Electronic Patient Health Record Research Articles

Ginkgo biloba extract prescriptions are associated with less frequent repeat visits to ENT doctors due to tinnitus: a retrospective cohort study.

We aimed to evaluate the drug utilization of Ginkgo biloba extract (Gbe), systemic corticosteroids (CSs), and pentoxifylline (PTXF) for the treatment of acute tinnitus by analyzing electronic patient health record data. In addition, we assessed whether the different drug treatments were associated with different frequencies of repeat visits to ear, nose, and throat (ENT) doctors. This retrospective cohort study used data from the IQVIA Disease Analyzer (DA) database. It included patients with an initial diagnosis of tinnitus between January 2005 and December 2021, treated by ENT specialists in Germany. Of 111,629 patients meeting all selection criteria, 51,205 received prescriptions of Gbe, 34,817 of systemic CSs, and 25,607 of PTXF. Gbe prescription was associated with significantly lower odds of a repeat consultation due to tinnitus compared to systemic CSs [odds ratio (OR) 0.91; 95% confidence interval (CI): 0.88-0.95] as well as PTXF (OR 0.74; 95% CI: 0.72-0.77). This association was significant in both men and women and in some age groups. Gbe is the most frequently ENT specialist-prescribed drug for the treatment of acute tinnitus. It is associated with a reduced likelihood of patients consulting their ENT specialist for tinnitus again compared to systemic CSs and PTXF.

Co-design of a digital violence prevention and management tool for psychiatric inpatient care: focus on supporting integration into electronic health record system

IntroductionViolence in psychiatric inpatient settings is a global challenge. Several methods have been developed and tested to help staff prevent the occurrence of violence on the wards. One novel and effective method is eDASA+APP, originating from Australian forensic psychiatric settings (Maguire et al. Int J Ment Health Nurs 2019; 281186-1197, Griffith et al. Psychiatr Serv 2021; 72 885-890). This electronic method contains an instrument (DASA) to assess the risk for imminent violence and includes evidence-based violence risk management methods for risk levels. It is important to ensure that this electronic intervention is integrated into daily clinical practice. This can be done in co-design between all that are involved e.g., staff and experts by experience, and by encouraging them to achieve a common goal and gain benefits by working together.ObjectivesThis prevention gives an overview of how the Finnish version of eDASA+APP was co-designed with healthcare staff and experts by experience, focusing on integration into the electronic patient health record system. The presentation is part of a larger research project testing eDASA+APP in Finnish psychiatric inpatient care.MethodsCo-design workshops focusing on three major themes: 1) identifying current practices and how eDASA+APP would fit in those, 2) producing a linguistically and culturally appropriate version of eDASA+APP, and 3) preferred use of eDASA+APP in an electronic patient health record system. Notes were kept during the workshops by researchers. Qualitative material were analysed with deductive content analysis. Results from the third theme are shared in this presentation.ResultsStaff and experts by experience described that integration of eDASA+APP in electronic patient health record system is supported if it 1) brings clear and fast information to the staff about the violence risk of a patient, 2) is a visible measure that is concretely in sight in electronic patient health record system, 3) provides information about which violence prevention and management interventions have worked with a patient, 4) involves patient preferences, and 5) consist of joint decisions that have been agreed multi-professionally.ConclusionsIntegration of eDASA+APP in the electronic patient health record system has the potential to succeed if it is realized in cooperation with staff and experts by experience, is technically easy to use, and the users have an understanding of its benefits to everyone involved.Disclosure of InterestNone Declared

A Nationwide Digital Multidisciplinary Intervention Aimed at Promoting Pneumococcal Vaccination in Immunocompromised Patients.

