Electronic Medical Documentation Research Articles

The Experience of Implementing the Polyclinic Computer Program into the Standardized Patient Methodology

Within the framework of primary specialized accreditation, the "Standardized Patient" methodology is actively used to evaluate student actions. The undeniable advantage of this technique is a two way assessment of the actions of the future doctor — the "patient" and the expert. Simultaneous video recording allows you to look at the situation from the inside. At the same time, in the routine practice of the doctor, the registration of medical documentation continues in 2 types — paper and electronic. Therefore, it becomes important to consider the introduction of an electronic medical documentation training point into the "Standardized Patient" program.

Bibliometric Analysis of Factors Affecting Performance and Completeness of Electronic Medical Records (EMR) in Primary Health Services

ABSTRACT Electronic Medical Records (EMR) completeness and accuracy are fundamental to effective patient care, clinical decision-making, and overall healthcare management. In recent years, there has been increasing attention to improving EMR documentation by healthcare professionals to improve data quality and patient care outcomes. This bibliometric study aimed to explore the trends, research focus, and gaps in the literature regarding EMR completeness from 2019 to 2024. The study used Publish or Perish software to collect data from Google Scholar with specific keywords such as Performance, Factors, Electronic Medical Record (EMR), EMR Completeness, Primary Healthcare, Filling, Documentation, and Medical Record Accuracy. The analysis included the 30 highest ranked journals. In addition, VOS Viewer was used for network visualization, overlay, and density to analyze thematic linkages and identify potential research gaps. Bibliometric analysis showed that Indonesia, the United States, and Ethiopia were the main contributors in EMR-related publications. Frequent themes such as data completeness, quality, and accuracy, emphasize their crucial role in the EMR research field. These findings emphasize the importance of continuously improving EMR data completeness and accuracy, which are critical for reliable clinical decision making and effective healthcare delivery. Future research should focus on developing methodologies to improve data quality and integration of EMR systems with other health information systems. In addition, exploration of policy and regulatory implications related to EMR completeness may provide valuable insights for healthcare practice. Keywords: EMR Completeness, Data Quality, Bibliometric Analysis, Health Documentation, VOS Viewer.

Nurse-Led Cardiac Rehabilitation Care Coordination Program: Improving Functional Outcomes for Patients Through Automatic Referral and Effective Care Coordination.

The aim of this investigation was to evaluate the impact of automated cardiac rehabilitation (CR) referral and nurse care coordination on patient and program outcomes. Specifically, the aim was to identify whether differences exist in physical and psychological function at CR Phase 2 enrollment and completion and CR Phase 2 participation and completion for hospitalized patients who receive in-person CR nurse visits versus phone consultation. Using a retrospective pre-/post-intervention descriptive design, a purposive sampling technique was used to select groups with matching clinical attributes. Dates were selected to mitigate the impact of COVID-19 on CR program enrollment and completion. Data were abstracted from the patient electronic medical record, telemetry documentation, and CR referral tracking tool. Patient descriptors included age, sex, cardiac diagnosis/procedure (post-coronary artery bypass graft surgery, myocardial infarction, percutaneous coronary intervention, heart failure, and aortic valve repair and replacement) and cardiac risk stratification category. Patient functional outcomes included the 6-min walk test and metabolic equivalents of task levels for functional capacity; psychological function was measured by the Patient Health Questionnaire assessment. Program outcomes included discharge to CR Phase 2 enrollment, CR sessions, and completion. Each group had 52 patients. Age was 64 ± 12yr, 68% were male. Perhaps indications for CR included coronary artery bypass graft surgery (44%), myocardial infarction (19%), percutaneous coronary intervention (20%), heart failure (10%), aortic valve repair and replacement (8%). Cardiac risk was low in 30%, intermediate in 65%, and high in 5%. The post-intervention group compared with the pre-intervention group had a shorter discharge to CR Phase 2 enrollment (35 ± 18 d vs 41 ± 28 d, P = .078) and significantly fewer sessions required for CR completion. Automated CR referral and nurse care coordination visits for hospitalized patients decreased the transition period between CR Phase 1 and 2. Patients were physically and psychologically prepared for earlier CR Phase 2 enrollment and successfully completed the program in fewer days than the pre-intervention group.

