Medical Information Services Research Articles

Socioeconomic disparities in prehospital cardiac arrest outcomes: An analysis of the NEMSIS database

BackgroundSocioeconomic disparities are engrained in the US healthcare system and may extend to the prehospital cardiac arrest setting where mortality is high. MethodsUsing the National Emergency Medical Services Information System (NEMSIS) database, 150,003 cases were analyzed comparing socioeconomic status and cardiac arrest outcomes. Cardiac arrest outcomes were measured by the percent of cases that achieved return of spontaneous circulation (ROSC) and the percent of cases in which ROSC occurred in the Emergency Department (ED) as opposed to a prehospital setting which was a proxy for the length of time spent in cardiac arrest. Chi-square tests checked for statistical significance and effect size was measured using Pearson's r values and linear regression coefficients. ResultsComparing neighborhood poverty level and the percent of cardiac arrest cases that achieved ROSC resulted in a Pearson's r value of 0.9424 (R2 = 0.8881, p < 0.005) and a linear regression coefficient of 2.088 (p < 0.05, R2 = 0.8881, 95% CI [1.059, 3.117]) meaning for every interval increase in poverty, the chance of an individual in cardiac arrest achieving ROSC decreases 2.09%. Comparing neighborhood poverty level and the percent of ROSC cases that occurred in the ED yielded a Pearson's r value of 0.9005 (R2 = 0.8109, p < 0.05) and a linear regression coefficient of 0.7701 (p < 0.05, R2 = 0.8109, 95% CI [0.254, 1.286]) meaning for every interval increase in poverty, the chance that ROSC is delayed increases 0.77%. ConclusionsLow income individuals in cardiac arrest have a statistically significant lower probability of achieving ROSC and a higher chance of delayed ROSC.

Characteristics of adult out-of-hospital cardiac arrest in the National Emergency Medical Services Information System.

BackgroundThe national incidence and characteristics of out‐of‐hospital cardiac arrest in the United States is unclear. We sought to describe the national characteristics of adult out‐of‐hospital cardiac arrest reported in the National Emergency Medical Services Information System (NEMSIS).MethodsWe used 2016 NEMSIS data, consisting of most emergency medical services (EMS) responses from 46 states and territories. We limited the analysis to adult (age ≥18 years) emergency “9‐1‐1” events. We defined out‐of‐hospital cardiac arrest as: (1) patient condition reported as cardiac arrest, (2) EMS reported attempted resuscitation of cardiac arrest, (3) EMS performance of cardiopulmonary resuscitation (CPR), or (4) EMS performance of defibrillation. We determined the incidence of adult out‐of‐hospital cardiac arrest among EMS responses. We also determined patient demographics (age, sex, race, ethnicity, location, US census region, and urbanicity), response characteristics (dispatch complaint and elapsed time) and clinical interventions (medications and procedures) of adult out‐of‐hospital cardiac arrest. We analyzed the data using descriptive techniques, calculating binomial proportions with exact 95% confidence intervals (CI).ResultsAmong 18,679,873 adult 9‐1‐1 responses, there were 224,992 with patient condition cardiac arrest, 344,274 with EMS‐reported attempted cardiac arrest resuscitation, 149,775 with EMS performance of CPR, and 185,388 cases with EMS performance of defibrillation, resulting in a total of 574,824 out‐of‐hospital cardiac arrest (incidence 30.8 per 1000 EMS 9‐1‐1 responses, 95% CI = 30.69–30.85). Among identified out‐of‐hospital cardiac arrest responses, most involved patients who were older (mean = 62.4 ± 20.1 years). Most out‐of‐hospital cardiac arrest occurred at home (58.8%), in the South census region (65.4%), and in urban settings (79.8%). The most commonly reported medications used in out‐of‐hospital cardiac arrest were: epinephrine (22.5%), amiodarone (2.9%), sodium bicarbonate (6.2%), glucose (3.0%), and naloxone (5.1%). Commonly reported procedures included CPR (26.1%), orotracheal intubation (14.2%), bag‐valve‐mask ventilation (10.1%), manual defibrillation (29.3%) and automated external defibrillation (5.6%). Out‐of‐hospital cardiac arrest EMS treatment times were: elapsed response time (median = 7 minutes [interquartile range (IQR) = 5–10]), scene time (median = 17 minutes [IQR = 12–25]), and elapsed transport time (median = 11 minutes [IQR = 6–17]).ConclusionsUsing information available in the 2016 NEMSIS data, we estimate that there were over 570,000 reported adult out‐of‐hospital cardiac arrests in the United States. These results highlight the challenges of characterizing the epidemiology of adult out‐of‐hospital cardiac arrest in the United States.

