Medical Record Information Research Articles

Sistem Informasi Rekam Medis Berbasis Web Menggunakan Teknologi Sidik Jari (Studi Kasus Puskesmas Kampung Sawah) Bandar Lampung

The information system at Kampung Sawah Community Health Center has several features such as patient registration, patient medical records, patient services, queues, and medical reports. Aim of this information system development is to facilitate the performance of administrators and doctors of Kampung Sawah Community Health Center in terms of searching patients’ data, storing the patient data, adding and storing the medical records, making the reports, and speeding up the data entry and identity data of the patients through fingerprint feature. This system facilitated the officials and doctors to process anywhere and the patient data was safe from physical disturbances because this system was connected to the internet.This medical record information system was built through PHP programming language supported by MySQL database. The design of this system involved the data flow diagrams. The result of this system was that the web-based information system for medical record had successfully been created and used by Kampung Sawah Community Health Center.Keywords: Information Systems, Medical Record, Web, Fingerprint

Pediatric SARS-CoV-2 seroprevalence during mitigation procedures in Southwestern Pennsylvania

BackgroundChildren infected with SARS-CoV-2 are often asymptomatic or have only mild symptoms, leading to underestimation of disease prevalence in symptom-based testing strategies. ObjectivesThis study sought to determine pediatric SARS-CoV-2 disease burden during local mitigation efforts by using antibody testing to compare seroprevalence estimates to cumulative PCR prevalence estimates. Study designIn this cross-sectional study, we collected 1142 strict phase and 1196 relaxed phase remnant blood specimens from patients less than 19-years-old in southwestern Pennsylvania (SWPA). Patients were excluded if their residential zip code was outside the region of interest, if they were under 6-months-old, or they had recently received antibody-modifying treatments. Demographic, encounter, and laboratory electronic medical record information was extracted. Samples were tested for SARS-CoV-2 spike protein IgG using an EUA ELISA, and PCR results were recorded from county health department data. Seroprevalence and Clopper-Pearson exact 95% confidence intervals were calculated. ResultsThe observed seroprevalence of SARS-CoV-2 spike protein antibodies in children during strictest mitigation was 0.53% (95% CI 0.19, 1.14) and 0.92% (95% CI 0.46,1.64) during moderately relaxed. Strict and relaxed phase PCR-based prevalence were significantly higher, 2.87% (95% CI 1.95, 4.08) and 3.64 (95% CI 3.01, 4.38), respectively. ConclusionsEstimates of pediatric seroprevalence were significantly lower than cumulative PCR prevalence estimates, and less than adult seroprevalence estimates, potentially due to biological, population, or sampling differences. Biological differences in pediatric immune responses to SARS-CoV-2 may make serosurvey interpretation challenging and these differences warrant further study.

Artificial Intelligence for Screening Chinese Electronic Medical Record and Biobank Information.

Objective: To establish a structured and integrated platform of clinical data and biobank data, and a client to retrieve these data. Study Design: Initially, the hospital information system (HIS) and biobank information system (BIS) were integrated through the patients' ID numbers. Then, natural language processing (NLP) was used to process the integrated unstructured clinical information. A query interface was designed for this system, which enabled researchers to retrieve clinical or biobank data. Finally, several queries were listed and manually checked to test the retrieval performance of the system. Results: The construction of the biobank screening system (BSS) was completed, and the data were structured. The BSS took an average of 2 seconds to perform a search for target patients/samples. The retrieval results were consistent with the HIS and BIS. For complex queries, we manually checked the retrieved patients/samples, and the system's accuracy was 100%. Conclusion: This NLP-based system improved biological sample screening and using of clinical data. We will continue to improve this system, enhance resource sharing, and promote the development of translational medicine.

Environmental factors related to sleep latency among inpatients in rehabilitation wards according to functional independence measure cognitive scores.

