Electronic Medical Record Software Research Articles

Sarcopenia in general practice: Towards improving muscle health screening, assessment and management in Australia.

An estimated one in five Australians aged 60 years and older have sarcopenia, marked by progressive and accelerated loss in muscle mass, strength and function. Sarcopenia is associated with considerable healthcare costs and a myriad of adverse health outcomes, including increased risk of death. Despite its clinical importance, muscle health is often overlooked in routine clinical practice, hindering diagnosis and treatment. In July 2023, eight representatives from Australia's primary care and research communities convened to discuss barriers to sarcopenia screening, assessment and management within routine clinical practice. Solutions were proposed to improve the implementation of muscle health assessment and management in general practice. This article summarises the key discussions and outcomes from this meeting. Strategies to improve the implementation of muscle health assessment and management in general practice include (1) improving public awareness; (2) professional education; (3) provision of tools and resources; (4) advocacy and policy; and (5) increasing collaborative efforts between healthcare professionals, professional societies, universities, electronic medical record software vendors and the government.

Ransomware Attacks Will Keep Coming — What Physician Leaders Should Do

Ransomware attacks on healthcare facilities are expected to continue, and every organization should consider itself a target. Physician leaders should develop contingency plans for how their organizations can best care for patients if essential technologies — electronic medical record software, telephones, email, and others — are out of commission for an extended period of time.

The Effect of an Electronic Medical Record-Based Clinical Decision Support System on Adherence to Clinical Protocols in Inflammatory Bowel Disease Care: Interrupted Time Series Study.

Clinical decision support systems (CDSSs) embedded in electronic medical records (EMRs), also called electronic health records, have the potential to improve the adoption of clinical guidelines. The University of Alberta Inflammatory Bowel Disease (IBD) Group developed a CDSS for patients with IBD who might be experiencing disease flare and deployed it within a clinical information system in 2 continuous time periods. This study aims to evaluate the impact of the IBD CDSS on the adherence of health care providers (ie, physicians and nurses) to institutionally agreed clinical management protocols. A 2-period interrupted time series (ITS) design, comparing adherence to a clinical flare management protocol during outpatient visits before and after the CDSS implementation, was used. Each interruption was initiated with user training and a memo with instructions for use. A group of 7 physicians, 1 nurse practitioner, and 4 nurses were invited to use the CDSS. In total, 31,726 flare encounters were extracted from the clinical information system database, and 9217 of them were manually screened for inclusion. Each data point in the ITS analysis corresponded to 1 month of individual patient encounters, with a total of 18 months of data (9 before and 9 after interruption) for each period. The study was designed in accordance with the Statement on Reporting of Evaluation Studies in Health Informatics (STARE-HI) guidelines for health informatics evaluations. Following manual screening, 623 flare encounters were confirmed and designated for ITS analysis. The CDSS was activated in 198 of 623 encounters, most commonly in cases where the primary visit reason was a suspected IBD flare. In Implementation Period 1, before-and-after analysis demonstrates an increase in documentation of clinical scores from 3.5% to 24.1% (P<.001), with a statistically significant level change in ITS analysis (P=.03). In Implementation Period 2, the before-and-after analysis showed further increases in the ordering of acute disease flare lab tests (47.6% to 65.8%; P<.001), including the biomarker fecal calprotectin (27.9% to 37.3%; P=.03) and stool culture testing (54.6% to 66.9%; P=.005); the latter is a test used to distinguish a flare from an infectious disease. There were no significant slope or level changes in ITS analyses in Implementation Period 2. The overall provider adoption rate was moderate at approximately 25%, with greater adoption by nurse providers (used in 30.5% of flare encounters) compared to physicians (used in 6.7% of flare encounters). This is one of the first studies to investigate the implementation of a CDSS for IBD, designed with a leading EMR software (Epic Systems), providing initial evidence of an improvement over routine care. Several areas for future research were identified, notably the effect of CDSSs on outcomes and how to design a CDSS with greater utility for physicians. CDSSs for IBD should also be evaluated on a larger scale; this can be facilitated by regional and national centralized EMR systems.

How do we achieve blinding in modern electronic and paper medical records during the conduct of transfusion trials?

