Appl Clin Inform - Assessment of readiness for clinical decision support to aid laboratory monitoring of immunosuppressive care at U.S. liver transplant centers.

Tópicos

{ care(1570) inform(1187) nurs(1089) }
{ medic(1828) order(1363) alert(1069) }
{ intervent(3218) particip(2042) group(1664) }
{ patient(1821) servic(1111) care(1106) }
{ analysi(2126) use(1163) compon(1037) }
{ design(1359) user(1324) use(1319) }
{ data(3963) clinic(1234) research(1004) }
{ record(1888) medic(1808) patient(1693) }
{ high(1669) rate(1365) level(1280) }
{ survey(1388) particip(1329) question(1065) }
{ clinic(1479) use(1117) guidelin(835) }
{ use(976) code(926) identifi(902) }
{ surgeri(1148) surgic(1085) robot(1054) }
{ ehr(2073) health(1662) electron(1139) }
{ monitor(1329) mobil(1314) devic(1160) }
{ result(1111) use(1088) new(759) }
{ studi(2440) review(1878) systemat(933) }
{ extract(1171) text(1153) clinic(932) }
{ method(984) reconstruct(947) comput(926) }
{ group(2977) signific(1463) compar(1072) }
{ can(774) often(719) complex(702) }
{ data(1737) use(1416) pattern(1282) }
{ system(1976) rule(880) can(841) }
{ sequenc(1873) structur(1644) protein(1328) }
{ network(2748) neural(1063) input(814) }
{ imag(2675) segment(2577) method(1081) }
{ patient(2315) diseas(1263) diabet(1191) }
{ motion(1329) object(1292) video(1091) }
{ treatment(1704) effect(941) patient(846) }
{ chang(1828) time(1643) increas(1301) }
{ algorithm(1844) comput(1787) effici(935) }
{ method(1557) propos(1049) approach(1037) }
{ general(901) number(790) one(736) }
{ search(2224) databas(1162) retriev(909) }
{ howev(809) still(633) remain(590) }
{ system(1050) medic(1026) inform(1018) }
{ health(3367) inform(1360) care(1135) }
{ model(3480) simul(1196) paramet(876) }
{ data(2317) use(1299) case(1017) }
{ age(1611) year(1155) adult(843) }
{ cost(1906) reduc(1198) effect(832) }
{ time(1939) patient(1703) rate(768) }
{ cancer(2502) breast(956) screen(824) }
{ drug(1928) target(777) effect(648) }
{ decis(3086) make(1611) patient(1517) }
{ method(2212) result(1239) propos(1039) }
{ model(3404) distribut(989) bayesian(671) }
{ imag(1947) propos(1133) code(1026) }
{ inform(2794) health(2639) internet(1427) }
{ measur(2081) correl(1212) valu(896) }
{ imag(1057) registr(996) error(939) }
{ bind(1733) structur(1185) ligand(1036) }
{ method(1219) similar(1157) match(930) }
{ featur(3375) classif(2383) classifi(1994) }
{ imag(2830) propos(1344) filter(1198) }
{ take(945) account(800) differ(722) }
{ assess(1506) score(1403) qualiti(1306) }
{ framework(1458) process(801) describ(734) }
{ problem(2511) optim(1539) algorithm(950) }
{ error(1145) method(1030) estim(1020) }
{ learn(2355) train(1041) set(1003) }
{ concept(1167) ontolog(924) domain(897) }
{ data(1714) softwar(1251) tool(1186) }
{ control(1307) perform(991) simul(935) }
{ model(2220) cell(1177) simul(1124) }
{ featur(1941) imag(1645) propos(1176) }
{ case(1353) use(1143) diagnosi(1136) }
{ studi(1410) differ(1259) use(1210) }
{ risk(3053) factor(974) diseas(938) }
{ perform(999) metric(946) measur(919) }
{ research(1085) discuss(1038) issu(1018) }
{ import(1318) role(1303) understand(862) }
{ model(2341) predict(2261) use(1141) }
{ visual(1396) interact(850) tool(830) }
{ compound(1573) activ(1297) structur(1058) }
{ perform(1367) use(1326) method(1137) }
{ studi(1119) effect(1106) posit(819) }
{ blood(1257) pressur(1144) flow(957) }
{ spatial(1525) area(1432) region(1030) }
{ state(1844) use(1261) util(961) }
{ research(1218) medic(880) student(794) }
{ patient(2837) hospit(1953) medic(668) }
{ model(2656) set(1616) predict(1553) }
{ signal(2180) analysi(812) frequenc(800) }
{ sampl(1606) size(1419) use(1276) }
{ gene(2352) biolog(1181) express(1162) }
{ data(3008) multipl(1320) sourc(1022) }
{ first(2504) two(1366) second(1323) }
{ activ(1138) subject(705) human(624) }
{ use(2086) technolog(871) perceiv(783) }
{ can(981) present(881) function(850) }
{ health(1844) social(1437) communiti(874) }
{ structur(1116) can(940) graph(676) }
{ use(1733) differ(960) four(931) }
{ implement(1333) system(1263) develop(1122) }
{ estim(2440) model(1874) function(577) }
{ process(1125) use(805) approach(778) }
{ activ(1452) weight(1219) physic(1104) }
{ method(1969) cluster(1462) data(1082) }
{ detect(2391) sensit(1101) algorithm(908) }

Resumo

