Patient Health Record Research Articles

Patient Health Record Protection Beyond the Health Insurance Portability and Accountability Act: Mixed Methods Study

Background The security and privacy of health care information are crucial for maintaining the societal value of health care as a public good. However, governance over electronic health care data has proven inefficient, despite robust enforcement efforts. Both federal (HIPAA [Health Insurance Portability and Accountability Act]) and state regulations, along with the ombudsman rule, have not effectively reduced the frequency or impact of data breaches in the US health care system. While legal frameworks have bolstered data security, recent years have seen a concerning increase in breach incidents. This paper investigates common breach types and proposes best practices derived from the data as potential solutions. Objective The primary aim of this study is to analyze health care and hospital breach data, comparing it against HIPAA compliance levels across states (spatial analysis) and the impact of the Omnibus Rule over time (temporal analysis). The goal is to establish guidelines for best practices in handling sensitive information within hospitals and clinical environments. Methods The study used data from the Department of Health and Human Services on reported breaches, assessing the severity and impact of each breach type. We then analyzed secondary data to examine whether HIPAA’s storage and retention rule amendments have influenced security and privacy incidents across all 50 states. Finally, we conducted a qualitative analysis of textual data from vulnerability and breach reports to identify actionable best practices for health care settings. Results Our findings indicate that hacking or IT incidents have the most significant impact on the number of individuals affected, highlighting this as a primary breach category. The overall difference-in-differences trend reveals no significant reduction in breach rates (P=.50), despite state-level regulations exceeding HIPAA requirements and the introduction of the ombudsman rule. This persistence in breach trends implies that even strengthened protections and additional guidelines have not effectively curbed the rising number of affected individuals. Through qualitative analysis, we identified 15 unique values and associated best practices from industry standards. Conclusions Combining quantitative and qualitative insights, we propose the “SecureSphere framework” to enhance data security in health care institutions. This framework presents key security values structured in concentric circles: core values at the center and peripheral values around them. The core values include employee management, policy, procedures, and IT management. Peripheral values encompass the remaining security attributes that support these core elements. This structured approach provides a comprehensive security strategy for protecting patient health information and is designed to help health care organizations develop sustainable practices for data security.

A Personal Health Record for patients with multiple sclerosis: A 2-year evaluation study

Abstract Background Multiple sclerosis (MS) is a chronic disease impacting the central nervous system, affecting 2.8 million people worldwide. Effective self-management is crucial for treating chronic diseases, including MS. Personal health records (PHRs) show promise in supporting self-management, potentially empowering patients and enhancing their engagement in treatment and health. However, implementation challenges persist. Objectives This study aimed to) assess the feasibility and usability of the PHR according to patients and healthcare professionals (HCPs), and 2) evaluate implementation determinants, and exploring preliminary effects on a range of outcomes related to the quality, efficiency, and costs of care, as well as health-related outcomes. Methods A mixed-methods study was conducted in a Dutch hospital. Quantitative data from 80 patients and 12 HCPs were collected via questionnaires at baseline (T0), after one (T1) and 2 years (T2). Focus group interview were conducted at T2 with 7 patients and 4 HCPs. Results Most patients never logged in during the first year and logged in a couple of times during the second year, with 15 minutes per log-in session. The HCPs mainly logged in a couple of times per year, averaging six minutes per session. Patients’ and HCPs’ usability and satisfaction scores were below average and moderate respectively. Various facilitators and barriers were identified, including knowledge gaps, staff capacity issues, and ICT obstacles. No significant differences were found in preliminary effects. Qualitative data highlighted benefits in terms of gaining insight into health data but revealed challenges with log-in issues and information retrieval. Conclusions Implementation challenges hindered PHR adoption. The evolving nature of PHRs requires ongoing evaluation and adaptation to optimize their potential benefits. Utilizing a participatory design approach and a dedicated implementation team could enhance adoption and maximize benefits. Key messages • A personal health record (PHR) for patients with MS was evaluated within the care setting of a Dutch hospital, demonstrating limited usability and moderate satisfaction. • Diverse obstacles impeded the adoption and uptake of the PHR, but potential solutions lie in continuous development with a participatory design approach and dedicated implementation team.

Digital health technology to support patient-centered shared decision making at point of care for juvenile idiopathic arthritis.