Regulatory aspects of transfusion medicine add complexity in blinded transfusion trials when considering various electronic record keeping software and blood administration processes. The aim of this study is to explore strategies when blinding transfusion components and products in paper and electronic medical records. Surveys were collected and interviews were conducted for 18 sites across various jurisdictions in North America to determine solutions applied in previous transfusion randomized control trials. Sixteen responses were collected of which 11 had previously participated in a transfusion randomized control trial. Various solutions were reported which were specific to the laboratory information system (LIS) and electronic medical record (EMR) combinations although solutions could be grouped into four categories which included the creation of a study product code in the LIS, preventing the transmission of data from the LIS to the EMR, utilizing specialized stickers and labels to conceal product containers and documents in the paper records, and modified bedside procedures and documentation. LIS and EMR combinations varied across sites, so it was not possible to determine combination-specific solutions. The study was able to highlight solutions that may be emphasized in future iterations of LIS and EMR software as well as procedural changes that may minimize the risk of unblinding.

Using Emr In A Corporate Hospital: Healthcare Providers Perspective From Bangladesh

Background: An Electronic Medical Record (EMR) is an essential tool for delivering high-quality healthcare in a hospital. In recent years, hospitals have increased their investment in EMRs to improve the level of integrated management of information. The purpose of this study was to explore the perspectives of using EMR among healthcare providers (HCPs) in a corporate hospital in Bangladesh.&#x0D; Methods: This cross-sectional study was conducted among 153 HCPs (doctors, nurses, lab technicians, drug dispensers, billing managers, and administrative personnel) who have access to EMR and working in a selected corporate hospital of Dhaka city. The study period was January to December 2019. HCPs were selected by convenience sampling technique. Data were collected by face-to-face interview using semi structured questionnaire. Data analysis was done by IBM SPSS software. Ethical issues were maintained strictly.&#x0D; Result: Study revealed that 59.5% HCPs were in the age group of 18-29 years with the mean age being 29.26 (±7.58) years. Only 32.7% HCPs had previous experience of using this type of software before working in the current hospital and 62.7% got technical training on EMR within the current hospital. The majority (81.7%) of the HCPs found that the technical training was effective for using the EMR software. The difficulty of using EMR was significantly associated with the age (p&lt;0.001), gender (p&lt;0.001), professional status (p&lt;0.001) and highest level of education (p&lt;0.001) of the HCPs. HCPs ability to overcome job related challenges was significantly associated with the professional status of them (p&lt;0.001). HCPs perception regarding effectiveness of EMR was found significantly associated with their place of technical training (p=0.004) and duration of the training (p=0.012).&#x0D; Conclusion: EMR can be a helpful tool for the health service providers to provider health services at the corporate hospitals. Digital literacy need to be increased among the HCPs to ensure effective use of EMRs. Regular maintenance and upgrades of the technology infrastructure are necessary for advanced record-keeping and quality service.&#x0D; JOPSOM 2021; 41(2):12-19

Unique clinical and prognostic behavior of patients diagnosed with combined exophytic and inverted papilloma histologic subtype.

To evaluate the clinical and prognostic behaviors of sinonasal papillomas. Patients diagnosed with sinonasal papilloma were reviewed between 2001 and 2016 at a tertiary rhinology practice. Using pathology-specific electronic medical record software, patients diagnosed with sinonasal papilloma were identified. Four subcategories of this lesion were identified: inverting (IP), exophytic (EP) oncocytic (OP) and inverting + exophytic (IP + EP) papillomas. A total of 107 patients were identified with unique sinonasal papilloma diagnoses. Of these, the majority were diagnosed with IP (87, 81.3%). The subpopulation of patients co-diagnosed with IP and EP (IP + EP) was unique with respect to clinical presentation and prognosis relative to both the IP and EP alone populations. IP + EP patients (5, 4.7%) were older with an average age of 75.25 years compared to 45 (EP) and 55.26 (IP), p < .0001. IP + EP patients more often presented with epistaxis (60%) compared to 33.3% (EP) and 4.6% (IP). Finally, all IP + EP patients had at least one recurrence of their disease, compared to 33.3% (EP) and 28.5% (IP). Each histopathologic subtype of sinonasal papilloma has unique clinical characteristics and recurrence rates after surgical resection. The subpopulation of patients diagnosed with IP + EP tends to be older, more likely to present with epistaxis, and more likely to recur. Additional investigation and analysis of this subpopulation is warranted. 4.

