E-mail Notification System Research Articles

Integrated Automatic Examination Assignment Reduces Radiologist Interruptions: A 2-Year Cohort Study of 232,022 Examinations

Radiology departments face challenges in delivering timely and accurate imaging reports, especially in high-volume, subspecialized settings. In this retrospective cohort study at a tertiary cancer center, we assessed the efficacy of an Automatic Assignment System (AAS) in improving radiology workflow efficiency by analyzing 232,022 CT examinations over a 12-month period post-implementation and compared it to a historical control period. The AAS was integrated with the hospital-wide scheduling system and set up to automatically prioritize and distribute unreported CT examinations to available radiologists based on upcoming patient appointments, coupled with an email notification system. Following this AAS implementation, despite a 9% rise in CT volume, coupled with a concurrent 8% increase in the number of available radiologists, the mean daily urgent radiology report requests (URR) significantly decreased by 60% (25 ± 12 to 10 ± 5, t = -17.6, p < 0.001), and URR during peak days (95th quantile) was reduced by 52.2% from 46 to 22 requests. Additionally, the mean turnaround time (TAT) for reporting was significantly reduced by 440 min for patients without immediate appointments and by 86 min for those with same-day appointments. Lastly, patient waiting time sampled in one of the outpatient clinics was not negatively affected. These results demonstrate that AAS can substantially decrease workflow interruptions and improve reporting efficiency.

Smart Waste Management System: A Novel Approach to Waste Collection in Twenty-First Century Smart City

It has been observed that domestic household bins are still being manually collected by the municipality. This old method of trash removal has flaws. It is labour-intensive. In this paper, we design and implement a novel innovative domestic waste management system. To achieve this aim, specific objectives had to be achieved. These were to design and implement a motor driver controller (MDC), obstacle detection system (ODS), email notification system, trash status monitoring, internet time-based trigger (ITT), and finally, integrating all the systems together. The project was divided into two phases: the design phase and the integration phase. The finished prototype was tested and demonstrated to function according to the design specifications. When the bin is empty, the system remains at the origin. Only when the bin is full that the system moves to the disposal point. When an obstacle is detected, it stops and sends a push notification via email to the user. Once the obstacle is removed, the system continues its path until it reaches its destination. The design objectives were achieved.

Non-destructive technique for erosion and corrosion monitoring system

Erosion and corrosion of pipeline occurs over time and this data should be given the same care as other data in oil and gas industry. Moreover, most notification systems available send an alert only when the issue is at a late stage. Therefore, the aim of this study is to create a monitoring system that would help in minimizing the impact of erosion and corrosion of pipeline related issues. There are three objectives includes: data separation, online and offline database storage and an email notification system. This study also emphasizes the importance of incorporating a database for evaluation of oil and gas pipeline’s wall thickness data in terms of its health status. As the data obtained is essential, a web application is created to store the data whenever internet is available. Otherwise, it will be stored in a temporary offline database known as MYSQL Workbench, and the data is automatically uploaded once the internet is available. A notification system via internet is developed to notify the executives regarding unhealthy pipeline status. A healthy pipeline wall thickness is between 4.3mm and 4.5mm. Thus, data with lower than 4.3mm is noted as eroded while data greater than 4.5mm is recorded as corroded. The monitoring system designed for online and offline data storage along with email notification performed accordingly. Therefore, the developed system fulfils the objectives and help in mitigating erosion and corrosion of pipelines related issues at an earlier stage in saving lives, maintenance fees and the environment.

Enhanced Communication for Interhospital Transfers Increases Preparedness in an Academic Tertiary Care Center.

