The document discusses how digital health and informatics can influence physiotherapy management and outcomes for stroke patients. It reviews 5 articles on this topic. The articles found that electronic medical records (EMRs) can help implement evidence-based guidelines, standardize care, improve documentation and coordination, and enable monitoring of patient progress. EMRs also allow identifying patients for research studies and individualizing rehabilitation. The document recommends that EMRs for stroke patients include clinical pathways, order sets, structured physiotherapy forms, and an evidence-based early mobilization strategy. Overall, incorporating digital health can help translate knowledge into practice and improve stroke care when implementing an EMR.
Patient Data Collection Methods. Retrospective Insights.QUESTJOURNAL
Introduction: Multiple classic and modern data collection techniques are presented in the current paper, but only a mix of them provides the appropriate approach to address patient safety problems. The current study aims to reveal the data collection methods applied worldwide. Materials and Methods: All scientific sources of the current article were identified mainly by research on Internet. The matching words used in the search of materials are “data collection methods”, “hospital reporting systems”, “incident reporting systems”, “patient events”, “patient reported data”. Relevant articles and studies covering the 2003-2016 timeframe were selected as a reference. Results: Various data collection procedures are available worldwide. During several years of research, it was concluded that a significant number of patient studies use the following patient data collection methods: retrospective record review, record review of current inpatients, staff interview of current inpatients and nominal group technique based consensus method. Conclusion: New trends in data collection techniques are also discussed, as they reveal the potential of the electronic environment. Future insights on this topic should consider the standardization of different data collection methods in order to improve data comparability aspects.
Great article on how to integrate machine learning and optimization technique.
One group of researchers was able to reduce heart failure readmissions by 35% by combining machine learning and decision science technique, see "Data-driven decisions for reducing readmissions for heart failure: general methodology and case study" (Bayati, et. al., 2014).
Improving Outcomes for Unfunded Cardiac Patients: A Team Approach
Joe Garcia DNP, RN
Mano y Corazón Binational Conference of Multicultural Health Care Solutions, El Paso, Texas, September 27-28, 2013
On February 10, 2015, the Department of Learning Health Sciences sponsored a talk by guest speaker, William A. Yasnoff, MD, PhD, FACMI.
This presentation is Copyright 2015 William A. Yasnoff. All Rights Reserved.
While the concept of a learning health system (LHS) is not new, our expectations for its functionality have evolved dramatically over the past five decades. Medical practitioners have traditionally shared new insights, albeit slowly, via the peer-reviewed medical literature. However, the increasing application of information technology in healthcare has provided us with the capabilities necessary to vastly accelerate and improve this process so that each patient encounter both utilizes collective prior experience and immediately provides new data to guide subsequent care. A functional model of the LHS and a framework for assessing progress are introduced to illustrate how we are moving towards this goal. Key developments in the field, including the author’s own research, related to databases and registries, decision support, electronic medical records, and health information infrastructure are described in the context of this framework. Finally, a proposed design and implementation strategy for a fully functional health information infrastructure, the key underlying component of the LHS, is presented. Moving forward with this approach, we now have the opportunity to begin building, testing, and utilizing the efficient LHS that can truly revolutionize health care.
William Yasnoff, MD, PhD, is the founder and a managing partner of National Health Information Infrastructure (NHII) Advisors. He is Managing Partner of NHII Advisors, an informatics consulting firm in Arlington, Virginia. He received his MD from Northwestern University in 1975 and his PhD in Computer Science, also from Northwestern University, in 1980. Dr. Yasnoff has also been an Adjunct Professor of Health Sciences Informatics at Johns Hopkins University for the past eleven years and Associate Editor of the Journal of Biomedical Informatics since 2000. In 2013 he was appointed to the Institute of Medicine’s Population Health and Public Health Practice Board.
Patient Data Collection Methods. Retrospective Insights.QUESTJOURNAL
Introduction: Multiple classic and modern data collection techniques are presented in the current paper, but only a mix of them provides the appropriate approach to address patient safety problems. The current study aims to reveal the data collection methods applied worldwide. Materials and Methods: All scientific sources of the current article were identified mainly by research on Internet. The matching words used in the search of materials are “data collection methods”, “hospital reporting systems”, “incident reporting systems”, “patient events”, “patient reported data”. Relevant articles and studies covering the 2003-2016 timeframe were selected as a reference. Results: Various data collection procedures are available worldwide. During several years of research, it was concluded that a significant number of patient studies use the following patient data collection methods: retrospective record review, record review of current inpatients, staff interview of current inpatients and nominal group technique based consensus method. Conclusion: New trends in data collection techniques are also discussed, as they reveal the potential of the electronic environment. Future insights on this topic should consider the standardization of different data collection methods in order to improve data comparability aspects.
Great article on how to integrate machine learning and optimization technique.
One group of researchers was able to reduce heart failure readmissions by 35% by combining machine learning and decision science technique, see "Data-driven decisions for reducing readmissions for heart failure: general methodology and case study" (Bayati, et. al., 2014).
Improving Outcomes for Unfunded Cardiac Patients: A Team Approach
Joe Garcia DNP, RN
Mano y Corazón Binational Conference of Multicultural Health Care Solutions, El Paso, Texas, September 27-28, 2013
On February 10, 2015, the Department of Learning Health Sciences sponsored a talk by guest speaker, William A. Yasnoff, MD, PhD, FACMI.
This presentation is Copyright 2015 William A. Yasnoff. All Rights Reserved.
While the concept of a learning health system (LHS) is not new, our expectations for its functionality have evolved dramatically over the past five decades. Medical practitioners have traditionally shared new insights, albeit slowly, via the peer-reviewed medical literature. However, the increasing application of information technology in healthcare has provided us with the capabilities necessary to vastly accelerate and improve this process so that each patient encounter both utilizes collective prior experience and immediately provides new data to guide subsequent care. A functional model of the LHS and a framework for assessing progress are introduced to illustrate how we are moving towards this goal. Key developments in the field, including the author’s own research, related to databases and registries, decision support, electronic medical records, and health information infrastructure are described in the context of this framework. Finally, a proposed design and implementation strategy for a fully functional health information infrastructure, the key underlying component of the LHS, is presented. Moving forward with this approach, we now have the opportunity to begin building, testing, and utilizing the efficient LHS that can truly revolutionize health care.
William Yasnoff, MD, PhD, is the founder and a managing partner of National Health Information Infrastructure (NHII) Advisors. He is Managing Partner of NHII Advisors, an informatics consulting firm in Arlington, Virginia. He received his MD from Northwestern University in 1975 and his PhD in Computer Science, also from Northwestern University, in 1980. Dr. Yasnoff has also been an Adjunct Professor of Health Sciences Informatics at Johns Hopkins University for the past eleven years and Associate Editor of the Journal of Biomedical Informatics since 2000. In 2013 he was appointed to the Institute of Medicine’s Population Health and Public Health Practice Board.