No study has investigated sleep-related environmental factors in patients according to their functional independence measure (FIM) cognitive scores. The aim of this study is to examine the associations between environmental factors such as noise and sleep latency according to the FIM cognitive scores among inpatients in rehabilitation wards. This is a prospective longitudinal study. This study measured the sleep state using a bed-based actigraphy, environmental data from Environmental Sensor®, and medical record information of 33 inpatients in the rehabilitation wards during 2018. A linear mixed-effect model was used to analyse the associations between sleep latency and environmental factors. Participants were grouped according to high or low FIM cognitive scores. The average patient age was 77.2 ± 10.9 years, and 48.5% were male. In the high FIM cognitive score group, the loudness and frequency of noise exceeding 40 dB during sleep latency were significantly associated with sleep latency. In the low FIM cognitive score group, only the noise frequency was associated with sleep latency, and intra-individual variance was larger than that of the high group. These findings suggest that providing night care with attention to subdued noise is important, particularly for patients with low cognitive functional independence levels measured by the FIM cognitive score.

Introduction Study Of Business Intelligence Hospital Medical Recording Data

In every health service facility in a hospital, it is obligatory to make medical records made by doctors and health workers related to the services provided by doctors and other health workers. Medical records made, both outpatient medical records and inpatient medical records, are stored in a medical record file storage area (filling).. Phe management of medical records with the standard Medical Record Information Management (MIRM) is to support orderly administration in the context of efforts to improve health services in hospitals which are supported by a medical record management system that is fast, precise, valuable, accountable, and focuses on patients and safety patients in an integrated manner. The purpose of this system plan is to make it easier for management and leaders to get a visual summary of information for decision making.

Pediatric Practice Redesign with Group Well Child Care Visits: A Multi-Site Study.

Multiple barriers exist to delivering efficient, effective well child care, especially in low-income, immigrant communities. Practice redesign strategies, including group well child care, have shown promise in improving care delivery and healthcare outcomes. To assess the feasibility of a group well child care program at multiple urban, academic practices caring for underserved, mostly immigrant children, and to evaluate health outcomes and process measures compared to traditional care. Prospective, intervention control study with participants recruited to group well child care visits or traditional visits during the first year of life. A culturally sensitive curriculum was designed based on American Academy of Pediatrics (AAP) recommendations. Process and health outcomes were analyzed via patient surveys and medical record information. One hundred and one families enrolled in group care and 74 in traditional care. Group care participants had higher rates of all recommended postpartum depression screening and domestic violence screening (65% vs 37%, 38% vs 17% respectively), higher anticipatory guidance retention (67% vs 37%) and higher patient satisfaction with their provider. The group care redesign did not increase length of time spent in clinic. Group well child care is a feasible method for practice redesign, which allows for increased psychosocial screening and anticipatory guidance delivery and retention compared to traditional visits, for low income, predominantly immigrant families. Parental satisfaction with group care is higher and these visits provide greater face-to-face time with the provider, without increasing time spent in the practice.

Testicular function in males with infantile nephropathic cystinosis.