This quality improvement project sought to enhance clinical information sharing for interhospital transfers to an inpatient hepatology service comprised of internal medicine resident frontline providers (housestaff) with the specific aims of making housestaff aware of 100% of incoming transfers and providing timely access to clinical summaries. In February 2020, an email notification system to senior medicine residents responsible for patient triage shared planned arrival time for patients pending transfer. In July 2020, a clinical data repository ("Transfer Log") updated daily by accepting providers (attending physicians and subspecialty fellows) became available to senior medicine residents responsible for triage. Likert scale surveys were administered to housestaff before email intervention (pre) and after transfer log intervention (post). The time from patient arrival to team assignment (TTA) in the electronic medical record was used as a proxy for time to patient assessment and was measured pre- and postinterventions; >2 hours to TTA was considered an extreme delay. Housestaff reported frequency of access to clinical information as follows: preinterventions 4/31 (13%) sometimes/very often and 27/31 (87%) never/rarely; postinterventions 11/26 (42%) sometimes/very often and 15/26 (58%) never/rarely (p = 0.02). Preinterventions 12/39 (31%) felt "not at all prepared" versus 27/39 (69%) "somewhat" or "adequately"; postinterventions 2/24 (8%) felt "not at all prepared" versus 22/24 (92%) somewhat/adequately prepared (p = 0.06). There was a significant difference in mean TTA between pre- and posttransfer log groups (62 vs. 40 minutes, p = 0.01) and a significant reduction in patients with extreme delays in TTA post-email (18/180 pre-email vs. 7/174 post-email, p = 0.04). Early notification and increased access to clinical information were associated with better sense of preparedness for admitting housestaff, reduction in TTA, and reduced frequency of extreme delays in team assignment.

Gisola: A High-Performance Computing Application for Real-Time Moment Tensor Inversion

Abstract Automatic moment tensor (MT) determination is essential for real-time seismological applications. In this article, Gisola, a highly evolved software for MT determination, oriented toward high-performance computing, is presented. The program employs enhanced algorithms for waveform data selection via quality metrics, such as signal-to-noise ratio, waveform clipping, data and metadata inconsistency, long-period disturbances, and station evaluation based on power spectral density measurements in parallel execution. The inversion code, derived from ISOLated Asperities—an extensively used manual MT retrieval utility—has been improved by exploiting the performance efficiency of multiprocessing on the CPU and GPU. Gisola offers the ability for a 4D spatiotemporal adjustable MT grid search and multiple data resources interconnection to the International Federation of Digital Seismograph Networks Web Services (FDSNWS), the SeedLink protocol, and the SeisComP Data Structure standard. The new software publishes its results in various formats such as QuakeML and SC3ML, includes a website suite for MT solutions review, an e-mail notification system, and an integrated FDSNWS-event for MT solutions distribution. Moreover, it supports the ability to apply user-defined scripts, such as dispatching the MT solution to SeisComP. The operator has full control of all calculation aspects with an extensive and adjustable configuration. MT’s quality performance, for 531 manual MT solutions in Greece between 2012 and 2021, was measured and proved to be highly efficient.

Improving ACGME Compliance for Obstetric Anesthesiology Fellows Using an Automated Email Notification System.

The Accreditation Council for Graduate Medical Education establishes minimum case requirements for trainees. In the subspecialty of obstetric anesthesiology, requirements for fellow participation in nonobstetric antenatal procedures pose a particular challenge due to the physical location remote from labor and delivery and frequent last-minute scheduling. In response to this challenge, we implemented an informatics-based notification system, with the aim of increasing fellow participation in nonobstetric antenatal surgeries. In December 2014 an automated email notification system to inform obstetric anesthesiology fellows of scheduled nonobstetric surgeries in pregnant patients was initiated. Cases were identified via daily automated query of the preoperative evaluation database looking for structured documentation of current pregnancy. Information on flagged cases including patient medical record number, operating room location, and date and time of procedure were communicated to fellows via automated email daily. Median fellow participation in nonobstetric antenatal procedures per quarter before and after implementation were compared using an exact Wilcoxon-Mann-Whitney test due to low baseline absolute counts. The fraction of antenatal cases representing nonobstetric procedures completed by fellows before and after implementation was compared using a Fisher's exact test. The number of nonobstetric antenatal cases logged by fellows per quarter increased significantly following implementation, from median 0[0,1] to 3[1,6] cases/quarter (p = 0.007). Additionally, nonobstetric antenatal cases completed by fellows as a percentage of total antenatal cases completed increased from 14% in preimplementation years to 52% in postimplementation years (p < 0.001). Through an automated email system to identify nonobstetric antenatal procedures in pregnant patients, we were able to increase the number of these cases completed by fellows during 3 years following implementation.

