Exchange Of Patient Information Research Articles

The Communication Conundrum: A Pilot Cross-Sectional Descriptive Examination of Family Nurse Perspectives Surrounding Patient Information Exchange During Interfacility Patient Transfers in Montana

Background:Interfacility patient transfers are fraught with issues such as missed or ineffective communication in Montana given wide geographic distance between facilities and variance in resources. Inaccurate, absent, or delayed patient details may negatively affect patient outcomes and further result in duplicative testing and medication errors.Objective:The objective of this study was to describe the process of patient information communication during interfacility transfers as perceived by nurses practicing in Montana.Methods:The study design was a pilot cross-sectional descriptive approach. An online Qualtrics survey included demographic questions, two exploratory communication competence instruments, and four open-ended questions regarding communicating interfacility transfer patient information.Results:A total of 33 nurses completed the study, with the majority practicing at a critical access hospital (n= 15, 47%). Communication competence mean scores increased with dyad conversations, and a lack of standardized handoff tools noted as a challenge. Nurses identified the following as barriers in the interfacility transfer handoff: incivility, amount of paperwork, interoperability issues, incomplete or outdated information, time, and resources.Implications for practice:There is wide variability in current communication practices, ranging from verbal to electronic document transfers. The rural healthcare space is prime to continue examinations surrounding workflow optimization, accuracy, and consistency in shared information exchange at the time of interfacility transfer. There is an opportunity for potential training and education surrounding effective communication, interpersonal behaviors that support cross-organizational interactions, and the development of a standardized handoff tool contextual for interfacility transfer patients.

Maxillary osteonecrosis of the jaw. A multidisciplinary approach, communication strategies, and technological tools for prophylaxis

Background. Maxillary osteonecrosis, particularly medication-related osteonecrosis of the jaw (MRONJ), necessitates prompt identification and a comprehensive approach for effective management. Early diagnosis and proactive dental care are crucial in mitigating the complications associated with this condition. Aims. This study aims to outline the importance of early detection, multidisciplinary collaboration, patient education, and proactive dental care in the management of maxillary osteonecrosis. Methods. The study emphasizes the utilization of standardized medical letters to facilitate communication between prescribing physicians and dentists, while ensuring the timely exchange of essential patient information. Additionally, patient education plays a pivotal role, with the distribution of informative leaflets at the initiation of Bone Modifying Agents (BMA) treatment, emphasizing the risks associated with MRONJ and the significance of maintaining oral health and making appropriate lifestyle choices. Results. Dentists are key stakeholders in the prophylaxis of MRONJ, undertaking primary and secondary prevention measures. Primary prophylaxis encompasses various dental procedures aimed at reducing bacterial load and mucosal irritation. Secondary prophylaxis involves educating patients on maintaining optimal oral health and adopting lifestyle modifications. Furthermore, an Android application assists dentists in assessing MRONJ risk factors and making informed treatment decisions based on factors such as BMA type, dose, duration of administration, and the presence of dental and general risk factors. Conclusions. In conclusion, a proactive approach to managing Maxillary Osteonecrosis involves early detection, multidisciplinary collaboration, patient education, and proactive dental care. By integrating standardized communication tools, patient education materials, and risk assessment technology, healthcare providers can optimize patient outcomes and minimize the incidence and severity of MRONJ complications.

Health Chain Connect

Electronic medical records are medical records of patient stored digitally on the internet. Patient information is stored in the blockchain, and this information is stored as a block of data in the blockchain. Encrypted using the AES algorithm used to encrypt all patient data. Blockchain networks are used in healthcare to exchange patient information and increase the efficiency, security, and transparency of medical information sharing in healthcare. Security, decentralized and transparency, the three main features of blockchain technology, make all applications secure and inaccessible to unauthorized persons.