STUDY QUESTIONDo males with the rare lysosomal storage disease infantile nephropathic cystinosis (INC) have a chance of biological fatherhood?SUMMARY ANSWERCryostorage of semen could be an option for approximately 20% of young males with INC, with surgical sperm retrieval from the centre of the testes providing additional opportunities for fatherhood.WHAT IS KNOWN ALREADYBiallelic mutations in the cystinosin (CTNS) gene in INC cause dysfunction in cystine transport across lysosomal membranes and cystine accumulation throughout the body. Spontaneous paternity in cystinosis has not been described, despite the availability of cysteamine treatment. Azoospermia has been diagnosed in small case series of males with INC. ART using ICSI requires few spermatozoa, either from semen or extracted surgically from the testes of azoospermic men. However, there is limited evidence to suggest this could be successful in INC.STUDY DESIGN, SIZE, DURATIONIn this prospective cohort study performed between 2018 and 2019, we performed a cross-sectional investigation of 18 male patients with INC to delineate endocrine and spermatogenic testicular function.PARTICIPANTS/MATERIALS, SETTING, METHODSSerum hormone levels, semen samples (according to World Health Organization 2010 standards), and testicular ultrasound images were analysed in 18 male patients aged 15.4–40.5 years. Surgical sperm extraction was performed in two, and their testicular biopsies were investigated by light and electron microscopy. Past adherence to cysteamine treatment was assessed from medical record information, using a composite scoring system.MAIN RESULTS AND THE ROLE OF CHANCEAdherence to cysteamine treatment was high in most patients. Testicular volumes and testosterone levels were in the normal ranges, with the exception of two and three older patients, respectively. Serum LH levels were above the normal range in all subjects aged ≥20 years. FSH levels were elevated in all but four males: three with spermatozoa in semen and one adolescent. Inhibin B levels were shown to be lower in older men. Testicular ultrasound revealed signs of obstruction in 67% of patients. Reduced fructose and zinc seminal markers were found in 33%, including two patients with azoospermia who underwent successful surgical sperm retrieval. Histology identified fully preserved spermatogenesis in the centre of their testes, but also tubular atrophy and lysosomal overload in Sertoli and Leydig cells of the testicular periphery.LIMITATIONS, REASONS FOR CAUTIONLimitations of this study are the small number of assessed patients and the heterogeneity of their dysfunction in cystine transport across lysosomal membranes.WIDER IMPLICATIONS OF THE FINDINGSThis study suggests that testicular degeneration in cystinosis results from the lysosomal overload of Sertoli and Leydig cells of the testicular periphery, and that this can possibly be delayed, but not prevented, by good adherence to cysteamine treatment. Endocrine testicular function in INC may remain compensated until the fourth decade of life; however, azoospermia may occur during adolescence. Cryostorage of semen could be an option for approximately 20% of young males with INC, with surgical sperm retrieval providing additional opportunities for biological fatherhood.STUDY FUNDING/COMPETING INTEREST(S)This work was supported by the Cystinosis Foundation Germany. The authors have no competing interests to declare.TRIAL REGISTRATION NUMBERn/a.

Secondary Warehouse Management System of Medical Low Value Consumables under SPD Mode and its Working Method

Objective: To study the secondary warehouse management system and operation mode of medical low value consumables under SPD mode. Methods: From August 2018 to August 2019, the management mode of the secondary warehouse management system of medical low value consumables was selected. According to the management method, it can be divided into the observation group and the control group. The relevant data of the observation group was based on SPD mode, and the data of the control group was based on the traditional mode. According to the improvement of the two groups of data management effect, data integration and analysis are carried out to judge the effectiveness of the SPD mode of medical low value consumables secondary warehouse management system and its working mode. Results: During the analysis of the two groups of data, the relevant data were analyzed. The data validity of the observation group was higher (94.0%), and the differences of the limitations and problems in the management process had more advantages, while the relevant data corresponding to the two groups of data had significant differences (P<0.05). Conclusion: According to the current research results, Based on the collection, storage and central management of data electronic medical record information, the secondary warehouse management system of medical low value consumables under SPD mode is connected with clinical information system and management information system, which realizes the unification, resource integration and efficient operation of different business systems in the hospital, so as to help improve the quality and efficiency of medical care, prevent and reduce medical errors, Control and reduce medical expenses.

Design And Build Information System Web-Based Medical Record (Case Study: Puskesmas Tambarangan)

The Puskesmas is a functional health organization which is the center for community health development and fostering community participation. Existing services at the puskesmas must be carried out properly and correctly in order to simplify and speed up the flow of services, a medical record data processing information system is very appropriate to simplify existing services at the puskesmas. This study aims to produce a patient medical record information system at Tambarangan Public Health Center. This system is built on a web-based basis using the CodeIgniter framework and will be developed using the waterfall medote.

Analysis of Factors Influencing Students to Enroll in Medical Record and Health Information Program at the School of Health Sciences Panakkukang Makassar, South Sulawesi

One of the principles of higher education is freedom in choosing a study program based on the student’s interests and abilities. These elements influence the student’s decisions in choosing a college/university. School of Health Sciences Panakkukang, one of the tertiary institutions organizing the D-3 Medical Records and Health Information (RMIK) Study Programs, is becoming an increasingly popular choice. This can be seen from the number of students enrolled (214 in 2016, 225 in 2017, 177 in 2018, and 122 in 2019). The students’ decision to choose the Study Program is influenced by cultural, social and personal factors. This study’s objective is to determine the effect of these factors on the selection of Study Programs. This research uses a descriptive analytic quantitative approach with a cross-sectional research design. The study population was 524 students with a sample of 84 respondents taken proportionally (20 first-year students, 28 second-year students and 36 thirdyear students). The results showed that the cultural and personal factors did not significantly influence the selection of D-3 RMIK Study Programs with sig. cultural factors of 0.595> 0.05, personal factors with sig. of 0.197> 0.05. While the social factors significantly influence the selection of D-3 RMIK Study Programs with sig. of 0.000 <0.05. The cultural, social and personal factors have a combined effect of 33.8%.
 