Facial Mask Detection Using Stacked CNN Model

The coronavirus outbreak has affected the whole world critically. Amongst all other things, wearing a mask nowadays is mandatory to avoid the spread of the virus according to the World Health Organization. All the people in the country prefer to live a salubrious life by wearing a mask in public gatherings to avoid contracting the deadly virus. Recognizing faces wearing a mask is often a tedious job as there are no substantial datasets available comprising of masked as well as unmasked images. In this paper, we propose a stacked Conv2D model that is highly efficient for the detection of facial masks. Such convolutional neural networks work effectively as they can deduce even minute pixels of the images. The proposed model is a stack of 2-D convolutional layers with relu activations as well as Max Pooling and we implemented this model by using Gradient Descent for training and binary cross-entropy as a loss function. We trained our model on an amalgam of two datasets that are RMFD (Real World Masked Face Dataset) and Kaggle Datasets. Overall, we achieved a validation/testing accuracy of 95% and a training accuracy of 97%. In addition to this, we also developed an email notification system that sends an email whenever a person is entering without a mask and it will also prompt the user to wear the mask before entering into the system. Such a system is beneficial to large multinational companies and can be deployed there as the spread of viruses there is high because employees are from different regions.

ELisA: the ATLAS logbook facility extensions

Information concerning the operation, configuration and behavior of the ATLAS experiment needs to be reported, gathered and shared reliably with the whole ATLAS community which comprises over three thousand scientists geographically distributed all over the world. To provide such functionality, a logbook facility, Electronic Logbook for the information storage of ATLAS (ELisA), has been developed and actively used since the beginning of the LHC Run 2 period. The facility includes a user-friendly web interface to browse activity logs and to report on system operations with a configurable email notification system; a RESTful API used programmatically by other tools and services of the data acquisition infrastructure, and a set of client API libraries and utilities to help user’s interaction with the REST API. Given its generic configuration capabilities, the ELisA facility has been recently deployed as a stand-alone logbook for other projects such as the commissioning of different sub-detectors and the offline assessment of data-quality. To ease this operation and to potentially extend ELisA usage to other projects, an extension of the database backend support is being implemented to reduce the dependency on the ORACLE database for the logbook deployment. Also, the deployment process of the logbook is being improved. This contribution will present the status of the logbook facility as well as the extensions and improvements implemented to ease the logbook portability to other projects.*

Assessing Patient Satisfaction and Experience With an Electronic Referral Process.

Our study aimed to identify patients' perception of an eReferral process and e-mail notification system. Patients within the Waterloo Wellington Local Health Integration Network who registered their e-mail address with physicians who adopted the eReferral system, and therefore received e-mail notifications of their booked appointment, were invited to complete an online satisfaction survey. This patient experience survey is an ongoing online link embedded within the confirmation e-mail of the booked appointment. The survey is hosted on the eReferral solution platform and has been operational since November 2017. The survey consists of 8 questions with 3 main categories to assess patients' opinion of their experience of the referral process and notification system using a 5-point Likert scale and open-ended questions. A total of 545 patients have completed the patient satisfaction survey within this reporting period with a response rate of 15%. In general, 94% of patients agreed that receiving a confirmation e-mail of their booked appointment had improved their experience with the referral process. The majority (94%) agreed that the eReferral process was easy to follow, and 83% agreed that they were able to get the care they needed within a reasonable time. Compared with their past referral experiences, 80% of patients felt more informed throughout this electronic referral process. Using binominal logistic regression, participants whose preferences were considered had 8.06 times higher odds to exhibit satisfaction with the referral process than those who did not. Patients' qualitative responses identified the eReferral process as being quick, efficient, and resulting in a sense of being in control of their own health care. There are some limitations to the system felt by some of the patients who responded to the open-ended questions of the survey. Patients identified the need to add a complementary structure to the notification design consisting of multiple dates and times with a chance to pick the appointment that suits patients best instead of being restricted to only 1 appointment date. A few patients thought that the heading of the e-mail notification system should be more distinguishable for easier tracking. Furthermore, some patients felt the need to add some notes to the initial e-mail advising patients of the next steps throughout their referral process. eReferral has improved patients' experience with the referral process. Our findings in this study would support the solution vendor in its efforts to refine and enhance active communication channels with patients for sustainable health care that meets patients' expectations and needs.