Despite availability of multiple FDA approved therapies, many children with juvenile idiopathic arthritis (JIA) suffer pain and disability due to uncontrolled disease. The term JIA includes a heterogeneous set of conditions unified by chronic inflammatory arthritis, collectively affecting 1:1,000 children. When reviewing treatment options with families the rheumatologist currently refers to the experience of the average patient in relatively small controlled clinical trials, to consensus-based treatment plans, or increasingly the choice is dictated by the formulary restrictions of insurance payers. The current paradigm for treatment selection does not incorporate real-world evidence of treatment effectiveness centered to the individual patients with whom decisions are to be made. Treatment decisions based on the evidence of the average patient are not optimized to reflect the unique clinical characteristics of an individual with JIA and their disease course, nor does it account for heterogeneous treatment effects. To guide treatment choices centered around each patient, we describe a novel concept of utilizing digital health technology to bring patient-centered information into shared decision-making discussions based on comparative effectiveness analysis of electronic health record or observational clinical registry data of patients with similar characteristics. The envisioned digital tool will organize and present data relevant to the individual patient and enable evidence-based individualized treatment decision making when used in a collaborative manner with the patient family and rheumatologist. Capabilities in digital health technology, data capturing, and analytical methodologies are ripe for this endeavor. This brings the concept of a learning health system directly to the point of care.

6663 Amputation Rate in Hospitalized Patients With Diabetic Foot Ulcer at Montefiore Medical Center, Bronx, NY

Abstract Disclosure: R. Lopez Fanas: None. A. Herrera Chancay: None. H. Tabassum: None. J. Milosavljevic: None. S. Xu: None. J. Daily: None. A.K. Myers: None. Introduction: Diabetic foot ulcers (DFU) are associated with poor outcomes including lower extremity amputations and death in individuals with diabetes. Our study aims to define health outcomes and explore the association of sociodemographic and clinical factors on amputation rates in patients hospitalized with DFU addressing an existing knowledge gap in our population. Methods: This was a retrospective review of the electronic health record of adult patients hospitalized with DFU at one of the three major Montefiore Medical Center hospitals in the Bronx, New York between 06/01/2016 and 05/30/2021. Patient data extracted from the index admission included demographics, comorbidities, and laboratory values. Survival and amputation rates were calculated for each patient over the five-year study period. Results: In our analysis of 650 patients, 88% self-identified as non-white, and only 23% had commercial insurance. The amputation rate during the initial DFU admission was 44%, with 76% experiencing at least one amputation over five years. Male sex, low BMI, and smoking were associated with amputation during the study period, with an OR of 0.62 (p=0.01), 0.98 (p=0.05), and 1.45 (p=0.05) respectively. Patients with history of osteomyelitis had a higher risk of any amputation during the index admission (OR 2.05, p<0.0001), and the 5-year study period (OR 3.03, p<0.0001). PAD or prior history of amputation increased the risk of any amputation during the study period, OR 2.11 (p=0.0002) and OR 7.92 (p<0.001) ESRD was associated with a higher risk of AKA and BKA during the index admission (OR 2.31, p=0.05). Elevated ESR, CRP, WBC, and low albumin were associated with amputation during admission, with ORs of 1.01 (p=0.0006), 1.05 (p<0.0001), 1.11 (p<0.0001), and 0.41 (p<0.0001), respectively. Discussion: This study revealed a 44% amputation rate during the initial DFU admission, with 76% experiencing at least one amputation within five years. Bivariate analyses identified male sex, lower BMI, and smoking as correlated with a heightened amputation risk, consistent with previous studies. Prior amputation, PAD, ESRD, and osteomyelitis were also associated with an increased risk. Multiple regression analysis found significant associations between elevated ESR, CRP, WBC, and low albumin with amputations. As a result, interventions need to be devised for patients with these characteristics to prevent this high rate of amputation. Presentation: 6/2/2024

Exploring the association of social connections and food security among adults with uncontrolled type 2 diabetes: a population-based study