Patient Blood Management: Impact of Quality Data on Patient OutcomesViewics
Patient blood management (PBM) has been proven to improve patient outcomes and save hospitals millions of dollars. Ensuring the quality of your data is central to decision making and critical to having a strong PBM program.
Would you like to learn how your organization can improve patient outcomes by implementing a PBM program based on accurate data?
If so, view this presentation by blood management expert Lance Trewhella. Lance presents how to develop a successful, evidence-based, multidisciplinary PBM program aimed at optimizing the care of patients who might need transfusion.
You’ll learn:
• Current recommendations for blood transfusion utilization
• The impact of quality data on PBM programs
• Best data practices in PBM
Jonathan Govette - Analyzing Unplanned Admissions and Readmissions After an O...Jonathan Govette
This project involves the comparison of
unplanned admission of patients to the
readmissions of patients within 30 days of
discharge after an interventional radiology
(IR) procedure has occurred using a
retrospective data analysis.
Health IT Summit in Chicago 2014 – “The EHR & Quality: The Current Evidence” with Abha Agrawal, MD, FACP, COO & VP of Medical Affairs, Norwegian American Hospital
Abha Agrawal, MD, FACP
COO & VP of Medical Affairs
Norwegian American Hospital
iHT2 case studies and presentations illustrate challenges, successes and various factors in the outcomes of numerous types of health IT implementations. They are interactive and dynamic sessions providing opportunity for dialogue, debate and exchanging ideas and best practices. This session will be presented by a thought leader in the provider, payer or government space.
Advanced Lab Analytics for Patient Blood Management ProgramsViewics
Reports indicate that 30 – 70% of blood transfusions are inappropriate. Inappropriate blood transfusions put patients at increased risk of post-surgical infections, multi-system organ failure, longer hospital stays, and higher mortality rates. The transfusion guidelines most clinicians learned in their training are now outdated. As such, blood transfusion practices vary widely, and overutilization remains a major quality and cost problem.
Patient Blood Management (PBM) programs are designed to optimize the use of transfusions through a team-based approach, evidence-based guidelines, and algorithms that together guide decisions regarding specifically which patients and clinical procedures warrant blood products, and how much to transfuse. PBM programs have been quite successful in improving patient morbidity and mortality outcomes and generating millions of dollars in savings for hospitals.
Laboratory analytics can be an effective means of instituting restrictive transfusion programs, and advanced lab analytics can be critical in implementing PBM programs, as lab testing and tracking blood usage is central to decision making, changing behavior, and improving performance.
Watch a presentation by Dr. Eleanor Herriman, Chief Medical Informatics Officer at Viewics. She unveils a new suite of advanced analytics tools that support PBS and other restrictive blood management programs, enabling health systems to better leverage their valuable lab medicine assets and fully integrate this key service line into these programs.
You’ll learn:
• How inappropriate blood transfusions are burdening our healthcare system, and the need for better utilization management tools
• New guidelines restricting red blood cell transfusions
• The role of advanced lab analytics in PBM programs
• How Viewics is leveraging advanced lab analytics to help health systems more easily and cost-effectively implement PBM programs
Best Practices for a Data-driven Approach to Test UtilizationViewics
Would you like to learn how data-driven interventions can improve laboratory test utilization in your organization? Would you like to hear about the impact that leading hospitals/health systems and managed care organizations have made through these interventions?
If so, you might be interested in this presentation by utilization management expert Dr. Michael Astion, Medical Director at the Department of Laboratories at Seattle Children’s Hospital and Clinical Professor of Laboratory Medicine at the University of Washington.
In this presentation, Dr. Astion discusses the current state of the misuse of laboratory testing in the United States and some of the interventions that are being implemented to improve it. He covers a number of common areas of unnecessary testing — from pure abuse to tests that could be useful but are ordered inappropriately.
You'll learn about:
• Two areas of laboratory testing where misordering of tests occur frequently
• Three interventions to improve the value of testing for patients
• The role of genetic counselors and other laboratory professionals in improving lab test ordering
• The national endeavor known as PLUGS, the Pediatric Laboratory Utilization Guidance Service
Tackling the U.S. Healthcare System’s Infectious Disease Management ProblemViewics
The United States healthcare system has a serious infectious disease management problem. The antibiotic resistance crisis is widespread, serious, costly, and deadly. Delays in pathogen identification lead to poor clinical outcomes, including increased mortality risk. And, optimally managing outbreaks is critical to health systems whose reimbursement is tied to the health of a population, such as ACOs.
Eleanor Herriman, MD, MBA, Chief Medical Informatics Officer at Viewics led an informative panel discussion with industry leaders on the issues surrounding the infectious disease management crisis. Margret Oethinger, MD, Ph.D., Medical Director of Providence Health & Services, and Susan E. Sharp, Ph.D., DABMM, FAAM, Regional Director of Microbiology and the Molecular Infectious Disease Laboratories, Department of Pathology, Kaiser Permanente and President-Elect, American Society for Microbiology cover the current state of infectious disease management in the U.S., and what can be done to improve it.
You’ll learn about:
• The magnitude of the U.S. health system’s infectious disease management problem
• The most serious concerns and trends for healthcare institutions and communities across the nation
• The most promising solutions to health systems’ most urgent infectious disease management challenges
Revolutionizing Renal Care With Predictive Analytics for CKDViewics
Chronic Kidney Disease (CKD) is a common and growing condition, affecting about half of the Medicare population and of diabetics. In the United States, the lifetime risk of CKD for 30-year-olds is now greater than half, and the prevalence of CKD is projected to rise significantly over the next 15 years.
Current methods of predicting which CKD patients will progress to renal failure and require dialysis or transplant have low accuracy rates, causing great anxiety and suboptimal care. Without accurate risk prediction, many patients are over-treated, effectively wasting limited resources and negatively impacting outcomes. Conversely, other patients may receive inadequate treatment, restricting options to only the most costly and least desirable interventions.
Watch this on-demand webinar with Dr. Navdeep Tangri, developer of the Kidney Failure Risk Equation, which revolutionizes the way CKD patients are managed by leveraging laboratory data to accurately predict the risk of kidney failure in patients with CKD.
You’ll learn:
• How CKD is burdening our healthcare system, and the need for better care management tools
• How the Kidney Failure Risk Equation was researched, developed, and validated
• How Viewics is implementing CKD predictive analytics to automatically deliver risk information to clinicians and issue customized, educational reports to patients and clinicians
Validity and bias in epidemiological studyAbhijit Das
Validity and bias are essential aspects of any research—a brief description of internal and external validity and different types of bias related to the epidemiological study.
Advanced Laboratory Analytics — A Disruptive Solution for Health SystemsViewics
As US healthcare systems grapple with the recent upheavals in care payment and delivery, they are turning to advanced analytics as their “central nervous systems” for driving care and financial performance.
Laboratory information — spanning chemistry, pathology, microbiology and molecular testing, for example — is among the best sources of data for these advanced analytics, including clinician decision support, predictive analytics, population health management, and personalized medicine. When strategically harnessed and integrated to create a patient-centric lab data lake, laboratory information can form an affordable yet competitively powerful advanced analytics solution well suited for many health systems — i.e., a disruptive option.