EHealth tools use and mental health: a cross-sectional network analysis in a representative sample

eHealth tools usage is vital for health care systems and increased significantly after the COVID-19 pandemic, which aggravated mental health issues. This cross-sectional study explored whether sociodemographic characteristics and mental health indices (stress and symptoms of anxiety and depression) were linked to the behavioral intention to use eHealth tools and eHealth tools usage in a representative sample from Poland using a network approach. Measurements were conducted in March 2023 among 1000 participants with a mean age of 42.98 (18–87) years, with 51.50% women. The measures included the behavioral intention to use eHealth tools (BI) based on the UTUAT2; eHealth tool use frequency (use behavior) including ePrescription, eSick leave, eReferral, electronic medical documentation (EMD), Internet Patient Account (IKP), telephone consultation, video consultation, mobile health applications, and private and public health care use; and the PSS-4, GAD-2, and PHQ-2. Furthermore, sociodemographic factors (sex, age, children, relationship status, education, and employment) were included in the research model. Network analysis revealed that mental health indices were weakly related to eHealth tools use. Higher stress was positively linked with mobile health application use but negatively linked to video consultation use. Use of various eHealth tools was intercorrelated. Sociodemographic factors were differentially related to the use of the eight specific eHealth tools. Although mental health indices did not have strong associations in the eHealth tools use network, attention should be given to anxiety levels as the factor with the high expected influence.

Feasibility of implementing a telephone-based frailty assessment.

Despite the growing literature on the importance of identifying and managing frailty, its assessment has been limited in clinical settings. With the goal of integrating frailty assessment into routine clinical practice, this quality improvement project aimed to determine the feasibility, acceptability, and utility of administering a telephone-based frailty assessment. Between 9/2020 and 6/2021, we identified 169 established patients with serious illnesses in an academic primary care-geriatric clinic. Patients were contacted via telephone, and their current medical, functional, nutritional, cognitive, and mood statuses were assessed using validated screening tools. A deficit-accumulation frailty score was then calculated using an electronic medical record-based frailty index calculator and standardized documentation with recommendations was generated for providers. The primary outcome was feasibility, measured as the proportion of patients successfully assessed. Secondary outcomes included completion rates of each domain, administration time, providers' perception, and clinical utility of the assessment. A total of 139 (82.2%) patients, mean age of 82 years, 63.3% frail were successfully assessed. Of the 139 assessments, medical and functional domains were completed for all, while nutrition, mood, and cognition were completed by 88.5% (n=123), 68.3% (n=95), and 59.7% (n=83) of the time, respectively. Conducting the full assessment took an average (standard deviation) time of 26.1 (7.3) minutes. Without the cognitive and mood domain, assessment took an average of 15.7 (7.5) minutes. Patients' providers found the information from the assessment helpful in evaluating and managing their patients. Care plans of 51.8% and 65.0% of patients who had mobility and mind issues, respectively, addressed these domains within 30 days after the assessment. Implementation of the telephone-based frailty assessment is feasible, acceptable, and has the potential to influence the care plans of older adults. This work demonstrated how frailty assessment can be integrated with the outpatient setting.

Elektroniczna dokumentacja medyczna - wybrane aspekty prawne

The purpose of this article is to discuss selected legal issues related to the keeping, access and sharing of medical records. Attention is paid to a specific form of medical records, namely electronic medical records (EDR). The legal basis and its dynamic changes regarding the introduction of electronic medical records to hospitals and other medical facilities were indicated. The issues of basic differences between traditional medical records and their electronic counterparts, the distinction between electronic medical records and electronic medical records, cases and conditions for preparing documentation in both forms, and specific documents should be prepared in an electronic version for specific reasons. There are also indicated entities with access and appropriate authorizations to electronic medical records. Attention is also paid on the meaning and form of the signature. At the end, the conclusions resulting from the implementation and use of electronic medical documentation are presented.

Supporting Doctor's Decisions Based on Electronic Medical Documentation in Polish.

