matching (VM), IFM and stent matching for image-guidance in delivery of SBRT for patients with PDAC. We hypothesize that there is no difference in shifts or efficacy between IFM, stents, and VM. Between April 2011- November 2015, 39 patients received SBRT for treatment of PDAC at our institution. Cone beam CT (CBCT) was performed for setup verification. We retrospectively analyzed 221 CBCT images for setup shifts based on either IFM, stent or celiac and SMA vasculature contoured using electronic patient information management system, version 2.60 (IMPAC Medical Systems, Inc. Sunnyvale, CA). Average shift magnitudes in each axis and average vector magnitudes were calculated. RTOG acute gastrointestinal (GI) radiation morbidity scoring criteria were used to assess toxicity. Statistical analyses were performed using JMP 12.1.0 (SAS Institute Inc., Cary, NC). Kaplan-Meier calculations as well as analysis of variance, likelihood ratio, and Wilcoxon tests were used to evaluate local control and survival and compare groups. Fifteen patients (38.5%) were treated with IFM, 9 (23%) with stents, and 15 (38.5%) with VM. Waiting times from initial consult to radiation treatment in the IFM, stent, and VM groups were 24 days (range 2-91 days), 14 days (range 9-56 days), and 19 days (range 5-39 days), respectively. The average magnitude for superior/inferior shifts was 0.45 ± 0.42 mm (IFM), 0.48 ± 0.46 mm (stent), and 0.37 ± 0.33 mm (VM) (P = 0.24), lateral shifts 0.42 ± 0.99 mm, 0.29 ± 0.35 mm, and 0.26 ± 0.22 (P = 0.26), and anterior/posterior shifts were 0.33 ± 0.40 mm, 0.34 ± 0.28 mm, and 0.37 ± 0.28 mm (P = 0.70). Vector magnitudes were 0.85 ± 1.04 mm, 0.74 ± 0.53 mm, and 0.67 ± 0.36 mm, respectively (P = 0.24). There were no documented complications from IFM or stent placement. There were no significant differences in GI toxicities between groups (P = 0.25), with a single instance of Grade 3 toxicity in the stent group. There were no significant differences in tumor resectability (P = 0.70), margin status (P = 0.43), local control (P = 0.31), or overall survival (P = 0.88). Vascular matching is a feasible, less invasive image-guidance technique that allows for reproducible and convenient SBRT delivery to PDAC and shorter treatment delays. There was no difference in positional shifts, toxicity, or outcomes for patients planned with IFM, stents, or VM. VM may be preferable over more invasive methods of target localization.

The influence of the type and design of the anesthesia record on ASA physical status scores in surgical patients: paper records vs. electronic anesthesia records.

BackgroundThe American Society of Anesthesiologists Physical Status classification (ASA PS) of surgical patients is a standard element of the preoperative assessment. In early 2013, the Department of Anesthesia was notified that the distribution of ASA PS scores for sampled patients at the University of Iowa had recently begun to deviate from national comparison data. This change appeared to coincide with the transition from paper records to a new electronic Anesthesia Information Management System (AIMS). We hypothesized that the design of the AIMS was unintentionally influencing how providers assigned ASA PS values.MethodsPrimary analyses were based on 12-month blocks of data from paper records and AIMS. For the purpose of analysis, ASA PS was dichotomized to ASA PS 1 and 2 vs. ASA PS >2. To ensure that changes in ASA PS were not due to “real” changes in our patient mix, we examined other relevant covariates (e.g. age, weight, case distribution across surgical services, emergency vs. elective surgeries etc.).ResultsThere was a 6.1 % (95 % CI: 5.1–7.1 %) absolute increase in the fraction of ASA PS 1&2 classifications after the transition from paper (54.9 %) to AIMS (61.0 %); p < 0.001. The AIMS was then modified to make ASA PS entry clearer (e.g. clearly highlighting ASA PS on the main anesthesia record). Following the modifications, the AS PS 1&2 fraction decreased by 7.7 % (95 % CI: 6.78–8.76 %) compared to the initial AIMS records (from 61.0 to 53.3 %); p < 0.001. There were no significant or meaningful differences in basic patient characteristics and case distribution during this time.ConclusionThe transition from paper to electronic AIMS resulted in an unintended but significant shift in recorded ASA PS scores. Subsequent design changes within the AIMS resulted in resetting of the ASA PS distributions to previous values. These observations highlight the importance of how user interface and cognitive demands introduced by a computational system can impact the recording of important clinical data in the medical record.

Türkiye’de Hukuksal Koşullar Çerçevesinde Elektronik Belge ve Finansal Bilgi Yönetimi Politikalarının Değerlendirilmesi:Türkiye Kalkınma Bankası Örneği

Corporate (institutional) information, in general, are composed of financial information and, administrative and technical information components. The information components of which is intense, are mainly shaped depending upon the organization’s main activities. In the study, it is aimed at the examination of methods towards current circumstances, issues and solution of the issues intended for electronic information and record management systems in Turkey. In this context, it was aimed at the research of awareness level, issues encountered and expectations on this topic in the Development Bank of Turkey in application size. Within this scope, the survey, which was developed in order to analyze current circumstances intended for electronic record and financial information systems of Development Bank of Turkey, was applied to 304 persons who use the system. Consequently it was proven that there is need for development of financial information systems and electronic information and records systems in Development Bank of Turkey.