L. Eleanor J. Herriman, MD, MBA, Chief Medical Informatics Officer of Viewics, explains why laboratory data should be a core strategic component for achieving success in value-based healthcare.
Understand what healthcare analytics is.
Identify the 5-stage Analytics Program Lifecycle (APL).
Understand how data analytics can be used in healthcare.
Check it on Experfy: https://www.experfy.com/training/courses/introduction-to-healthcare-analytics.
Proposed Framework For Electronic Clinical Record Information Systemijcsa
This research paper is drawn from an ongoing, large-scale project of implementing Electronic Clinical Record (ECR). The overall aim in this study is to develop a deeper understanding of the socio-technical aspects of the complexities and challenges emerging from the implementation of the ECR, and in particular to study how to manage a gradual transition to digital record. We have proposed ECR conceptual mode. The end result of our research was a collection of ideas / surveys, and field work that clinical institutions and medical informatics must consider to ensure that patients and clinics do not lose long-term access to ECR and technology continually progress. Results of our study identified the need for more research in this particular area as no definitive solution to long-term access to electronic clinical records was revealed. Additionally, the research findings highlighted the fact that a few medical institutions may actually be concerned about long-term access to electronic records.
An integrated model of psychosocial cancer care: a work in progress…Cancer Institute NSW
Cancer patients are faced with a multitude of stressors, from diagnosis, through treatment, at recurrence, in the stages following treatment completion, and in the terminal phase. Psychosocial care has been highlighted as a critical aspect of providing comprehensive patient-focused care. Specifically, one of the goals of The NSW Cancer Plan 2011-2015 is to improve the quality of life of people with cancer and their carers. This project was initiated to improve the current psychosocial model of care at The Kinghorn Cancer Centre (TKCC), to better reflect an integrated, holistic and comprehensive model of patient-centred care.
Presented at the 7th Healthcare CIO Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand on July 8, 2016
Chapter 4 Knowledge Discovery, Data Mining, and Practice-Based Evi.docxchristinemaritza
Chapter 4 Knowledge Discovery, Data Mining, and Practice-Based Evidence
Mollie R. Cummins
Ginette A. Pepper
Susan D. Horn
The next step to comparative effectiveness research is to conduct more prospective large-scale observational cohort studies with the rigor described here for knowledge discovery and data mining (KDDM) and practice-based evidence (PBE) studies.
Objectives
At the completion of this chapter the reader will be prepared to:
1.Define the goals and processes employed in knowledge discovery and data mining (KDDM) and practice-based evidence (PBE) designs
2.Analyze the strengths and weaknesses of observational designs in general and of KDDM and PBE specifically
3.Identify the roles and activities of the informatics specialist in KDDM and PBE in healthcare environments
Key Terms
Comparative effectiveness research, 69
Confusion matrix, 62
Data mining, 61
Knowledge discovery and data mining (KDDM), 56
Machine learning, 56
Natural language processing (NLP), 58
Practice-based evidence (PBE), 56
Preprocessing, 56
Abstract
The advent of the electronic health record (EHR) and other large electronic datasets has revolutionized efficient access to comprehensive data across large numbers of patients and the concomitant capacity to detect subtle patterns in these data even with missing or less than optimal data quality. This chapter introduces two approaches to knowledge building from clinical data: (1) knowledge discovery and data mining (KDDM) and (2) practice-based evidence (PBE). The use of machine learning methods in retrospective analysis of routinely collected clinical data characterizes KDDM. KDDM enables us to efficiently and effectively analyze large amounts of data and develop clinical knowledge models for decision support. PBE integrates health information technology (health IT) products with cohort identification, prospective data collection, and extensive front-line clinician and patient input for comparative effectiveness research. PBE can uncover best practices and combinations of treatments for specific types of patients while achieving many of the presumed advantages of randomized controlled trials (RCTs).
Introduction
Leaders need to foster a shared learning culture for improving healthcare. This extends beyond the local department or institution to a value for creating generalizable knowledge to improve care worldwide. Sound, rigorous methods are needed by researchers and health professionals to create this knowledge and address practical questions about risks, benefits, and costs of interventions as they occur in actual clinical practice. Typical questions are as follows:
•Are treatments used in daily practice associated with intended outcomes?
•Can we predict adverse events in time to prevent or ameliorate them?
•What treatments work best for which patients?
•With limited financial resources, what are the best interventions to use for specific types of patients?
•What types of indi ...
OverviewWrite a 3-4 page evidence-based health care delivery pla.docxgerardkortney
Overview
Write a 3-4 page evidence-based health care delivery plan for one component of a heart failure clinic.
Nursing within an organization is a critical component of health care delivery and is an essential ingredient in patient outcomes (Kelly & Tazbir, 2014). The concern for quality care that flows from evidence-based practice generates a desired outcome. Without these factors, a nurse cannot be an effective leader. It is important to lead not only from this position but from knowledge and expertise.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
•Competency 2: Explain the accountability of the nurse leader for decisions that affect health care delivery and patient outcomes. ◦Describe accountability tools and procedures used to measure effectiveness.
•Competency 3: Apply management strategies and best practices for health care finance, human resources, and materials allocation decisions to improve health care delivery and patient outcomes. ◦Develop an evidence-based plan for health care delivery.
•Competency 4: Apply professional standards of moral, ethical, and legal conduct in professional practice. ◦Apply professional and legal standards in support of a care plan.
•Competency 5: Communicate in manner that is consistent with the expectations of a nursing professional. ◦Write content clearly and logically, with correct use of grammar, punctuation, and mechanics.
◦Correctly format citations and references using current APA style.
Reference
Kelly, P., & Tazbir, J. (2014). Essentials of nursing leadership and management (3rd ed.). Clifton Park, NY: Delmar.
Context
In an effort to improve the patients' health literacy concerning heart failure, it is important that the clinic staff and the hospital staff present a consistent, evidence-based message on self-care to these patients and their families in order to decrease acute exacerbation and re-admissions. Review current evidence for clinical practice guides or protocols when developing your patient teaching plans and materials. Consider the following:
•What does the patient know about the disease process as a baseline?
•What does the patient need to do understand as far as the best self-care processes?
•Can the patient identify proper medication compliance?
•Is there a financial issue that affects compliance?
•Who buys and prepares the food in the home?
•Can the patient verbalize when to seek medical assistance?
Questions to Consider
To deepen your understanding, you are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community.
•What factors contribute to inadequate quality of care?
•How effective are organizational mandates for quality?
•How do financial concerns impact health and safety goals?
Suggested Resources
The following optional resources are provided to support you in complet.
Patient Blood Management: Impact of Quality Data on Patient OutcomesViewics
Patient blood management (PBM) has been proven to improve patient outcomes and save hospitals millions of dollars. Ensuring the quality of your data is central to decision making and critical to having a strong PBM program.
Would you like to learn how your organization can improve patient outcomes by implementing a PBM program based on accurate data?