Immunocompromised patients (IPs) are at high risk for infections, some of which are vaccine-preventable. The Israeli Ministry of Health recommends pneumococcal conjugate vaccine 13 (PCV13) and pneumococcal polysaccharide vaccine 23 (PPSV23) for IP, but vaccine coverage is suboptimal. We assessed the project's effectiveness in improving the pneumococcal vaccination rate among IP. An automated population-based registry of IP was developed and validated at Maccabi Healthcare Services, an Israeli health maintenance organization serving over 2.6 million members. Included were transplant recipients, patients with asplenia, HIV or advanced kidney disease; or those receiving immunosuppressive therapy. A personalized electronic medical record alert was activated reminding clinicians to consider vaccination during IP encounters. Later, IP were invited to get vaccinated via their electronic patient health record. Pre- and post-intervention vaccination rates were compared. Between October 2019 and October 2021, overall PCV13 vaccination rates among 32,637 IP went up from 11.9% (n = 3882) to 52% (n = 16,955) (p < 0.0001). The PPSV23 vaccination rate went up from 39.4% (12,857) to 57.1% (18,652) (p < 0.0001). In conclusion, implementation of targeted automated patient- and clinician-facing alerts, a remarkable increase in pneumococcal vaccine uptake was observed among IP. The outlined approach may be applied to increase vaccination uptake in large health organizations.

Diagnosis of Chronic Diseases Based on Patients’ Health Records in IoT Healthcare Using the Recommender System

Due to the growth of IoT applications, especially health care, the information of patients’ health records using data collection from IoT-connected devices has been considered. Biological data of patients in the health record helps to monitor the patient’s status and identify various diseases. Chronic diseases are a type of silent disease that, if not diagnosed in time, can cause irreparable damage to patients. The use of patients’ medical record data for early diagnosis of chronic diseases has recently attracted the attention of many researchers. On the other hand, the application of machine learning methods in the form of recommender systems has taken an important step in improving medical services and health care. In this paper, a medical recommender system was presented to identify and treat chronic diseases using an IoT device. In the present method, the electronic patient health record dataset that is loaded in the PhysioNet data repository has been used. In the present dataset, patients’ health records have been recorded according to the identified diseases and the physician’s diagnosis. In the proposed method, the K -nearest neighbor classification method is used to identify the type of disease, and the collaborative filtering method is used to find the appropriate treatment for patients. The results of the implementation of the proposed method show that this approach, based on the use of symptom similarity among patients, has good accuracy in diagnosing and predicting chronic diseases and has provided higher results than previous methods.

POS-282 ASSOCIATION BETWEEN PRIMARY CARE CODING OF CHRONIC KIDNEY DISEASE (CKD) AND SUBSEQUENT HOSPITALISATIONS AND DEATH: A COHORT ANALYSIS USING NATIONAL AUDIT DATA

In UK primary care, there are payment incentives to test for chronic kidney disease (CKD) and to add CKD-specific diagnosis codes to the electronic patient health record to establish a register of stage 3-5 CKD patients. The National Chronic Kidney Disease Audit (NCKDA) in England and Wales found that not all patients with biochemical evidence of CKD stages 3-5 were coded; those who were not coded had less cardiovascular preventative care than those who were coded. Practice-level coding is less likely to be influenced by individual patient characteristics and is therefore potentially less confounded than analyses using patient-specific coding decisions. We investigated the association between practice-level coding of CKD and individual adverse outcomes to quantify the effects of coding in patients with CKD. We conducted a retrospective cohort study linking NCKDA primary care records with Hospital Episode Statistics (HES) admissions and Office for National Statistics (ONS) mortality data in England. Patients with confirmed CKD (2 x estimated glomerular filtration rate < 60 ml/min/1.73m2, separated by ≥ 90 days, with the latest measure within 2 years prior to data extraction) were included, excluding those with coded initiation of renal replacement therapy. Cox proportional hazards regression models with splines, adjusted for practice characteristics, were used to investigate the association between practice percentage of confirmed CKD cases with a stage 3-5 CKD code and patient outcomes: hospitalisation for cardiovascular (CV) events, hospitalisation for heart failure (HF), hospitalisation with acute kidney injury (AKI) and all-cause mortality. 167,208 patients from 637 primary care practices in England were included in analysis, with a median follow up time of 3.8 years for hospitalisations and 4.3 years for deaths. Patient characteristics were well balanced in the two-thirds of most typically performing practices (55% to 88% coded CKD), but with slight differences at the extremes. Rates of CV and HF admissions were significantly reduced as practice CKD coding performance increased (Figure 1). In practices coding 60% of CKD cases, patients had a 4.8% (0.9%, 9.0%) higher hazard of CV hospitalisations and an 8.6% (1.5%, 16.1%) higher hazard of HF hospitalisations than the average practice (74% coded). Trends of a small reduction in AKI but no substantial change in risk of deaths were also observed as CKD coding increased. Figure 1. Percent difference in hazard rates of outcomes according to practice percent coded CKD, compared to median practice coding (74% coded) among patients with confirmed CKD in the two-thirds of most typically performing practices (55% to 88% coded). Adjusted for practice characteristics: mean age, percent male, median rank of index of multiple deprivation, diabetes prevalence, hypertension prevalence, CVD prevalence, percent of CKD cases at stages 3b-5, percent of CKD patients admitted for COPD in last 3 years, percent of CKD patients admitted for cancer in last 3 years, percent GFR test in last year in diabetes, percent GFR test in last year in CKD, percent of adult population with CKD Increased CKD coding in primary care and subsequent care efforts appear to play a role in improving patient outcomes, although residual confounding due to unobserved practice characteristics cannot be ruled out.