Factors associated with mortality in patients presenting to the emergency department with severe hypernatremia.

Hypernatremia is a common electrolyte disorder associated with prolonged hospitalization and death. Severe hypernatremia is defined as a serum sodium (Na(+)) concentration >160 mmol/L. To the best of our knowledge, there is little information on patients with severe hypernatremia, Na(+) >160 mmol/L. Therefore, in this study, we aimed to determine the frequency, demographic and clinical characteristics, comorbid conditions and treatment strategies in patients presenting to the emergency department with severe hypernatremia, and also to evaluate the effects of these factors on mortality. A retrospective chart review was performed on patients presenting to the emergency department between January 2011 and June 2014. Patients with Na(+) >160 mmol/L were screened retrospectively via the hospital electronic information management system and patient medical record files. During the 3.5 years of screening, 256 patients (0.04 %) with Na(+) >160 mmol/L presented to the emergency department. The mean age of the patients included in the study was 74.4 ± 15.2 years, mean Na(+) level was 168.7 ± 7.4 mmol/L and, mean mortality was 49.5 % during the hospitalization. Multivariable Cox regression analysis showed that low systolic blood pressure, low pH, Na(+) >166 mmol/L, increased plasma osmolarity, mean sodium reduction rate ≤-0.134 mmol/L/h, dehydration, and, pneumonia to be independently associated with mortality. This study describes the demographic and clinical characteristics of patients with Na(+) >160 mmol/L in a large population along with comorbid conditions, incidence, treatment strategies and, its association with mortality.

Implementation of Hepatitis Information Management System in Iran.

Introduction:Nowadays, hepatitis is of the most important health priorities around the world, where information plays a very significant role in specialized diseases prevention planning, and policy- and decision-making processes. Thus, this study addressed challenges of hepatitis information management and investigated the outcomes of establishing a hepatitis information management system to overcome such challenges. To this end, this research intended to study the implementation of an Electronic hepatitis information management system.Methodology:This is an applied-developmental study with following specifications and procedures: preparation of study proposal and design, justification of the design’s stakeholders, approval of the design by the Postgraduate Education Council of Faculty, determination of pilot hepatitis control center, software development, deciding on control, prevention, and treatment centers, and finally development of a network-based system for collecting and managing hepatitis information.Findings:Results indicated that the inconsistency and lack of integrity of data, as well as the lack of communication between related units prevented timely information register of viral hepatic patients and services that are provided to them. This inhibited the possibility of considering a follow-up process. However, the implementation of this system and involvement of relevant units greatly solved these problems.Conclusion:Results show that the implementation of an electronic system for the management of hepatitis control, prevention, and treatment is a regional and national requirement; since, this system with its empowered infrastructure is capable in providing desired services to all laboratories, counseling and health centers, specialized clinics, and physicians connected to the hepatitis network. This enables them to follow up and monitor patients’ conditions. That mentioned system paves the way for the analysis of gathered information, managers’ and specialists’ access in different regions to the data for making appropriate and accurate decisions.

Alberta Management of Mineral Resources and its Reference to China

Alberta, known as the “Energy Province”, has abundant natural resources with the largest reserve among all other provinces in Canada. The mining rights in Alberta are mainly taken charge by the Alberta Energy and separated from land rights. The rights are divided into three forms-Permit, leases and Licence, and can be divided further into different kinds according to different mineral resources. The electronic information management mode is applied to the management of mineral rights, which offers a significant reference to the category of mineral rights, the management of energy minerals and the acceleration of mineral rights electronic computerization in our country.

Best Practices for the Authentication of Official Electronic Legal Material

Many state governments publish primary legal material online, potentially saving money, increasing efficiency, and expanding access to such material. However, the transition away from print raises many important questions about the management of electronic legal information, including issues related to the trustworthiness of the information as it moves from the content originator to the end user. In states publishing primary legal material online, it is critically important that state officials take steps to ensure that the electronic legal information they publish is unaltered and can be verified as authentic. Digital authentication solutions assure users that the material is trustworthy and has not been altered since dissemination by a trusted source. These best practices, which stem from analyses of other studies and discussions with countless experts in the field, are designed to help cut through the confusion related to the selection, implementation, and maintenance of a digital authentication solution for the electronic publication of official legal material. The authors created these best practices because they are in states on the leading edge of state government publication of official, authentic versions of primary legal material online, and they personally observed a need for this guidance. As such, they created these best practices primarily for use by those charged with implementing and investigating digital authentication solutions, but they may also benefit anyone interested in digital authentication.

Some correlates of electronic health information management system success in nigerian teaching hospitals.