 Keywords: cultural, social, personal factors.

Tinjauan Pelaksanaan Review Berkas Rekam Medis Sesuai Standar Manajemen Informasi Dan Rekam Medik (MIRM 13.4) Di Rumah Sakit Imelda Pekerja Indonesia Tahun 2020


 One of the parameters for determining the quality of health services in the hospital is data or information from good and complete medical records. Medical records are an important part of helping the implementation of service delivery to patients at the hospital. Standards relating to medical records in SNARS Edition 1 are in the group of hospital management standards, namely Medical Record Information Management (MIRM) regarding medical record document processing including provision, filling of medical records and reviewing medical records. This research method is descriptive with the method of observation. When this research was conducted in July 2020 at the Imelda Hospital Worker Indonesia Medan. The population taken was 705 medical record documents while the sample in this study was 87 medical record documents. Based on the results of the study, in the review the accuracy of returning medical record documents was 57.4% and 42.5% were incorrect. Readability review of ER assessment as much as 63.2%, assessment of Inpatient as much as 56.3%, CPPT as much as 60.9%, approval for action as much as 77%, reports of anesthesia as much as 68.9%. 3 forms of completeness review are complete, namely Education Assessment, rejection and education form (100%). Suggestions in this study are that review officers must be more assertive to remind every doctor or other medical personnel to pay attention to the accuracy of the restoration, the legibility of medical record files and the completeness of medical record documents. As well as regularly socializing the elements of the MIRM 13.4 assessment.

Therapeutic Drug Monitoring-Based Efficacy and Safety of Bedaquiline in Chinese Multidrug-Resistant Tuberculosis

Background: Bedaquiline was approved by the US Food and Drug Administration (FDA) for the treatment of drug-resistant tuberculosis in 2012, and significantly improved multidrug-resistant tuberculosis (MDR-TB) patients treatment outcomes. However, data of the efficacy, safety of bedaquiline for the Chinese tuberculosis patients were still lacked, and the plasma concentration of bedaquiline during the treatment and its elimination after treatment discontinuation also had not yet be elucidated. In this study, we demonstrated the efficacy and safety of bedaquiline for the treatment of MDR-TB or XDR-TB patients based on the therapeutic drug monitoring. Methods: 35 patients who started on bedaquiline for drug-resistant tuberculosis were identified. We extracted the patient's medical record information based on their informed consent, and established a standardized monitoring system to track outcomes of patients started on bedaquiline for MDR-TB. The plasma concentration of bedaquiline were determined by ultra-performance liquid chromatography combined with tandem mass spectrometry. Findings: After the 24 weeks bedaquiline treatment, 80% of these patients’ sputum culture conversed negative, and the median time to culture conversion was 75.5 (IQR 52-126) days. 21 (21/26, 80.8%) patients were eventually cured, 2 (2/26, 7.7%) patients failed. The most frequently adverse events during the treatment included QTc prolongation (16/35, 45.7%), peripheral neuropathy (9/35, 25.7%), and gastrointestinal disturbances (8/35, 22.9%). During treatment, the median plasma bedaquiline were fluctuated around 0.6 µg/ml, and gradually decreased after bedaquiline discontinued, about 0.2 µg/ml of bedaquiline was still undegraded after bedaquiline withdrawal 13 months. Moreover, combination with clofazimine increased the possibility of QTc prolongation during the treatment of MDR-TB with bedaquiline, and the decreased serum potassium concentration was also a reason for the prolonged QTc induction with bedaquiline. Interpretation: This study highlighted the efficacy and safety of bedaquiline based on the plasma concentration monitoring, analyzed the reasons of bedaquiline induced QTc prolongation, which had not yet be elucidated before. Funding: This work was supported by the Hospital Pharmacy Special Project of Zhejiang Pharmaceutical Society (2018ZYY31, 2019ZYY27, 2020ZYY08), Zhejiang Medical and Health Science and Technology Plan (2015PYA008, 2020KY741) and Zhejiang Provincial Natural Science Foundation of China under Grant (LYY18H300001), Medical promising youngster of Hangzhou. Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: This study was approved by the Ethic Committee of Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine.

