Health Information Technology Commons^™

Impact Of Electronic Health Records On Patient Outcomes, Lilian Ndifon, Jude E. Edwards, Leila Halawi

Leila A. Halawi

With the passing of the HITECH Act, EHRs have come into prominence and sharper focus, due to efforts by the government to push for a national adoption of EHRs into our healthcare system. This push for a national adoption of EHRs is based on the premise that it will help improve the quality delivery of health care services and reduce costs. However, this push for a “national adoption” has experienced mixed results. This study was designed to assess the impact of EHRs post-2009, the year of the HITECH Act, to review some of the key contributing factors to this mixed …

A Qualitative Review Of Differential Diagnosis Generators, William Bond Md, Ms, Linda M. Schwartz Mde, Ahip, Cm, Kevin R. Weaver Do, Donald Levick Md, Mba, Michael Guliano Md, Med, Mhpe, Mark L. Graber Md

Kevin Weaver, D.O., FACOEP

No abstract provided.

Prognostic Indices For Hospitalized Older Adults: A Meta-Analysis And Systematic Review, Ariba Khan, Ayesha Maria, James Hocker, Maharaj Singh, Michelle Simpson

Ariba Khan, MD, MPH

Background: A prognostication predictive model incorporated into the electronic health record (EHR) may be useful in assisting the health care team in accurately predicting mortality and may be used in appropriately allocating palliative care services.

Purpose: To systematically review and summarize current medical literature regarding the factors predictive of mortality in an inpatient population above 65 years of age.

Methods: Nondisease-specific prognostication indices that predict 1-year mortality in an inpatient population of adults over age 65 were included. We excluded studies that estimated intensive care unit, disease-specific or in-hospital mortality. A MEDLINE, CINAHL, Ovid and Cochrane literature search of English-language …

An Automated Model Using Electronic Health Record Data To Identify Delirium Among Hospitalized Older Adults: A Pilot Project, Ariba Khan, Maharaj Singh, Hina Singh, Ayesha Maria, Michelle Simpson

Ariba Khan, MD, MPH

Background: Delirium is a serious change in mental status with adverse outcomes, but remains underrecognized. The electronic health record (EHR) may assist in the identification of delirium.

Purpose: This study was performed to generate an automated delirium identification model using data from the EHR among hospitalized older adults.

Methods: Inpatients 65 years and older were included in this cross-sectional study. The researchers used “confusion assessment method” as the gold standard to identify delirium. Four categories of variables were obtained from the EHR on the day of and the day prior to researcher assessment: 1) hypoactive delirium (any one of the …

Feasibility And Compliance With Daily Home Ecg Monitoring Of The Qt Interval In Heart Transplant Recipients, Erik V. Carter, Kathleen T. Hickey, David M. Pickham, Lynn V. Doering, Belinda Chen, Patricia R. E. Harris, Barbara J. Drew

Patricia Harris

About 13% of adult heart transplant recipients do not survive to one year and a major cause of death is acute cellular allograft rejection.^1,2 According to the 2009 annual United States data published from the International Society for Heart Lung Transplantation Registry, acute rejection occurs in 25 – 35% of transplant recipients within the first year following transplant surgery.³ In order to detect the early stages of rejection so that more aggressive and early immunosuppressant therapy can be initiated, frequent biopsies of heart tissue are performed (typically, weekly or every other week in the first 3 months and …

Smartphone Mobile Application To Enhance Diagnosis Of Skin Cancer: A Guide For The Rural Practitioner, Shane E. Cook, Louis C. Palmer Md, Franklin D. Shuler Md, Phd

Franklin D. Shuler

Primary care physicians occupy a vital position to impact many devastating conditions, especially those dependent upon early diagnosis, such as skin cancer. Skin cancer is the most common cancer in the United States and despite improvements in skin cancer therapy, patients with a delay in diagnosis and advanced disease continue to have a grave prognosis. Due to a variety of barriers, advanced stages of skin cancer are more prominent in rural populations. In order to improve early diagnosis four things are paramount: increased patient participation in prevention methods, establishment of screening guidelines, increased diagnostic accuracy of malignant lesions, and easier …

Discordant Documentation Of Obesity Body Mass Index And Obesity Diagnosis In Electronic Medical Records, Jennifer T. Fink, George L. Morris Iii, Maharaj Singh, David A. Nelson, Renee E. Walker, Ron A. Cisler

Maharaj Singh

Purpose: This study examined concordance between presence of obesity body mass index (BMI), defined as BMI ≥ 30, in the patient’s electronic medical record (EMR) and a documented diagnosis of obesity.