We describe new functionalities that have been added to an existing and widely used software solution in Polish public healthcare. The system automatically evaluates a number of medical scores. It provides epidemiologic monitoring concerning infectious diseases; classifies a particular patient to a specific risk group; and detects anomalies. Moreover, an analysis of a prescribed drug is performed.

Cyfryzacja ochrony zdrowia a konieczność wprowadzania nowych rozwiązań prawnych

The necessity of providing healthcare to citizens is one of the basic principles of every state, regulated by provisions of national, EU or international law and comple-mented by soft law. Civilisational changes and technological advancement make it possible to develop new healthcare tools and services (i.a. telemonitoring, telecon-sulting, telerehabilitation and electronic medical documentation). The COVID-19 pandemic greatly emphasised the need to provide such services. The wide use of e-health, however, which may be a remedy for numerous problems that the health-care sector is wrestling with, requires securing the rights of those who are not digitally included, especially the elderly. The prevalence of various degrees of digital exclusion, not only among the elderly, makes these issues socially significant and they should be solved by law. The purpose of the article is an initial analysis of the validity of developing e-health services in the ageing society in Poland and a presentation of proposals for adjusting legal solutions as regards the use of digital tools in healthcare to the changing reality.

Thyroid dysfunction in cerebral venous thrombosis: a retrospective cohort study

BackgroundCerebral venous thrombosis (CVT) is a multifactorial disease with a variety of related conditions and risk factors. Thyroid dysfunction—especially hyperthyroidism—has been linked to CVT, but this is mainly based on case reports ranging back to 1913, while systematic investigations addressing this issue are lacking. Therefore, we investigated the frequency and clinical characteristics of thyroid dysfunction in a large single-center cohort of CVT patients.MethodsWe retrospectively identified all consecutive patients with aseptic CVT treated at our center between 2006 and 2020. Clinical information was extracted from our electronic medical documentation system. Thyroid-stimulating hormone (TSH) had been routinely measured at admission, free thyroid hormones and thyroid autoantibodies were analyzed whenever available.ResultsOf 120 patients with imaging-confirmed CVT, our main analysis included 107 patients (mean age 42 ± 16 years, 74% female) in whom TSH measurements were available. Nineteen patients (17.8%, 95% confidence interval 10–25%) had thyroid dysfunction. Two had newly diagnosed hyperthyroidism (1.9%, 95% confidence interval 0–4%) caused by Graves’ disease, but without typical symptoms for this condition. Seventeen patients (15.9%, 95% confidence interval 9–23%) had hypothyroidism (12 previously diagnosed with ongoing thyroid hormone replacement therapy; 5 with newly diagnosed subclinical hypothyroidism). Clinical CVT characteristics were similar comparing patients with versus without thyroid dysfunction.ConclusionWe observed a remarkably high prevalence of thyroid dysfunction in CVT patients. Whether this finding reflects a causal relationship warrants further studies. Despite that, the frequent coexistence of both diseases argues for TSH screening in CVT patients.

The experience of executing preventive measures to protect a nursing home in Taiwan from a COVID-19 outbreak.

We share our strategies for preventing the COVID-19 outbreak in a nursing home in Taiwan. We compared the number of outpatient department visits, the days of prescription from the outpatient department, the number of emergency department visits of the nursing home residents and staff, the number of admissions, and the days of admission of the residents for respiratory tract infection treatment between 2019 and 2020 to examine the effect of our preventive measures in the nursing home. Residents and staff who continuously lived and worked in the nursing home from 2019 to 2020 were included. The differences in outcomes between 2019 and 2020 were examined using pairedsamplet tests. The multivariate analyses were presented through generalized estimating equation analysis. A cohort of 183 residents and 127 staff was included and their electronic medical documentation was analyzed in two periods: January-September 2019 and January-September 2020. These residents had lower numbers of outpatient department visits (P < 0.001), days of prescription from the outpatient department (P < 0.001), number of emergency department visits (P < 0.001), number of admissions (P < 0.001), and days of admission (P < 0.001) to treat respiratory tract infections from January-September 2020 than January-September 2019. These staff members had lower numbers of outpatient department visits (P = 0.015) and days of prescription from the outpatient department (P = 0.009) to treat respiratory tract infections from January-September 2020 than January-September 2019. The association between our preventive measures and decreasing the risk of respiratory tract infection in nursing home residents and staff could be found. Sharing these experiences is valuable, as they provide important insights related to clinical practice during the COVID-19 pandemic.