CKGROUND: Following liver transplantation, patients require lifelong immunosuppressive care and monitoring. Computerized clinical decision support (CDS) has been shown to improve post-transplant immunosuppressive care processes and outcomes. The readiness of transplant information systems to implement computerized CDS to support post-transplant care is unknown.OBJECTIVES: a) Describe the current clinical information system functionality and manual and automated processes for laboratory monitoring of immunosuppressive care, b) describe the use of guidelines that may be used to produce computable logic and the use of computerized alerts to support guideline adherence, and c) explore barriers to implementation of CDS in U.S. liver transplant centers.METHODS: We developed a web-based survey using cognitive interviewing techniques. We surveyed 119 U.S. transplant programs that performed at least five liver transplantations per year during 2010-2012. Responses were summarized using descriptive analyses; barriers were identified using qualitative methods.RESULTS: Respondents from 80 programs (67% response rate) completed the survey. While 98% of programs reported having an electronic health record (EHR), all programs used paper-based manual processes to receive or track immunosuppressive laboratory results. Most programs (85%) reported that 30% or more of their patients used external laboratories for routine testing. Few programs (19%) received most external laboratory results as discrete data via electronic interfaces while most (80%) manually entered laboratory results into the EHR; less than half (42%) could integrate internal and external laboratory results. Nearly all programs had guidelines regarding pre-specified target ranges (92%) or testing schedules (97%) for managing immunosuppressive care. Few programs used computerized alerting to notify transplant coordinators of out-of-range (27%) or overdue laboratory results (20%).CONCLUSIONS: Use of EHRs is common, yet all liver transplant programs were largely dependent on manual paper-based processes to monitor immunosuppression for post-liver transplant patients. Similar immunosuppression guidelines provide opportunities for sharing CDS once integrated laboratory data are available.

Resumo Limpo

ckground follow liver transplant patient requir lifelong immunosuppress care monitor computer clinic decis support cds shown improv posttranspl immunosuppress care process outcom readi transplant inform system implement computer cds support posttranspl care unknownobject describ current clinic inform system function manual autom process laboratori monitor immunosuppress care b describ use guidelin may use produc comput logic use computer alert support guidelin adher c explor barrier implement cds us liver transplant centersmethod develop webbas survey use cognit interview techniqu survey us transplant program perform least five liver transplant per year respons summar use descript analys barrier identifi use qualit methodsresult respond program respons rate complet survey program report electron health record ehr program use paperbas manual process receiv track immunosuppress laboratori result program report patient use extern laboratori routin test program receiv extern laboratori result discret data via electron interfac manual enter laboratori result ehr less half integr intern extern laboratori result near program guidelin regard prespecifi target rang test schedul manag immunosuppress care program use computer alert notifi transplant coordin outofrang overdu laboratori result conclus use ehr common yet liver transplant program larg depend manual paperbas process monitor immunosuppress postliv transplant patient similar immunosuppress guidelin provid opportun share cds integr laboratori data avail

Resumos Similares

Comput. Biol. Med. - Smart medical environment at the point of care: auto-tracking clinical interventions at the bed side using RFID technology. ( 0,683983428003141 )
Telemed J E Health - Engaging patients via mobile phone technology to assist follow-up after hospitalization in Quito, Ecuador. ( 0,676451041382718 )
J Telemed Telecare - Patients' experiences of telerehabilitation at home after shoulder joint replacement. ( 0,675262105026022 )
Int J Med Inform - Health information exchange interventions can enhance quality and continuity of HIV care. ( 0,664250196943759 )
J Med Syst - Prioritizing barriers to successful implementation of hospital information systems. ( 0,664144946468323 )
Appl Clin Inform - Usability Evaluation of An Electronic Medication Administration Record (eMAR) Application. ( 0,663839185559597 )
Comput Methods Programs Biomed - A preliminary study on the use of clinical care classification in nursing documentation data sets. ( 0,663267608688999 )
Appl Clin Inform - Understanding interprofessional communication: a content analysis of email communications between doctors and nurses. ( 0,656562933247589 )
AMIA Annu Symp Proc - A real-time screening alert improves patient recruitment efficiency. ( 0,655144592717748 )
Int J Med Inform - Evaluating the use of a computerized clinical decision support system for asthma by pediatric pulmonologists. ( 0,637296271359334 )