P115 Implementation of a vaccination tool in the electronic patient health record significantly increases vaccination coverage

BackgroundPatients with immune-mediated inflammatory diseases (IMID) are at higher risk for infectious diseases. Despite this increased risk and the available guidelines1, we reported a sub-optimal vaccination rate of 27.4% of IMID patients in 2018. In the meantime, a vaccination module was introduced in the electronic patient health record of our hospital to accurately document and monitor vaccination status of patients. The impact of this new module on vaccination coverage was re-evaluated in the same IMID patients in 2021.MethodsBetween Aug and Oct 2021, the vaccination status of 1448 (out of the original 1488) IMID patients (44.8% male, median age 53.6 years) was collected (798 patients with IBD, 612 with rheumatological, and 38 with dermatological inflammatory conditions) and compared to that of 2018. The vaccination status was obtained mainly through the patients’ electronic medical records. Missing data were added after contacting patients or their general practitioner.ResultsFrom 2018 to 2021, the overall vaccination coverage of all IMID patients significantly increased from 27.4% to 51.9% (p<0.001, Figure 1).The vaccination coverage in IBD patients increased significantly from 75.9% to 86.3% for influenza (p<0.001), from 72.9% to 88.7% for pneumococci (p<0.001), from 66.0% to 80.2% for hepatitis B (p<0.001), from 79.9% to 85.7% for tetanus (p=0.041) and from 42.2% to 60.4% overall (p<0.001) (Figure 1 and Table 1).Similarly, the vaccination coverage significantly increased for rheumatology patients, namely from 69.3% to 78.3% for influenza (p<0.001), from 34.5% to 85.0% for pneumococci (p<0.001), from 32.8% to 36.5% for hepatitis B (p<0.001) and from 7.8% to 32.6% overall (p<0.001) (Figure 1 and Table 1).For patients with dermatological inflammatory conditions, vaccination coverage significantly increased from 60.5% to 81.6% for pneumococci (p=0.031) and from 47.1% to 55.3% for hepatitis B (p=0.002) (Table 1). ConclusionThe suboptimal vaccination rate measured in 2018 and the COVID-19 pandemic stressed the importance of vaccination recommendations to patients and healthcare professionals. We here show that the implementation of a vaccination tool integrated in the electronic medical record of patients is correlated with a significant increase in specific vaccination rates and also in the total amount of IMID patients that were fully vaccinated according to guidelines.Reference1. Rahier JF, Magro F, Abreu C, et al. Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis. 2014;8:443–468.

Augmenting security for electronic patient health record (ePHR) monitoring system using cryptographic key management schemes

Augmenting security for electronic patient health record (ePHR) monitoring system using cryptographic key management schemes

P205 The contemporary presentation and management of giant cell arteritis with large vessel vasculitis