If so, view this presentation by blood management expert Lance Trewhella. Lance presents how to develop a successful, evidence-based, multidisciplinary PBM program aimed at optimizing the care of patients who might need transfusion.
You’ll learn:
• Current recommendations for blood transfusion utilization
• The impact of quality data on PBM programs
• Best data practices in PBM
Jonathan Govette - Analyzing Unplanned Admissions and Readmissions After an O...Jonathan Govette
This project involves the comparison of
unplanned admission of patients to the
readmissions of patients within 30 days of
discharge after an interventional radiology
(IR) procedure has occurred using a
retrospective data analysis.
Health IT Summit in Chicago 2014 – “The EHR & Quality: The Current Evidence” with Abha Agrawal, MD, FACP, COO & VP of Medical Affairs, Norwegian American Hospital
Abha Agrawal, MD, FACP
COO & VP of Medical Affairs
Norwegian American Hospital
iHT2 case studies and presentations illustrate challenges, successes and various factors in the outcomes of numerous types of health IT implementations. They are interactive and dynamic sessions providing opportunity for dialogue, debate and exchanging ideas and best practices. This session will be presented by a thought leader in the provider, payer or government space.
Advanced Lab Analytics for Patient Blood Management ProgramsViewics
Reports indicate that 30 – 70% of blood transfusions are inappropriate. Inappropriate blood transfusions put patients at increased risk of post-surgical infections, multi-system organ failure, longer hospital stays, and higher mortality rates. The transfusion guidelines most clinicians learned in their training are now outdated. As such, blood transfusion practices vary widely, and overutilization remains a major quality and cost problem.
Patient Blood Management (PBM) programs are designed to optimize the use of transfusions through a team-based approach, evidence-based guidelines, and algorithms that together guide decisions regarding specifically which patients and clinical procedures warrant blood products, and how much to transfuse. PBM programs have been quite successful in improving patient morbidity and mortality outcomes and generating millions of dollars in savings for hospitals.
Laboratory analytics can be an effective means of instituting restrictive transfusion programs, and advanced lab analytics can be critical in implementing PBM programs, as lab testing and tracking blood usage is central to decision making, changing behavior, and improving performance.
Watch a presentation by Dr. Eleanor Herriman, Chief Medical Informatics Officer at Viewics. She unveils a new suite of advanced analytics tools that support PBS and other restrictive blood management programs, enabling health systems to better leverage their valuable lab medicine assets and fully integrate this key service line into these programs.
You’ll learn:
• How inappropriate blood transfusions are burdening our healthcare system, and the need for better utilization management tools
• New guidelines restricting red blood cell transfusions
• The role of advanced lab analytics in PBM programs
• How Viewics is leveraging advanced lab analytics to help health systems more easily and cost-effectively implement PBM programs
Best Practices for a Data-driven Approach to Test UtilizationViewics
Would you like to learn how data-driven interventions can improve laboratory test utilization in your organization? Would you like to hear about the impact that leading hospitals/health systems and managed care organizations have made through these interventions?
If so, you might be interested in this presentation by utilization management expert Dr. Michael Astion, Medical Director at the Department of Laboratories at Seattle Children’s Hospital and Clinical Professor of Laboratory Medicine at the University of Washington.
In this presentation, Dr. Astion discusses the current state of the misuse of laboratory testing in the United States and some of the interventions that are being implemented to improve it. He covers a number of common areas of unnecessary testing — from pure abuse to tests that could be useful but are ordered inappropriately.
You'll learn about:
• Two areas of laboratory testing where misordering of tests occur frequently
• Three interventions to improve the value of testing for patients
• The role of genetic counselors and other laboratory professionals in improving lab test ordering
• The national endeavor known as PLUGS, the Pediatric Laboratory Utilization Guidance Service
Tackling the U.S. Healthcare System’s Infectious Disease Management ProblemViewics
The United States healthcare system has a serious infectious disease management problem. The antibiotic resistance crisis is widespread, serious, costly, and deadly. Delays in pathogen identification lead to poor clinical outcomes, including increased mortality risk. And, optimally managing outbreaks is critical to health systems whose reimbursement is tied to the health of a population, such as ACOs.
Eleanor Herriman, MD, MBA, Chief Medical Informatics Officer at Viewics led an informative panel discussion with industry leaders on the issues surrounding the infectious disease management crisis. Margret Oethinger, MD, Ph.D., Medical Director of Providence Health & Services, and Susan E. Sharp, Ph.D., DABMM, FAAM, Regional Director of Microbiology and the Molecular Infectious Disease Laboratories, Department of Pathology, Kaiser Permanente and President-Elect, American Society for Microbiology cover the current state of infectious disease management in the U.S., and what can be done to improve it.
You’ll learn about:
• The magnitude of the U.S. health system’s infectious disease management problem
• The most serious concerns and trends for healthcare institutions and communities across the nation
• The most promising solutions to health systems’ most urgent infectious disease management challenges
Revolutionizing Renal Care With Predictive Analytics for CKDViewics
Chronic Kidney Disease (CKD) is a common and growing condition, affecting about half of the Medicare population and of diabetics. In the United States, the lifetime risk of CKD for 30-year-olds is now greater than half, and the prevalence of CKD is projected to rise significantly over the next 15 years.
Current methods of predicting which CKD patients will progress to renal failure and require dialysis or transplant have low accuracy rates, causing great anxiety and suboptimal care. Without accurate risk prediction, many patients are over-treated, effectively wasting limited resources and negatively impacting outcomes. Conversely, other patients may receive inadequate treatment, restricting options to only the most costly and least desirable interventions.
Watch this on-demand webinar with Dr. Navdeep Tangri, developer of the Kidney Failure Risk Equation, which revolutionizes the way CKD patients are managed by leveraging laboratory data to accurately predict the risk of kidney failure in patients with CKD.
You’ll learn:
• How CKD is burdening our healthcare system, and the need for better care management tools
• How the Kidney Failure Risk Equation was researched, developed, and validated
• How Viewics is implementing CKD predictive analytics to automatically deliver risk information to clinicians and issue customized, educational reports to patients and clinicians
Validity and bias in epidemiological studyAbhijit Das
Validity and bias are essential aspects of any research—a brief description of internal and external validity and different types of bias related to the epidemiological study.
Advanced Laboratory Analytics — A Disruptive Solution for Health SystemsViewics
As US healthcare systems grapple with the recent upheavals in care payment and delivery, they are turning to advanced analytics as their “central nervous systems” for driving care and financial performance.
Laboratory information — spanning chemistry, pathology, microbiology and molecular testing, for example — is among the best sources of data for these advanced analytics, including clinician decision support, predictive analytics, population health management, and personalized medicine. When strategically harnessed and integrated to create a patient-centric lab data lake, laboratory information can form an affordable yet competitively powerful advanced analytics solution well suited for many health systems — i.e., a disruptive option.
L. Eleanor J. Herriman, MD, MBA, Chief Medical Informatics Officer of Viewics, explains why laboratory data should be a core strategic component for achieving success in value-based healthcare.
Understand what healthcare analytics is.