J Am Med Inform Assoc - Evaluation of medium-term consequences of implementing commercial computerized physician order entry and clinical decision support prescribing systems in two 'early adopter' hospitals. ( 0,637204284761163 )
Artif Intell Med - Physicians' responses to clinical decision support on an intensive care unit--comparison of four different alerting methods. ( 0,636288379567762 )
J Am Med Inform Assoc - Changes in end-user satisfaction with Computerized Provider Order Entry over time among nurses and providers in intensive care units. ( 0,634144794677581 )
Appl Clin Inform - Contributors to frequent telehealth alerts including false alerts for patients with heart failure: a mixed methods exploration. ( 0,6271489843988 )
Telemed J E Health - Home telehealth: facilitators, barriers, and impact of nurse support among high-risk dialysis patients. ( 0,624833878647754 )
J Telemed Telecare - A pilot study of the effectiveness of home teleconsultations in paediatric palliative care. ( 0,621763492676833 )
AMIA Annu Symp Proc - A mixed methods approach for measuring the impact of delivery-centric interventions on clinician workflow. ( 0,619694201118051 )
Appl Clin Inform - Implementing Black Box Warnings (BBWs) in Health Information Systems: An Organizing Taxonomy Identifying Opportunities and Challenges. ( 0,617941197987558 )
Int J Med Inform - To test or not: a registry-based observational study of an online decision support for prostate-specific antigen tests. ( 0,616169733500587 )
J Am Med Inform Assoc - The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals. ( 0,615940025856519 )
Appl Clin Inform - Computerized Physician Order Entry (CPOE) in pediatric and neonatal intensive care: Recommendations how to meet clinical requirements. ( 0,615017576375953 )
BMC Med Inform Decis Mak - Prescriber and staff perceptions of an electronic prescribing system in primary care: a qualitative assessment. ( 0,614203905246723 )
Int J Med Inform - Does an integrated Emergency Department Information System change the sequence of clinical work? A mixed-method cross-site study. ( 0,610576573303938 )
Telemed J E Health - Cost-benefit analysis on the use of telemedicine program of Kosova for continuous medical education: a sustainable and efficient model to rebuild medical systems in developing countries. ( 0,609198911666191 )
Int J Med Inform - Effects of a computerized decision support system on pressure ulcers and malnutrition in nursing homes for the elderly. ( 0,608827153388025 )
Int J Med Inform - A nationwide computerized patient medication history: evaluation of the Austrian pilot project e-Medikation. ( 0,604696762102845 )
Int J Med Inform - Comparing the working time between Bar-Code Medication Administration system and traditional medication administration system: an observational study. ( 0,604018902945385 )
BMC Med Inform Decis Mak - Speech recognition software and electronic psychiatric progress notes: physicians' ratings and preferences. ( 0,601762960831055 )
Telemed J E Health - Providers' perspectives: utilizing telepsychiatry in schools. ( 0,601186638589885 )
BMC Med Inform Decis Mak - Using a computerized provider order entry system to meet the unique prescribing needs of children: description of an advanced dosing model. ( 0,59963920513566 )
BMC Med Inform Decis Mak - Implementation of an integrated preoperative care pathway and regional electronic clinical portal for preoperative assessment. ( 0,599280445271658 )
J Am Med Inform Assoc - Unrealized potential and residual consequences of electronic prescribing on pharmacy workflow in the outpatient pharmacy. ( 0,598646733503165 )
J. Med. Internet Res. - Finding collaborators: toward interactive discovery tools for research network systems. ( 0,598578289635811 )
Appl Clin Inform - Novel computerized health risk appraisal may improve longitudinal health and wellness in primary care: a pilot study. ( 0,596925626993523 )
BMC Med Inform Decis Mak - Participatory eHealth development to support nurses in antimicrobial stewardship. ( 0,59591614845723 )
BMC Med Inform Decis Mak - Effects of a computerized feedback intervention on safety performance by junior doctors: results from a randomized mixed method study. ( 0,594140177867607 )
Int J Med Inform - Bridging two translation gaps: a new informatics research agenda for telemonitoring of chronic disease. ( 0,594026426954117 )
J Am Med Inform Assoc - Implementation of the Department of Veterans Affairs' first point-of-care clinical trial. ( 0,593666877748261 )
Int J Med Inform - The effects of EMR deployment on doctors' work practices: a qualitative study in the emergency department of a teaching hospital. ( 0,593160361201219 )