Abstract Background/Aims Giant cell arteritis with large vessel vasculitis (LV-GCA) represents a distinct, less researched sub-category of giant cell arteritis (GCA). In comparison to cranial GCA, the patient’s diagnostic pathway is less well described and it is thought that LV-GCA is underdiagnosed, including in patients with polymyalgia rheumatica and cranial-GCA. Advances in imaging (e.g. PET-CT) and treatment (tocilizumab), have provided additional options in the diagnosis and management of LV-GCA. The aim was to describe the contemporary clinical journey for patients diagnosed with LV-GCA. Methods The electronic patient health record system in NHS Lothian (TrakCare) was used to collect relevant data. Patients with imaging-confirmed large vessel vasculitis, diagnosed with GCA after 1 January 2017 were included. Follow-up was until August 2020. Results Eighteen patients with LV-GCA were included. The mean age was 65 years and 66.7% were female. Two patients had known cranial-GCA but 89% of patients were diagnosed exclusively with large vessel involvement. The most common symptoms were malaise (55%), weight loss (55%), polymyalgia rheumatica (55%) and limb claudication (44%). Pyrexia of unknown origin was a feature in only 17% of patients. Two patients were asymptomatic and were investigated on the basis of raised inflammatory markers. Mean CRP at baseline was 99mg/L and ESR 85mm/hour. The mean time from symptom-onset to diagnosis was 6.8 months (range 1 to 15 months). Sixteen patients (89%) were reviewed by at least one other secondary care specialist. One third of patients were referred from General Medicine followed by Vascular Surgery (16%) and General Practice (16%). 7/18 patients were inpatients at the time of referral. 56% of patients required two modalities of imaging to confirm large vessel involvement. The most commonly used imaging techniques (in descending order) were CT-Chest/Abdomen/Pelvis, CT-angiogram, PET-CT and Vascular Ultrasound. 50% of patients underwent follow-up imaging, most commonly MR- or CT-angiography. Mean follow-up was for 1.6 years. The mean prednisolone dose at 3 months (n = 18) was 24mg daily and 8mg at 12 months (n = 12). 28% of patients relapsed during the follow-up period at 4, 5, 8, 9 and 24 months post-diagnosis. 7/18 patients were commenced on methotrexate for steroid-side effects or for relapse. 8/18 received subcutaneous tocilizumab in combination with methotrexate in two cases. Three patients were started on azathioprine but only one continued. Conclusion In modern-day clinical practice, patients with LV-GCA experience a longer time to diagnosis than those with cranial symptoms. Patients with LV-GCA can experience an array of constitutional symptoms. Frequently, more than one imaging modality is required to confirm LV-GCA and the majority of patients will have seen other hospital specialists or have been admitted to hospital before diagnosis. Methotrexate and tocilizumab are the most frequently-used and effective steroid-adjunct in this single-centre cohort. Disclosure O. Cronin: None. N.D. McKay: Consultancies; Gilead. Other; Has received support for conference attendance from Pfizer and Gilead, Has received educational support from UCB, Gilead, Celgene, Biogen, Sanofi, Abbvie, Novartis, Pfizer. H. Preston: None. H. Harris: None. B. Hauser: None.

P210 Tocilizumab versus prednisolone only treatment for giant cell arteritis: an observational study

Abstract Background/Aims Giant cell arteritis (GCA) is a medical emergency that requires prolonged high dose glucocorticoids (GC). Tocilizumab (TCZ) is currently approved for GCA in combination with GC tapering for those at high risk of glucocorticoid toxicity, who relapse or have refractory disease. The aim is to evaluate indications and characteristics of patients who were started on TCZ and to assess the rate of relapse and steroid tapering for patients on TCZ compared with an age matched prednisolone (PDN) only treated control group (CTRL). Methods Retrospective review of electronic patient health record data of patients who were diagnosed and treated for GCA in a single rheumatology centre from January 2017- July 2020. All patients were initially treated with high dose PDN (40-60 mg/day) with subsequent steroid tapering with or without TCZ (162 mg/week). Results We included 36 GCA patients who were treated with TCZ+PDN and 26 patients with PDN only. Mean age of patients started on TCZ was 69.3±6.8, 81% were female. There was no significant demographic difference to the CTRL group.The most common reason for starting TCZ (50%) was a GCA relapse requiring uptitration of PDN. 13 patients (36%) started TCZ as they had developed significant steroid side effects including steroid-induced diabetes, hypertension and osteoporosis related fragility fractures. Almost one fifth of patients (19.4%) who were started on TCZ had imaging evidence of large vessel involvement.The mean PDN dose of patients who started TCZ was 26.6±13.1 mg/day. Patients who started TCZ were able to approximately half the PDN dose every 3 months. The average daily PDN dose was 11.3±7.0 mg after 3 months, 6.0±4.3 mg after 6 months, and 3.3±4.7 mg after 12 months of starting TCZ. When compared with the CTRL group (4%), significantly more TCZ patients (41.7%) were able to reduce the PDN dose to a low dose (0-5 mg) after 6 months treatment (p = 0.001).During the course of treatment more CTRL patients (34.6%) relapsed than patients receiving TCZ (11.1% vs CTRL, p = 0.013). The majority of TCZ patients (88.9%) stayed in remission and 2 (5.6%) patients completed 12 months treatment and have ceased therapy. 4 (11.1%) patients stopped Tocilizumab due to side effects (diarrhoea, diverticulitis, scalp irritation) and 2 stopped due to concerns over long term risks. Conclusion Our real-world study shows that TCZ is predominantly initiated in those who relapse or develop GC related side effects. Patients who received TCZ were able to half their PDN dose every 3 months and had lower 6 and 12-month PDN requirements compared to those on PDN solely. The relapse rate was significantly higher in the PDN only treated group than in the TCZ group. TCZ is a good option as steroid sparing agent for the treatment of GCA. Disclosure H. Preston: None. O. Cronin: None. B. Kuske: None. N.D. McKay: None. B. Hauser: Honoraria; Dr Hauser has received speaker fees from Roche.