A Retrospective Comparative Analysis of Intensive Vs. Non-Intensive Chemotherapy in Treatment Naïve Acute Myeloid Leukemia (AML) Patients in India

Background &amp; Significance: Acute Myeloid Leukemia (AML) is a hematological malignancy characterized by the rapid proliferation of abnormal myeloid cells. Intensive chemotherapy has been the main stay of therapy in young adults whereas Azacytidine and Venetoclax based therapy is preferred in older and unfit patients of AML. As per Indian Acute Leukemia Research Database of (INwARD) of the Hematology Cancer Consortium, 3+7 is the most commonly used intensive chemotherapy in India induction mortality (n=392) is 16.9% (range 6.1 - 43%). (1) Another Indian Study of acute leukemia (n=268), highlighted that 54% had baseline infections. Only 40% of infected patients received induction therapy as compared to 93% of non-infected patients. Venetoclax has improved outcomes in AML. There is an unmet need for protocols for younger patients who are unfit for 3+7 due to multi drug resistant baseline infections or ECOG ≥2 or organ dysfunction. Poor risk cytogenetics and mutations are associated poor response to intensive therapies. We did retrospective comparative analysis of overall outcomes in patients receiving intensive chemotherapy versus non-intensive chemotherapy in a tertiary care centre of North India Material &amp; Methods: We did a retrospective comparison of intensive chemotherapy 3+7/ FLAG based therapy versus Azacytidine and Venetoclax based therapy since 2019. Institutional electronic medical record software (PARAS) was utilized to identify patients. Type of therapy was decided as per physician discretion. Patients who were elderly (age &amp;gt;60 years), ECOG PS 2 or more, or clinic-radiological evidence of infection. Intensive therapy included received Inj. Daunorubicin 60 mg/m2 IV once daily for 3 days and Inj. Cytarabine 100 mg/m2 IV as a continuous infusion for 7 days. Or FLAG/VEN based therapy Inj. Fludarabine 30 mg/m2 IV once daily for 4 days, Cytarabine 1500 mg/m2 IV once daily for 4 days. Inj. Filgrastim (biosimilar)5 mcg/kg s/c once daily from day 1 to ANC &amp;gt; 500 cells/ μL. Non-Intensive therapy arm received Inj. Azacytidine @75mg/m2 for 7 days with Tab Venetoclax 100mg once a day for 7-14 days as per patient tolerance. Posaconazole was used as a anti-fungal prophylaxis. We recorded baseline characteristics, type of therapy, compared the tolerability and efficacy of both the regimens. We did survival analysis using Kaplan Meier Curves and statistical analysis using SPSS version 25. Results: Baseline Data is presented in Table 1, 69 patients received intensive chemotherapy and 58 patients received non-intensive therapy. Patient in the intensive therapy arm were younger and fit whereas patients were older in the non-intensive therapy arm. Post Induction bone marrow evaluation was done between day 28 to day 35 post therapy. CR rate was 78.2 per cent in Intensive therapy arm v/s 51.7 per cent in non-intensive therapy arm. Patients were stratified as per ELN risk category. Patients in the standard risk and intermediate risk groups did better in the intensive therapy arm but outcome did not differ in patients of poor risk ELN category patients. Fig:1 Non- intensive therapy was better tolerated with fewer grade 3 or more febrile neutropenia and fewer 3 rd line antibiotics lesser duration of stay. The decision between intensive and non-intensive chemotherapy should be carefully individualized, considering patient age, performance status, cytogenetic risk, and comorbidities. Conclusion: Our study re-affirms the role of intensive chemotherapy in younger and fitter patients, however in adverse risk ELN patients non-intensive therapy appears non inferior to intensive therapy

Understanding data provenance when using electronic medical records for research: Lessons learned from the Deliver Primary Healthcare Information (DELPHI) database.

We set out to assess the impact of Choosing Wisely Canada recommendations (2014) on reducing unnecessary health investigations and interventions in primary care across Southwestern Ontario. We used the Deliver Primary Healthcare Information (DELPHI) database, which stores deidentified electronic medical records (EMR) of nearly 65,000 primary care patients across Southwestern Ontario. When conducting research using EMR data, data provenance (i.e., how the data came to be) should first be established. We first considered DELPHI data provenance in relation to longitudinal analyses, flagging a change in EMR software that occurred during 2012 and 2013. We attempted to link records between EMR databases produced by different software using probabilistic linkage and inspected 10 years of data in the DELPHI database (2009 to 2019) for data quality issues, including comparability over time. We encountered several issues resulting from this change in EMR software. These included limited linkage of records between software without a common identifier; data migration issues that distorted procedure dates; and unusual changes in laboratory test and medication prescription volumes. This study reinforces the necessity of assessing data provenance and quality for new research projects. By understanding data provenance, we can anticipate related data quality issues such as changes in EMR data over time-which represent a growing concern as longitudinal data analyses increase in feasibility and popularity.