Post Emergency Obstetric Hysterectomy Morbidities in the University of Port Harcourt Teaching Hospital - A Five Year Review.

Hysterectomy in the peripartum period is a life-saving emergency procedure that is associated with both intra-operative and post-operative morbidities. This study aims to determine the prevalence of emergency obstetric hysterectomy (EOH), the indications, and the pattern of post-emergency obstetric hysterectomy complications and their outcome in our setting. This was a retrospective study of parturients that had an emergency obstetric hysterectomy (EOH) over a five (5)-year period from 1st January 2008 - 31st December 2012. The case records of these patients were retrieved from the medical record library and information relating to age, parity, booking status, indications, type of hysterectomy, and complications of the procedure were extracted. The data obtained were analysed using the statistical product and service solutions (SPSS) 15.0. There were 16,720 deliveries during the five-year period of the study. Emergency obstetric hysterectomies were performed in sixty-nine patients giving a prevalence of 0.4% or 1:242 (4.1 per 1,000) deliveries. Uterine rupture, 33(47.8%) was the leading indication, while the subtotal hysterectomy was the commonest surgery performed 42 (60.9%). The commonest post-hysterectomy morbidities were anaemia, 60 (86.9%) and wound sepsis, 16 (23.2%). Maternal mortality occurred in 7 patients giving a case fatality rate of 10.1%. The prevalence of EOH in this study was high with uterine rupture as the leading indication. Wound sepsis and anaemia were the most common post-EOH complications and the case fatality rate was high. Measures must be put in place to prevent uterine rupture and obstetric haemorrhage in our setting.

Assessing the clinical utility of genetic risk scores for targeted cancer screening

BackgroundGenome-wide association studies have identified thousands of disease-associated single nucleotide polymorphisms (SNPs). A subset of these SNPs may be additively combined to generate genetic risk scores (GRSs) that confer risk for a specific disease. Although the clinical validity of GRSs to predict risk of specific diseases has been well established, there is still a great need to determine their clinical utility by applying GRSs in primary care for cancer risk assessment and targeted intervention.MethodsThis clinical study involved 281 primary care patients without a personal history of breast, prostate or colorectal cancer who were 40–70 years old. DNA was obtained from a pre-existing biobank at NorthShore University HealthSystem. GRSs for colorectal cancer and breast or prostate cancer were calculated and shared with participants through their primary care provider. Additional data was gathered using questionnaires as well as electronic medical record information. A t-test or Chi-square test was applied for comparison of demographic and key clinical variables among different groups.ResultsThe median age of the 281 participants was 58 years and the majority were female (66.6%). One hundred one (36.9%) participants received 2 low risk scores, 99 (35.2%) received 1 low risk and 1 average risk score, 37 (13.2%) received 1 low risk and 1 high risk score, 23 (8.2%) received 2 average risk scores, 21 (7.5%) received 1 average risk and 1 high risk score, and no one received 2 high risk scores. Before receiving GRSs, younger patients and women reported significantly more worry about risk of developing cancer. After receiving GRSs, those who received at least one high GRS reported significantly more worry about developing cancer. There were no significant differences found between gender, age, or GRS with regards to participants’ reported optimism about their future health neither before nor after receiving GRS results.ConclusionsGenetic risk scores that quantify an individual’s risk of developing breast, prostate and colorectal cancers as compared with a race-defined population average risk have potential clinical utility as a tool for risk stratification and to guide cancer screening in a primary care setting.

Neuman Systems Model in perioperative nursing care for adolescents with juvenile idiopathic scoliosis.