Telemed J E Health - A retrospective evaluation of remote pharmacist interventions in a telepharmacy service model using a conceptual framework. ( 0,592772744088725 )
J Telemed Telecare - The use of email as a component of adult stammering therapy: a preliminary report. ( 0,591882169854525 )
Appl Clin Inform - Novel Representation of Clinical Information in the ICU: Developing User Interfaces which Reduce Information Overload. ( 0,591879476609609 )
J Am Med Inform Assoc - Physicians' opinions of a health information exchange. ( 0,591615262163995 )
IEEE J Biomed Health Inform - Design of a RESTful web information system for drug prescription and administration. ( 0,591218099972583 )
AMIA Annu Symp Proc - Supporting information use and retention of pre-hospital information during trauma resuscitation: a qualitative study of pre-hospital communications and information needs. ( 0,590429853324325 )
Int J Med Inform - Evaluating the medication process in the context of CPOE use: the significance of working around the system. ( 0,587373546556475 )
Health Info Libr J - Evaluation of three point-of-care healthcare databases: BMJ Point-of-Care, Clin-eguide and Nursing Reference Centre. ( 0,584621885527459 )
J Med Syst - A secure 2G-RFID-Sys mechanism for applying to the medical emergency system. ( 0,584084290662509 )
BMC Med Inform Decis Mak - Qualitative evaluation of a diabetes electronic decision support tool: views of users. ( 0,583668347177992 )
Appl Clin Inform - Use of clinical decision support to improve the quality of care provided to older hospitalized patients. ( 0,58018254340667 )
Int J Med Inform - Lost in translation: the challenges of seamless integration in nursing practices. ( 0,580084317123328 )
Perspect Health Inf Manag - Incorporating patient perspectives into the personal health record: implications for care and caring. ( 0,579472916293545 )
BMC Med Inform Decis Mak - Quality of prenatal and maternal care: bridging the know-do gap (QUALMAT study): an electronic clinical decision support system for rural Sub-Saharan Africa. ( 0,579003311528896 )
Int J Med Inform - Perceptions regarding the ease of use and usefulness of health information exchange systems among medical providers, case managers and non-clinical staff members working in HIV care and community settings. ( 0,577374801819652 )
AMIA Annu Symp Proc - How do interruptions impact nurses' visual scanning patterns when using barcode medication administration systems? ( 0,576114220811876 )
J Telemed Telecare - Mobile computing and the quality of home care nursing practice. ( 0,576075066093153 )
Appl Clin Inform - Impact of clinical reminder redesign on physicians' priority decisions. ( 0,575267400686968 )
Artif Intell Med - Safety and usability evaluation of a web-based insulin self-titration system for patients with type 2 diabetes mellitus. ( 0,574466208456101 )
J Med Syst - Design and development of a Telephone-Linked Care (TLC) system to reduce impulsivity among violent forensic outpatients and probationers. ( 0,574252233761184 )
Int J Med Inform - The fungibility of time in claims of efficiency: the case of making transmission of prescriptions electronic in English general practice. ( 0,572404627444493 )
J Am Med Inform Assoc - Patient portal doldrums: does an exam room promotional video during an office visit increase patient portal registrations and portal use? ( 0,57209601848284 )
J Am Med Inform Assoc - Characteristics and effects of nurse dosing over-rides on computer-based intensive insulin therapy protocol performance. ( 0,572050308804288 )
AMIA Annu Symp Proc - Coordination of care for complex pediatric patients: perspectives from providers and parents. ( 0,570999490409136 )
Int J Med Inform - Barriers and facilitators to the use of computer-based intensive insulin therapy. ( 0,568880855741364 )
BMC Med Inform Decis Mak - A pilot with computer-assisted psychosocial risk-assessment for refugees. ( 0,568798432086866 )
BMC Med Inform Decis Mak - Identification of features of electronic prescribing systems to support quality and safety in primary care using a modified Delphi process. ( 0,568088590964221 )
J. Med. Internet Res. - Development of an interactive, Web-delivered system to increase provider-patient engagement in smoking cessation. ( 0,567557201250996 )
J Am Med Inform Assoc - Content and functional specifications for a standards-based multidisciplinary rounding tool to maintain continuity across acute and critical care. ( 0,566978680225728 )
Appl Clin Inform - An evaluation of the usability of a computerized decision support system for nursing homes. ( 0,566683532498975 )