Unpacking the Racial Gap: Helicobacter pylori Infection Clearance Among Different Racial Groups.

Introduction Helicobacter pylori (H. pylori) is a bacteria causing chronic stomach infections, influenced by various factors, including host traits and bacterial virulence. It uses both urease-dependent and independent mechanisms to survive acidic gastric environments. Management entails diagnosis, treatment, and eradication verification. Combining drugs is key to overcoming resistance and ensuring bacteria elimination, thus preventing recurrence and complications. H. Pylori eradication mitigates gastric cancer risk and alleviates symptoms. Racial disparities persist despite declining H. pylori and gastric cancer incidence in the United States (US). African Americans (AA) have higher gastric cancer risks than non-Hispanic Whites. Addressing these disparities is crucial to protect high-risk populations. Methods This study retrospectively compiled H. pylori infection data from 2009 to 2022, categorized by race. Propensity score matching balanced initial group characteristics before analysis. Chi-squared and odds ratio tests were used on the cohort, with Kaplan Meier and Log Rank methods evaluating disease clearance in ethnic groups. Data were extracted from the Sunrise Electronic Medical Record software, including patient demographics, health details, and treatment specifics. Patients aged 18-65 with H. pylori infection at Nassau University Medical Center, who followed their treatment, were selected. Data were processed using Statistical Package for the Social Sciences (SPSS) and RStudio software. Results The study initially included 10,040 H. pylori-diagnosed patients, with 9,288 meeting the study's criteria after attrition. Predominantly female (64.7%), the cohort was racially diverse. A longer disease clearance time was noted among Hispanics (p=0.044). Binomial logistic regression analysis identified influential factors like high school graduation rates, poverty level income, and language proficiency on disease clearance. An odds ratio analysis further emphasized language barriers (HR 0.346, p=0.043) and education status (HR 0.756, p=0.025) as primary covariates impacting disease clearance, underlining the role of socio-economic factors and language proficiency in health outcomes. Conclusion The study highlights racial disparities in H. pylori clearance rates, particularly among Hispanics, necessitating culturally sensitive interventions. It advocates for improved diagnostics, increased healthcare access, and social determinants of health-focused initiatives. It identifies socio-economic status and language proficiency as key factors impacting health outcomes, calling for actions to bridge these disparities. Addressing these differences can decrease healthcare inequalities and economic burden, improving overall health outcomes and reducing costs associated with H. pylori clearance.

National survey of user-reported usability of electronic medical record software in ophthalmology in Germany.

A nationwide, comparative survey of the physician-reported usability of electronic medical record (EMR) software used by ophthalmologists in Germany using the System Usability Scale (SUS) as a standardized metric. A cross-sectional survey of members of the German Ophthalmological Society (DOG) and professional association of ophthalmologists (BVA) was conducted in May 2022. All 7788 physician members of both societies were invited to participate in an anonymous online-survey by individualized links. User-reported usability of the participants main software used for electronic medical recordkeeping was assessed using the SUS (range 0-100). A total of 881 participants with 51 different EMRs completed the entire questionnaire. Mean EMR-SUS score was 65.7 (SD ± 23.5). Significant differences in mean SUS of several EMR programs were observed with a range of 31.5 to 87.2 in programs with 10 or more responses. 31.8% of all main program SUS ratings were below 50 points. Female gender was associated with 4.02 higher SUS score (95% CI 0.46-7.59). Main program SUS was positively correlated with overall work-related satisfaction and work environment SUS but negatively correlated with the number of programs in the work environment. The SUS of the entire digital work environment including all programs used daily was closely correlated with the main EMR SUS, but not the number of programs used. Our survey revealed a fragmented pattern of EMR use by ophthalmologists in Germany with many competing software products and widely diverging mean System Usability Scale scores. A considerable share of ophthalmologists report EMR usability below what is commonly considered acceptable.

DEPLOYR: a technical framework for deploying custom real-time machine learning models into the electronic medical record.