To implement the nursing process, based on the Neuman Systems Model and the International Classification of Nursing Practice terminology, in the care of an adolescent who underwent corrective surgery for juvenile idiopathic scoliosis. This is a qualitative study of the type of single case, with triangulation of data collection techniques (formal clinical interview, notes in a field diary and medical record information), developed with a 17-year-old adolescent and indication for corrective surgery. The empirical materials generated with the interviews carried out at admission and at discharge, observation and medical record information were treated with categorical content analysis. The categories of personal condition, anxiety, selfconcept, meaningful people, facilitating health resources, school, free time and leisure were recurrent. Diagnoses were defined with a focus on Anxiety, Knowledge on pain management (control) and Willingness (or readiness) to learn, associating them with the respective nursing interventions. The Model contributed to assess and recognize surgery stressors for the adolescent and to theoretically base the nursing process. The classification allowed systematizing nursing care records, elements of clinical practice, unifying vocabulary and codes.

Short-term Renoprotective Effect of SGLT-2 Inhibitor for Renal Function and Albuminuria in Type 2 Diabetes: a Retrospective Study

The purpose of this study was to clarify the profiles of patients in whom SGLT-2 inhibitors are more likely to exert a renal protective effect in clinical practice. We retrospectively analyzed the medical record information of sixty-three type 2 diabetic patients (33 males, 30 females, average age 53.0 ± 13.0 years) who were given usual doses of a SGLT-2 inhibitor. We investigated changes in body weight, blood pressure, glucose metabolism index, lipid metabolism index, estimated glomerular filtration rate (eGFR), and albuminuria (urinary albumin-to-creatinine ratio, UACR) 3 months before and after administration of a SGLT-2 inhibitor. Three months after administration of an SGLT-2 inhibitor, there were improvements in glucose tolerance, weight loss, blood pressure, and lipid indices. In all cases, there was no significant change in eGFR, but UACR decreased significantly. UACR decreased regardless of angiotensin II receptor blocker medication and significantly decreased in nephropathy patients with microalbuminuria or overt albuminuria. UACR decreased only in the group in which blood pressure, body weight, and hemoglobin A1c decreased before and after administration of the SGLT-2 inhibitor. Our study shows that the renoprotective effects of SGLT-2 inhibitors are more likely to be exerted in diabetic nephropathy patients who have advanced to at least microalbuminuria stage, and in addition to direct renal protection, the comprehensive effects of SGLT-2 inhibitors, which lower body weight, blood pressure, and blood glucose, are also important for their renal protection effects.

Heart and Lung Disorders Complicating Pregnancy and the Puerperium: Pitfalls in Practice & Lessons Learned

Objective: To review a case series of 12 women with unexpected heart and lung disorders that occurred during pregnancy and the puerperium, describing for teaching purposes the pitfalls in practice and the lessons learned from this experience. Materials & Methods: We reviewed case files of women with medical and/or hypertensive complications of pregnancy that were evaluated for medicolegal defense purposes by the first author between 1986-2015. Twelve women in these case files experienced unexpected cardiovascular and/or cardiopulmonary complications late in pregnancy or early in the puerperium. For each case, the pertinent medical record information was extracted. Important concepts as lessons learned are summarized and referenced for teaching purposes. Results: Five women had undetected preexisting heart disease which acutely deteriorated during the third trimester, four women developed postpartum heart failure related to pregnancy and delivery, and three women suffered an intrapartum cardiac arrest; none survived. Their case presentations illustrate the importance of obstetric health care professionals being alert to the signs/symptoms of developing cardiopulmonary disease late in pregnancy and following delivery so that timely evaluation and intervention can be accomplished to potentially avoid morbidity and mortality. Diagnostic categories include peripartum heart failure, high-risk chronic hypertension, superimposed preeclampsia, amniotic fluid embolism, pulmonary embolism and Raynaud’s with occult pulmonary hypertension. Conclusion: These cases illustrate the diversity of ways that cardiovascular disease can suddenly complicate pregnancy and the early postpartum period. A major part of any effort to enhance safer motherhood is a heightened awareness by obstetric specialists to consider the possibility of heart disease in all maternity patients so that appropriate consultation and collaboration with other specialists might help avoid major maternal morbidity or mortality.

Modeling physician variability to prioritize relevant medical record information.