Pharma Collaboration for Transparent Medical Information (phactMI™) Benchmark Study: Trends, Drivers, and Value of Product Support Activities, Key Performance Indicators, and Other Medical Information Services: Insights from a Survey of 27 US Pharmaceutical Medical Information Departments.

A benchmarking survey was conducted by the pharmaceutical collaboration for transparent Medical Information (phactMI™) consortium, with the goal to capture insights from the 27 member companies and their medical information organizations. phactMI™ Benchmarking Committee delivered an electronic survey to 27 United States (US) member companies' Medical Information (MI) departments between December 12, 2017 and February 20, 2018. The survey consisted of approximately 300 questions, divided into 9 topics which included multiple choice and open-ended questions about the following categories: medical information support provided based on different product lifecycles, key metrics measured to assess department performance, and other key services provided by medical information groups. The extent of MI product support varied across the lifecycle of a product. Most companies provided MI product support throughout the product lifecycle starting from investigational all the way through mature; however, the extent of activities varied. The top key performance indicators (KPIs) that were reported to senior leadership included response turnaround time (59%) and inquiry volume (48%). Among the 27 companies, 85% noted using customer satisfaction surveys administered via links within written response documents and 52% verbally via the company's call center. Other services with which MI groups noted most involvement included congress booth support (100%), insights/metric reporting (96%), and training the sales force on the MI function (74%). Additional services included payor support clinical pathway submissions (22%), presenting at advisory boards (22%), and competitive intelligence (26%). The results of this survey provide pharmaceutical MI groups with opportunities to consider services or activities that could enhance the support these groups provide to their customers and business partners.

Abstract 203: Characteristics of Emergency Medical Service Responses for Adults With Cardiovascular Disease-related Chief Complaints in The United States, 2016

Background: Gaps exist in understanding the commonality of cardiovascular disease (CVD)-related responses by emergency medical services responders in the United States (US) community setting. Objective: We examined characteristics of CVD-related responses among US adults with 9-1-1 emergency medical services (EMS) responses in a national database. Methods: The 2016 National Emergency Medical Services Information System (NEMSIS) database (Version 2.2.1) from 49 states was used. CVD-related chief complaints were defined by data element E09_12 in the NEMSIS code book. Exclusions were EMS cancellations, persons not found, those with unknown sex, and patients aged &lt;18 years. Rates (per 1,000 EMS responses) were calculated for total population and by patient demographics. Chi-square statistical tests were used to assess associations. Percentages of CVD-related chief complaints were calculated for EMS responses (incident patient disposition, type of destination, and reasons for destination), and clinical characteristics (provider’s primary impression, provider’s secondary impression, primary symptom, and EMS condition code). Results: We identified over 19.8 million EMS responses among adults aged ≥18 years old in 2016, including 1,336,684 (67.4 per 1,000 EMS responses) with CVD-related chief complaints. Rates of CVD-related chief complaints per 1,000 EMS responses for females (68.5), patients aged 65-74 years old (87.7), Hawaiian Pacific Islanders (83.6), whites (73.4), and those living in the South census region (72.8) were significantly higher than their respective counterparts. Among EMS responses, most CVD-related chief complaints were treated and transported by EMS (83.1%), and of those transported by EMS, 83.5% were transported to a hospital. Reasons for hospital destinations among adults with CVD-related chief complaints were patient’s preferred hospital (34%) and closest facility (32.9%). Most CVD-related chief complaints were chest pain or discomfort according to provider’s primary impression (48%) and provider’s secondary impressions (6.1%). Finally, pain (46.2%) was the most frequently reported condition as primary symptom among EMS patient with CVD-related chief complaints. Conclusion: Approximately 1-in-15 EMS (9-1-1) responses among adults involved a CVD-related chief complaint. Future research could focus on trends for CVD-related EMS responses overtime. Keyword: 9-1-1 emergency system, prehospital cardiovascular disease, CVD-related events.