A cashless payment transaction (CPaT) using RFID technology

&lt;span&gt;Virtual money is an actual money that a person own but in a form of a plastic card, an online account and a token or a ticket. Referring to the cash-base system, it is full of fraud and money scam activity. It even happens in a smaller division of a human population which are among family members. For example, when a child decided to do a money scam towards their parents by asking for extra money for what they actually needed to pay for school internal fee and with today’s technology, they can easily recreate a receipt of the payment based on the amount of money they have scammed. In this Cashless Payment Transaction (CPaT) in a school based on Low Frequency (LF) RFID Technology system, the system offers a virtual money transaction in the plastic card form and allows the transaction to be monitored by parents with the help of Radio Frequency Identification (RFID) technology, MySQL database and Email notification system. The MySQL database is paired with the PHP prgramming language where the calculation for deduction credit will be done before being updated to the RFID card and MySQL database. As a result, the system will allow a cash-free transaction for school payment activity and allow parents to monitor their child spending activity and nutrition intake via MySQL database that are designed based on Graphical User Interface (GUI) within one minute after the transaction is successfully done.&lt;/span&gt;

1233. An Automated E-mail Notification Systemic to Infectious Disease Specialists and Effect on the Management of Staphylococcal aureus Bacteremia in a Community Hospital setting

Background Staphylococcus aureus is the leading cause of community and healthcare-associated bacteremia and carries a high burden with a substantial mortality, ranging from 20 to 40 %. Evidence suggests infectious disease (ID) consultation improves mortality and adherence to the Infectious Diseases Society of America (IDSA) guidelines. Due to complications from a lack of ID consultation, a notification system consisting of automated e-mails to ID providers was implemented. The objective of this study was to review the impact of the automatic notification to ID consultants with positive blood culture results in a community hospital system.MethodsCases of staphylococcus aureus bacteremia were identified from the microbiology database by at least one positive blood culture. The automated e-mail notification system was implemented in December 2014. ID providers were encouraged to verbally contact primary providers for positive results. Cases of bacteremia prior to implementation of the automated notification system were compared with those post-intervention. Patients under age 18 were excluded. Data gathered included mortality, re-admission rates, and compliance with IDSA guidelines.ResultsThere were no significant differences in inpatient mortality (9 vs. 18%, P = 0.180). 30-day mortality between the two groups (18 vs. 20%, P = 0.815). The 30-day readmission rate among surviving patients was reduced by 50% (40% vs. 19%, P = 0.014). Compliance with antibiotic duration in complicated bacteremia increased post-intervention (57% vs. 85%, P = 0.04).ConclusionAn automatic notification to ID specialists reporting patients with Staphylococcus aureus bacteremia led to improved compliance with IDSA guidelines regarding antibiotic duration and reduced re-admission rates. There was no effect on overall mortality.Table 1: Patient DemographicsPre Intervention (N = 57)Post Intervention (N = 60) P-valueAverage patient age (years)64.462.20.448Male63%63%1Immunosuppressed16%13%0.80Complicated bacteremia70%69%1Table 2: Patient OutcomesPreintervention(N = 57)Postintervention(N = 60) P-valueInpatient mortality9%18%0.18030-day mortality (%)18%20%0.815Readmitted within 30 days40%19%0.014Bedside ID consult75%78%0.888Appropriate antibiotic duration-complicated bacteremia (>28 days)57%85%0.04 All authors: No reported disclosures.

Use of an automated notification tool to drive real-time patient symptom intervention.

160 Background: Cancer Treatment Centers of America, Inc. (CTCA) is a national network of hospitals that specialize in the treatment of patients fighting complex or advanced-stage cancer. The Symptom Inventory Tool (SIT) is an assessment tool that captures the patients’ perceived symptom burden for real-time clinical intervention, from baseline and every 21 days thereafter. The SIT is comprised of questions utilizing the M.D. Anderson Symptom Inventory tool, a validated assessment instrument with questions added and a free text box by CTCA. Methods: An e-mail notification system associated with the SIT was established to allow efficient communication with specialists and support team members who would not traditionally see the patient without such a trigger signifying a need. While the SIT report is housed within the EHR, an automated e-mail profile may be established for each clinician and or team, tailored to the clinical specialty, based on symptom(s) of interest. Patients completing the SIT and scoring a particular symptom(s) at or above a threshold will “trigger” notification of that their score along with information allowing follow-up. Notifications can be set at 15 minute intervals, hourly, daily, etc. Results: 31 users/groups, representing a wide variety of disciplines and multiple care teams, currently utilize the SIT e-mail functionality including: Pain, Distress, Mind Body Medicine, Survivorship, Physical Therapy, and Sleep. The content of the e-mail consists of the patient name, medical record number, and (self-defined) symptom scores of interest. These same patients triggering a notification may be readily tracked for follow-up by the support team throughout their course of treatment or seen only once depending upon patient preference and identified need. Conclusions: The e-mail notification process has promoted communication with specialists and other support team members outside of the core team, cognizant of their different communication needs. Moreover, it allows for effective alignment of resources based on clinician expertise.