Heatlhcare institutions are establishing frameworks to govern and promote the implementation of accurate, actionable, and reliable machine learning models that integrate with clinical workflow. Such governance frameworks require an accompanying technical framework to deploy models in a resource efficient, safe and high-quality manner. Here we present DEPLOYR, a technical framework for enabling real-time deployment and monitoring of researcher-created models into a widely used electronic medical record system. We discuss core functionality and design decisions, including mechanisms to trigger inference based on actions within electronic medical record software, modules that collect real-time data to make inferences, mechanisms that close-the-loop by displaying inferences back to end-users within their workflow, monitoring modules that track performance of deployed models over time, silent deployment capabilities, and mechanisms to prospectively evaluate a deployed model's impact. We demonstrate the use of DEPLOYR by silently deploying and prospectively evaluating 12 machine learning models trained using electronic medical record data that predict laboratory diagnostic results, triggered by clinician button-clicks in Stanford Health Care's electronic medical record. Our study highlights the need and feasibility for such silent deployment, because prospectively measured performance varies from retrospective estimates. When possible, we recommend using prospectively estimated performance measures during silent trials to make final go decisions for model deployment. Machine learning applications in healthcare are extensively researched, but successful translations to the bedside are rare. By describing DEPLOYR, we aim to inform machine learning deployment best practices and help bridge the model implementation gap.

Outcomes of Surgical Exploration of Acute Scrotal Pain Raising Suspicion of Testicular Torsion.

Background and objective Testicular torsion (TT) is a surgical emergency, affecting approximately one in every 4000 males under the age of 25 years annually in the United States. In this study, we aimed to determine the outcomes of emergency scrotal surgical exploration of cases that raised suspicion of TT presenting to Salmaniya Medical Complex (SMC), Bahrain's largest secondary and tertiary care center. Methods This was a retrospective cohort study. The data were collected from the hospital's electronic medical record software (I-SEHA). The data included patientage, Doppler ultrasound (DUS) findings prior to any surgical procedure, type of surgical procedure, and the surgical findings of that procedure. Results Of the 198 patients who underwent scrotal exploration, 141 had presented with signs and symptoms suggestive of TT. The mean age of the patients was 22.3 ±9.3years. Doppler imaging was performed preoperatively on 135 out of 141 (95.7%) patients. After scrotal exploration, 91.4% of the patients were found to have TT. The proportion of patients with salvageable testiswas 78.7%. Conclusions The study found that surgical exploration remains the definitive method in the management of acute scrotum in TT patients. Our findings are in line with those from other similar studies and meta-analyses.

Neutrophil to lymphocyte ratio can predict overall survival in patients with stage II to III colorectal cancer.

The neutrophil-to-lymphocyte ratio (NLR) is a prognostic inflammatory marker in colorectal cancer (CRC), however, little is known for its prognostic role in stage II to III CRC patients underwent curative resection. This study was aimed to investigate prognostic role of NLR in stage II to III CRC patients underwent surgery. Medical records of 1378 newly diagnosed CRC patients between June 2006 and March 2020 were reviewed. Data were collected by using electronic medical record software. Survival rate were analyzed using the Kaplan-Meier method. The cutoff values of NLR in stage II to III CRC patients were defined by maximally selected log-rank statistics. Multivariable cox proportional-hazard models were performed to find risk factors associated with overall survival (OS) in stage II to III CRC patients underwent surgery. Among 1378 CRC patients enrolled, 910 patients underwent surgery. In entire surgical cohort, age, body mass index (BMI), CEA, carbohydrate antigen 19-9 (CA 19-9), lymphatic invasion, NLR, and albumin-to-globulin ratio (AGR) were found to be risk factors associated with OS (all P < .05). In stage II to III CRC patients underwent curative resection (n = 623), age, BMI, lymphatic invasion, AGR, and NLR were found to be risk factors associated with OS (all P < .05). In the multivariable analysis, CA 19-9 and lymphatic invasion were independent risk factors for OS in entire surgical cohort. In the multivariable analysis for the stage II to III CRC patients, age, BMI, lymphatic invasion and NLR (Hazard ratio = 2.41, 95% confidential interval [CI]: 1.04-5.595, P = .041) were independent risk factors for OS. NLR can be used as a clinically simple and useful parameter for predicting OS in stage II to III CRC patients undergoing curative resection, however, its optimal cutoff value should be further evaluated.

