Perspectives in health information management / AHIMA, American Health Information Management Association最新文献

Computerized clinical decision support systems (CDSS) are increasingly being used to facilitate the role of clinicians in complex decision-making processes. This systematic review evaluates evidence of the available CDSS developed and tested to support the decision-making process in primary healthcare for stroke prevention and barriers to practical implementations in primary care settings. A systematic search of Web of Science, Medline Ovid, Embase Ovid, and Cinahl was done. A total of five studies, experimental and observational, were synthesised in this review. This review found that CDSS facilitate decision-making processes in primary health care settings in stroke prevention options. However, barriers were identified in designing, implementing, and using the CDSS.

Studies have quantified various specific benefits related to the use of medical scribes, finding physician workflow and productivity improvements, with some demonstrating marginal value or detrimental impact. However, this evidence base misses a critical underlying issue with the expanding number of physicians using medical scribes routinely. There are an estimated 28,000-33,000 peer reviewed biomedical journals worldwide, currently publishing an estimated 1.8-2 million scientific articles every year. Over a typical physician's career from the 11-13 years of undergraduate through medical school and specialty/residency training as well as 34-36 practice/care delivery years beyond (to age 65), this yields 84-94+ million peer reviewed journal articles that are published in the global medical literature and to be potentially consumed/ considered over a roughly 47-year career. Clinical trial results in various stages of peer review, with 409,000 clinical trials registered in 2022, augment this massive volume of new clinical and bioscience information that clinicians might utilize to advance their care delivery by over 19 million bioscientific reports over a lifetime of training and care delivery. Inclusive of clinical trial reports and peer reviewed journal articles, a physician might derive clinical care value from an expanding career-long evidence base of 103-113+ million scientific communications. Even if only 0.1 percent of the global output of biomedical science has clinical relevance to a highly specialized physician, the narrowed career-long total remains a staggering 103,000 journal publications and clinical trial reports. For physicians with a more general and diverse clinical focus such as family medicine, emergency medicine physicians, and hospitalists, if 1 percent of newly published evidence-based literature is pertinent, the total career-long estimate is over 1 million journal articles and clinical trials to be reviewed and clinically integrated. As a result, a challenging issue created by the increasing role of medical scribes is not just evaluating their value (or lack thereof) for practicing physicians in their workflows and productivity. Rather it concerns the impact that medical scribes may be having by decoupling physicians from the iterative technological and cognitive progression of the electronic health record (EHR) and its evolving artificial intelligence (AI), which can facilitate the integration of the year-over-year proliferation of clinically pertinent new scientific evidence into a physician's practice of medicine. This commentary addresses the challenge to the evolution of the AI of the EHR posed by physicians' increasing use of and reliance upon medical scribes, and highlights how medical scribes may also, inadvertently, isolate and insulate physicians from their essential role in continuous refinement and advancement of EHR AI. Consideration is given to the broader challenge of inadequate focus and resources neede

The transition to a new electronic health record (EHR) system requires an understanding of how the new system addresses the needs, business processes, and current activities of a healthcare system. To address such requirements, a multidisciplinary team conducted a current state workflow assessment (CSWFA) of clinical and administrative functions to elicit and document business processes (via process diagrams), requirements, workarounds, and process issues (i.e., user interface issues, training gaps) at one healthcare facility. We provided a novel method of evaluating the implementation process to ensure that a CSWFA was documented with key stakeholders. In this analysis, we describe the CSWFA approach and expected outcomes with a specific emphasis on how a qualitative approach can be integrated to explore underlying patterns and relationships in the data. Overall, this methodology enables practitioners to deliver data-driven support initiatives that optimize EHR implementation while considering user experience, productivity, and patient safety.

Primary care physicians (PCPs) have an important role in the identification and management of Attention Deficit Hyperactivity Disorder (ADHD). There is a paucity of research on PCPs' practices related to the discussion of educational interventions. We conducted a retrospective chart review using Natural Language Processing to extract data on how often PCPs in an outpatient clinic: 1) discuss educational support with patients and caregivers; and 2) obtain educational records. About three-quarters of patients had at least one term related to educational support included in at least one note, but only 13 percent of patients had at least one educational record uploaded into the electronic health record (EHR). There was no association between having an educational document uploaded into the EHR and inclusion of a term related to educational support in a note. Almost half (48 percent) of these records were unclearly labeled. Further education of PCPs is warranted to increase discussions of educational support and obtaining educational records, as is collaboration with health information management professionals around labeling.

Objective: The expansion of mobile applications as a tool for road traffic health and safety may develop several issues from the perspective of information management. Quality assessment of these apps, especially from an information system management perspective, appears inevitable, as their possible low quality may cause irreversible injury or fatal consequences. This study aimed to evaluate the quality of the apps in the three subcategories of road traffic safety apps (including Accident Record and Report (ARR), Distraction Management (DM), and Vehicle Operating, Fixing, and Maintenance (VOFM)) using the Mobile Application Rating Scale (MARS), which rates 23 evaluation criteria organized in five domains (Engagement, Esthetics, Information, and Subjective Quality) with particular attention to the five rights framework of health information system.

Method: The researchers retrieved road traffic health and safety mobile apps from Google Play. First, the domain expert panel (n= 7) (from disciplines of HIM and medical informatics) was formed. They scrutinized and discussed the MARS items and mapped them into the five rights framework of information quality. Moreover, the researchers assigned the apps to the information system or decision support system category. Two researchers independently reviewed the apps and conducted the qualitative content analysis to categorize them into ARR, DM, and VOFM classes. Finally, the quality of the apps was assessed using the MARS rating scale (max=5) in terms of 1) app classification category with a descriptive aim; 2) app subjective and objective quality categories comprised of engagement, functionality, esthetics, and information sections; and 3) an optional app-specific section. The mean scores for the subjective quality, objective quality, and app-specific sections were calculated separately for each mobile app. A score ≥ 3.0 was considered acceptable.