Vascular surgeon wellness and burnout: A report from the Society for Vascular Surgery Wellness Task Force

IntroductionPhysician burnout has been linked to medical errors, decreased patient satisfaction, and decreased career longevity. In light of the increasing prevalence of cardiovascular disease, vascular surgeon burnout presents a legitimate public health concern owing to the impact on the adequacy of the vascular surgery workforce. The aims of this study were to define the prevalence of burnout among practicing vascular surgeons and identify factors that contribute to burnout to facilitate future Society for Vascular Surgery (SVS) initiatives to mitigate this crisis. MethodsIn 2018, active SVS members were surveyed electronically and confidentially using the Maslach Burnout Inventory. The survey was tailored to explore specialty-specific issues, and to capture demographic and practice-related characteristics. Emotional exhaustion (EE) and depersonalization (DP) were analyzed as dimensions of burnout. Consistent with convention, surgeons with a high score on the DP and/or EE subscales of the Maslach Burnout Inventory were considered to have at least one manifestation of professional burnout. Risk factors associated with symptoms of burnout were identified using bivariate analyses (χ2, Kruskal-Wallis). Multivariate logistic regression models were developed to identify independent risk factors for burnout. ResultsOf 2905 active SVS members, 960 responded to the survey (34% participation rate). After excluding retired surgeons and incomplete submissions, responses from 872 practicing vascular surgeons were analyzed. The mean age was 49.7 ± 11.0 years; the majority of respondents (81%) were male. Primary practice settings were academic (40%), community practice (41%), veteran's hospital (3.3%), active military practice (1.5%), or other. Years in practice averaged 15.7 ± 11.7. Overall, 41% of respondents had at least one symptoms of burnout (ie, high EE and/or high DP), 37% endorsed symptoms of depression in the past month, and 8% indicated they had considered suicide in the last 12 months. In unadjusted analysis, factors significantly associated with burnout (P < .05) included clinical work hours, on-call frequency, electronic medical record and documentation requirements, work-home conflict, and work-related physical pain. On multivariate analysis, age, work-related physical pain and work-home conflict were independent predictors for burnout. ConclusionsSymptoms of burnout and depression are common among vascular surgeons. Advancing age, work-related physical pain, and work-home conflict are independent predictors for burnout among vascular surgeons. Efforts to promote vascular surgeon well-being must address specialty-specific challenges, including the high prevalence of work-home conflict and occupational factors that contribute to work-related pain.

103. IMPLEMENTATION OF A HEALTH LITERACY- INFORMED EDUCATIONAL INTERVENTION FOR CHILDREN AND CAREGIVERS DURING HOSPITALIZATION WITH ASTHMA

Background Asthma is the most prevalent chronic disease of children. Poor health literacy and ineffective teaching can result in poorer outcomes, increased Emergency Department visits, readmissions, and increased costs to the system. Aim Statement Our primary aims for this project are: 1) Increase the percent of families who receive multimodal asthma education (verbal, video, and handout) during hospitalization for asthma. 2) Decrease rates of inpatient hospital readmissions for asthmatics aged 2-18. Interventions A multidisciplinary QI team including physicians, nurses, respiratory therapists, and ancillary providers was formed. Chart audits were done to assess baseline documentation of asthma education on the acute care floors from July 2017 through February 2019. Three PDSA cycles were conducted with interventions including: 1) identification of asthma nurse champions and pilot of new educational materials to families on our pilot unit (March 2019); 2) training all unit staff on asthma education materials (April-May 2019); 3) improvement of electronic medical record asthma education documentation (June-July 2019). Statistical process control charts were used to assess the impact of these interventions. Measures Outcome measures were percent of encounters with any asthma education documented and readmission rates. Process measures were the percent of encounters with each multimodal (verbal, video, or handout) type. Balancing measures included hospital length of stay, time from admission to teaching, and time from discharge order placement to hospital discharge. Results Encounters with any asthma education documented increased from baseline of 63% to 84% post interventions, with special cause improvement noted. There was also an increase in video education from 0% to 65%. It is too early to report impact on hospital readmission rates which we continue to trend. Our interventions led to no change in our balancing measures. Conclusions and Next Steps We have been able to successfully increase the overall patient and caregiver asthma education as well as increase use of multimodal methods of asthma teaching. New multimodal education materials implemented have standardized the content and process for asthma education. Ongoing efforts are being made to produce sustained change and to spread asthma education hospital wide. We speculate the project has potential to influence population level asthma outcomes as we continue to expand our reach throughout the health system and community.