Identify the 5-stage Analytics Program Lifecycle (APL).
Understand how data analytics can be used in healthcare.
Check it on Experfy: https://www.experfy.com/training/courses/introduction-to-healthcare-analytics.
Proposed Framework For Electronic Clinical Record Information Systemijcsa
This research paper is drawn from an ongoing, large-scale project of implementing Electronic Clinical Record (ECR). The overall aim in this study is to develop a deeper understanding of the socio-technical aspects of the complexities and challenges emerging from the implementation of the ECR, and in particular to study how to manage a gradual transition to digital record. We have proposed ECR conceptual mode. The end result of our research was a collection of ideas / surveys, and field work that clinical institutions and medical informatics must consider to ensure that patients and clinics do not lose long-term access to ECR and technology continually progress. Results of our study identified the need for more research in this particular area as no definitive solution to long-term access to electronic clinical records was revealed. Additionally, the research findings highlighted the fact that a few medical institutions may actually be concerned about long-term access to electronic records.
An integrated model of psychosocial cancer care: a work in progress…Cancer Institute NSW
Cancer patients are faced with a multitude of stressors, from diagnosis, through treatment, at recurrence, in the stages following treatment completion, and in the terminal phase. Psychosocial care has been highlighted as a critical aspect of providing comprehensive patient-focused care. Specifically, one of the goals of The NSW Cancer Plan 2011-2015 is to improve the quality of life of people with cancer and their carers. This project was initiated to improve the current psychosocial model of care at The Kinghorn Cancer Centre (TKCC), to better reflect an integrated, holistic and comprehensive model of patient-centred care.
Presented at the 7th Healthcare CIO Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand on July 8, 2016
Chapter 4 Knowledge Discovery, Data Mining, and Practice-Based Evi.docxchristinemaritza
Chapter 4 Knowledge Discovery, Data Mining, and Practice-Based Evidence
Mollie R. Cummins
Ginette A. Pepper
Susan D. Horn
The next step to comparative effectiveness research is to conduct more prospective large-scale observational cohort studies with the rigor described here for knowledge discovery and data mining (KDDM) and practice-based evidence (PBE) studies.
Objectives
At the completion of this chapter the reader will be prepared to:
1.Define the goals and processes employed in knowledge discovery and data mining (KDDM) and practice-based evidence (PBE) designs
2.Analyze the strengths and weaknesses of observational designs in general and of KDDM and PBE specifically
3.Identify the roles and activities of the informatics specialist in KDDM and PBE in healthcare environments
Key Terms
Comparative effectiveness research, 69
Confusion matrix, 62
Data mining, 61
Knowledge discovery and data mining (KDDM), 56
Machine learning, 56
Natural language processing (NLP), 58
Practice-based evidence (PBE), 56
Preprocessing, 56
Abstract
The advent of the electronic health record (EHR) and other large electronic datasets has revolutionized efficient access to comprehensive data across large numbers of patients and the concomitant capacity to detect subtle patterns in these data even with missing or less than optimal data quality. This chapter introduces two approaches to knowledge building from clinical data: (1) knowledge discovery and data mining (KDDM) and (2) practice-based evidence (PBE). The use of machine learning methods in retrospective analysis of routinely collected clinical data characterizes KDDM. KDDM enables us to efficiently and effectively analyze large amounts of data and develop clinical knowledge models for decision support. PBE integrates health information technology (health IT) products with cohort identification, prospective data collection, and extensive front-line clinician and patient input for comparative effectiveness research. PBE can uncover best practices and combinations of treatments for specific types of patients while achieving many of the presumed advantages of randomized controlled trials (RCTs).
Introduction
Leaders need to foster a shared learning culture for improving healthcare. This extends beyond the local department or institution to a value for creating generalizable knowledge to improve care worldwide. Sound, rigorous methods are needed by researchers and health professionals to create this knowledge and address practical questions about risks, benefits, and costs of interventions as they occur in actual clinical practice. Typical questions are as follows:
•Are treatments used in daily practice associated with intended outcomes?
•Can we predict adverse events in time to prevent or ameliorate them?
•What treatments work best for which patients?
•With limited financial resources, what are the best interventions to use for specific types of patients?
•What types of indi ...
OverviewWrite a 3-4 page evidence-based health care delivery pla.docxgerardkortney
Overview
Write a 3-4 page evidence-based health care delivery plan for one component of a heart failure clinic.
Nursing within an organization is a critical component of health care delivery and is an essential ingredient in patient outcomes (Kelly & Tazbir, 2014). The concern for quality care that flows from evidence-based practice generates a desired outcome. Without these factors, a nurse cannot be an effective leader. It is important to lead not only from this position but from knowledge and expertise.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
•Competency 2: Explain the accountability of the nurse leader for decisions that affect health care delivery and patient outcomes. ◦Describe accountability tools and procedures used to measure effectiveness.
•Competency 3: Apply management strategies and best practices for health care finance, human resources, and materials allocation decisions to improve health care delivery and patient outcomes. ◦Develop an evidence-based plan for health care delivery.
•Competency 4: Apply professional standards of moral, ethical, and legal conduct in professional practice. ◦Apply professional and legal standards in support of a care plan.
•Competency 5: Communicate in manner that is consistent with the expectations of a nursing professional. ◦Write content clearly and logically, with correct use of grammar, punctuation, and mechanics.
◦Correctly format citations and references using current APA style.
Reference
Kelly, P., & Tazbir, J. (2014). Essentials of nursing leadership and management (3rd ed.). Clifton Park, NY: Delmar.
Context
In an effort to improve the patients' health literacy concerning heart failure, it is important that the clinic staff and the hospital staff present a consistent, evidence-based message on self-care to these patients and their families in order to decrease acute exacerbation and re-admissions. Review current evidence for clinical practice guides or protocols when developing your patient teaching plans and materials. Consider the following:
•What does the patient know about the disease process as a baseline?
•What does the patient need to do understand as far as the best self-care processes?
•Can the patient identify proper medication compliance?
•Is there a financial issue that affects compliance?
•Who buys and prepares the food in the home?
•Can the patient verbalize when to seek medical assistance?
Questions to Consider
To deepen your understanding, you are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of your professional community.
•What factors contribute to inadequate quality of care?
•How effective are organizational mandates for quality?
•How do financial concerns impact health and safety goals?
Suggested Resources
The following optional resources are provided to support you in complet.
Presentation for UP MSHI HI201 Health Informatics class under Dr. Iris Tan and Dr. Mike Muin. Check out my blog - http://jdonsoriano.wordpress.com/2014/10/09/fitting-the-pi…making-it-work/
Research studies show thatevidence-based practice(EBP) leads t.docxronak56
Research studies show thatevidence-based practice(EBP) leads to higher qual-
ity care, improved patient out-
comes, reduced costs, and greater
nurse satisfaction than traditional
approaches to care.1-5 Despite
these favorable findings, many
nurses remain inconsistent in their
implementation of evidence-based
care. Moreover, some nurses,
whose education predates the in-
clusion of EBP in the nursing cur-
riculum, still lack the computer
and Internet search skills neces-
sary to implement these practices.