First steps towards a shared care model for spinal cord injury in rural Switzerland

Background: Persons with spinal cord injury regularly consult primary and secondary care physicians for their holistic needs. However, in remote areas of Switzerland general practitioners (GPs) compensate for a potential undersupply of specialized services. Building collaboration and distributing roles between GPs and specialists is needed to improve the continuity of care for persons with spinal cord injury living in rural Switzerland. This intervention study aims to develop, implement and evaluate an integrated care model as a case in point.
 Intervention: As part of the study, physicians from specialized spinal cord injury centers, specialized mobile nurses and GPs collaborate to improve patients' outcomes and providers’ experience with delivery of care. Measures to enhance collaboration include joint continuous medical education, training in the primary care practices and support for complex patients. Medical education topics cover the most prevalent secondary health conditions, as well as physicians’ priorities and interests for shared care. During the design of the intervention, persons with spinal cord injury and their families were engaged in a sounding board, where they expressed their wishes and concerns. 
 First results: Seven primary care practices were successfully recruited to expand competences in spinal cord injury care. Persons with spinal cord injury, living in the practices’ catchment area were invited to the practice. Mixed methods evaluate patient and health provider outcomes at specific time points. Baseline results on the collaboration between GPs and specialists, show high physician satisfaction ratings. Challenges in collaboration seem to be related to unclear roles and responsibilities due to different expectations among physicians. Between baseline and 1-year follow-up, significant differences were found in the average number of patients’ GP visits. 
 Next steps: As a second study phase, more primary care practices will be recruited. Healthcare professionals will discuss and negotiate their roles and responsibilities in round tables. To support a common understanding, a toolkit for primary care will be developed. Lastly, more components that enhance shared care should be introduced such as joint patient consultations or information exchange platforms.

Facilitators and barriers to communication in rehabilitation services across healthcare levels: a qualitative case study in a Norwegian context

BackgroundPeople with problems in functioning following severe injury or illness often need multiple and combined interventions in their rehabilitation processes. In these processes, communication and collaboration between the involved healthcare professionals are essential. Despite efforts in research and policy, communication across hospital and primary healthcare services and within the primary healthcare settings remains challenging. In one region of Norway, a new intermunicipal rehabilitation team has been established to supplement the traditional services and context-bound research is needed to gain insight into the complexity of the new communication structures that are developing. The aim of this study was to explore facilitators and barriers to communication to inform further improvement of the services.MethodsA qualitative case study design was used to explore the exchange of patient information in the rehabilitation processes of four patients. Data collection included participant observations in communication situations and an exploration of the electronic patient records of these four patients. Reflexive thematic analysis was used to analyse the empirical data.ResultsThe complex rehabilitation processes explored involved a large number of actors across healthcare organisational levels. Lacking a common culture for rehabilitation, poor access to written information and unclear responsibility for sharing information across organisational boundaries seemed to represent barriers to interprofessional communication. Joint meetings, the use of common rehabilitation tools and language and establishing informal communication channels served to facilitate communication.ConclusionThe intermunicipal team collaborating across different organisational levels added complexity to communication structures, but also facilitated interprofessional communication by promoting formal and informal ways of exchanging information. However, the intricate organisational divisions of healthcare provision in the Norwegian context represent boundaries which can be difficult to overcome. Therefore, cross-organisational coordination services should be developed.

ChatGPT in orthopedics: a narrative review exploring the potential of artificial intelligence in orthopedic practice.

The field of orthopedics faces complex challenges requiring quick and intricate decisions, with patient education and compliance playing crucial roles in treatment outcomes. Technological advancements in artificial intelligence (AI) can potentially enhance orthopedic care. ChatGPT, a natural language processing technology developed by OpenAI, has shown promise in various sectors, including healthcare. ChatGPT can facilitate patient information exchange in orthopedics, provide clinical decision support, and improve patient communication and education. It can assist in differential diagnosis, suggest appropriate imaging modalities, and optimize treatment plans based on evidence-based guidelines. However, ChatGPT has limitations, such as insufficient expertise in specialized domains and a lack of contextual understanding. The application of ChatGPT in orthopedics is still evolving, with studies exploring its potential in clinical decision-making, patient education, workflow optimization, and scientific literature. The results indicate both the benefits and limitations of ChatGPT, emphasizing the need for caution, ethical considerations, and human oversight. Addressing training data quality, biases, data privacy, and accountability challenges is crucial for responsible implementation. While ChatGPT has the potential to transform orthopedic healthcare, further research and development are necessary to ensure its reliability, accuracy, and ethical use in patient care.