Characteristics of paediatric out-of-hospital cardiac arrest in the United States

BackgroundThe absence of nationwide surveillance data on out-of-hospital cardiac arrest (OHCA) in the United States (US) limits understanding of the epidemiology of paediatric OHCA. We investigated the national characteristics of paediatric OHCA using the National Emergency Medical Services Information System (NEMSIS). MethodsWe conducted a cross-sectional study using the 2016 NEMSIS dataset, a national registry of emergency medical services (EMS) activations at 46 states in the US. We included paediatric patients (age <18 years) with “9-1-1” EMS responses to OHCA. We defined OHCA as (a) presence of cardiac arrest; (b) EMS reported initiation of cardiac arrest resuscitation; (c) performance of chest compressions; or (d) performance of defibrillation. We reported the incidence and characteristics of paediatric OHCA, stratified by age group: <1 year: infants, 1–5 years: young children, 6–12 years: older children, and 13–17 years: adolescents. ResultsAmong 1,531,469 paediatric EMS responses, we identified a total of 23,514 EMS responses to paediatric OHCA (95% confidence interval [CI], 23,217–23,814), incidence of 15.4 per 1000 paediatric EMS responses (95% CI, 15.2–15.5), and estimated national incidence of 37.9 per 100,000 child-years (95% CI, 37.4–38.4). Among 23,514 EMS responses to paediatric OHCA, we observed 4515 (19.2%) of EMS responses in infants, 5588 (23.8%) in young children, 4976 (21.2%) in older children, and 8435 (35.9%) in adolescents. ConclusionUsing data from the NEMSIS, we estimate that there are over 23,000 annual paediatric OHCA in the US. These data provide key insights of paediatric OHCA in the US.

Sistem Informasi Pelayanan Medis Pada Pasien di Klinik Insani Citeureup Berbasis Java

The purpose of this research is to design a medical service information system for Java-based human citeureup clinical patients to accelerate and manage patient data, search for medical service information systems and to produce medical service information systems in Java-based human clinical clinics. The research method used by researchers is a qualitative research method that is research on research conducted descriptive and using analysis. The results obtained were about medical service information systems to assist in processing patient data. The construction of this information system is expected to facilitate and provide maximum service to patients as well as facilitate the processing of transaction data for reporting, data and information management processes become more effective, produce faster output and no longer use incorrect data input or require duplication of data.

Pharma Collaboration for Transparent Medical Information (phactMI™) Benchmark Study: Results of Organizational Structure and Resourcing of Medical Information Services in Support of Building Departmental Strategies.

An opportunity exists to leverage the collective insights and experiences of phactMI™ member companies on current medical information (MI) services across the pharmaceutical industry. The collective insights provide considerations for refined MI strategies and enhanced MI services. The trend of organizational structure and challenge of resourcing for MI services are key areas to support efficiency and bring value to the overall organization. Between December 2017 and February 2018, all 27 phactMI™ member companies were electronically sent a 300-question survey to support the development of MI services across the pharmaceutical industry. The survey had 9 key areas of focus, including organizational structure and resourcing. All 27 companies responded to the survey. Although the 27 companies survey differed in structure and size, the MI responsibilities performed both by in-house and outsourced groups were similar with each organization. Half of the groups outsourced various responsibilities which supported the non-product roles, such as quality assurance, compliance reporting, vendor operations management, reporting/analytics, technology and digital support, content-related process work, presentation specialists, and payer and health system support. Despite the ever-changing nature of the pharmaceutical industry, most responsibilities and outsourced work by MI groups remain the same over time. These findings provide MI teams various options for organizational structuring and resource strategies for MI services. These results highlight the services and focus areas that MI departments can explore and support the development of additional MI services across the pharmaceutical industry.

RANCANG BANGUN SISTEM INFORMASI PELAYANAN MEDIS PADA KLINIK DR. AFRIYANTI MENGGUNAKAN MODEL WATERFALL

Service process, it is necessary to handle and process the relevant data well. Dr. Clinic Afriyanti is a health unit that provides public health services to the community. In the health services provided at the Dr. Afriyanti is currently still conventional which includes writing and storing patient data still using paper media. And there are no important reports required for the clinic. From these conditions can hamper the time when searching for patient data, and also can lead to errors in writing. Besides, the stored data is vulnerable to unpredictable data loss and damage. To overcome the problems that exist in the previous system, we need a computer-based information system. With this program, it will be easier to find patient data, patient data is stored more safely and can make reports easily and with accurate results. This research uses UML as a tool and PHP as a programming language in the design of medical service information systems.