Prediction of physical violence in schizophrenia with machine learning algorithms

Patients with schizophrenia have been shown to have an increased risk for physical violence. While certain features have been identified as risk factors, it has been difficult to integrate these variables to identify violent patients. The present study thus attempts to develop a clinically-relevant predictive tool. In a population of 275 schizophrenia patients, we identified 103 participants as violent and 172 as non-violent through electronic medical documentation, and conducted cross-sectional assessments to identify demographic, clinical, and sociocultural variables. Using these predictors, we utilized seven machine learning classification algorithms to predict for past instances of physical violence. Our classification algorithms predicted with significant accuracy compared to random discrimination alone, and had varying degrees of predictive power, as described by various performance measures. We determined that the random forest model performed marginally better than other algorithms, with an accuracy of 62% and an area under the receiver operator characteristic curve (AUROC) of 0.63. To summarize, machine learning classification algorithms are becoming increasingly valuable, though, optimization of these models is needed to better complement diagnostic decisions regarding early interventional measures to predict instances of physical violence.

What's Important: The Social Contract Between Surgeons and Residents Is Still Relevant.

What's Important: The Social Contract Between Surgeons and Residents Is Still Relevant.

Total blood lymphocyte count as a prognostic factor among unselected inpatients

PurposeThe aim of this study was to determine the relationships between total lymphocyte count (TLC) and prognosis among inpatients. Patients and methodsWe retrospectively analyzed data from electronic medical documentation of 54 976 inpatients hospitalized in an urban university hospital during 3 consecutive years (2014–2017). ResultsTLC was available for 12 651 (23.01%) of the inpatients. Patients with TLC <0.8 G/L constituted about 15% of the inpatients studied and had the highest risk of death, hospital readmission within 14 days, hospital readmission within 30 days and hospital readmission within 1 year, the lowest values for biochemical parameters of nutritional status assessment, and the highest C-reactive protein levels. An increase in TLC was associated with reduced risk of in-hospital death (odds ratio [OR]; 95% confidence interval [CI]): 0.31; 0.27–0.36 and 14-day readmission: 0.78; 0.72–0.86. The risk of in-hospital death associated with the Nutritional Risk Screening 2002 (NRS-2002) score, blood albumin concentration, and the score for the combined values of hemoglobin, TLC, albumin and neutrophils (HLAN) was (OR; 95% CI): 2.44; 2.35–2.53; 0.32; 0.28–0.36; and 0.96; 0.94–0.97; respectively. ConclusionsTLC < 0.8 G/L is associated with the highest risk of in-hospital death, 14-day and 30-day readmission, and longer in-hospital stay. An increase in TLC predicted in-hospital survival and freedom from early readmission with a power similar to or greater than a number of prognostic formulas based on questionnaires (e.g. NRS-2002), biochemical parameters (e.g. albumin) and formulas composed of multiple parameters (e.g. HLAN).