BackgroundPrimary health care professionals are held accountable for various quality measures in the treatment of patients with chronic diseases such as diabetes. Uncontrolled type 2 diabetes (T2D) remains a considerable health problem; thus, further studying patients with this condition is important for delivering effective interventions. Social determinants of health (SDoH) have been shown to affect various aspects of diabetes care in different subpopulations. We studied the association of SDoH with uncontrolled T2D in a population of adult primary care patients.MethodsWe retrospectively searched our electronic health record for adult patients (≥18 years) with a diagnosis of T2D and a hemoglobin A1c (HbA1c) level of 8% or higher. Patients were empaneled to 2 primary care clinic sites between January 1, 2021, and January 31, 2022. Patients were grouped by HbA1c level to stratify patients according to the extent of uncontrolled T2D. Patient characteristics were compared among groups. Unadjusted and adjusted multinomial logistic regression analysis was used to estimate the odds of various SDoH factors among patient groups with different levels of uncontrolled T2D.ResultsThe study cohort included 1,596 patients. Most patients were White (79%), and the median age was 58.8 years. The median HbA1c level was 8.9%, and approximately 68% of patients were obese (body mass index [BMI] ≥30). When the study population was grouped by HbA1c level (8% to < 9% [n = 806], ≥9% to < 12% [n = 684], and ≥12% [n = 106]), significant differences among groups were observed in age group (P < .001), marital status (P < .001), race (P < .001), ethnicity (P = .001), and BMI category (P = .01). In groups with higher HbA1c levels, we noticed a higher percentage of patients who were aged 51 to 65 years or single. Among patients with uncontrolled HbA1c levels, more patients were obese than overweight. Patients in the intermediate HbA1c group had increased odds of food insecurity and some decreased social connections, even after adjusting for age, sex, race, ethnicity, and marital status.ConclusionsAmong patients with uncontrolled T2D, higher HbA1c levels were associated with decreased social connections and increased food insecurity. Our findings provide insight into the role of these SDoH in managing T2D and have important implications for primary care practice.

Development of a minimum data set for a blockchain-based personal health records (PHRs), for patient/physician interaction in family medicine

BACKGROUND: The primary requirement for a capable patient health record (PHR) that can interact appropriately with the family medicine system and collect and share qualified data is a minimum data set (MDS) aligned with family medicine’s functions and goals. The aim of this research was to determine the MDS for a blockchain-based PHR system that can effectively interact with family medicine providers and collect and share qualified data. This MDS is intended to be applicable to all members of the community covered by family medicine. MATERIALS AND METHODS: This applied study was conducted in 2022 in a cross-sectional and descriptive approach in three phases. In the first phase, a content analysis related to the research objectives was conducted in scientific databases, search engines, and websites of the centers and scientific research organizations with publications and policy-making in this field. Consequently, 11 studies were selected for use in the second and third phases. In the second phase, to determine information needs, a researcher-developed questionnaire including 17 classes was given to 50 people under the cover of the family medicine plan in Shiraz city. By choosing one of the two options “Yes” or “No” by them, the necessary data classes were determined. In the third phase, the second researcher-developed questionnaire was designed and administered to 100 family physicians in Shiraz city. This questionnaire included the data elements corresponding to the data classes approved in the previous phase. The family physicians were asked to rate the importance of each data element using a Likert scale with five options, ranging from “very unimportant” to “very important.” The necessary data elements were determined based on these scores. RESULTS: In the first questionnaire, 16 of the 17 data classes received approval from individuals covered by the family medicine plan. Consequently, a questionnaire comprising 16 classes and 105 data elements was administered to the family physicians. Ultimately, the MDS was determined to include 16 classes and 72 data elements. CONCLUSIONS: Determining essential data elements, especially for patient/physician interaction in family medicine, should be such that they can be managed by the person while being comprehensive and providing sufficient help to the physician during the treatment process. This MDS can be used to interact with and refer PHRs to other physicians and specialists, as well as help interoperability between the PHR and other health systems, such as hospital information systems (HIS) and electronic health records (EHRs).

A Development of an IoT-Based Healthcare System Using Distributed Blockchain Technology

Modern healthcare systems have two main sections: electronic health records (EHRs) and remote patient monitoring (RPM). With these sections, several issues have arisen related to comprehensiveness, which these sections lack in covering all the data information about the patient’s state, and other issues in privacy and security. Many types of research have been presented to solve these issues or mitigate their effects. One of these ideas is to use blockchain technology. However, some research may not utilize this technique properly, where data comprehensiveness problems remain and the preservation of individual nodes' data may be compromised. This paper introduces a new system called Patient Health Record (PHR), which will provide comprehensive patient health data and IoT device reading. PHR data is protected using a multi-peer, distributed, and decentralized system based on blockchain. A smart contract has been created for the system through which the PHR data will be cached in the blockchain. It is deployed on the Proof of Authority network to increase the speed of transaction processing, which is important in processing data for IoT devices. The proposed system is evaluated according to a range of metrics (cost, immutability, data storage, and estimated time) to validate the system.