Principles and Considerations for Responsible Sharing of Safety Information Via the Medical Information Channel

The approach used by medical information services in answering unsolicited safety-related questions from health care professionals regarding prescription medicines varies widely across the pharmaceutical industry. A significant amount of information is available in the public domain, but this can be difficult to filter and determine what is most appropriate for a given situation. A team representing the medical information group MILE (Medical Information Leaders Europe) and European Federation of Pharmaceutical Industries and Associations Pharmacovigilance Expert Group have partnered to develop principles and considerations on how to answer unsolicited safety questions. Essentially two key principles are important in ensuring success: (1) Effective collaboration between medical information and patient safety teams is important for an optimal outcome providing accurate, useful, and timely information. This article discusses considerations for an effective, efficient collaboration between medical information and patient safety and suggests a way of working. (2) Collaborating teams will need to evaluate and select the most appropriate sources of information to answer the question. Sources of information that may or may not be in the public domain are discussed. Adoption of principles and considerations discussed in this article may be expected to improve current safety information-sharing practices that tend to be conservative and risk averse. In addition, this presents the opportunity to initiate discussions with regulatory authorities to realize the benefits that will come through greater transparency and communication to support safe and effective use of medicines.

Abstract 230: Opioid-Related Cardiac Arrest Incidence and Epidemiology in Maine

Introduction: The frequency of opioid-related cardiac arrest (ORCA) is increasing across several geographic regions in the United States. Understanding how Maine’s urban and rural areas are affected by ORCA is necessary to improving prevention and treatment of this public health threat. Hypothesis: Patient demographics, clinical features, rurality and survival to emergency department (ED) admission vary significantly between ORCA and non-ORCA. Methods: We evaluated the National Emergency Medical Services Information System data from 2016-2017 for all emergency 911 responses in which emergency medical services (EMS) reported non-traumatic out of hospital cardiac arrest (OOHCA). We defined ORCA as EMS suspected opioid overdose as the primary etiology, or an overdose without established etiology and naloxone administered during cardiopulmonary resuscitation (CPR). Rurality was assigned using Rural-Urban Commuting Area Codes (RUCA). Demographics and arrest-specific factors were compared between ORCA and non-ORCA, followed by logistic regression to evaluate how ORCA was associated with survival to ED admission. Results: There were 3131 EMS responses for OOHCA during the study period. One hundred sixty-eight (5%) patients met the definition of ORCA. These patients were younger (35 ± 9 years vs 62 ± 17 years, p&lt;0.001), less likely to have the reported diagnosis or treatment for chronic medical conditions (p&lt;0.001-0.02), an initial shockable rhythm (12% vs 28%, p&lt;0.001), occur in a public place (13% vs 23%, p=0.02), or be witnessed (38% vs 60%, p&lt;0.001), but more likely to receive bystander CPR (27% vs 16%, p&lt;0.001) and report illicit drug use (19% vs 2%, p&lt;0.001). ORCA was more likely to occur in metropolitan or large rural areas compared to small rural or isolated rural areas (75% vs 25%, p&lt;0.001). After adjusting for age, gender, initial shockable rhythm, witnessed arrest, bystander CPR, and rurality, patients with ORCA had an increased odds of surviving to ED admission (OR 1.83 [CI 1.11-2.95]). Conclusions: Patients in Maine with ORCA are distinctly different from patients with non-ORCA, are more likely to survive to ED admission and are seen more commonly in metropolitan and large rural areas.

Use of Mechanical Cardiopulmonary Resuscitation Devices for Out-of-Hospital Cardiac Arrest, 2010-2016

Out-of-hospital cardiac arrest is a common scenario facing prehospital emergency medical services (EMS) professionals and nearly always involves either manual or mechanical cardiopulmonary resuscitation (CPR). Mechanical CPR devices are expensive and prior clinical trials have not provided evidence of benefit for patients when compared with manual CPR. To investigate the use of mechanical CPR in the prehospital setting and determine whether patient demographic characteristics or geographical location is associated with its use. A retrospective cross-sectional study was performed using the 2010 through 2016 National Emergency Medical Services Information System data. Participants included all patients identified by EMS professionals as having out-of-hospital cardiac arrest. Use of CPR, categorized as manual or mechanical. From 2010 to 2016, 892 022 patients (38.6% female, 60.4% male, missing for 1%; mean [SD] age, 61.1 [20.5] years) with out-of-hospital cardiac arrest were identified by EMS professionals. Overall, manual CPR was used for 618 171 patients (69.3%) and mechanical CPR was used for 45 493 patients (5.1%). The risk-standardized rate of mechanical CPR use, accounting for patient demographic and geographical characteristics, rose from 1.9% in 2010 to 8.0% in 2016 (P < .001). In multivariable analyses, use of mechanical CPR devices was increasingly likely over time among patients identified with out-of-hospital cardiac arrest treated by EMS professionals, increasing from an adjusted odds ratio of 1.58 (95% CI, 1.42-1.77; P < .001) when comparing 2011 with 2010, to an adjusted odds ratio of 11.32 (95% CI, 10.22-12.54; P < .001) when comparing 2016 with 2010. In addition, several other patient demographic and geographical characteristics were associated with a higher likelihood of receiving mechanical CPR, including being 65 years or older, being male, being Hispanic, as well as receiving treatment in the Northeast Census Region, in a suburban location, or in a zip code with a median annual income greater than $20 000. Mechanical CPR device use increased more than 4-fold among patients with out-of-hospital cardiac arrest treated by EMS professionals. Given the high costs of mechanical CPR devices, better evidence is needed to determine whether these devices improve clinically meaningful outcomes for patients treated for out-of-hospital cardiac arrest by prehospital EMS professionals to justify the significant increase in their use.