Augmenting security for electronic patient health record (ePHR) monitoring system using cryptographic key management schemes

Security plays a major role in most of the fields including pharmaceutical field. Authorization and Authentication are the key concepts in supporting notable areas of the cyber-health world. HIPAA's (Health Insurance Portability and Accountability Act) ultimate focus is to preserve the privacy of the health records of an individual without disclosing it and preventing the data from unauthorized access. A complaint key management solution is applied over the patient's health records to reduce the risk factor while engaging with cryptographic mechanisms. Though there are many existing cryptographic algorithms such as Elliptic curve cryptography, Elgammal's key exchange algorithm which provides security to the access of patient's health records, the proposed key management solution will overlay the same variant of security to the Electronic Health Records (EHR). This paper provides the countermeasures for improving security and suggests a key recovery mechanism for the protection of keys used in the security mechanism.

Are high-cost drug funding mechanisms fit for purpose? A retrospective study of individual funding requests in an NHS tertiary hospital.

To report on a retrospective study of individual funding request (IFR) submissions from a large tertiary hospital and describe gaps in current mechanisms for funding of high-cost medicines in England. Data on the number and outcome of IFR submissions submitted to commissioners between 2014/15 and 2018/19 was extracted from the electronic patient health record and a local high-cost drug database. In total, 230 IFRs were submitted: 112 to NHS England and 118 to a Clinical Commissioning Group (CCG). The decline rate for IFRs was 71% for NHS England and 34% for CCGs. Lack of exceptionality was the primary reason cited for declining IFRs submitted between 2016-18 (n = 42/45; 93%). Half of the patients whose IFR was declined received treatment funded through other routes, the majority (13/23; 57%) from internal hospital budget. This was governed via a local high-cost drug panel. Positive clinical outcomes were observed in 50% (4/8) of patients who received NHS England IFR-funded treatment, 54% (19/35) who received CCG IFR-funded treatment and 91% (21/23) who were funded via other routes. The high rate of IFR decline signals inefficient use of resource expended in the IFR process. Gaps in access to high-cost medicines remain for patients with rare and refractory disease requiring urgent treatment, largely due to the demand for exceptionality from NHS commissioners. Local mechanisms address this unmet need but have limitations. An outcomes-based evaluation approach to commissioning and greater transparency of previous funding decisions by commissioners may improve efficiency and equity in the IFR system.