As a result, misconceptions about
EBP—that it’s too difficult or too
time-consuming—continue to
flourish.
In the first article in this series
(“Igniting a Spirit of Inquiry: An
Essential Foundation for Evidence-
Based Practice,” November 2009),
we described EBP as a problem-
solving approach to the delivery
of health care that integrates the
best evidence from well-designed
studies and patient care data,
and combines it with patient
preferences and values and nurse
expertise. We also addressed the
contribution of EBP to improved
care and patient outcomes, de-
scribed barriers to EBP as well as
factors facilitating its implementa-
tion, and discussed strategies for
igniting a spirit of inquiry in clin-
ical practice, which is the founda-
tion of EBP, referred to as Step
Zero. (Editor’s note: although
EBP has seven steps, they are
numbered zero to six.) In this
article, we offer a brief overview
of the multistep EBP process.
Future articles will elaborate on
each of the EBP steps, using
the context provided by the
Case Scenario for EBP: Rapid
Response Teams.
Step Zero: Cultivate a spirit of
inquiry. If you’ve been following
this series, you may have already
started asking the kinds of ques-
tions that lay the groundwork
for EBP, for example: in patients
with head injuries, how does
supine positioning compared
with elevating the head of the
bed 30 degrees affect intracranial
pressure? Or, in patients with
supraventricular tachycardia,
how does administering the
!-blocker metoprolol (Lopressor,
Toprol-XL) compared with ad-
ministering no medicine affect
By Bernadette Mazurek Melnyk, PhD,
RN, CPNP/PMHNP, FNAP, FAAN,
Ellen Fineout-Overholt, PhD, RN,
FNAP, FAAN, Susan B. Stillwell, DNP,
RN, CNE, and Kathleen M.
Williamson, PhD, RN
The Seven Steps of Evidence-Based Practice
Following this progressive, sequential approach will lead
to improved health care and patient outcomes.
This is the second article in a new series from the Arizona State University College of Nursing and Health Innova-
tion’s Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving
approach to the delivery of health care that integrates the best evidence from studies and patient care data with clini-
cian expertise and patient preferences and values. When delivered in a context of caring and in a supportive organi-
zational culture, the highest quality of care and best patient outcomes can be achieved.
The purpose of this s ...
Protocols and Evidence based Healthcare: information technology tools to support best practices in health care, information technology tools that inform and empower patients.
The Perception of Emergency Medical Staff on the Use of Electronic Patient Cl...ijtsrd
Background The electronic recording of patient information in ambulance services has provided healthcare professionals with the ability to send patient data to their GP or other relevant services electronically. It is critical to comprehend how paramedics view and adjust to electronic platforms as technology continues to advance. Objective To identify the facilitators and barriers EMS staff encounter when using e PCR. To explore the overall perception of EMS staff towards the utilization of e PCR in EMS settings. Method Four databases were searched including PubMed, Scopus, Medline and Science Direct. Result All 11 publications were evaluated for qualitative data and the publication was found to be of fair or good quality. Studies investigating the perception of staff found mixed perceptions. The search generated a total of 1365 potential articles. After the initial screening process, 229 duplicate records were removed Out of the remaining 1136 papers, 1079 were excluded as they did not meet the selection criteria the title, abstract, and keywords. Of the remaining 57 papers, a full text screening eliminated 46 for the study design quantitative studies n=22 , no perception of staff documented n=19 and no full text available n=5 . Thus, 11 papers that met the inclusion criteria were selected for final analysis. The risk of bias was quantified using CASP. A qualitative synthesis was conducted and three major themes emerged Facilitators, Barriers and overall perception of staff. Conclusion This systematic review found that EMS staff hold complex and diverse views on e PCR systems. While several facilitators and barriers impact e PCR adoption, it has been found that e PCR has the potential to enhance documentation, communication, data driven decision making and finally the ability to improve overall patient care quality. To ensure successful adoption, addressing technical issues, data security and training requirements and organisational barriers is important. Reshma Joe | Jomin George "The Perception of Emergency Medical Staff on the Use of Electronic Patient Clinical Records Systems in Emergency Medical Service: A Systematic Review" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd62365.pdf Paper Url: https://www.ijtsrd.com/medicine/other/62365/the-perception-of-emergency-medical-staff-on-the-use-of-electronic-patient-clinical-records-systems-in-emergency-medical-service-a-systematic-review/reshma-joe
Computer validation of e-source and EHR in clinical trials-KuchinkeWolfgang Kuchinke
Clinical Trials in the Learning Health System (LHS): Computer System Validation of eSource and EHR Data.
The question that was addressed: How to make a clinical trial data management system that uses EHR data, Patient Reported Outcome (PRO) and eSource data as part of the Learning Health System compliant with regulations and with Good Clinical Practice (GCP)?
The Learning Health System (LHS) connects health care with translational and clinical research. It generates new medical knowledge as a by-product of the care process and its aim is to improve health and safety of patients. The LHS generates and applies knowledge. For this purpose, clinical research, which is research involving humans, must be part of the LHS. Two general types of research exists: observational studies and clinical trials.
Clinical data drive the LHS, because results from randomized controlled trials are seen as “gold standard” for medical evidence. For this reason the concept of using data gathered directly from the patient care environment has enormous potential for accelerating the rate at which useful knowledge is generated.
All computer systems involved in clinical trials must undergo Computer System Validation (CSV). For this process, a legal framework for the TRANSFoRm project was developed. It was used for data privacy analysis of the data flow in two research use cases: an epidemiological cohort study on Diabetes and a randomised clinical trial about different GORD treatment regimes.
Computerized system validation is the documented process to produce evidence that a computerized system does exactly what it is designed to do in a consistent and reproducible manner. The validation of electronic source data in clinical trials presents many challenges because of the blurring of the border between care and research. Here we present our approach for the validation of eSource data capture and the developed documentation for the CSV of the complete data flow in the LHS developed by the TRANSFoRm project. An important part hereby played the GORD Valuation Study.
Computer System Validation - privacy zones, eSource and EHR data in clinical ...Wolfgang Kuchinke
Clinical Trials in the Learning Health System (LHS): Computer System Validation of eSource and EHR Data.
The question that was addressed: How to make a clinical trial data management system that uses EHR data, Patient Reported Outcome (PRO) and eSource data as part of the Learning Health System compliant with regulations and with Good Clinical Practice (GCP)?
The Learning Health System (LHS) connects health care with translational and clinical research. It generates new medical knowledge as a by-product of the care process and its aim is to improve health and safety of patients. The LHS generates and applies knowledge. For this purpose, clinical research, which is research involving humans, must be part of the LHS. Two general types of research exists: observational studies and clinical trials.
Clinical data drive the LHS, because results from randomized controlled trials are seen as “gold standard” for medical evidence. For this reason the concept of using data gathered directly from the patient care environment has enormous potential for accelerating the rate at which useful knowledge is generated.