Principles and Considerations for Responsible Sharing of Safety Information Via the Medical Information Channel.

The approach used by medical information services in answering unsolicited safety-related questions from health care professionals regarding prescription medicines varies widely across the pharmaceutical industry. A significant amount of information is available in the public domain, but this can be difficult to filter and determine what is most appropriate for a given situation. A team representing the medical information group MILE (Medical Information Leaders Europe) and European Federation of Pharmaceutical Industries and Associations Pharmacovigilance Expert Group have partnered to develop principles and considerations on how to answer unsolicited safety questions. Essentially two key principles are important in ensuring success: (1) Effective collaboration between medical information and patient safety teams is important for an optimal outcome providing accurate, useful, and timely information. This article discusses considerations for an effective, efficient collaboration between medical information and patient safety and suggests a way of working. (2) Collaborating teams will need to evaluate and select the most appropriate sources of information to answer the question. Sources of information that may or may not be in the public domain are discussed. Adoption of principles and considerations discussed in this article may be expected to improve current safety information-sharing practices that tend to be conservative and risk averse. In addition, this presents the opportunity to initiate discussions with regulatory authorities to realize the benefits that will come through greater transparency and communication to support safe and effective use of medicines.

Racial/Ethnic Disparities in Pain Treatment: Evidence From Oregon Emergency Medical Services Agencies.

Despite the critical role that Emergency Medical Services (EMS) provides in the health care system, racial/ethnic treatment disparities in EMS remain relatively unexamined. To investigate racial/ethnic treatment disparities in pain assessment and pain medication administration in EMS. A retrospective analysis was performed on 25,732 EMS encounters from 2015 to 2017 recorded in the Oregon Emergency Medical Services Information System using multivariate logistic regression models to examine the role of patient race/ethnicity in pain assessment and pain medication administration among patients with a traumatic injury. Hispanic and Asian patients were less likely to receive a pain assessment procedure and all racial/ethnic patients were less likely to receive pain medications compared with white patients. In particular, regarding the adjusted likelihood of receiving a pain assessment procedure, Hispanic patients were 21% less likely [95% confidence interval (CI), 10%-30%; P<0.001], Asian patients were 31% less likely (95% CI, 16%-43%; P<0.001) when compared with white patients. Regarding the adjusted likelihood of receiving any pain medications, black patients were 32% less likely (95% CI, 21%-42%; P<0.001), Hispanic patients were 21% less likely (95% CI, 7%-32%; P<0.01), and Asian patients were 24% less likely (95% CI, 1%-41%; P<0.05) when compared with white patients. Racial/ethnic minorities were more likely to experience disadvantages in EMS treatment in Oregon. Hispanic and Asian patients who requested EMS services in Oregon for traumatic injuries were less likely to have their pain assessed and all racial/ethnicity patients were less likely to be treated with pain medications when compared with white patients.

Patients' and healthcare providers' perspectives on diabetes management: A systematic review of qualitative studies.