Prognostic Significance of Hospitalization Status at Second Cycle of Hypomethylating Agent Induction Therapy in Acute Myeloid Leukemia Patients Ineligible for Intensive Chemotherapy

Introduction: Hypomethylating agents (HMAs) are used as induction therapy for patients with acute myeloid leukemia (AML) who are ineligible for intensive chemotherapy. HMA therapy is frequently initiated in the hospital and some patients remain hospitalized through the initiation of cycle 2 (C2). Clinicians are often faced with the decision to administer C2 while the patient is still hospitalized, however, there is a paucity of prognostic information to guide treatment decisions in this common scenario. Methods: We conducted a retrospective review of patients diagnosed with treatment naïve, de novo and secondary AML who were ineligible for induction chemotherapy (at the discretion of the treating physician based on advanced age, comorbidities, or other reasons) at a single, tertiary, referral center. Patients were included if they received induction therapy with an HMA, including azacitidine and decitabine between 7/1/2008 and 7/1/2018. Exclusion criteria included receipt of intensive induction chemotherapy and inadequate electronic medical documentation. Patients were divided into four groups: patients who were discharged after completion of C1 and received C2 as an outpatient (discharged after C1), patients who received C1 and C2 during the same hospitalization (C1-C2 continuous hospitalization), those who received one total cycle (C1 only), and patients who received C1 as an outpatient (C1 outpatient). The groups were analyzed separately for the primary outcome of overall survival (OS), calculated by Kaplan Meier analysis. Results: Out of 105 patients identified who received an HMA, 100 patients were identified who met inclusion/exclusion criteria and their baseline characteristics are shown in Table 1. Most patients had de novo AML (39.0%), although 33.0% and 19.0% of patients had AML secondary to myelodysplastic syndrome (MDS) and myeloproliferative neoplasm (MPN), respectively. Additionally, 8 patients (8.0%) had therapy related AML. The majority of patients had an Eastern Cooperative Oncology Group (ECOG) performance status of 1 or 2 at induction. Patients who received C1 as an outpatient had a significantly better performance status than those who did not (p= 0.033) Decitabine was the most common HMA (57.0%) administered and was most often on 5-day schedule. Eight patients (8.0%) were continually hospitalized until C2, 5 because of active medical issues (most often fevers requiring intravenous antibiotics), 2 had physical debility precluding discharge home, and 1 was receiving intrathecal chemotherapy twice weekly for central nervous system involvement of AML. The median OS was 15.6 months (95% CI 2.66-28.6) in patients who received C1 outpatient, 10 months (95% CI 6.67-13.43) in patients discharged after C1, 4 months (95% CI 2.40-6.40) in the C1-C2 continuous hospitalization group, and 1 month (95% CI 0.61-1.30) in those who only received C1 as shown in Figure 1. Patients discharged after C1 had a significantly longer OS compared to the C1-C2 continuous hospitalization group (p=0.003). There was a trend (p=0.054) towards worse survival in patients who received C1 only compared to patients hospitalized continually from C1-C2. Conclusions: Continued hospitalization from C1 to C2 of HMA therapy led to an extremely poor median survival of 4 months in this cohort, compared to 10 months in patients who were able to be discharged after C1 and receive C2 as an outpatient. Patients who only received a single cycle of HMA did not have a significantly different survival as compared to patients who were continually hospitalized from C1 to C2. While this is a small retrospective series, these data suggest that AML patients still requiring hospitalization at time of C2 of HMA therapy should be re-evaluated for alternative therapeutic approaches including hospice given poorer outcomes. Although this grouping selects for patients who are sicker and unable to leave the hospital, there is apparent lack of significant benefit of continued HMA therapy in the majority of patients while inpatient. The impact on hospital length of stay, unnecessary utilization of healthcare resources, and patient's quality of life should also be considered in these cases. Prospective identification of these patients with a poorer prognosis could lead to better alternatives for therapeutic approaches. Disclosures Kremyanskaya: Incyte, Celgene, Constellation, Protagonist.: Research Funding; La Jolla: Consultancy. Navada:Onconova Therapeutics Inc: Research Funding. Mascarenhas:Merus: Research Funding; Pharmaessentia: Consultancy, Membership on an entity's Board of Directors or advisory committees; Merck: Research Funding; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Incyte: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Research Funding; Promedior: Research Funding; Roche: Consultancy, Research Funding; Janssen: Research Funding; CTI Biopharma: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding.