Electronic patient files in hospital information systems

HintergrundDie Einführung einer elektronischen Patientenakte (EPA) im Bereich der Ophthalmologie stellt für viele Kliniken eine Herausforderung dar. Obwohl alle Kliniken ein Krankenhausinformationssystem (KIS) besitzen, sind die wenigsten dieser Systeme für die komplexe ophthalmologische Patientenakte gerüstet.MethodikWir berichten über die Implementierung einer ophthalmologischen EPA innerhalb des vorherrschenden KIS (Agfa-ORBIS; Agfa HealthCare GmbH, Bonn). Dabei werden sowohl die digitale Aktenführung als auch die Anbindung der vorhandenen Untersuchungsgeräte dargestellt.ErgebnisseDie von uns entwickelte EPA wird im klinischen Alltag seit 2009 genutzt und seitdem kontinuierlich weiterentwickelt. Durch eine enge Zusammenarbeit mit der IT-Abteilung konnten alle Untersuchungsgeräte digital angebunden werden und ein papierloses Arbeiten ermöglichen und die Nachteile der Papierakte vermeiden.DiskussionDie Nutzungsmöglichkeiten einer in das vorhandene KIS implementierten EPA sind vielfältig. Durch solch ein System kann eine lückenlose, fächerübergreifende und ubiquitäre Dokumentation erfolgen. Die Alternative stellt die Anschaffung eines Drittsystems dar, welches sowohl durch eine Schnittstelle mit dem Hauptsystem verbunden werden muss als auch deutliche höhere Anschaffungs- und Erhaltungskosten aufweist.

Current use of measurement instruments by physiotherapists working in Germany: a cross-sectional online survey

BackgroundThe use of measurement instruments in physiotherapy has been recommended in clinical practice guidelines to improve evidence-based practice. The aims of the study were (a) to describe the current use of measurement instruments by physiotherapists working in Germany and (b) to investigate the facilitators and barriers to use measurement instruments.MethodsThis cross-sectional study used a nationwide online survey, which was accessible to all physiotherapists working in Germany.ResultsIn total, 522 adult physiotherapists working in Germany completed the questionnaire. The mean age of the respondents was 38 years, 63% were female, and 53% had >10 years of work experience.Thirty-one percent of the respondents used measurement instruments in ≥80% of their patients, and 26% used measurement instruments in ≤20%. Measurement instruments were used for diagnostic and prognostic purposes by 69% and 22% of respondents, respectively. The three most frequently reported measurement instruments were “goniometer” (n = 254), some kind of a “visual/numeric analogue scale” (n = 139), and the “manual examination of muscle-strength” (n = 54). Seven of the 13 most stated measurement instruments measure activities or participation.The most important facilitator was physiotherapists’ positive attitudes towards measurement instruments. Two out of three respondents reported having sufficient knowledge and skills to apply measurement instruments in clinical practice. The most pronounced barriers were insufficient additional financial compensations and requiring extra time to document test scores. Seventy-eight percent of the respondents could imagine using an electronic device for a user-friendly patient health record system in clinical practice.ConclusionsThe limited use of measurement instruments reported by physiotherapists working in Germany appears to be due to organisational issues, in combination with a lack of knowledge and skills needed to apply the measurement instruments, rather than due to individual or managerial reasons. To support the use of measurement instruments, sufficient time resources and adequate financial compensation are required. Educational approaches should focus on imparting patient-centred and patient-reported outcomes to quantify activities and participation. Electronic patient health record systems have potential to facilitate the application of standardised measurement instruments if the barriers identified in this survey are addressed properly.

Facilitators and barriers using an electronic patient health record system in physiotherapy – a survey among physiotherapists in Germany

Relevance: The impact of treatment on patients’ daily activities can be assessed with valid and reliable outcome measures, but the use of standardized outcome measures by physiotherapists appeared to be limited in many countries (1). The need for physiotherapist to use standardized measures has been recognized and is recommended in clinical practice guidelines. A range of strategies was implemented that aimed to increase physiotherapists’ use of standardized outcome measures (1). However, little is known about the usage of electronic patient health record system as an assistive tool to reinforce clinical application of outcome measures.

A Novel Reference Security Model with the Situation Based Access Policy for Accessing EPHR Data.

Electronic Patient Health Record (EPHR) systems may facilitate a patient not only to share his/her health records securely with healthcare professional but also to control his/her health privacy, in a convenient and easy way even in case of emergency. In order to fulfill these requirements, it is greatly desirable to have the access control mechanism which can efficiently handle every circumstance without negotiating security. However, the existing access control mechanisms used in healthcare to regulate and restrict the disclosure of patient data are often bypassed in case of emergencies. In this article, we propose a way to securely share EPHR data under any situation including break-the-glass (BtG) without compromising its security. In this regard, we design a reference security model, which consists of a multi-level data flow hierarchy, and an efficient access control framework based on the conventional Role-Based Access Control (RBAC) and Mandatory Access Control (MAC) policies.