ObjectivePatient information can be retrieved more efficiently in electronic medical record (EMR) systems by using machine learning models that predict which information a physician will seek in a clinical context. However, information-seeking behavior varies across EMR users. To explicitly account for this variability, we derived hierarchical models and compared their performance to nonhierarchical models in identifying relevant patient information in intensive care unit (ICU) cases.Materials and methodsCritical care physicians reviewed ICU patient cases and selected data items relevant for presenting at morning rounds. Using patient EMR data as predictors, we derived hierarchical logistic regression (HLR) and standard logistic regression (LR) models to predict their relevance.ResultsIn 73 pairs of HLR and LR models, the HLR models achieved an area under the receiver operating characteristic curve of 0.81, 95% confidence interval (CI) [0.80–0.82], which was statistically significantly higher than that of LR models (0.75, 95% CI [0.74–0.76]). Further, the HLR models achieved statistically significantly lower expected calibration error (0.07, 95% CI [0.06–0.08]) than LR models (0.16, 95% CI [0.14–0.17]).DiscussionThe physician reviewers demonstrated variability in selecting relevant data. Our results show that HLR models perform significantly better than LR models with respect to both discrimination and calibration. This is likely due to explicitly modeling physician-related variability.ConclusionHierarchical models can yield better performance when there is physician-related variability as in the case of identifying relevant information in the EMR.

Desain Analisis Sistem Informasi Laboratorium Rekam Medis Elektronik

This study aims to create an electronic medical record information design system where an electronic medical record system is a system that provides complete information on patient data and medical records during the maintenance and storage of all patient data. The Archive Management System at the Indonusa Surakarta Polytechnic Medical Records Laboratory is not yet computerized. Patient data entry still uses paper, while the recording and storage of medical records is done manually. This study aims to make applications related to electronic medical record information systems at the Indonusa Surakarta Polytechnic Laboratory. In this descriptive study the researcher used a qualitative approach, what will be done to the person in charge of the medical record laboratory. Based on the study results by conducting questionnaires and observations, data relevant to outpatient outpatient recordings is needed, for example medical information record numbers, patient data info, and disease data info, in designing an electronic medical record information system.

The Association of Surrogate Decision Makers’ Anxiety and Depression Levels at Baseline with End-of-Life Patient Care Decisions

Rationale: Little is known about how the psychological status of surrogate decision-makers (SDMs) influences their decisions regarding end-of-life patient care. Anecdotal evidence suggests high psychological distress may lead to denial of poor prognosis and continued aggressive treatments. We hypothesized that SDM psychological distress is associated with greater use of life-sustaining treatments and lower hospice use for seriously ill older adults. 
 Objectives: To determine the relationships between surrogate anxiety and depression levels and surrogates’ decisions regarding end-of-life treatments. 
 Methods: This prospective observational study enrolled patient/surrogate dyads from three Midwestern hospitals in one metropolitan area. Eligible patients were 65 years or older and admitted to the medicine or medical intensive care services. Baseline surveys between hospital days 2 and 10 assessed anxiety (GAD-7) and depression (PHQ-9) levels, and SDM preference for do-not-resuscitate (DNR) status. Chart reviews of the electronic medical record and regional health information exchange six months after enrollment identified the use of aggressive life-sustaining treatments and hospice for patients who died. 
 Results: There were 278 patient/surrogate dyads. After adjusting for other demographic and illness factors, anxiety (adjusted odds ratio [aOR] 1.09; 95% CI 1.02, 1.16; P=.007) and depression (aOR 1.08; 95% CI 1.02, 1.15; P=.011) were associated with greater preference for DNR status. Among patients who died (n=115), anxiety (aOR 0.89; 95% CI 0.79, 0.99; P=.039) was associated with less use of aggressive life-saving interventions within the last 30 days, and anxiety (aOR 1.23; 95% CI 1.09, 1.39; P<.001) and depression (aOR 1.14; 95% CI 1.04, 1.25; P=.004) were associated with greater hospice use. 
 Conclusions: Contrary to our hypothesis, heightened SDM psychological comorbidities at baseline are associated with greater DNR preference, as well as less life-sustaining treatment and more hospice use at the end of life. More research is needed to understand the impact of psychological distress on surrogate decision-making.