TOPICALITY OF IMPLEMENTATION OF MOBILE MEDICAL APPLICATIONS WITHIN THE FRAMEWORK OF ELECTRONIC HEALTH IN UKRAINE: THE EXPERIENCE OF LEADING COUNTRIES OF THE WORLD

Today, in the field of healthcare of the leading countries of the world there is a technological breakthrough due to the use of modern electronic systems. Thanks to the use of medical electronic technologies, it is possible to improve the quality of medical and pharmaceutical care for all segments of the population. The eHealth system provides opportunities for direct participation of patients in their health, which involves organization of a healthy lifestyle and disease prevention. The aim of the study was to analyze the experience of implementation of mobile medical applications and electronic medical systems within eHealth in the healthcare systems of the leading countries of the world and Ukraine. Materials and Methods of the Ministry of Health of Ukraine, FDA, WHO, NHS, ABI Research and other open information databases and statistical agencies were used in the work. The analytical, comparative and generalization of scientific information methods were chosen for the research. Results and Discussion. Modern reformation and further development of the healthcare system of Ukraine provides for the introduction of not only government programs of reimbursement, but also the introduction of electronic information systems, mobile applications for medical, pharmaceutical workers and patients at all stages of medical and pharmaceutical care. The integrated implementation of eHealth determines availability of the necessary healthcare management information system, which should have the following components: registers of medical institutions, services, doctors, patients, diagnosis coding system and electronic medical documentation (electronic medical records and prescriptions). Currently, 1472 medical institutions, 24506 doctors and 21068249 patients have joined eHealth in Ukraine. Conclusions. It has been determined that information electronic technologies allow not only to reduce government spending on the healthcare, but also to achieve a reduction in the number of errors in prescriptions, visits to doctors without the necessary needs and decrease the total number of deaths. The introduction of electronic technologies, in particular mobile applications for the national healthcare system in Ukraine should be controlled by state authorities and independent international organizations on the control and development of information electronic systems.

Digitalna medicina

The digital health industry is developing rapidly: many new subjects are involved in the field of medicine; new opportunities for distant medical services, diagnostics, monitoring of patients’ health, and conducting medical research are emerging; electronic medical documentation is being developed, global medical information databases are being formed, etc. At the same time, the format of doctor-patient relationships is being transformed and new issues and challenges arise that require ethical evaluation. I identified three areas of digital medicine and analyzed issues of confidentiality, informed consent, autonomy and equity in each case. The impact of digital health technologies on the ethical contexts of medicine is uneven: telemedicine possesses the smallest revolutionary potential, which changes the mechanisms of doctor-patient interaction and actualizes issues of cultural differences. mHealth technologies significantly affect patient autonomy and change ways of sharing medical information. Artificial Intelligence (AI) is diverse in medicine, it can depersonalize relationships in medicine, radically change ideas about the role of the doctor and patient, lead to a radical restructuring of the medical care system in the center of which will be the new model of patient interaction with automated medical agents and systems.

Prediction of Lower Extremity Injuries from Vertical Jump Kinetic Data in Collegiate Athletes

PURPOSE: The vertical jump provides critical kinetic information regarding athletic performance, and can be quantified by the force-time (F-T curve) with defined phases of movement. Alterations in the efficiency of mechanisms used for force production could potentially lead to abnormal force dissipation and resultant injury. The purpose of this study was to identify which force plate variables from a vertical jump task could identify collegiate athletes who sustained a lower extremity injury. METHODS: Vertical jump testing using a force plate with dedicated software (SpartaTrac system) was performed by all healthy varsity collegiate athletes at several intervals throughout the athletic year over 3 academic years. The testing procedure consisted of each subject performing a series of 6 consecutive vertical jumps. Injuries were documented by the team athletic trainers and verified with the health care organization’s electronic medical documentation system. Injuries were defined as occurring no more than 60 days after a jump and defined as lower extremity by OSICS 10 code. 234 lower extremity injuries were identified. Subjects were matched by age, sex and sport. Vertical jump variables used were load, explode and drive, operationally defined as the average eccentric rate of force development, average concentric force, and concentric impulse, respectively. Logistic regression was used to determine if the battery of variables could predict whether or not an athlete would sustain a lower extremity injury. Additionally, athletes who sustained an ACL injury were identified, matched, and analyzed correspondingly. RESULTS: Load, explode, and drive, when entered into the regression equation, showed the ability to predict lower extremity injury, χ2= 14.6, df=4, P < 0.01; with explode independently showing significant prediction at P = 0.02. Load, explode, and drive also showed the ability to predict ACL injury, χ2= 13.92, df = 3, P < 0.01, with load and explode independently showing significant prediction at P < 0.05. CONCLUSION: The force plate variables collected from vertical jumps were able to identify athletes who sustained a lower extremity injury. Additionally, these variables were able to identify athletes who sustained an ACL injury.