186: IMPLEMENTATION OF A CRITERIA-BASED ALGORITHM FOR ALBUMIN UTILIZATION FOLLOWING CARDIAC SURGERY

Introduction: Although there is ample evidence supporting goal-directed fluid therapy during the perioperative period in cardiac surgical patients, there is inconsistent data on the fluid of choice. Existing literature has shown conflicting results between crystalloids vs. colloids (specifically albumin), creating ambiguity regarding albumin’s safety, efficacy, and place in therapy. The goal of this study was to develop and implement a criteria-based algorithm for albumin utilization following cardiac surgery and analyze its ability to standardize quality of care, enhance appropriateness of albumin utilization, and optimize documentation. Methods: The implemented process strategy incorporated a multi-phase approach: (1) criteria-based albumin algorithm implementation; (2) provider education; and (3) enhancements to the electronic medical record software to facilitate accurate documentation. All adult cardiac surgery patients who received postoperative albumin during the following periods were included: provider-driven prescribing (retrospective control, 4 months) versus criteria-based prescribing per algorithm (prospective study cohort, 4 months). The primary objective of the study was to evaluate the impact of this intervention on albumin utilization/appropriateness and quality of care (ICU length of stay, ventilator days, vasopressor use, and Hi-Flow/BIPAP post-extubation, dialysis requirement, and blood product transfusion/FFP). Secondary endpoints included the accuracy of albumin utilization documentation following enhancements to the electronic medical record software. Results: Following implementation, per-patient albumin vial requirements (5.27 vs. 4.03, p=0.67) and appropriateness of albumin utilization was maintained between groups (98% versus 95%, p=0.13). All quality of care metrics were similar between the groups. The accuracy of albumin utilization documentation demonstrated a statistically significant increase of 8% (89% vs 97% p=0.0003) following criteria-based algorithm implementation. Safety outcomes of mortality and incidence of adverse events were similar between cohorts. Conclusions: Development and implementation of a criteria-based algorithm to drive albumin utilization in postoperative cardiac surgery patients is safe and feasible.

The use of neuropsychiatric symptoms as biomarkers for a prodromal state among an electronic medical record cohort of neurodegenerative disorders

AbstractBackgroundNeuropsychiatric symptoms including anxiety, depression, psychosis, hallucinations, delusions, agitation, as well as sleep disturbances are associated with the development of dementia. We aim to show how they may be utilized as biomarkers of a prodromal state of neurodegenerative disorders.MethodA cohort of Alzheimer’s disease (AD) and Dementia with Lewy body (DLB) patients was created using EPIC electronic medical record software. Data was compiled and analyzed using Microsoft Excel program.ResultIn our cohort of 5,784 AD patients, 1,721 (29.8%) held a diagnosis of anxiety, 2,727 (47.2%) depression, 2,231 (38.6%) psychosis, 165 (2.9%) hallucinations, 144 (2.5%) delusions, 376 (6.5%) agitation, and 1,242 (21.5%) sleep disturbance. Of 355 DLB patients, 110 (31.0%) had anxiety, 165 (46.5%) depression, 183 (51.6%) psychosis, 81 (22.8%) hallucinations, 18 (5.1%) delusions, 34 (9.6%) agitation, and 95 (26.8%) sleep disturbance. Of 81 patients with diagnoses of both AD and DLB, 36 (44.4%) had anxiety, 45 (55.6%) depression, 57 (70.4%) psychosis, 18 (22.2%) hallucinations, 7 (8.6%) delusions, 7 (8.6%) agitation, and 27 (33.3%) sleep disturbance. Many patients in the cohort held more than one neuropsychiatric diagnosis.ConclusionNeuropsychiatric symptoms have been shown to precede the onset of neurodegenerative disorders, including AD and DLB, by years to decades. Our study aims to demonstrate the use of neuropsychiatric symptoms as biomarkers for the future development of neurodegenerative disease.

Using the Electronic Medical Record to Increase Laboratory Test Monitoring in Ocular Inflammation Patients: A Quality Improvement Study.