Despite the availability of evidence-based guidance to deliver effective diabetes care, many patients do not achieve goals as recommendations. This systematic review was to synthesize useful insight perspectives by patients and providers to identify factors related to diabetes management using Chronic Care Model. This systematic review aimed to synthesize perspectives by patients and providers in order to identify factors related to diabetes management. Databases were searched including CINAHL, PubMed, Science Direct, and Web of Science from January 2001 to September 2017. Combination of search terms were used like 'qualitative,' 'diabetes management,' 'patients' perspective,' and 'provider's perspective.' All qualitative studies used were in English with available full text. Chronic Care Model framework was used to analyze the content and to organize the findings. Of 108 articles used, only 23 of this met the inclusion criteria. Nine factors were identified including community linkage, health service system for diabetic patients, continuity of care, self-management, providers' support, referral system, patient-provider interaction, increasing competency of healthcare providers and family support. Community linkage was revealed to be an important factor to encourage diabetic patients to look after their disease while health service system showed the limit of accessibility due to location, medical service availability, finance, information, and time. Continuity of care has shown lack of coordination in referral system within a health care team and self-management was dependent on the knowledge, beliefs, attitude, and behavior of the patient. More so, providers' support through an effective plan and/or strategy has also indicated to help patients get their target goal. Poor interaction between patients and health providers was found to be largely attributed to language barrier and lack of communication skill. Improving competency for the health providers can be achieved through continuing professional education. Both perspectives supported a family involvement and community resources for diabetes patients. Factors related to diabetes management from nine themes showed various gaps in both perspectives. Further research on new models for diabetes management is required.

Comprehensive analysis of medical service information publicity in Shanxi province from 2005 to 2016

Objective To comprehensively analyze the medical service information of the province, for evidence of continuous improvement of medical service quality. Methods Collecting and analyzing the medical service information from 2005 to 2016 as provided by the Health and Family Planning Commission of Shanxi province. Results The number of medical institutions with information disclosure in Shanxi province increased gradually, with the contents being more and comprehensive. The number of discharges and the average hospitalization expenses were basically on the rise year by year, and the average length of stay was on the decline. Conclusions Comprehensive analysis of medical service information publicity provides an effective information platform in facilitating patients′ choice of hospitals, social supervision and evaluation hospital, and guiding hospitals to focus on improving medical quality. Key words: Quality of health care; Medical service information; Disclosure; Public reporting

Approach to Onboarding Emergency Medical Services (EMS) Data Into a Syndromic Surveillance System

ObjectiveTo describe the strategy and process used by the Florida Department of Health (FDOH) Bureau of Epidemiology to onboard emergency medical services (EMS) data into FDOH’s syndromic surveillance system, the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE-FL).IntroductionSyndromic surveillance has become an integral component of public health surveillance efforts within the state of Florida. The near real-time nature of these data are critical during events such as the Zika virus outbreak in Florida in 2016 and in the aftermath of Hurricane Irma in 2017. Additionally, syndromic surveillance data are utilized to support daily reportable disease detection and other surveillance efforts. Although syndromic systems typically utilize emergency department (ED) visit data, ESSENCE-FL also includes data from non-traditional sources: urgent care center visit data, mortality data, reportable disease data, and Florida Poison Information Center Network (FPICN) data. Inclusion of these data sources within the same system enables the broad accessibility of the data to more than 400 users statewide, and allows for rapid visualization of multiple data sources in order to address public health needs. Currently, the ESSENCE-FL team is actively working to incorporate EMS data into ESSENCE-FL to further increase public health surveillance capacity and data visualization.MethodsThe ESSENCE-FL team worked collaboratively with various public health program stakeholders to bring EMS data, aggregated by the FDOH Bureau of Emergency Medical Oversight Emergency Medical Services Tracking and Reporting System (EMSTARS) team, into ESSENCE-FL. The ESSENCE-FL team met with the EMSTARS team to discuss use cases, demonstrate both systems, and to obtain project buy-in and support. Initial project meetings included review of ESSENCE-FL system support, user types (roles and access), as well as data security and compliance. An overall project timeline was established, and deliverables were added into system support contracts. Multiple stakeholders, across disciplines representing each key use case, reviewed the Florida version of the National Emergency Medical Services Information System (NEMSIS) version 3.4 data dictionary to identify program-specific data element needs. An element scoring spreadsheet was returned to the ESSENCE-FL team. These scores were aggregated and discordant scores were reviewed by the ESSENCE-FL team. A one-month extract of EMS data was reviewed to assess variable completeness and relevance. Monthly team meetings facilitated the final decisions on the data elements by leveraging lessons learned through onboarding other data sources, findings from the analysis of the one-month extract, stakeholder comments, and advice from other states known to be leveraging EMS data for public health surveillance.ResultsThrough a collaborative and broad approach with partners, the ESSENCE-FL team attained stakeholder buy-in and identified 81 data elements to be included in the EMS feed to ESSENCE-FL. The final list of data elements was determined to best support health surveillance of this population prior to presenting to the ED. The inclusion of the EMS data in ESSENCE-FL will increase the epidemiologic characterization and analysis of the opioid epidemic in Florida. Additional key use cases identified during this project included enhanced injury surveillance, enhanced occupational health surveillance, and characterization of potential differences between EMS and ED visits.ConclusionsThis comprehensive approach can be used by other jurisdictions considering adding EMS data to their syndromic surveillance systems. When considering onboarding a new data source into a surveillance system, it is important to work closely with stakeholders from disciplines representing each of the key use cases to broaden buy-in and support for the project. Through employing this comprehensive approach, syndromic surveillance systems can be better developed to include data that are widely utilizable to many different stakeholders in the public health community.