Results: A total number of 42 apps met the criteria for the assessment. The average objective quality scores were computed as 2.6, 2.2, and 3.0 for the ARR, DM, and VOFM apps, respectively. Therefore, the quality of the apps in the ARR and DM subgroups was not acceptable. Moreover, the quality of the apps in the VOFM subcategory was considered moderate. Furthermore, the subjective quality and app-specific sections of apps in the ARR and DM categories were less than moderate. Most apps had the potential of an information system or decision support system. Also, the criteria measured by MARS could be mapped to the five rights framework of information management.

Conclusion: The findings of this study revealed the existing gaps in three subcategories of road traffic safety apps. Considering the multiple criteria of the MARS and having in mind the framework of five rights, developers of the apps may develop better products in road traffic health and safety.

Since 2020, health informaticians have developed and enhanced public-facing COVID-19 dashboards worldwide. The improvement of dashboards implemented by health informaticians will ultimately benefit the public in making better healthcare decisions and improve population-level healthcare outcomes. The authors evaluated 100 US city, county, and state government COVID-19 health dashboards and identified the top 10 best practices to be considered when creating a public health dashboard. These features include 1) easy navigation, 2) high usability, 3) use of adjustable thresholds, 4) use of diverse chart selection, 5) compliance with the Americans with Disabilities Act, 6) use of charts with tabulated data, 7) incorporated user feedback, 8) simplicity of design, 9) adding clear descriptions for charts, and 10) comparison data with other entities. To support their findings, the authors also conducted a survey of 118 randomly selected individuals in six states and the District of Columbia that supports these top 10 best practices for the design of health dashboards.

The World Health Organization's International Classification of Diseases (ICD) has become the international standard diagnostic classification for reporting morbidity and mortality. In 2015, the United States transitioned from the 9th to 10th Revision. The update was necessary due to major structural limitations of the ICD-9 system. Concerns of the transition mainly centered around clinical usage and cost; however, there were concerns for overlapping codes with the same classification but different meanings between the two versions. Duplicate codes could pose an issue for big data retrospective studies that overlap between the two systems. Therefore, the goals of this study are to further explore and identify duplicate ICD codes between the systems. ICD-9-CM and ICD-10-CM code files were obtained from the Centers for Medicare & Medicaid Services. There were 14,567 ICD-9-CM codes and 91,737 unique ICD-10-CM codes tabulated. Duplicated items between the files were isolated. Four hundred sixty-nine duplicate codes were identified, consisting of 39 E Codes and 430 V Codes. These twin codes contain classifications for external causes of injury and factors influencing health status and contact with health services. Therefore, special attention should be drawn to retrospective research involving methods of injury spanning ICD-9 and ICD-10 systems.

The objective of the study is to identify challenges and associated factors for privacy and security related to telehealth visits during the COVID-19 pandemic. The systematic search strategy used the databases of PubMed, ScienceDirect, ProQuest, Embase, CINAHL, and COCHRANE, with the search terms of telehealth/telemedicine, privacy, security, and confidentiality. Reviews included peer-reviewed empirical studies conducted from January 2020 to February 2022. Studies conducted outside of the US, non-empirical, and non-telehealth related were excluded. Eighteen studies were included in the final analysis. Three risk factors associated with privacy and security in telehealth practice included: environmental factors (lack of private space for vulnerable populations, difficulty sharing sensitive health information remotely), technology factors (data security issues, limited access to the internet, and technology), and operational factors (reimbursement, payer denials, technology accessibility, training, and education). Findings from this study can assist governments, policymakers, and healthcare organizations in developing best practices in telehealth privacy and security strategies.

This study evaluated the readability and suitability of a university health center public website. Readability formulas estimated the reading grade and age required for comprehension of health information. The Suitability Assessment of Materials (SAM) instrument determined adequacy of the webpages for the intended audience. Readability showed the reading grade level, representing the youngest reader able to process the material, ranged from 10.1 to 14.6, averaging 12.5 (midway through 12th grade in the US educational system). Full comprehension required higher education levels, up to postgraduate. Suitability scores for some webpages indicated deficiencies in readability, motivation to learn, and instructions for healthy behavior changes. Content on the website may be difficult for some students to comprehend based on the reading grade level, but overall suitability results are satisfactory. All webpage updates should bear these parameters in mind to ensure content is fully accessible to college students, faculty, and staff.

Despite the cooperative sharing of health information exchange (HIE), various distinct limitations and barriers are found (i.e., substantial time and resources are being used to achieve health information). This paper investigates the limits of healthcare information sharing policy implementation for patient referral systems in Thailand. Mixed-methods research methodology, both quantitative and qualitative mechanisms, are conducted. The study results present the correlation between the current HIE among the hospitals in patient referral systems and the limitations of implementing the HIE policy, composed of technical, economic, political, and legal barriers. The statistical test reveals that these four main barriers could limit information sharing or impede Thailand's standard healthcare information-sharing policy and practice development. Predominantly, it is further found that there is no standard for data collection and data archiving systems; unclear guidelines, practices, and procedures; and a lack of standard practice due to fragmented administration. Foremost of all, the data ownership of any competent authorities or related regulators could cause any constraints in information sharing (e.g., complexity and processing time). This paper's findings will be beneficial to stakeholders, such as policymakers interested in achieving meaningful use, facilitating the adoption and implementation of HIE at a national level to ensure patients' safety and enhance healthcare quality.