ObsPack: a framework for the preparation, delivery, and attribution of atmospheric greenhouse gas measurements

Abstract. Observation Package (ObsPack) is a framework designed to bring together atmospheric greenhouse gas observations from a variety of sampling platforms, prepare them with specific applications in mind, and package and distribute them in a self-consistent and well-documented product. Data products created using the ObsPack framework (called "ObsPack products") are intended to support carbon cycle modeling studies and represent a next generation of value-added greenhouse gas observation products modeled after the cooperative GLOBALVIEW products introduced in 1996. Depending on intended use, ObsPack products may include data in their original form reformatted using the ObsPack framework or may contain derived data consisting of averages, subsets, or smoothed representations of original data. All products include extensive ancillary information (metadata) intended to help ensure the data are used appropriately, their calibration and quality assurance history are clearly described, and that individuals responsible for the measurements (data providers or principal investigators (PIs)) are properly acknowledged for their work. ObsPack products are made freely available using a distribution strategy designed to improve communication between data providers and product users. The strategy includes a data usage policy that requires users to directly communicate with data providers and an automated e-mail notification system triggered when a product is accessed. ObsPack products will be assigned a unique digital object identifier (DOI) to ensure each product can be unambiguously identified in scientific literature. Here we describe the ObsPack framework and its potential role in supporting the evolving needs of both data providers and product users.

Optimizing the real‐time ground level enhancement alert system based on neutron monitor measurements: Introducing GLE Alert Plus

AbstractWhenever a significant intensity increase is being recorded by at least three neutron monitor stations in real‐time mode, a ground level enhancement (GLE) event is marked and an automated alert is issued. Although, the physical concept of the algorithm is solid and has efficiently worked in a number of cases, the availability of real‐time data is still an open issue and makes timely GLE alerts quite challenging. In this work we present the optimization of the GLE alert that has been set into operation since 2006 at the Athens Neutron Monitor Station. This upgrade has led to GLE Alert Plus, which is currently based upon the Neutron Monitor Database (NMDB). We have determined the critical values per station allowing us to issue reliable GLE alerts close to the initiation of the event while at the same time we keep the false alert rate at low levels. Furthermore, we have managed to treat the problem of data availability, introducing the Go‐Back‐N algorithm. A total of 13 GLE events have been marked from January 2000 to December 2012. GLE Alert Plus issued an alert for 12 events. These alert times are compared to the alert times of GOES Space Weather Prediction Center and Solar Energetic Particle forecaster of the University of Málaga (UMASEP). In all cases GLE Alert Plus precedes the GOES alert by ≈8–52 min. The comparison with UMASEP demonstrated a remarkably good agreement. Real‐time GLE alerts by GLE Alert Plus may be retrieved by http://cosray.phys.uoa.gr/gle_alert_plus.html, http://www.nmdb.eu, and http://swe.ssa.esa.int/web/guest/space‐radiation. An automated GLE alert email notification system is also available to interested users.

Use of self-reporting outcomes to inform patient care.