Progress in the Development of the Standardized Public Health Emergency Preparedness Terminology

ObjectiveThe purpose of this project is to demonstrate the progress in development of a standardized public health (PH) emergency preparedness and response data ontology (terminology) through collaboration between the Centers for Disease Control and Prevention (CDC), Division of Emergency Operations (DEO), and the Logical Observation Identifiers Names and Codes (LOINC) system.IntroductionThe U.S. Department of Homeland Security National Incident Management System (NIMS) establishes a common framework and common terminology that allows diverse incident management and support organizations to work together across a wide variety of functions and hazard scenarios1. Using common terminology helps avoid confusion and enhances interoperability, particularly in fast-moving public health (PH) emergency responses. In addition, common terminology allows diverse incident management and support organizations to work together across a wide variety of functions and scenarios1. LOINC is one of a suite of designated standards for the electronic exchange of public health and clinical information. Implementation of LOINC facilitates improvement of semantic interoperability, including unified terminology2. More than 68,100 registered users from 172 countries use LOINC to move interoperable data seamlessly between systems3. The CDC Division of Emergency Operations (DEO) leads development of standardized PH emergency preparedness and response terminology to improve effective and interoperable communications between national and international partners. Realizing the scale of LOINC support and implementation across the global public health arena, CDC DEO collaborates with LOINC to further enhance and harmonize the current PH emergency response terminology and to attain critical PH emergency management and preparedness and response requirements.MethodsDEO analyzed 87,863 LOINC terms that were included in LOINC version 2.64, released on 06/15/20183. Access to this LOINC version was obtained through the Regenstrief LOINC Mapping Assistant (RELMA). RELMA is a Windows-based LOINC utility developed by the Regenstrief Institute (Indiapolis, USA) for searching the LOINC database and mapping local codes to LOINC codes4. The relevance of LOINC terminology to PH emergency preparedness and response was assessed through evaluating existing LOINC terminology against terminology specified by the World Health Organization PH Emergency Operation Centers (EOC). The following functions were evaluated: 1) Managing and Commanding; 2) Operating; 3) Planning/Intelligence; 4) Logistics and 5) Finance/Administration5. LOINC terminology was also evaluated against the CDC PH EOC Minimum Data Set (MDS)6 that contains 315 standardized terms. Analysis of fully specified LOINC terms was conducted through assessment of such LOINC term parts (attributes) as the code, name (component), system, method and class. Recommendations of gaps and enhancements were coordinated with LOINC management for inclusion of the new terminology in the release of version 2.65 .ResultsA new LOINC method, “CDC.EOC”, is under development. Currently, the “emergency management incident” terminology presented by LOINC is limited by such characteristics as event type, event location and event name and requires amplification regarding to PH operations (i.e., communication, logistics etc.).As a result of this investigation, emergency management terms are now being classified according to the type of incident or event (i.e., hurricane, outbreak, etc.) under LOINC code 80394-0. Similarly laboratory and clinical terms are being classified under a provisional LOINC code (89724-9). Two panels were created: 1) The emergency medical systems from the National Emergency Medical Services Information System (NEMSIS) was added under the NEMSIS.Panel (n= 177 terms) and 2) the Data Elements for Emergency Departments Systems (DEEDS) panel (n = 152 terms) was added with two subpanels: Attach.ED and Panel.ED.Assessing existing LOINC taxonomy and codification, DEO is working with the LOINC management team on evaluating additional options for reconciliation the PH emergency preparedness and response common information exchange reference model and LOINC standard. This process aims to further improve semantic interoperability of PH emergency preparedness and response information.ConclusionsThe LOINC terminology standardization is essential for improving PH preparedness and response data exchange and semantic interoperability. Collaboration with the Regenstrief Institute (LOINC) allows CDC to meet the terminology needs of PH emergency management and defines new opportunities for reconciliation data exchange between NIMS partners. This collaborative effort incorporates critically needed PH emergency and preparedness terminology and hierarchical structure in the LOINC standard.