Consultants’ and referrers’ perceived barriers to closing the cross-institutional referral loop, and perceived impact on clinical care

BackgroundCross-institutional (external) referrals are prone to communication breakdowns, increasing patient safety risks, clinician burnout, and healthcare costs. To close these external referral loops, referring primary care physicians (PCPs) need to receive patient information from consultants at different healthcare institutions. Although existing studies investigated the early phases of external referral loops, we lack sufficient knowledge about the closing phases of these loops. This knowledge could allow health care institutions to improve care coordination and rates of closed referral loops by implementing socio-technical interventions for patient information exchange throughout a referral loop. Human factors engineering (HFE) provides a systematic approach to advance our understanding of barriers perceived by physicians. Using HFE, our objective was to characterize referring and consulting physicians’ barriers to closing referral loops and implications for care. MethodsThis qualitative cross-sectional study included semi-structured interviews with referrers and external consultants. We used the Systems Engineering Initiative for Patient Safety 2.0 framework to conduct rapid qualitative analyses, determining perceived barriers and related implications. Main measures were consultants’ and referrers’ perceptions of, and experiences with, barriers to external referrals. ResultsSix referring PCPs and 12 consultants participated from two healthcare systems and four medical specialties. Physicians perceived three main barriers in external referrals: receipt of excessive and unnecessary faxed documents, missing or delayed documentation, and organizational policies regarding information privacy interfering with closing the loop. Compared to internal referrals, physicians reported increased staff burden, patient frustration, and delays in diagnosis with external referrals. Consultants reported the ability to provide the same level of care to patients with internal or external referrals. However, consultants described communication breakdowns that prohibited confirmation of follow-up plan retrieval, initiation, or effectiveness. ConclusionPhysicians reported technological and organizational barriers to closing cross-institutional referral loops. Promises of HIE technology for external referrals have not fully materialized. Among physicians and patients, retrieval and exchange of medical information increases perceived workload, burden, and frustration. These increases are not accurately captured by traditional organizational metrics. This study provides evidence that informs future human factors engineering research to address perceived barriers and guide future HIE design or implementation.

Patient safety culture in home care settings in Sweden: a cross-sectional survey among home care professionals

BackgroundThe connection between a weak patient safety culture and adverse patient events is well known, but although most long-term care is provided outside of hospitals, the focus of patient safety culture is most commonly on inpatient care. In Sweden, more than a third of people who receive care at home have been affected by adverse events, with the majority judged to be preventable. The aim of this study was to investigate the patient safety culture among care professionals working in care at home with older people.MethodsThis cross-sectional study used a purposive sample of 66 municipal care workers, health care professionals, and rehabilitation staff from five municipal care units in two districts in western Sweden who provided care at home for older people and had been employed for at least six months. The participants completed the Hospital Survey on Patient Safety Culture (HSOPSC) self-report questionnaire, which assessed aspects of patient safety culture—norms, beliefs, and attitudes. Logistic regression analysis was used to test how the global ratings of Patient safety grade in the care units and Reporting of patient safety events were related to the dimensions of safety culture according to the staff’s professions and years of work experience.ResultsThe most positively rated safety culture dimension was Teamwork within care units (82%), which indicates good cooperation with the closest co-workers. The least positively rated dimensions were Handoffs and transitions among care units (37%) and Management support (37%), which indicate weaknesses in the exchange of patient information across care units and limited support from top-level managers. The global rating of Patient safety grade was associated with Communication openness and Management support (p < 0.01 and p = 0.03, respectively). Staff with less work experience evaluated the Patient safety grade higher than those with more work experience.ConclusionsThis study suggests that improvements are needed in care transitions and in support from top-level managers and that awareness of patient safety should be improved in staff with less work experience. The results also highlight that an open communication climate within the care unit is important for patient safety.

Improving Dementia Caregiver Activation With a Brief Communication Module.

Objective: Palliative care often plays a pivotal role in supporting informal caregivers of persons living with dementia who experience a lack of continuity in care. Dementia caregiver activation, the caregiver's willingness and ability to navigate care needs, requires communication skills for developing relationships with healthcare providers. Communication activation is important because caregivers facilitate physician and patient information exchange. This study aimed to explore changes in communication outcomes (attitude, knowledge, and skills) and impact on caregiver communication activation (confidence, self-report) following completion of a brief communication module. Methods: A 15-minute asynchronous online module was developed to provide caregivers with communication skills for working with doctors and nurses. Caregivers completed pre/post module measures of communication outcomes, a vignette for applying communication strategies and were interviewed within a week of module completion to assess self-reported communication activation. Module acceptability was also evaluated. Results: Communication knowledge (P < .01) significantly increased and nearly all participants (99%) demonstrated use of module-specific communication skills after completing the module. While not statistically significant, caregiver attitudes were in the expected direction. Caregiver self-reported communication confidence (P < .001) significantly increased and 84% of caregivers described communication activation at post-module. Caregivers (83%) were likely to recommend the module. Conclusions: The brief communication module for dementia caregivers in this project offers an online resource with low time-burden that results in caregiver communication activation. Future testing in the clinical setting will increase understanding of its efficacy and integration and could be a viable resource for palliative care providers.