Toward Personalized Care and Patient Empowerment and Perspectives on a Personal Health Record in Hemophilia Care: Qualitative Interview Study.

To enable personalized treatment and shared decision-making in chronic care, relevant health information is collected. However, health information is often fragmented across hospital information systems, digital health apps, and questionnaire portals. This also pertains to hemophilia care, in which scattered information hampers integrated care. We intend to co-design a nationwide digital personal health record (PHR) for patients to help manage their health information. For this, user perspectives are crucial. This study aims to assess patients' and health care providers' perspectives regarding the use of a PHR in hemophilia care in the Netherlands, required functionalities, and expectations and concerns. In this semistructured interview study, 19 pediatric and adult persons with hemophilia, parents, and women with other inherited bleeding disorders, as well as 18 health care providers working within and outside of hemophilia treatment centers, participated. Perspectives of patients and providers were explored separately. To explore requirements, participants were asked to prioritize functionalities. Participants expected a PHR would increase the transparency of health information, improve patients' understanding of their illness, and help the coordination of care between health care providers and institutions. Prioritized functionalities included the integration of relevant health information and patient-entered data. Formulated expectations and concerns focused on 4 themes: usability, safety, inclusiveness, and implementation. While patients expressed worries over medicalization (ie, more confrontational reminders of their illness), providers were concerned about an increased workload. People with hemophilia, their parents, and health care providers welcomed the development of a PHR, as they expected it would result in better coordinated care. Formulated expectations and concerns will contribute to the successful development of a PHR for persons with hemophilia, and ultimately, for all persons with a chronic condition.

Efficient Intrusion Detection in Patient Health Records Based on LSTM-Based RNN

Advancements in Information and Communication Technology applications play an important role in the field of healthcare and bio-medical engineering. The process of image processing and analysis starts from receiving visual information to giving out the description of the scene for improving the visual appearance of the human viewer and extract the features of the data. Moreover, IDS can be deployed along with other security mechanisms as a line of defence to ensure security of system and network resources. There have been various efforts in designing IDS using Machine Learning (ML) techniques. Additionally, by developing a hybrid strategy for intrusion detection and classification and using feature engineering approaches to extract significant features for learning, among other things, efforts have been made to improve the classification performance of ML-based IDS. However, as networking technology have advanced, attack types have evolved as well. For this reason, an efficient and successful intrusion detection and classification system must be created. To address the issue and achieve good generalization ability for intrusion detection and classification, the paper presents empirical analysis of LSTM based RNN classifiers. The suggested methods' effectiveness is assessed using a range of performance metrics, such as recall, f-score, accuracy, precision, and False Positive Rate (FPR). The LSTM based RNN method recognize attacks with 99.2% accuracy with minimum time complexity (5 s).

Dizziness and Imbalance Across the Lifespan: Findings of a Pediatric and Adult Vestibular Clinic.

To evaluate diagnostic trends in pediatric and adult patients presenting for multidisciplinary subspecialty evaluation of dizziness and imbalance across the lifespan. Retrospective chart review. Single pediatric and single adult academic tertiary care hospital. Retrospective review of electronic health record for patients presenting to an adult or pediatric multidisciplinary vestibular clinic from 2017 to 2020, including clinical data, physical therapy evaluation, and audiovestibular testing. A total of 1934 patients aged 1 to 95 were evaluated. Most patients were female (n = 1188, 61%); the largest cohort was in the fifth decade of life (n = 321, 17%). Seventy-six percent of patients (n = 1470) were assigned a pathologic diagnosis. Central causes of dizziness were most common in children and young adults, comprising 38% to 54% of all diagnoses in ages 1 to 30. The proportion of peripheral vestibular disorders increased with age, peaking at 32% in ages 61 to70. Vestibular migraine was the most common pathologic diagnosis in ages 6 to 20 (n = 110, 39%) and 31 and 50 (n = 69, 17%) regardless of gender, but was more prevalent in females (21% vs 14%; P < .0001). The prevalence of benign paroxysmal positional vertigo (BPPV) increased throughout the lifespan, peaking at age 71 to 80. Meniere's disease (MD) did not occur within the first decade of life, but increased thereafter, peaking at ages 51 to 60. Multidisciplinary vestibular evaluation resulted in a diagnosis for the majority of patients. Vestibular diagnoses vary across the lifespan however among most age groups, central disorders, including migraine disorders, outnumber peripheral vestibulopathies. The prevalence of peripheral vestibular disorders such as BPPV and MD increased with age. Level IV.