All computer systems involved in clinical trials must undergo Computer System Validation (CSV). For this process, a legal framework for the TRANSFoRm project was developed. It was used for data privacy analysis of the data flow in two research use cases: an epidemiological cohort study on Diabetes and a randomised clinical trial about different GORD treatment regimes.
Computerized system validation is the documented process to produce evidence that a computerized system does exactly what it is designed to do in a consistent and reproducible manner. The validation of electronic source data in clinical trials presents many challenges because of the blurring of the border between care and research. Here we present our approach for the validation of eSource data capture and the developed documentation for the CSV of the complete data flow in the LHS developed by the TRANSFoRm project. An important part hereby played the GORD Valuation Study.
Computer System Validation with privacy zones, e-source and clinical trials b...Wolfgang Kuchinke
Clinical Trials in the Learning Health System: Computer System Validation of eSource and EHR Data. Basic question is how to make a clinical trial data management system that uses EHR data, Patient Reported Outcome (PRO) and eSource data as part of the Learning Health System compliant with regulations and with Good Clinical Practice (GCP)? Computer System Validation (CSV) is a requirement for all computer systems involved in clinical trials for drug submission. It consists of documented processes to produce evidence that a computerized system does exactly what it is designed to do in a consistent and reproducible manner. Validation begins with the system requirements definition and continues until system retirement. For example, the components of a clinical trials
framework used in our case are: Patient eligibility checks and enrolment, pre-population of eCRFs with data from EHRs, PROM data collection by patients, storing of a copy of study data in the EHR, and validation of the Study System that coordinates all study and data collection events.
eSource direct data entry in clinical trials and GCP requirements. It is the duty of physicians who are involved in medical research to protect the privacy and confidentiality of personal information of research subjects. Any eSource system should be fully compliant with the provisions of applicable data protection legislation. This creates the need to develop and implement processes that ensure the continuous control of the investigators over these data. This has to be the focus of CSV. Clinical Data drive the LHS. The results from randomized controlled trials are seen as the “gold standard” for medical evidence, but such trials are often performed outside the usual system of care and recruit highly selected populations. For this reason, the concept of using data gathered directly from the patient care environment has enormous potential for accelerating the rate at which useful knowledge is generated.
This leads to the requirement for validating electronic source data in clinical trials. This includes validation for clinical data that is either captured from the subject directly or from the subject’s medical records. The problem is the correct and appropriate system validation of electronic source data. The main componenets of CSV are the Validation Master Plan), User Requirements Specification, Hardware Requirements Specification, Design qualification, Installation qualification, Operational qualification, Performance qualification.
Any instrument used to capture source data should ensure that the data are captured as specified within the protocol. Source data should be accurate, legible, contemporaneous, original, attributable, complete and consistent. An audit trail should be maintained as part of the source documents for the original creation and subsequent modification of all source data.
Similar to My Top 5 articles from 2015-16 about Informatics and Digital Health in Physiotherapy and Stroke (20)
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
My Top 5 articles from 2015-16 about Informatics and Digital Health in Physiotherapy and Stroke
1. My Top 5 articles from 2015-16 about
Informatics and Digital Health in
Physiotherapy and Stroke
Samantha Plumb
Health Informatics and
Digital Health 2016
1
The focus of my review is how informatics and digital health has and may
influence the management of and clinical outcomes for stroke patients, in
particular applying evidence based physiotherapy.
I chose this topic because:
• this is my clinical area of expertise
• the number of people annually affected by stroke, living with stroke and
dying from stroke is increasing worldwide
• timely access to information and intervention, and co-ordinated care is
critical to the outcome for stroke patients
• application of evidence based practice (EBP) to reduce variation in care can
be enhanced through digital health such as electronic medical records (EMR)
2. Search Strategy applied across 2015- 2016
Search terms:
#1:“physiotherapy or “physical therapy”
and
#2:“stroke”
and
#3:“digital health” or “informatics” or “electronic medical record” or “electronic health record”
Type of
Database
Search fields Search terms Total No. of
articles
Shortlisted for
review
Reason for
exclusion
Cinahl Title and abstract #1 and #2 and #3 0 0
Cochrane Title and abstract #1 and #2 and #3 0 0
Pedro Title and abstract #1 and #2 and #3 0 0
Medline Title and abstract #1 and #2 and #3 5 2 3 articles less relevant
Embase Title and abstract #1 and #2 and #3 5 0 3 conference papers
2 not in English
Scopus Title and abstract #1 and #2 and #3 6 3 2 articles less relevant
1 article duplicated
from Medline search
2
3. Rationale for top 5 papers
• All 5 papers link digital health with improving clinical outcomes for
stroke patients
• All 5 papers identify physiotherapy as an important component of
treatment in stroke care. This includes important to patients (i.e..
physical outcomes) and demonstrated through EBP.
• Papers identify areas of success and future considerations for digital
health and stroke
• Papers will all be useful in the development and build of an EMR
• Only those papers that were in English were considered
• The lack of literature to choose from in this area should be noted
3
4. Article 1:
Poder U, Dahm MF, Karlsson N, Wadensten B. (2015) Standardised care plans for in hospital stroke
care improve documentation of health care assessments. Journal of Clinical Nursing. 24, 2788-2796
Key messages from the article
• It is imperative that patients are treated in accordance with evidence
based practice to achieve best outcomes
• A rapid reliable clinical diagnosis should occur as soon as possible to
form the basis for continued management
• Use of multidisciplinary standardised care plans (SCP) or clinical
pathways within an EMR can assist in implementing EBP, reducing
variation in care, providing high quality patient care, and improving
patient outcomes
• This study found that in comparison to working on paper pre EMR
implementation, the SCP within the EMR led to improved
documentation, more patients receiving the same high quality care
and improved patient safety
• The was also a significant improvement in the proportion of patients
assessed by physiotherapists in accordance with the guidelines which
led to improved opportunity for early rehabilitation
• Critical success factors include ensuring the layout of the SCP in the
EMR is of practical use, user-friendly, clarity on who is responsible for
each section and that the SCP allows for flexibility while still upholding
standardisation
Link with the rationale
• SCP or clinical pathways within an EMR are a
proven tool to implement EBP and reduce
variation in care
• Clinical pathways for stroke should include
• referrals to physiotherapy
• evidence based physiotherapy assessment, intervention
and discharge
• Duke University Hospital in the USA is leading the
way with demonstrating benefits from embedding
clinical pathways into the EMR
4
5. Article 2:
Amin K (2015). Replacing paper with digital recording. Journal of stroke and cerebrovascular diseases.
24(1), 144-147
Key messages from the article
• This study implemented an electronic version from paper for
documenting multi-disciplinary team meetings (eMDT) including
therapy goals to be able to monitor patient progress.