J. Med. Internet Res. - Perceived barriers and facilitators of using a Web-based interactive decision aid for colorectal cancer screening in community practice settings: findings from focus groups with primary care clinicians and medical office staff. ( 0,566138539256104 )
Int J Med Inform - Prescribers' interactions with medication alerts at the point of prescribing: A multi-method, in situ investigation of the human-computer interaction. ( 0,565138837480219 )
Appl Clin Inform - Advice for Decision Makers Based on an Electronic Health Record Evaluation at a Program for All-inclusive Care for Elders Site. ( 0,565100808130263 )
Int J Med Inform - Effects of a computerized decision support system on care planning for pressure ulcers and malnutrition in nursing homes: an intervention study. ( 0,563549374709712 )
Int J Med Inform - Evaluation of the national nursing model and four nursing documentation systems in Finland--lessons learned and directions for the future. ( 0,560581191805745 )
Telemed J E Health - Barriers and facilitators to pediatric emergency telemedicine in the United States. ( 0,559105580354736 )
Int J Med Inform - Paper persistence, workarounds, and communication breakdowns in computerized consultation management. ( 0,558177004349539 )
J Am Med Inform Assoc - Information needs of case managers caring for persons living with HIV. ( 0,557042139623333 )
J Telemed Telecare - The benefits of e-health support for older family caregivers in rural areas. ( 0,555220391479286 )
J. Med. Internet Res. - Collecting maternal health information from HIV-positive pregnant women using mobile phone-assisted face-to-face interviews in Southern Africa. ( 0,555134239663321 )
BMC Med Inform Decis Mak - Addressing tensions when popular media and evidence-based care collide. ( 0,554607522888574 )
J. Med. Internet Res. - Evaluating user experiences of the secure messaging tool on the Veterans Affairs' patient portal system. ( 0,554052897707839 )
Telemed J E Health - Examining perceptions of a smartphone-based intervention system for alcohol use disorders. ( 0,553836815427452 )
J Biomed Inform - Design and development of a mobile computer application to reengineer workflows in the hospital and the methodology to evaluate its effectiveness. ( 0,553513232199487 )
Int J Med Inform - Using Cognitive Work Analysis to fit decision support tools to nurse managers' work flow. ( 0,553485933695616 )
J Clin Monit Comput - Clinical refinement of the automatic lung parameter estimator (ALPE). ( 0,553252175702275 )
J Am Med Inform Assoc - Computerized provider documentation: findings and implications of a multisite study of clinicians and administrators. ( 0,551644976802726 )
J Am Med Inform Assoc - Challenges to nurses' efforts of retrieving, documenting, and communicating patient care information. ( 0,551622858619294 )
Int J Med Inform - Evaluation of a comprehensive EHR based on the DeLone and McLean model for IS success: approach, results, and success factors. ( 0,550888362100117 )
AMIA Annu Symp Proc - Implementation of an electronic referral system for outpatient specialty care. ( 0,550410335884168 )
J Am Med Inform Assoc - 'Too much, too late': mixed methods multi-channel video recording study of computerized decision support systems and GP prescribing. ( 0,550251453854554 )
J Innov Health Inform - Using information to deliver safer care: a mixed-methods study exploring general practitioners' information needs in North West London primary care. ( 0,550069049800457 )
J. Med. Internet Res. - Development and testing of a multidimensional iPhone pain assessment application for adolescents with cancer. ( 0,550012176644815 )
Appl Clin Inform - Evaluation of a user guidance reminder to improve the quality of electronic prescription messages. ( 0,549209790232324 )
Int J Med Inform - Adoption of a clinical decision support system to promote judicious use of antibiotics for acute respiratory infections in primary care. ( 0,548769522384603 )
Telemed J E Health - A telehealth strategy for increasing adherence in the treatment of hypertension in primary care. ( 0,548640633504369 )
Telemed J E Health - PsychVACS: a system for asynchronous telepsychiatry. ( 0,54792611911685 )
J Am Med Inform Assoc - Towards public health decision support: a systematic review of bidirectional communication approaches. ( 0,547839952380977 )
Int J Med Inform - Impact of IT-supported clinical pathways on medical staff satisfaction. A prospective longitudinal cohort study. ( 0,547814136067801 )
J. Med. Internet Res. - Web-based intervention in mindfulness meditation for reducing residual depressive symptoms and relapse prophylaxis: a qualitative study. ( 0,547786186001334 )
Telemed J E Health - Teleconsultations in public primary care units of the city of belo horizonte, Brazil: profile of patients and physicians. ( 0,547404096238028 )