GPT-Based Model for Concise Summaries of Patient Health Information.

Although Patient Health Records (PHRs) are vital tools for patients, enabling them to access and manage health information, it remains challenging for doctors and patients to gather a swift overview of a patient's health status based on the extensive information included in the PHR. Our study introduces a generative pre-trained transformer-based language model to summarize health information documented in previously developed PHRs efficiently. By fine-tuning the model, we achieved results comparable to those of other studies in this domain, despite utilizing a smaller dataset. This data-to-text application represents a novel method that can be expected to promote enhanced information management in the medical field.

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

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

Stigmatizing and affirming provider language in medical records on hospitalized patients with opioid use disorder.

Stigma within the healthcare environment limits access to treatment for opioid use disorder (OUD), even as OUD results in significant morbidity and mortality. Language in clinical documentation affects patient experience and future care through the transmission of stigma or positive regard. With the passage of the 21st Century Cures Act, patients have full access to their medical records online. The objective of our study was to understand providers' use of stigmatizing and affirming language in the electronic health record (EHR) for OUD patients with long hospital stays. We selected patients with a first-time referral to the Duke University Hospital OUD consult service who met diagnostic criteria for OUD with a hospital stay ≥28 days from July 2019 to February 2022. Two reviewers independently evaluated each admission and discharge note for stigmatizing or affirming language and the group met weekly to validate coding reliability. Forty-eight patients (96 notes) met our inclusion criteria. We identified 434 occurrences of stigmatizing and 47 occurrences of affirming language. One-third (34%) of stigmatizing language appeared in system-generated fields (drop-down categories and diagnosis codes) and the rest was authored by providers. Stigmatizing language was present in both provider- and system-generated language and was nine times more frequent than affirming language in the medical records of hospitalized patients with OUD. While provider education may reduce stigmatizing language, institutional level changes to the EHR and International Classification of Disease codes are necessary to decrease stigmatizing language within medical records.

Association of Lamotrigine Plasma Concentrations With Efficacy and Toxicity in Patients With Epilepsy: A Retrospective Study.

There is limited evidence to support the currently suggested lamotrigine (LTG) therapeutic reference range of 2.5-15 mg/L for the treatment of seizures. The objective of this study was to evaluate the association of LTG plasma concentrations with the efficacy and toxicity of the treatment in patients with epilepsy. Patients whose LTG plasma concentration was measured between January 2013 and February 2022 were included. Efficacy was defined as seizure freedom for at least 6 months around the time of measured LTG concentration. Toxicity was defined as any LTG-related adverse drug effect documented in each patient's health record or when the reason for measuring the LTG concentration was toxicity. In addition, the dose-concentration relationship of LTG was assessed. In total, 549 concentrations from 259 patients with epilepsy were included. The most common reasons for therapeutic drug monitoring were suspected inefficacy (39%) and pregnancy (21%). The LTG plasma concentration was not associated with efficacy (adjusted odds ratio = 0.94; 95% confidence interval, 0.85-1.04). The LTG plasma concentration was positively associated with the incidence of toxicity after adjusting for age, sex, and number of antiepileptic drugs (odds ratio = 1.11; 95% confidence interval, 1.04-1.19). The daily dose had a significant linear correlation with the LTG plasma concentration ( P < 0.001). The LTG plasma concentration was associated with toxicity, whereas no association with efficacy was found. A reference range of 2.5-10 mg/L may be considered to decrease the risk of toxicity while maintaining similar efficacy. Therapeutic drug monitoring may be useful when LTG-related toxicity is suspected and in cases of pharmacokinetic changes (eg, pregnancy and concomitant use of interacting drugs) that can influence the LTG plasma concentration.