Modern Approaches to Identification of Adverse Events in Perinatal Medicine

Introduction. In the past two decades, among the various international initiatives aimed at enhancing the quality of medical care, the greatest number of them is aimed at improving the patient's safety situation. Scientific sources suggest that severe evadable adverse events complicate up to 15% of all hospitalizations, of which approximately 0.7-0.9% of cases can lead to death. It is considered that in perinatal practice, mistakes less frequently lead to adverse events and harm, due to a healthier contingent of patients and the modern paradigm of support for normal and physiological processes, instead of diseases. However, according to scientific literature, up to 1-4% of births are complicated by adverse events, of which up to 2/3 can be considered as preventative.The aim of the research is to determine the content of the major modern organizational tools for identification and registration of adverse events and medical errors in perinatal medicine.Materials and methods. We conducted the content analysis of scientific medical and methodological literature, aimed at identifying the key characteristics and content of organizational instruments for identification and registration of medical errors in perinatal medicine.Research results. Content analysis of printed materials and electronic Internet resources allowed us to determine the main requirements for incident reporting system. The subject of analysis can be any incident of patient safety: a medical error and an adverse event. The review of literature allowed us to reveal the evolution of organizational instruments for registration of adverse events in perinatal medicine. At the lower level, there is the analysis of all cases of deaths of mothers, fetuses and newborns, at the second level – registration of all adverse events with causing harm to the patient; at the third level –registration of near-misses events, the list of which can be personally developed by the department / institution management, adapting the already known tools to their own conditions and to the level of the existing patient safety culture; at the fourth level – registration of the so-called triggers, identification of which in the medical documentation is the basis for its detailed analysis in order to identify the adverse event that occurred during the treatment of patient, and, finally, the fifth level – voluntary reporting of medical errors, occurring at the department. The next, higher level of registration of adverse events and medical errors in perinatal medicine is identification and registration of the so-called uncompleted, timely prevented adverse events. The literature review has shown that most countries have implemented the WHO Maternal Near Miss Tool at the national level. However, it is noted that the main disadvantage of this tool is the lack of registration of uncompleted adverse events associated with the newborn. The standard for detecting adverse medical events was a voluntary incident-reporting system. Yet, these systems in a large number of cases do not reveal the actual frequency of adverse events. Public health researchers found that medical staff volunteered to report only 10-20% of errors, of which from 90 to 95% did not cause any harm to patients. Therefore, hospitals need a more effective way of detecting events that harm patients in order to quantify their degree and severity, as well as determine the effectiveness of the measures taken to improve the patient's safety during the treatment and diagnostic process. In this aspect, the Global Trigger Tool, developed by the Institute for Healthcare Improvement (USA), could be the most effective in assessing the safety of in-patient care provision. This methodology represents a list of triggers (prompts) that are defined for their purpose-oriented search in medical paper / electronic documentation. Perinatal trigger tool includes 8 indicators that may indicate an adverse event associated with pregnancy and childbirth. Currently, the global trigger methodology provides for prospective monitoring of clearly defined indicators online in the application of electronic medical documentation, and retrospective monitoring – in the analysis of medical records after the patient's discharge from the hospital.Conclusions. The latest global trends in the provision of medical care, namely the emphasis on patient safety, require new approaches to address the problem of medical errors and adverse events in perinatal medicine. Incident-reporting systems and the culture of patient safety, essential for their successful operation, should be the key elements of patient safety systems, which are implemented at the hospital, regional and national levels.