Methods: We conducted a retrospective review of the EMR in a large health care system for a 1-year period (2012). A total of 397,313 patients met the study criteria of having at least one physician visit, being at least 18 years of age, and not being pregnant. Of those, 158,327 (40%) had a recorded BMI ≥ 30. We examined the EMR of these obese patients to determine whether a …

Prognostic Indices For Hospitalized Older Adults: A Meta-Analysis And Systematic Review, Ariba Khan, Ayesha Maria, James Hocker, Maharaj Singh, Michelle Simpson

Maharaj Singh

Background: A prognostication predictive model incorporated into the electronic health record (EHR) may be useful in assisting the health care team in accurately predicting mortality and may be used in appropriately allocating palliative care services.

Purpose: To systematically review and summarize current medical literature regarding the factors predictive of mortality in an inpatient population above 65 years of age.

Methods: Nondisease-specific prognostication indices that predict 1-year mortality in an inpatient population of adults over age 65 were included. We excluded studies that estimated intensive care unit, disease-specific or in-hospital mortality. A MEDLINE, CINAHL, Ovid and Cochrane literature search of English-language …

An Automated Model Using Electronic Health Record Data To Identify Delirium Among Hospitalized Older Adults: A Pilot Project, Ariba Khan, Maharaj Singh, Hina Singh, Ayesha Maria, Michelle Simpson

Maharaj Singh

Background: Delirium is a serious change in mental status with adverse outcomes, but remains underrecognized. The electronic health record (EHR) may assist in the identification of delirium.

Purpose: This study was performed to generate an automated delirium identification model using data from the EHR among hospitalized older adults.

Methods: Inpatients 65 years and older were included in this cross-sectional study. The researchers used “confusion assessment method” as the gold standard to identify delirium. Four categories of variables were obtained from the EHR on the day of and the day prior to researcher assessment: 1) hypoactive delirium (any one of the …

Engaging Patients In Underserved Populations With Health Information Technology (Hit), Treva Strasen, Shannon F. Johnson

Shannon F Johnson

Federally Qualified Health Centers (FQHCs) are working to meet a national mandate to have meaningful use of electronic health records by 2014 which includes engaging patients in their healthcare. By integrating mobile technologic solutions that consider patient preferences towards MT, healthcare providers will be able to develop effective, efficient, and sustainable HIT programs to improve patient outcomes. The goal of this study was to gain a deeper understanding of how best to activate patients in underserved populations to use mobile technology (MT) to improve their health and communication with their healthcare providers. A survey study was performed with a convenience …

A Business Case For Tele-Intensive Care Units, Alberto Coustasse, Stacie Deslich, Deanna Bailey, Alesia Hairston, David Paul

Alberto Coustasse, DrPH, MD, MBA, MPH

Objectives: A tele-intensive care unit (tele-ICU) uses telemedicine in an intensive care unit (ICU) setting, applying technology to provide care to critically ill patients by off-site clinical resources. The purpose of this review was to examine the implementation, adoption, and utilization of tele-ICU systems by hospitals to determine their efficiency and efficacy as identified by cost savings and patient outcomes. Methods: This literature review examined a large number of studies of implementa­tion of tele-ICU systems in hospitals. Results: The evidence supporting cost savings was mixed. Implementation of a tele- ICU system was associated with cost savings, shorter lengths of stay, …

Big Data Management In United States Hospitals: Benefits And Barriers, Chad Schaeffer, Ariful Haque, Lawrence Booton, Jamey Halleck, Alberto Coustasse

Jamey Halleck

Big Data has been considered as an effective tool to reduce healthcare costs by eliminating adverse events and reducing readmissions in hospitals. The purpose of this study was to examine the emergence of Big Data in the United Sates healthcare industry, to evaluate hospital’s ability to effectively make use of complex information, and to predict the potential benefits hospitals might realize if they are successful. The findings of the research suggest that there were a number of benefits expected by hospitals when using Big Data analytics, including cost savings and business intelligence. In addition, hospitals have recognized that there have …