Hemoglobin concentration and body mass index are determinants of plasma von Willebrand factor and factor VIII levels

BackgroundVon Willebrand Disease (VWD) is the most common inherited bleeding disorder. VWD is characterized by an abnormal quantity or quality of von Willebrand Factor (VWF). Anemia is often found at presentation for a bleeding disorder evaluation due to chronic blood loss. Objectives/HypothesisWe hypothesized that anemia is associated with elevations in both VWF and factor VIII (FVIII) over baseline. We also hypothesized that obesity would be associated with increased levels of VWF. MethodsWe conducted a single-center review of the electronic health record for patients that had proximal von Willebrand profiles and Hb data. ResultsWe identified 4552 unique subjects with VWF studies and a CBC within 24 h. We found that decreasing hemoglobin inversely correlated with VWF antigen, VWF ristocetin cofactor activity, and FVIII activity. We also found that obesity and Black race were independently associated with increased VWF antigen, activity, and FVIII activity. Hb, race, and body mass index (BMI) continued to be determinants of VWF and FVIII levels in multivariable analysis. ConclusionOur study demonstrates that anemia, race, and BMI were found to be associated with elevation of VWF antigen, VWF activity, and FVIII levels. As many individuals with anemia present for evaluation for a bleeding disorder, these variables need to be considered. Key points- Anemia was found to be associated with elevation of VWF antigen, VWF activity and FVIII levels.- Testing von Willebrand factor at times of anemia may mask a diagnosis of von Willebrand Disease.

E055 The experience of pain in patients with rheumatoid arthritis - findings from a qualitative study of REMORA app users’ experiences

Abstract Background/Aims The Remote Monitoring in Rheumatoid Arthritis (REMORA) system enables people with rheumatoid arthritis (RA) to track daily symptoms, such as pain and fatigue, via a smartphone app. Graphed symptoms are made available in the electronic health record for patients and clinicians to review together during clinical consultations. REMORA aims to help patients and clinicians to understand fluctuations in disease activity and flares in between clinical appointments. Here, we discuss how patients and clinicians interacted with the data in REMORA, and if and how these interactions provided new knowledge to support person-centred care. Methods Patients and clinicians recruited to take part in a REMORA feasibility trial were invited to participate in this qualitative study about their experience of using the system. We conducted semi-structured interviews (in person, or via telephone or video conference) and observed clinical consultations while taking field notes. Both interviews and clinic observations were audio-recorded, transcribed, and uploaded to NVivo 12 Plus software. Thematic analysis was guided by the Theoretical Domains Framework. Results 21 patients (of 32 consented patients who initiated symptom tracking) and seven clinicians from two study sites were interviewed. Five consultations were observed. Patients tracking their symptoms using the REMORA app highlighted how this helped them to remember periods where they had experienced pain. Clinicians were able to see where pain flares occurred. This created an opportunity for patients and clinicians to discuss pain, in turn supporting decision making around identifying and managing flares, and identifying positive responses to treatment. Some patients expressed difficulty in knowing whether to score all the joint pain they experienced, or just pain secondary to RA. At times they found it difficult to distinguish the origin of pain which created anxiety around score accuracy. For some patients, there was a dissonance between their pain experiences and the pain scores they reported in the REMORA app. For example, sometimes they entered scores that were lower than their actual pain levels because they did not want to admit, and formalise, how bad the pain was. Reviewing these pain scores together enabled clinicians and patients to discuss and interpret the symptom scores, giving clinicians new insights into patients’ approach to their RA. Conclusion The REMORA system captures longitudinal symptom scores to help direct clinical management plans. Patients engaged with the pain scoring function in various ways, and pain reports submitted through the app may not always fully represent people’s actual experiences of pain from their RA and other conditions. During consultations, skilful questioning by clinicians about patient-generated data can create new insights into how an individual copes with and manages their pain and wider long-term condition. Disclosure D. Dowding: None. S. Skyrme: None. Y. Masood: None. S.N. van der Veer: None. D.J. Griffiths-Jones: None. W. Dixon: Consultancies; WGD has received consultancy fees from Google unrelated to this work. C.A. Sharp: None.

Design and evaluation of a web-based electronic health record for amblyopia.