Knowledge and practice of handoff among doctors in a tertiary care hospital in Manipur: A cross-sectional study

ABSTRACT Context: The exchange of patient information and the transfer of responsibility for patient care between health-care providers constitute a vital aspect of health-care communication and maintain continuum of care and patient safety. There are limited data on knowledge and practice of handoff among resident doctors in Manipur. Aims: To assess the knowledge and practice of handoff among resident doctors of a tertiary care hospital, in Imphal, and to determine the association between sociodemographic characteristics and handoff practice. Subjects and Methods: A cross-sectional study among 279 resident doctors of a tertiary care hospital in Manipur was conducted. The data were collected using a pretested structured questionnaire. Statistical Analysis: The data were analyzed using IBM SPSS version 26.0. Descriptive statistics such as percentage, mean, and standard deviation were used to represent quantitative data. Chi-square test or Fisher’s exact test were used for categorical data. P &lt; 0.05 was considered statistically significant. Results: The mean age of participants was 29.65 ± 3.97 years. More than two-thirds of the participants were inadequately practicing handoff in patient care. There were significant associations between the knowledge pertaining to questions, “When does handoff occur in patient care?” (P = 0.013), “What is the purpose of handoff?” (P = 0.024), and “What are the characteristics of good handoff?”(P = 0.019) with the practice of handoff. Conclusion: Although more than 4/5th of the doctors had good knowledge, only a quarter of them had adequate handoff practice.

Machine Learning Approach for Rapid, Accurate Point-of-Care Prediction of M-Spike Values in Multiple Myeloma.

The gold standard for monitoring response status in patients with multiple myeloma (MM) is serum and urine protein electrophoresis which quantify M-spike proteins; however, the turnaround time for results is 3-7 days which delays treatment decisions. We hypothesized that machine learning (ML) could integrate readily available clinical and laboratory data to rapidly and accurately predict patient M-spike values. A retrospective chart review was performed using the deidentified, electronic medical records of 171 patients with MM. Random forest (RF) analysis identified the weighted value of each independent variable (N = 43) integrated into the ML algorithm. Pearson and Spearman coefficients indicated that the ML-predicted M-spike values correlated highly with laboratory-measured serum protein electrophoresis values. Feature selected RF modeling revealed that only two variables-the first lagged M-spike and serum total protein-accurately predicted the M-spike. Taken together, our results demonstrate the feasibility and prognostic potential of ML tools that integrate electronic data to longitudinally monitor disease burden. ML tools support the seamless, secure exchange of patient information to expedite and personalize clinical decision making and overcome geographic, financial, and social barriers that currently limit the access of underserved populations to cancer care specialists so that the benefits of medical progress are not limited to selected groups.

Conducting Qualitative Research under Pandemic Restrictions - Considerations, Challenges, and Benefits: A Methodological Field Report.