• Implementation resulted in patients being more likely to receive
appropriate care as recommended by the stroke guidelines, enabled
easy retrieval of information, enhanced documentation and
communication and allowed monitoring of individual patient progress
• Data points and objective measures were identified and agreed
amongst the team as an essential item for objective and concise
information to monitor progress
• Widely used and recognised assessment scales were used to allow for
data sharing and comparison with national and international projects
• Training on the new system and change management through staff
engagement were identified as reasons for project success
• eMDT was interfaced with other ehealth systems e.g.: PAS
• Functionality of the system included analytics such as trending data
Link with the rationale
• It is well known that co-ordinated care within a stroke unit
significantly improves outcomes for stroke inpatients
• This communication tool enables co-ordinated care
• Improved communication amongst staff will ultimately lead to
better care for patients. It also helps to reduce unnecessary
investigations, duplication of tasks and time wasted searching for
paper based forms
• Training and change management are key to introducing any new
IT system.
• Implementing IT related to clinical areas should be led as a clinical
project
5
6. Article 3:
Rand M and Darbinian J. (2015). Effect of an evidence-based intervention on the level of function in
acute intracerebral and subarachnoid hemorrhagic stroke patients on a neurointensive care unit.
Archives of Physical Medicine and Rehabilitation. 96, 1191-1199.
Key messages from the article
• Evidence based practice is that an early mobilisation strategy, in
the acute phase of stroke is associated with reduced physical
impairments, enhanced functional recovery and decreased
hospital length of stay
• An evaluation of physiotherapy literature indicates that a
mobility intervention lasting between 30 to 60 minutes, 5 to
7d/wk. provides significant benefit in functional recovery after
stroke
• Patients were identified for this study through the EMR
identifying those within the inclusion criteria
• The EMR was used for standardised patient level data and
narrative notes
• The study demonstrated that adoption of an evidence based
early mobilisation strategy lead to enhanced mobility
achievements for stroke patients
• It is important to minimise adverse impacts on data quality such
as incomplete information, inconsistency resulting in data source
mismatch and inaccurate nonstandard-based information
Link with the rationale
• The EMR provides enhanced capability for conducting research
• The EMR provides opportunity for implementing an EBP early
mobilisation strategy
• This can be supported with clinical decision support and close
patient monitoring
• Atomised data as compared to free text notes provide greater
opportunity for research
• Consideration should be given to mandatory fields within an EMR
to minimise adverse impacts on data quality
6
7. Article 4:
Yan L, Li C, Chen J, Miranda J, Luo R, Betteger J, Zhu Y, Feigin V, O’Donnell M, Zhao D, and Wu Y.
(2016). Prevention, management and rehabilitation of stroke and low-and middle-income countries.
eNeurologiaSci. 2, 21-30.
Key messages from the article
• Many causes of stroke are modifiable as identified by the
INTERSTROKE study, such as physical inactivity
• Highly active individuals have a 27% lower risk of stroke incidence
or mortality than less-active individuals, and moderately active
individuals compared with inactive persons
• Appropriate physical activity is also a secondary prevention for
stroke intervention
• Digital health is associated with improved clinical decision making
and increased efficiency for health care providers, such as tablet
base risk assessment tools and mobile phone apps for clinicians
• Mobile technology such as the Stroke Riskometer App allows
users to identify their relative risk of stroke development
• Digital health makes it possible to individualise interventions for
physical activity
• Self management interventions have been demonstrated to
reduce the risk of stroke recurrence
• Insufficient evidence to support the effectiveness of tele-
rehabilitation on mobility and health related quality of life
Link with the rationale
• An EMR provides an opportunity for greater self-management
through a patient portal. The Royal Children's Hospital have
successfully linked their patient portal to the My Health Record.
• The use of mobile solutions by patients and clinicians will
significantly increase over the next 10 years.
• It is important that these are tested and validated and considered
appropriate for use by a governing body within the healthcare
environment
• Telehealth is also a growing area of digital health where
physiotherapy may have an impact. This has not been the case to
date for stroke patients.
7
8. Article 5:
Lee H, Seo S and Song J (2016).Information on functioning found in the medical records of patients
with stroke. Journal of Physical therapy Science.28, 2722-2726.
Key messages from the article
• EMRs ensure timely and accessible information is
available across the hospital continuum of care
• Structured forms and documents within the EMR
provide groups of data and ensures a common
language to facilitate communication amongst health
professionals
• Structured admission and discharge summaries are
valuable if they are similar across hospital EMR
systems
• Use of stroke specific measurement tool data within
an individuals EMR (e.g.. Bergs balance scale) allows
for atomised data
• This study linked EMR related information to concepts
and ICF codes (health related functioning framework)
and noted information related to physical functioning,
walking, transferring was frequently found within an
EMR
Link with the rationale
• Structured physiotherapy forms and documents will improve
consistency of documentation and save clinical time
• Agreed measurement tools allow for greater research capability
and monitoring of patient progress over time
• The DHHS will be focusing on patient reported outcomes
measures in 2017 and these should be included within the build
of an EMR
8
9. Recommendations
• Applying digital health and informatics to the care of stroke patients is critical to the ongoing improvements in outcomes and quality of care provided
to patients
• “The global burden of stroke requires innovative, effective and widely available strategies for stroke prevention”. (Yan et al. 2016)
• It is known that patients who receive organised inpatient care in a stroke unit are more likely to be alive, independent and living at home within one
year after stroke and implementing an EMR will assist in co-ordinating and organising care for these patients whilst in hospital.
Predictions
• Use of smart watches, iphones and fitbits will be a significant part of health care in the future with links to the patient my health record / EMR.
• “Portable sensor technology may offer a future alternative to floor markers in measuring distance walked for stroke patients through wireless
transmission of data to a mobile phone, and EMR” (Yan et al 2016)
• Patients will become more involved in their healthcare in the future through the use of patient portals to the EMR
• Many applications will be developed for stroke . It will be important that these are appropriately tested and validated and interoperable with other
systems
• Device integration where vitals automatically flow into the EMR during the acute phase of stroke will assist in identifying deteriorating patients in a
more timely and accurate way
• Predictive models for mobility achievement (prognosis of clinical outcomes) built into the EMR will assist with discharge planning for clinicians,
patients and families
Questions for further research
• Research is required into the impact and implementation of digital health on the prevention of stroke, and improving outcomes for those who
experience a stroke
• Research is required into EMR enhanced predictive models for physical outcomes after stroke to successfully guide physiotherapy intervention and
discharge planning
• Research is required into the use of risk stratification via the EMR for secondary strokes and readmissions. Risk stratification will help to individualise
physiotherapy intervention and requirements for community links once the patient is discharged from hospital. 9
10. Summary and Conclusions
As the health service where I work embarks on implementing an EMR, it is
important that the EMR enables translation of knowledge into practice. Important
considerations for stroke and physiotherapy include:
• Clinical pathways and work flows
• Order sets to ensure standardisation of care and reduced variation. Order sets
should include referrals to Allied Health (physiotherapy)
• Multidisciplinary approach to care with appropriate documentation in the EMR
• Implementing easy to use structured forms for physiotherapy assessment and
discharge
• Incorporating an EBP early mobilisation strategy into the EMR with best practice
alerts
• Ensuring subject matter experts inform these processes
• Ensuring reporting and analytical functionality is available
10