Treatment of chronic, noninfectious ocular inflammation includes corticosteroids, disease-modifying antirheumatic medications, and biologics. To mitigate adverse effects associated with the use of these medications, routine laboratory test monitoring is recommended throughout treatment. We evaluated the effectiveness of an alert added to the electronic medical record (EMR) to aid in laboratory test monitoring for patients prescribed these high-risk medications. A prospective, interventional study assessed the effect of the alert within the EMR on laboratory test ordering at the Division of Ocular Immunology at the Wilmer Eye Institute. The primary outcome measure was the change in number of ordered laboratory tests at 3, 6, and 12 months after the alert activation compared with pre-intervention levels and overall through the study period. The laboratory tests that were monitored included complete blood count, comprehensive metabolic panel, dual-energy x-ray absorptiometry (DXA) scanning, fasting lipid panel, and interferon gamma release assays. The laboratory test orders for 153 patients on high risk medications were analyzed. Only the frequency of ordering the DXA and interferon gamma release assays increased significantly, compared with baseline, throughout the study. Conversely, there was a significant decrease in the frequency of ordering of fasting lipid profiles and hemoglobin A 1c at each time point and for complete blood count and comprehensive metabolic panel at the 6-month time point. An EMR alert results in increased laboratory test ordering initially for tests drawn on a yearly basis, but the effect on more frequently ordered tests wanes with time if the alert can be silenced by the provider. Nonetheless, it provides a novel mechanism to increase laboratory ordering in patients on high-risk medications that can be adapted for use in other EMR software. Future studies are needed to assess whether physician laboratory test ordering behavior is altered throughout the study period with the use of a non-silencable alert.

Incidence of drug-drug interactions of QT-prolonging drugs in an onco-hematological outpatient

Abstract Background Oral anticancer therapy is increasingly integrated into the care of patients (pts) with cancer. Recognition and management of pharmacodynamic drug-drug interactions is critical to provide efficacious and safe anticancer treatment. Purpose We aimed to gain insight into the real-world prevalence of potentially significant drug-drug interactions of QT-prolonging with oral antineoplastic agents used in an Oncohematological Hospital Methods We performed a prospective observational study in an oncohematological hospital between October 2020 and June 2021. Consecutive pts diagnosed with an oncohematological neoplasia and who were evaluated before start treatment with an oral anticancer drug or suport treatment (antibiotics, antivirals) were included. Cancer treatment data were obtained from our prescription software System. Demographic data and concomitant medication were obtained from our electronic medical record software. Micromedex was used to find potencial QT-prolonging interactions between anticancer drugs and chronic medication, and were classified as major or moderate. Results Oncohematological treatment was started in 1.217 pts during the study period. A total of 266 potential drug-drug interactions were detected in 171 patients (14.5%). A total of 46 drug-drug interactions of QT-prolonging (17.3%) were detected in 37 pts (21.6%), 22 men and 15 women, with a median age of 66.6 (range 40.9–87.3). Twenty-one (45.7%) and 25 (56.3%) drug interactions of QT-prolonging were classified as major and moderate, respectively, with a median interaction per pts 1.24 (1–3). The 3 most common cancers were: Renal carcinoma in 12 pts (32.4%), non-small cell lung carcinoma in 9 pts (24.7%) and prostate carcinoma in 4 pts (10.8%). The most commonly detected interacting drugs were sunitinib 12 pts (26.1%), osimertinib 10 pts (21.7%), and cabozantinib 5 pts (10.9%) among oncohematological drugs, and citalopram 8 (17.4%), quetiapine 6 (13%) and tramadol 5 (10.8%) among concomitant drugs. Conclusion Drug-drug interactions can play a significant role in drugs' cardiac safety in oncohematological pts, specially in renal, lung and prostate cancers, with more than one potential interacting drug or at least one major interaction. Cardiac monitorizacion should be considered when potential drug drug interaction is detected. Funding Acknowledgement Type of funding sources: None.

Electronic medical record use and associated factors among healthcare professionals at public health facilities in Dire Dawa, eastern Ethiopia: A mixed-method study.

Despite the significant benefits of digital health technologies (ITs), developing countries are lagging behind their developed counterparts in the adoption of electronic medical records (EMRs) in a healthcare setting. EMRs have long been considered essential elements in improving the quality of healthcare. However, the rate of utilization of EMRs among healthcare providers still remains low, particularly in developing countries. This study aimed at exploring EMR use and its determinants among healthcare providers at public health facilities in Dire Dawa, eastern Ethiopia. A quantitative cross-sectional study was conducted among 402 health professionals working at public health facilities supplemented with an exploratory qualitative study in Dire Dawa, Ethiopia. Descriptive summary statistics and binary and multivariable logistic regression analysis were used to explore the determinant factors of EMR use, while qualitative data were thematically analyzed. Overall, about a quarter (26.6%) of health professionals were using electronic medical records. A work experience of 6 years or less [adjusted odds ratio (AOR) = 2.23; 95% confidence interval (CI): [1.15-4.31]], a discussion on EMR (AOR = 14.47; 95% CI: [5.58-7.57]), the presence of an EMR manual (AOR = 3.10; 95% CI: [1.28-7.38]), and a positive attitude toward the EMR system (AOR = 11.15; 95% CI: [4.90-25.36]) and service quality (AOR = 8.02; 95% CI: [4.09-15.72]) were independent determinants of EMR use. Poor collaboration among stakeholders and dependence on the software programs of NGOs were the main challenges cited by key informants. The findings of this study indicate that EMR use by health professionals in the study area is very low. Several organizational, technical, and behavioral factors were identified for this low utilization. Therefore, there is a need to leverage EMRs through continuous technical support and commitment to enhance its use, which has the potential to improve health service performance. Developing locally applicable EMR software should be considered.