Nowadays, an electronic health information management system (EHIMS) is crucial for patient care in hospitals. This paper explores the aspects and elements that contribute to the success of EHIMS in Nigerian teaching hospitals. The study adopted a survey research design. The population of study comprised 442 health information management personnel in five teaching hospitals that had implemented EHIMS in Nigeria. A self-developed questionnaire was used as an instrument for data collection. The findings revealed that there is a positive, close relationship between all the identified factors and EHIMS’s success: technical factors (r = 0.564, P < 0.05); social factors (r = 0.616, P < 0.05); organizational factors (r = 0.621, P < 0.05); financial factors (r = 0.705, P < 0.05); and political factors (r = 0.589, P < 0.05). We conclude that consideration of all the identified factors was highly significant for the success of EHIMS in Nigerian teaching hospitals.

Geriatric Telemedicine: Background and Evidence for Telemedicine as a Way to Address the Challenges of Geriatrics.

ObjectivesThe global population of elderly people is increasing at a remarkable rate, which may be expected to continue for some time. Older patients require more care, and with the current model of care delivery, the costs may be expected to rise, although higher cost is unsustainable. For this reason, a new pattern of practice is needed. Telemedicine will be presented as a highly effective and necessary tool in geriatrics.MethodsThis review will present some of the background and evidence for telemedicine as a way to address the challenges of geriatrics through geriatric telemedicine. Some of the evidence for the value of telemedicine as a tool for physicians and healthcare systems is presented.ResultsTelemedicine offers many means to address the problems of geriatric care in creative ways. The use of electronic medicine, telecommunications, and information management has now found its way into the very fabric of health care. The use of telemedicine is a fait accompli in much of the world, and it continues to have an increasing role deeply imbedded in our electronic practices coupled with social media.ConclusionsThe evidence for successful incorporation of telemedicine into practice is abundant and continues to accrue. This is a great opportunity for medical practice to evolve to new levels of engagement with patients and new levels of attainment in terms of quality care.

Designing an electronic personal health record for professional Iranian athletes.

Background:By providing sports organizations with electronic records and instruments that can be accessed at any time or place, specialized care can be offered to athletes regardless of injury location, and this makes the follow-up from first aid through to full recovery more efficient.Objectives:The aim of this study was to develop an electronic personal health record for professional Iranian athletes.Patients and Methods:First, a comparative study was carried out on the types of professional athletes’existing handheld and electronic health information management systems currently being used in Iran and leading countries in the field of sports medicine including; Australia, Canada and the United States. Then a checklist was developed containing a minimum dataset of professional athletes’ personal health records and distributed to the people involved, who consisted of 50 specialists in sports medicine and health information management, using the Delphi method. Through the use of data obtained from this survey, a basic paper model of professional athletes' personal health record was constructed and then an electronic model was created accordingly.Results:Access to information in the electronic record was through a web-based, portal system. The capabilities of this system included: access to information at any time and location, increased interaction between the medical team, comprehensive reporting and effective management of injuries, flexibility and interaction with financial, radiology and laboratory information systems.Conclusions:It is suggested that a framework should be created to promote athletes’ medical knowledge and provide the education necessary to manage their information. This would lead to improved data quality and ultimately promote the health of community athletes.

An empirical study of the complexity of requirements management in construction projects

Purpose – The purpose of this paper is to investigate in-depth the current approach of managing client requirements in construction and to highlight the significant factors, which contribute to the complexity of managing the requirements in order to define a better approach. Design/methodology/approach – A case study of a leading international global built asset and engineering consultancy organization was conducted over two years. The case study was conducted principally using semi-participant observations supplemented with other qualitative data collection methods (i.e. interviews, questionnaires and document analysis). Thematic analysis was used to analyze the data. Findings – The results highlight major factors associated with the complexity of managing client requirements information, which include: mechanisms for documentation, storage and access, distribution of requirements information between stakeholders and across lifecycle phases of a project, traceability management and the provision of effective change management incorporating dependency checking and impact analysis. Research limitations/implications – The main limitation of the research is the use of an in-depth study of a single organization, which applied the same project management method across all the projects they managed. Further work is planned to develop the proposed framework fully, and develop a software platform to operationalize and evaluate its industrial applicability with construction projects. Practical implications – The implications of this research is that a better approach to managing requirements information is needed, which will facilitate the design, construction and operations of buildings within budget and time. An integrated framework and an associated tool are suggested to implement the approach. Originality/value – This study identifies major research gaps and problems in the architecture, engineering, construction and facilities management industry; proposes and presents Electronic Requirements Information Management framework to facilitate lifecycle management of the requirements.

LIFE SCIENCE TECHNOLOGIES: DIGITAL LAB MANAGEMENT

Some scientists keep experimental records on sticky notes. Some groups maintain ordering information in the head of a single technician. But for researchers looking for more stable, searchable, and sharable records, digital options such as electronic laboratory notebooks (ELNs) and laboratory information management systems (LIMS) are readily available. Scientists can start with a simple online notebook or choose a complete lab management package to track the entire lifecycle of their projects.