Amblyopia, or lazy eye, is a type of visual impairment in which the eyesight is not complete, even with the use of glasses. For the treatment of this disease, accurate and continuous examinations are needed. Nowadays, patient-centered care, by relying on web-based electronic records for amblyopia, has the potential to reduce treatment costs, increase the quality of care, and improve the safety and effectiveness of treatment. Therefore, the purpose of this study is to design and evaluate an Electronic Health Record (EHR) for patients with amblyopia. The present study is applied developmental research. Using a Morgan table as a sampling tool, a straightforward random sampling technique selected 150 records from 1,500 records that were free of flaws. The design of the electronic version proceeded in a cascading manner so that after the design of each part, it was presented to the amblyopia experts, and if approved, the next part was designed. To design this EHR, the C# programming language and MySQL database were used. A system evaluation was performed by entering and recording patient information. For this purpose, the standard Questionnaire of User Interaction Satisfaction (QUIS), consisting of 18 questions, was used. According to the amblyopia EHR data elements, the data of physician and patient, examinations, website members, and members' roles were determined. After defining the fields and classes that explain the tables, the EHR was designed. The usability evaluation of the system showed that the mean selection of very good and good options by the users of EHRs was over 90%, indicating the patients' acceptance of web-based EHRs. The design of an EHR for amblyopia is an effective step toward integrating and improving the information management of these patients. It will also enable the storage and retrieval of patients' information to reduce and facilitate the control of amblyopia complications.

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

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

Preoperative Mobile Health Data Improve Predictions of Recovery From Lumbar Spine Surgery.

Neurosurgeons and hospitals devote tremendous resources to improving recovery from lumbar spine surgery. Current efforts to predict surgical recovery rely on one-time patient report and health record information. However, longitudinal mobile health (mHealth) assessments integrating symptom dynamics from ecological momentary assessment (EMA) and wearable biometric data may capture important influences on recovery. Our objective was to evaluate whether a preoperative mHealth assessment integrating EMA with Fitbit monitoring improved predictions of spine surgery recovery. Patients age 21-85 years undergoing lumbar surgery for degenerative disease between 2021 and 2023 were recruited. For up to 3 weeks preoperatively, participants completed EMAs up to 5 times daily asking about momentary pain, disability, depression, and catastrophizing. At the same time, they were passively monitored using Fitbit trackers. Study outcomes were good/excellent recovery on the Quality of Recovery-15 (QOR-15) and a clinically important change in Patient-Reported Outcomes Measurement Information System Pain Interference 1 month postoperatively. After feature engineering, several machine learning prediction models were tested. Prediction performance was measured using the c-statistic. A total of 133 participants were included, with a median (IQR) age of 62 (53, 68) years, and 56% were female. The median (IQR) number of preoperative EMAs completed was 78 (61, 95), and the median (IQR) number of days with usable Fitbit data was 17 (12, 21). 63 patients (48%) achieved a clinically meaningful improvement in Patient-Reported Outcomes Measurement Information System pain interference. Compared with traditional evaluations alone, mHealth evaluations led to a 34% improvement in predictions for pain interference (c = 0.82 vs c = 0.61). 49 patients (40%) had a good or excellent recovery based on the QOR-15. Including preoperative mHealth data led to a 30% improvement in predictions of QOR-15 (c = 0.70 vs c = 0.54). Multimodal mHealth evaluations improve predictions of lumbar surgery outcomes. These methods may be useful for informing patient selection and perioperative recovery strategies.

Root Cause Analysis of Gaps in Non-communicable Disease Monitoring in a Sub-district Hospital, Tamil Nadu: A Quality Improvement Initiative.

Introduction Non-communicable diseases (NCDs) present a significant public health challenge globally, and India is deeply affected. With the largest population in the world, India struggles with a high burden of NCDs, encompassing cardiovascular diseases, diabetes, cancer, and chronic respiratory conditions. These ailments contribute substantially to morbidity and mortality, placing a strain on healthcare systems. Despite efforts through public health initiatives, NCD monitoring and management remain deficient, especially at grassroots levels. Methods At a sub-district hospital in Tamil Nadu, India, a quality improvement initiative targeted diabetes and hypertension, prevalent NCDs. Utilizing Fishbone analysis and process flow diagrams, we identified gaps in NCD monitoring. Employing the Plan-Do-Study-Act model and reorienting the patient flow, we enhanced NCD monitoring by optimizing patient health record maintenance within the hospital. Results Root cause analysis identified a lack of patient record protocols and patient loss of records as key hindrances in NCD monitoring. We revamped patient flow and implemented a robust record-keeping system, boosting access to patient health records. This initiative was embraced by healthcare providers, enhancing NCD management. Leveraging these records, we assessed control rates of diabetes and hypertension patients effectively. Conclusion The research underscores the importance of maintaining comprehensive patient health records in healthcare centers for enhancing NCD monitoring. These records serve as valuable tools for healthcare providers, aiding in the monitoring and treatment of patients with diabetes and hypertension. By leveraging these records, healthcare providers can achieve better disease control outcomes, thereby improving the overall management of NCDs.