Cycle Threshold Value as a Predictor of Severity and Intensive Care Unit Admission for Children Presenting to the Emergency Department With COVID-19: A Single-Center Experience From Saudi Arabia.

Introduction: The alarming infection rates of COVID-19 and variability in disease severity and outcome created the need for a prognostic marker to predict disease severity, prioritize services, and assist in clinical decision-making. The cycle threshold (Ct) value was hypothesized to be inversely correlated with viral load and subsequently disease severity. Therefore, it gained clinical interest and was an important topic for research. In this study, we aimed to determine the accuracy of the Ct value as a predictor of clinical severity in children presenting to the emergency department with COVID-19. Specifically, we aimed to compare the relationship between clinical severity among patients with high vs. low Ct values as well as to assess the correlation between the mean Ct value with the mean number of symptoms.Methods: This is a single-center retrospective cohort study. Data were obtained from the electronic medical record software of King Abdulaziz Medical City in Jeddah, Saudi Arabia. The present study included randomly selected COVID-19 cases aged ≥1 months to 18 years who presented to the emergency department between March 2020 and May 2021. Collected clinical data were matched with laboratory data at the time of diagnosis to examine the association between Ct values and clinical factors.Results: A total of 191 COVID-19 PCR-positive children were included with an overall mean Ct value of 11.5, a median of 10, and a highest Ct value of 25. The mean age of the patients was 95 months. More than half (51.35%) of the patients were admitted to the hospital, while 2.09% were admitted to the intensive care unit and one patient (0.52%) died. There was no significant association between Ct values and demographics or clinical characteristics of the patients.Conclusion: We demonstrated a lack of association between SARS-CoV-2 Ct value detected in nasopharyngeal swabs with disease severity, number of symptoms, oxygen requirement, intensive care unit admission, or length of hospital stay in the pediatric population presenting to the emergency department with COVID-19. This finding does not support the routine reporting of Ct values to aid clinicians in making clinical and patient-management decisions for COVID-19 patients or guide infection control or public health decisions. Further studies confirming our observations are needed.

Current situation of electronic medical records in ophthalmological departments in Germany

Electronic medical records are required in ophthalmology clinics to be integrated into digital care networks and efficient clinical registry databases. To assess the prevalence and methods of electronic medical recordkeeping in inpatient ophthalmological care in Germany. An online questionnaire was sent to all German university eye hospitals and ophthalmology departments in June 2021. It included13 open and closed option questions concerning current practices of digital recordkeeping, including the structure of data storage and the recording of billing-relevant codes in the departments. A total of 44 (44%) out of 100 clinics responded. Patient documentation was completely digital in15 (34%) clinics and partly digital and paper-based in the remaining29 (66%). A total of 16different constellations of documentation programs were specified. The most frequently used programs were Orbis (27%) (Dedalus HealthCare, Bonn, Germany), FIDUS (18%) (Arztservice Wente, Darmstadt, Germany), and SAP/i.s.h.med (16%) (SAP Deutschland, Walldorf, Germany; Cerner Deutschland, Berlin, Germany) and 3 clinics indicated primary use of paper records. Structured documentation of findings was performed in 61% of the departments, while 23% used asemistructured manner and 15% used anonstructured format. Electronic documents are stored as DICOM (Digital Imaging and Communications in Medicine) documents 20% of the clinics and as PDF (Portable Document Format) files in 34% of the clinics while 23% store scanned printouts. Methods of medical record keeping in German eye clinics are heterogeneous, with paper-based documentation continuing to play an important role. This, as well as the high number of different electronic medical record software pose important challenges in terms of interoperability and secondary use of clinical data.