Direct-to-patient disclosure of results of mismatch repair screening for Lynch syndrome via electronic personal health record: a feasibility study.

PurposeThe adoption of universal mismatch repair (MMR) screening of colorectal (CRC) and endometrial cancers (EC) has the potential to improve detection of Lynch syndrome (LS) and health outcomes among cancer patients and family members. Electronic patient health records (ePHRs) represent an innovative, resource-efficient route to deliver results directly to patients that could be enhanced by multi-media interventions to improve critical downstream outcomes. The current study examines feasibility and acceptability of this approach.MethodsPatients hospitalized for resection of CRC or EC were recruited to receive their MMR result via institutional ePHR. Baseline and follow-up assessments were conducted.Results74% (49/66) of eligible patients consented, and 81% (29/36) participants who had a result posted to their ePHR completed follow-up, surpassing feasibility thresholds, with 14% (5/36) receiving an abnormal result. Ratings of the study approach surpassed the acceptability threshold–97% had a mean score of ≥4 on a 7-point scale–and were high regardless normal or abnormal result. Ineligibility was more common among non-White (p=0.009) and ≥65 (p=0.035) participants due to low Internet use/no access.ConclusionePHR-based result disclosure for MMR screening is feasible to study and acceptable to patients, but minority and elderly patients may experience greater barriers to participation.

Point-of-Care INR Determination, Coumadin Dosage Changes, and Use of a Historical, Self-Updating Database in a Prison

Coumadin is the most dangerous medicine in common use in primary care medicine as well as in the correctional setting. In the Maryland Division of Correction's Eastern Correctional Institution, a multivendor collaboration between the medical director and a clinical pharmacist maintained a point-of-care, finger stick international normalized ratio determination using a portable monitor. With an anticoagulation clinic protocol as a guide, changes are considered in the Coumadin dosage and made through the usual procedure. Results are recorded in an electronic patient health record and tracked in a database that shows the current data page as well as updated historical data for each inmate.

A Review of Medication Reconciliation Issues and Experiences with Clinical Staff and Information Systems

Medication reconciliation was developed to reduce medical mistakes and injuries through a process of creating and comparing a current medication list from independent patient information sources, and resolving discrepancies. The structure and clinician assignments of medication reconciliation varies between institutions, but usually includes physicians, nurses and pharmacists. The Joint Commission has recognized the value of medication reconciliation and mandated implementation in 2006; however, a variety of issues have prevented simple, easy, and universal implementation. This review references issues related to the development and the implementation of medication reconciliation including: - the need of a system or standard for accurate drug identification to create a definitive 'gold standard' patient medication list, - identifying stakeholders of medication reconciliation within the institution and contrasting staff interest and participation with institutional resources, - observations and opportunities of integrating medication reconciliation with the electronic patient health record, and - summarizing a series of institutions experiences developing and implementing medication reconciliation. Last, as medication reconciliation becomes a regular process within medical centers, key concepts for effective implementation are discussed.

Die elektronische Anwendung der NANDA-, NOC- und NIC-Klassifikationen und Folgerungen für die Pflegepraxis

The data model developed on behalf of the Nursing Service Commission of the Canton of Zurich (Pflegedienstkommission des Kantons Zürich) is based on the NANDA nursing diagnoses, the Nursing Outcome Classification, and the Nursing Intervention Classification (NNN Classifications). It also includes integrated functions for cost-centered accounting, service recording, and the Swiss Nursing Minimum Data Set. The data model uses the NNN classifications to map a possible form of the nursing process in the electronic patient health record, where the nurse can choose nursing diagnoses, outcomes, and interventions relevant to the patient situation. The nurses' choice is guided both by the different classifications and their linkages, and the use of specific text components pre-defined for each classification and accessible through the respective linkages. This article describes the developed data model and illustrates its clinical application in a specific patient's situation. Preparatory work required for the implementation of NNN classifications in practical nursing such as content filtering and the creation of linkages between the NNN classifications are described. Against the background of documentation of the nursing process based on the DAPEP(1) data model, possible changes and requirements are deduced. The article provides a contribution to the discussion of a change in documentation of the nursing process by implementing nursing classifications in electronic patient records.