The Covid-19 pandemic has a significant impact on professionals working in the medical area, with very high workload and tightened safety restrictions for physicians, nurses, caregivers, and patients. One of the main target participants in health services research are medical professionals. Their experiences contribute immensely to any research project aiming to improve delivery and quality of care. Furthermore, their input gives significantly greater insights into the handling of the pandemic and into what future improvements should be considered. In our research project ADAPTIVE (Impact of Digital Technologies in Palliative Care) we evaluate with qualitative research methods the impact of a web-based software on communication, teamwork, and lasting transformations in accountability in multidisciplinary teams (e. g., medication and independent decisions). In this paper, we discuss the challenges and benefits of conducting a qualitative research project under pandemic conditions by illustrating the progress of ADAPTIVE. ADAPTIVE started in March 2020 and ended in August 2021. For data collection, we interviewed 26 participants about using a web-based program to facilitate the exchange of patient information in multidisciplinary teams in outpatient palliative care in Germany (mainly physicians and nurses). However, due to emerging hygiene regulations, corona-related restrictions, and the ongoing workload of medical professionals, the recruiting and interviewing process were challenging. Hence, we had to modify the original study design of two face-to-face interviews per participant and a focus group discussion into one telephone interview. The focus groups were cancelled. We discussed several adjustments to the data collection. However, the privacy policies of different clinics, participants' lack of experience with video calls, and a potential poor internet connectivity eliminated the option of digital video interviewing. Therefore, we interviewed 21 participants by telephone and only five face-to-face. Further, the focus group discussions initially planned had to be dropped since a simultaneous gathering of the participants was not possible due to several reasons. Nonetheless, we obtained many insights into the usage of digital support systems in palliative care by conducting 26 interviews, allowing us to complete the research project. Telephone interviews come with limitations. Firstly, it may be difficult for participants to establish a trusting relationship with the interviewer. Secondly, non-verbal communication is lost during a telephone interview. However, expanding the survey methodology to include telephone interviews gave us the option of allowing us to expand the recruitment nationwide and overcome issues successfully. Recruitment and data collection showed to be more time-consuming under pandemic circumstances, and further survey methods such as focus groups were nearly impossible. However, a qualitative research design offers greater flexibility when adapting study designs.

Nationwide evaluation of pancreatic cancer networks ten years after the centralization of pancreatic surgery

BackgroundDue to centralization of pancreatic surgery, patients with pancreatic cancer are treated in pancreatic cancer networks, composed of referring hospitals (Spokes) and an expert center (Hub). This study aimed to investigate I) how pancreatic cancer networks are organized and II) evaluated by involved clinicians. MethodsTwo online surveys were sent out between January–May 2022. Part I was sent out to the surgical network directors of all hospitals of the Dutch Pancreatic Cancer Group (DPCG). Part II was sent out to all involved clinicians in the Hubs-and-Spokes networks. ResultsThere was a large variety between the 15 networks concerning number of affiliated Spokes (1-7), annual pancreatoduodenectomies (20-129), and use of a service level agreement (SLA) (40%). More Spoke clinicians considered the Spoke the best location for diagnostic workup (74% vs 36%, P < 0.001). Only 30% of Spoke clinicians attended the Hubs multidisciplinary team meeting frequently. More Hub clinicians thought that exchange of patient information should be improved (37% vs 51%, P = 0.005). ConclusionA large variety in Dutch pancreatic cancer networks was observed concerning number of affiliated Spokes, use of SLAs, and logistic aspects of network care. Improvement of network care concern agreements on diagnostic workup, use of SLA, Spoke participation in the MDT, and patient information exchange.

An Edge-AI-Enabled Autonomous Connected Ambulance-Route Resource Recommendation Protocol (ACA-R3) for eHealth in Smart Cities

The Autonomous Connected Ambulance (ACA) has been an unprecedented necessity in the demand-supply management sector of the healthcare sector. However, the traditional prototypes designed for such an un-manned vehicle do not match the demands of the advanced communication technologies incorporated in today’s sophisticated distributed networks. As a result, in the current era of edge computing strengthened by many AI-enabled algorithms, there is an urgent need to design a Route Resource Recommendation Protocol for ACA under Edge-AI. Designing such a protocol requires addressing the major challenges to optimize the routes for ACA and, thereby, enhance the services of emergency eHealth centers through a governing telehealth monitoring administrator. Therefore, in this article, a dedicated and novel “ACA-Route Resource Recommendation (R3)” protocol is proposed to address the issues of connectivity and resource management in ACA to optimize the routes for ACA. The ACA-R3 protocol abides by the operational standards of both the eHealth protocol and governing protocol. The primary objective of the current research work was to reduce the handover time and simplify the patient-information exchange during the time of demanded emergencies. The proposed ACA-R3 protocol can enhance the collaborative distributive resource management for reliable decision-making from the data generated by the GPS tracking unit in ACA and Edge-AI. The experimental results obtained from three different cases of traffic congestion are evaluated, validated, and reported in this article.

Incomplete patient information exchange and unnecessary repeat diagnostics during oncological referrals in the Netherlands: exploring the role of information exchange.