US Medical Information Websites Benchmarking: How Is the Industry Fairing in Usability?

This study of 23 US-based biopharmaceutical medical information (MI) websites was conducted to assess usability and identify best practices and areas of potential improvement. In this systematic review, websites were evaluated from June 22-November 1, 2016, and awarded points based on content, functionality, and navigation (maximum score of 42). Low-, mid-, and high-range usability scores were ≤13, 14-27, ≥28, respectively. Mean scores were 7 of 17, 4 of 10, and only 5 of 15 criteria for content, functionality, and navigation. The mean usability score across all websites was 15 of 42 criteria. Larger companies generally had a higher mean usability score. A minor trend was also observed with regard to usability score and industry size (r2 = 0.3). Only 2 websites scored high, whereas 13 scored in the mid- and 8 in the lower range of usability. Overall, websites scored low when pertaining to presence of novel content type, search engine optimization, presence of social media, and MI services offered. Overall site architecture, presence of self-certification, and mobile compatibility scored fairly well across the industry. The majority of websites scored in the low to midrange, which suggests an industry-wide opportunity for improvement. In order to meet the evolving needs of health care professionals, MI websites need to be optimized for content, navigation, and functionality. Ensuring MI websites are discoverable through search engines and improving the level of MI services offered was also deemed to be important features to incorporate into a given MI website optimization strategy.

Pediatric firearm incidents: It is time to decrease on-scene mortality.

Previous epidemiological studies on pediatric firearm mortality have focused on overall mortality rather than on-scene mortality. Despite advances in trauma care, the number of potentially preventable deaths remains high. This study used the National Emergency Medical Services Information Systems database to characterize patterns of on-scene mortality in order to identify patients who may benefit from changes to prehospital care practices. National Emergency Medical Services Information Systems database was searched for all pediatric firearm incidents from 2010 to 2015. Data on demographics, anatomic location of injury, intent and location of incident, and on-scene mortality were analyzed using Student's t test for continuous variables and χ test for categorical variables. A linear regression model was used to calculate independent predictors of mortality. Sixteen thousand eight hundred eight patients were identified, with a mortality rate of 6.1%. Most mortalities suffered cardiac arrest on-scene; 72.6% of these were prior to Emergency Medical Services (EMS) arrival, which carried a significantly higher mortality rate than arrest after EMS arrival. No difference was seen in anatomic location of injury in those who arrested before and after EMS arrival. Compressible injuries were most common with the lowest mortality. Noncompressible injuries together accounted for 25.8% of injuries and 23.5% of mortalities. To our knowledge, this is the largest study of on-scene mortality in pediatric firearm injury. Cardiac arrest prior to EMS arrival was a considerable source of on-scene mortality; significantly more of these patients died than those who arrested after EMS arrival. The mortality of compressible injuries was very low, implying that use of compression and tourniquets have been effective in stopping life-threatening extremity bleeding. Noncompressible injury mortality could be decreased with education of bystanders and more aggressive on-scene intervention. Through the evaluation of on-scene mortality specifically, this study offers insight into potential areas of focus to improve prehospital care of pediatric gunshot victims. Therapeutic/Care management, level IV.

Understanding physicians’ adoption of electronic medical records: Healthcare technology self-efficacy, service level and risk perspectives

Most developed countries across the globe are deploying electronic medical record (EMR) as one of the most important initiatives in their healthcare policy. EMR can not only reduce the problems associated with managing paper medical records but also improve the accuracy of medical decisions made by physicians and increase the safety of patients. Considering that physicians are the primary users of EMR, their willingness to use EMR is a critical success factor for EMR implementation in a hospital. This study aims to extend an individual-level information technology adoption model by incorporating three additional variables to investigate whether the individual characteristics of a physician affect EMR adoption. A field survey is conducted with a total of 217 physicians from 15 different academic medical centers and metropolitan hospitals for six weeks. Then, the Structural Equation Modeling (SEM) analysis results indicate that perceived service level is an important antecedent of perceived usefulness. Healthcare technology self-efficacy, perceived risk, and perceived service level are also important antecedents of perceived ease of use. This study is concluded with implications for academics, hospital managers, governments, and medical information service providers.