Big Data Management In United States Hospitals: Benefits And Barriers, Chad Schaeffer, Ariful Haque, Lawrence Booton, Jamey Halleck, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Big Data has been considered as an effective tool to reduce healthcare costs by eliminating adverse events and reducing readmissions in hospitals. The purpose of this study was to examine the emergence of Big Data in the United Sates healthcare industry, to evaluate hospital’s ability to effectively make use of complex information, and to predict the potential benefits hospitals might realize if they are successful. The findings of the research suggest that there were a number of benefits expected by hospitals when using Big Data analytics, including cost savings and business intelligence. In addition, hospitals have recognized that there have …

The Qualitative And Quantitative Effects Of Patient Centered Medical Home In The Veterans Health Administration, Samuel N. Lovejoy, Eric Stalnaker, William K. Willis, Alberto Coustasse

Alberto Coustasse, DrPH, MD, MBA, MPH

Since the 1990’s, the Veteran’s Health Administration (VHA) has implemented a system of primary care that has been considered some of the best care that can be offered (Klein, 2011). The Patient Center Medical Home (PCMH) Model, also called “Patient Aligned Care Team” (PACT) in the VHA, has been coordinating and integrating services which ensure optimal health outcomes at an acceptable value (Bidassie, Davies, Stark, & Boushon, 2014).

PACT was created in 2010, building on 20 years of the VHA transforming from a loosely based system of inpatient services to a provider of outpatient primary care for veterans. From 2010 …

A Data-Driven Behavior Modeling And Analysis Framework For Diabetic Patients On Insulin Pumps, Sanjian Chen, Lu Feng, Michael Rickels, Amy Peleckis, Oleg Sokolsky, Insup Lee

Oleg Sokolsky

About 30%-40% of Type 1 Diabetes (T1D) patients in the United States use insulin pumps. Current insulin infusion systems require users to manually input meal carb count and approve or modify the system-suggested meal insulin dose. Users can give correction insulin boluses at any time. Since meal carbohydrates and insulin are the two main driving forces of the glucose physiology, the user-specific eating and pump-using behavior has a great impact on the quality of glycemic control.

In this paper, we propose an “Eat, Trust, and Correct” (ETC) framework to model the T1D insulin pump users’ behavior. We use machine learning …

Past, Present, And Future Of Ehealth And Mhealth Research To Improve Physical Activity And Dietary Behaviors, Corneel Vandelanotte, Andre Müller, Camille Short, Melanie Hingle, Nicole Nathan, Susan Williams, Michael Lopez, Sanjoti Parekh, Carol Maher

Andre M Müller

Security Risk Management In Healthcare: A Case Study, Humayun Zafar

Humayun Zafar

We investigated the effectiveness of a security risk management program at a large healthcare institution. Using a survey, we explored how nine critical success factors : executive management support, organizational maturity, open communication, risk management stakeholders, team member empowerment, holistic view for an organization, security maintenance, corporate security strategy, and human resource development impacted SRM effectiveness.

Learning Objectives:

• Introduce the audience to security risk management in a healthcare setting.
• Explain the value of unstructured interviews in the healthcare context.
• Highlight potential for future research in this area.

Measurement Error In Performance Studies Of Health Information Technology: Lessons From The Management Literature, Adam Seth Litwin, Ariel Avgar, Peter Pronovost

Adam Seth Litwin

Just as researchers and clinicians struggle to pin down the benefits attendant to health information technology (IT), management scholars have long labored to identify the performance effects arising from new technologies and from other organizational innovations, namely the reorganization of work and the devolution of decision-making authority. This paper applies lessons from that literature to theorize the likely sources of measurement error that yield the weak statistical relationship between measures of health IT and various performance outcomes. In so doing, it complements the evaluation literature’s more conceptual examination of health IT’s limited performance impact. The paper focuses on seven issues, …

Explaining The Health Information Technology Paradox, Ariel Avgar, Adam Seth Litwin

Adam Seth Litwin

Excerpt] The substantial gap between the promise inherent in upgrading information systems in health care and the documented reality has baffled health care scholars. Why is a technology so clearly capable of creating efficiencies, increasing safety, and promoting greater information sharing and coordination across professionals failing to live up to expectations?