Data management in transmural care is complex. Without digital innovations like Health Information Exchange (HIE), patient information is often dispersed and inaccessible across health information systems between hospitals. The extent of information loss and consequences remain unclear. We aimed to quantify patient information availability of referred oncological patients and to assess its impact on unnecessary repeat diagnostics by observing all oncological multidisciplinary team meetings (MDTs) in a tertiary hospital. During 84 multidisciplinary team meetings, 165 patients were included. Complete patient information was provided in 17.6% (29/165, CI = 12.3-24.4) of patients. Diagnostic imaging was shared completely in 52.5% (74/141, CI = 43.9-60.9), imaging reports in 77.5% (100/129, CI = 69.2-84.2), laboratory results in 55.2% (91/165, CI = 47.2-62.8), ancillary test reports in 58.0% (29/50, CI = 43.3-71.5), and pathology reports in 60.0% (57/95, CI = 49.4-69.8). A total of 266 tests were performed additionally, with the main motivation not previously performed followed by inconclusive or insufficient quality of previous tests. Diagnostics were repeated unnecessarily in 15.8% (26/165, CI = 10.7-22.4) of patients. In conclusion, patient information was provided incompletely in majority of referrals discussed in oncological multidisciplinary team meetings and led to unnecessary repeat diagnostics in a small number of patients. Additional research is needed to determine the benefit of Health Information Exchange to improve data transfer in oncological care.

Necessity of providing dental care to medically compromised patients in Japan’s super-aged society and the way forward

Devising an appropriate dental treatment plan for patients with pre-existing medical conditions is a demanding task. Dentists must consider the sometimes life threatening, interactions between ongoing medical conditions and dental treatment. Stakes are particularly high for the elderly on prescription drugs and other therapies for medical conditions while they seek dental care for advanced oral diseases. Given that Japan is an ageing society, it is crucial to create avenues for medical and dental practitioners to share patient information and collaborate.to,improve care This paper examined trends from demographic data to suggest that there is an impending further rise in the number of medically compromised elderly seeking dental treatment. For patient safety and improved public health, it is important that dental practitioners evaluate the nature and ongoing treatment of pre-existing medical conditions amongst new patients and account for their impact on dedicated and dental status. This paper supports the relevance of comprehensive clinical practice guidelines and the need to train dental practitioners to adopt a multidisciplinary approach to dental care. In order to meet the future needs of an ageing population, the Japanese Society of Dentistry for Medically Compromised Patients needs to take initiative and suggest mechanisms to exchange patient information freely and encourage multidisciplinary dental practices.

34504 Mixed methods validation of a patient-centered educational atopic dermatitis mobile health application

Atopic dermatitis (AD) has a complex disease course and treatment landscape; bidirectional exchange of disease and patient information is challenging within short a dermatology encounter. Patients often turn to digital resources to seek guidance for self-management, yet many current eczema apps insufficiently support evidence-based guidelines and lack patient engagement in their development. EczemaQ was co-developed with patients as an evidence-based mobile health educational tool to address this gap. In order to validate EczemaQ’s use with AD patient and clinician end-users, ethics approval was granted by the McGill University Center for Applied Ethics for an iterative, explanatory sequential mixed methods (QUAN-QUAL) study. First, quantitative (QUAN) data will be collected through Technology Acceptance Model 2 and Patient Activation Measure questionnaires to obtain preliminary app usability information, and analyzed via descriptive statistics. This data will then inform qualitative (QUAL) data collection via semi-structured focus groups to gain a deeper understanding of end-user priorities, analyzed via thematic analysis. Two QUAN-QUAL arms will occur simultaneously: one arm for patients (eligible patients diagnosed with AD), and one arm for clinicians (AD experts including dermatologists, nurses, pharmacists, and general physicians). A Beta version of the EczemaQ app will be created based on the first iteration of the two arms of the QUAN-QUAL model; EczemaQ Beta will then undergo a second iteration of the process to obtain a finalized EczemaQ app. We offer an example of an integrated knowledge translation tool, featuring genuine patient and clinician partnership, towards bettering AD patient care.