176 Background: Cancer Treatment Centers of America, Inc (CTCA) is a national network of hospitals that specialize in the treatment of patients fighting complex or advanced-stage cancer. The Symptom Inventory Tool (SIT) is an assessment tool that captures the patients’ perceived symptom burden for real-time clinical intervention, from the point of no intervention (baseline) and every 21 days or greater. The SIT is comprised of 27 questions utilizing the MD Anderson Symptom Inventory tool, a validated assessment instrument with eight questions added and a free text box by CTCA. The SIT became an integral part of patient care at CTCA beginning in 2012. Methods: Non-clinical stakeholders administer the SIT via an electronic tablet. Upon completion of the assessment, a trending graph known as Symptoms-at-a-Glance (SAG) report is auto populated and available to clinicians in the EHR or may be printed at the point of care. The SAG provides run graphs for each symptom including arrows identifying clinically relevant changes in score. An accompanying e-mail notification system was created for physicians to review specific symptoms of interest at a threshold of their choosing, and refer patients to other specialties deemed integral for the patient’s treatment plan. Results: The SIT assessment is utilized by the nurse as a starting point from which they can initiate a more pointed conversation with the patient including the need for appropriate intervention including follow-up with the oncologist and/or referral to a member of the extended integrative care team. The percentage of new and returning patients completing an assessment is at 94.94% and 84.81%, respectively, for patients (1/1/14-6/9/14) across CTCA suggesting this process is useful for both patient and clinicians. Patients comment that the time for self-reflection is a healthy exercise enabled by the user-friendly tablet. Clinicians value both the ease of administration/use as well as the ability to create a large data set for quality improvement. Conclusions: With a majority of new and returning patients participating in the SIT, the SAG report fully implemented into the EHR along with the use of an e-mail functionality, clinicians and physicians can now better manage symptom burden real time

Impact of an automated email notification system for results of tests pending at discharge: a cluster-randomized controlled trial

Physician awareness of the results of tests pending at discharge (TPADs) is poor. We developed an automated system that notifies responsible physicians of TPAD results via secure, network email. We sought to evaluate the impact of this system on self-reported awareness of TPAD results by responsible physicians, a necessary intermediary step to improve management of TPAD results. We conducted a cluster-randomized controlled trial at a major hospital affiliated with an integrated healthcare delivery network in Boston, Massachusetts. Adult patients with TPADs who were discharged from inpatient general medicine and cardiology services were assigned to the intervention or usual care arm if their inpatient attending physician and primary care physician (PCP) were both randomized to the same study arm. Patients of physicians randomized to discordant study arms were excluded. We surveyed these physicians 72 h after all TPAD results were finalized. The primary outcome was awareness of TPAD results by attending physicians. Secondary outcomes included awareness of TPAD results by PCPs, awareness of actionable TPAD results, and provider satisfaction. We analyzed data on 441 patients. We sent 441 surveys to attending physicians and 353 surveys to PCPs and received 275 and 152 responses from 83 different attending physicians and 112 different PCPs, respectively (attending physician survey response rate of 63%). Intervention attending physicians and PCPs were significantly more aware of TPAD results (76% vs 38%, adjusted/clustered OR 6.30 (95% CI 3.02 to 13.16), p<0.001; 57% vs 33%, adjusted/clustered OR 3.08 (95% CI 1.43 to 6.66), p=0.004, respectively). Intervention attending physicians tended to be more aware of actionable TPAD results (59% vs 29%, adjusted/clustered OR 4.25 (0.65, 27.85), p=0.13). One hundred and eighteen (85%) and 43 (63%) intervention attending physician and PCP survey respondents, respectively, were satisfied with this intervention. Automated email notification represents a promising strategy for managing TPAD results, potentially mitigating an unresolved patient safety concern. ClinicalTrials.gov (NCT01153451).

Design and implementation of an automated email notification system for results of tests pending at discharge

Physicians are often unaware of the results of tests pending at discharge (TPADs). The authors designed and implemented an automated system to notify the responsible inpatient physician of the finalized results of TPADs using secure, network email. The system coordinates a series of electronic events triggered by the discharge time stamp and sends an email to the identified discharging attending physician once finalized results are available. A carbon copy is sent to the primary care physicians in order to facilitate communication and the subsequent transfer of responsibility. Logic was incorporated to suppress selected tests and to limit notification volume. The system was activated for patients with TPADs discharged by randomly selected inpatient-attending physicians during a 6-month pilot. They received approximately 1.6 email notifications per discharged patient with TPADs. Eighty-four per cent of inpatient-attending physicians receiving automated email notifications stated that they were satisfied with the system in a brief survey (59% survey response rate). Automated email notification is a useful strategy for managing results of TPADs.