환자 안전을 위한 요양병원 인수인계 현황에 대한 조사연구

This study is related to 80% of communication errors among medical personnel among safety accidents in nursing hospitals in Korea, and 37% errors occur in the handover process of exchanging patient information between nurses. It is emphasized that there is a close relationship with With the aging society, the number of nursing hospitals is also increasing, so it was attempted to provide basic data to prepare a management strategy to improve the takeover by grasping the current status of the nursing hospital takeover.&#x0D; This study conducted a questionnaire survey on 102 nurses working in 4 nursing hospitals located in P city from September 30 to October 11, 2019. The collected data were analyzed using SPSS/WIN 21.0, and the reliability of the tool was measured by Cronbach's ɑ, and descriptive statistics were performed on the general characteristics of subjects and characteristics related to takeover, the degree of error experience, and the causes of errors.&#x0D; As for the takeover-related characteristics of the subjects of this study, 15 respondents (63.8%) answered that there is no written guideline or checklist for handover, and 'there is no written guideline or checklist on handover. There were 92 nurses (92.1%) who thought it was necessary, and as a result of the handover error experience, 'have ever been criticized or complained of from a patient or guardian due to a handover error' was 1.89±0.73. The highest score was 1.73±0.73 for 'Sometimes a shift worker said that he did not take over even though he was given a handover', followed by 'Sometimes I misunderstood the details of the handover' and 'I called to confirm because the handover was incorrect. 'Has ever been' with 1.72±0.87. As for the cause of errors in the takeover of nurses, it was found that nurses considered ‘xcessive workload’ to be the most common cause of errors during takeover with a score of 2.69±0.67. Next, 'there is no standardized handover guidelines (contents, methods)' with 2.64±0.80 and 'personal tendencies work during takeover' with 2.61±0.74, indicating human error in relation to errors occurring in the handover process. It was found that the possibility of The subjects of this study mentioned excessive workload, lack of guidelines, and human error as causes of takeover errors during takeover. Therefore, since reducing handover errors is an important factor for patient safety, we believe that standardized guidelines are needed as a method to reduce the causes of handover errors.

Data Confidentiality in Healthcare Monitoring Systems Based on Image Steganography to Improve the Exchange of Patient Information Using the Internet of Things.

Recently, with the availability of fast and reliable Internet, the distance between a patient and a doctor is becoming unimportant. Physicians will be able to request the medical images of their patients regardless of the geographical area. However, a lot of challenges face such successful implementation. To facilitate remote diagnosis, patient electronic medical record (EMR), including medical images, that originates in one system needs to be exchanged either within the same organization or across different organizations. Steganography is the practice of concealing a secret message inside a cover medium. In this paper, steganography will be used to embed the patient's personal information securely and imperceptibly in their medical images to enhance confidentiality in case of a distant diagnosis. The security of the medical data is improved to maintain confidentiality and integrity using IoT. The least significant bit of the approximate coefficient of integer wavelet transform is proposed. The distortion between the cover image and stego-image is obtained by measuring the mean square error and PSNR, and normalized cross-correlation is utilized to estimate the degree of closeness between the cover image and stego-image.

Electronic Health Record-Integrated Tumor Board Application to Save Preparation Time and Reduce Errors.

Multidisciplinary oncology meetings, or tumor boards (TBs), ensure and facilitate communication between specialties regarding the management of cancer cases to improve patient care. The organization of TB and the preparation and presentation of patient cases are typically inefficient processes that require the exchange of patient information via e-mail, the hunting for data and images in the electronic health record, and the copying and pasting of patient data into desktop presentation software. We implemented a standards-based electronic health record-integrated application that automated several aspects of TB organization and preparation. We hypothesized that this application would increase the efficiency of TB preparation, reduce errors in patient entry, and enhance communication with the clinical team. Our experimental design used a prospective evaluation by pathologists who were timed in preparing for weekly TBs using both the new application and the conventional method. In addition, patient data entry errors associated with each method were tracked, and TB attendees completed a survey evaluating satisfaction with the new application. The total time savings for TB preparation using the digital TB application over the conventional method was 5 hours and 19 minutes, representing a 45% reduction in preparation time (P < .01). Survey results showed that 91% of respondents preferred the digital method and believed that it improved the flow of the TB meeting. In addition, most believed that the digital method had an impact on subsequent patient care. This study provides further evidence that new electronic systems have the potential to significantly improve the overall TB paradigm by optimizing and enhancing case organization, preparation, and presentation.