Where Are My Patients? It Is Time to Automate Notification of Hospital Use to Primary Care Practices

The hospital-to-community transition is fraught with risks for patients, with 30-day readmission rates of 20% for Medicare patients. Poorly coordinated transitions of care translate to unplanned readmission costs to Medicare of more than $17 billion/year. Calls for better physician communication to improve care coordination abound; however, primary care physicians cannot better coordinate care when, in many cases, they are not even aware that their patients have been admitted to the hospital. During the past 30 years, we have made little progress in systematically improving communication between hospital and posthospital providers to coordinate postdischarge care. Hospitals and physicians need better tools to coordinate care transitions. It is time to automate the hospital discharge notification process, notify practice staff, and stop expecting physician-to-physician communication. Notification can be efficiently supported by computerized systems that do not rely on physicians to "close the loop" back to primary care. We present four clinical programs in which automated notification of primary care staff was used to ensure appropriate follow-up and coordination of care for patients. These automated systems use a secure online Web site or an encrypted e-mail notification system that alerts clinicians and practice staff to hospital registration of the patient. In each program, notification triggers a nurse-directed clinical assessment and care coordination plan and helps ensure timely primary care follow-up. We believe automated notification is a necessary tool to support coordination of care in the new delivery models such as the patient-centered medical home.

MO-D-I-618-03: A Web-Based Lead Apparel Management System for Medical Enterprises

Purpose: Accrediting bodies often require facilities to have a system for managing radiation protective apparel. In larger hospitals and medical enterprises, the standardization and monitoring of radiation protective apparel becomes increasingly difficult. The purpose of this work was to develop a web-based infrastructure for inventory control of radiation protective (lead) apparel across a large-scale hospital system. Method and Materials: A centralized database was developed and made accessible by a departmental website using Active Server Pages (ASP). Unique identifiers were assigned and entered into the database for the current apparel inventory. Quality control (QC) records — including lead patency checks were also integrated into the system. An automated email notification system was implemented for overdue QC tests. Web-based education modules were posted and an enterprise wide policy was formed to identify staff responsibilities and quality control methodology. Results: Responsible individuals were assigned to monitor local section inventory changes and ensure proper care of apparel. Quality checks, unique identification and centralized ordering of apparel were coordinated through the Medical Physics office. For the four major enterprise sections, (two hospitals — with inpatient and outpatient centers) over 1081 different pieces of lead apparel were uniquely identified, inventoried and inspected. The web-based system allowed staff and managers across the enterprise to access current inventory and latest quality control results for apparel in their section. Reminders of overdue checks are sent out monthly with no user interaction. Conclusion: The web-based information system is effective at dissemination of information throughout a medical enterprise. Centralized systems of inventory control and quality assurance testing reduce redundancy throughout departments. Assigning unique identifiers has the potential to reduce conflicts in inventory management and provides a system to return apparel that has been accidentally moved. Policy formation encourages this integration throughout the enterprise.

Integration of radiologist peer review into clinical review workstation.

Professional peer review of random prior radiologist's interpretations is mandated by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The JCAHO expects documentation of 5% rate of random peer-review cases. Countless hours are spent in departments fulfilling these requirements. The integration of the peer-review process into the radiologist's interpretation workflow was expected to increase the percentage of documented peer review, yet decrease the time and effort for this documentation. radStation clinical review workstations are deployed at every reading station. When a requisition is bar-coded, radStation retrieves the patient's clinical information and automatically displays the prior comparison report. If the radiologist agrees with the prior report, a single click on a "quality assurance' agree box documents the agreement. In the case of a discordance, an additional dialog box automatically appears and the radiologist enters the reason for disagreement and then submits the case as a discrepancy. The system holds the discordance for 3 to 5 working days, then notifies the original radiologist via E-mail that a prior interpretation has been submitted for peer review, lists the submitted discrepancy reason, and provides a link to display the discordant report. The peer-review database is separate from the existing radiology information system (RIS). At the end of every month, summary reports of all peer-review activity are generated automatically. Initial benchmarks of our deployed system anticipate documentation of long-term random peer-review rate at greater than 50% of interpreted cases. The system enhances the peer-review process by integrating it with the normal interpretation workflow. The time to complete peer review using radStation is less than 1 second per normal case and less than 60 seconds for a discordant case. The E-mail notification system is fully automated, eliminating the need for secretarial involvement in the data collection. This system has completely replaced a manual paper-based system. The integration of peer review directly into the radiologist's interpretation workstation greatly enhances the capability to easily exceed JCAHO standards. The overall increase in peer-review documentation should continue to improve the ability to document a consistent high quality of patient care.