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Opportunities for Using Health Information Technology for Elderly Care in the Emergency Departments: A Qualitative Study. 在急诊科使用医疗信息技术为老年人提供护理的机会:定性研究。
Ghazal Shagerdi, Haleh Ayatollahi, Morteza Hemmat

Introduction: Recently, several technologies have been developed for being used in the field of geriatric emergency medicine. As a large number of elderly patients visit emergency departments, the use of health information technology in this department can help to improve patient care and control the outcome of diseases. The present study aimed to identify opportunities for using various health information technologies for elderly care in the emergency department.

Methods: This qualitative study was conducted in 2020. The participants included geriatricians, geriatric nurses, emergency medicine specialists, and nurses who worked in the emergency department. In total, 33 semi-structured interviews were conducted, and data were analyzed by using framework analysis method and MAXQDA software.

Results: The findings of the qualitative study included four main themes, nine subthemes, and 20 categories. The main themes were the common process of elderly care in the emergency departments, data required for elderly care in the emergency departments, the elderly treatment team, and current information technologies used in the emergency departments for elderly care. Overall, the results showed that there was no specific workflow for elderly care in the emergency departments; the great workload of this department prevents the clinicians to conduct cognitive and functional assessments; geriatricians were not involved in the care process; and none of the current information systems were designed specifically for elderly patients. It seems that using specific heath information technology for elderly care in the emergency department can help to overcome current challenges.

Conclusion: Identifying opportunities for using health information technologies for geriatric patients in the emergency department can lead to better use of financial, physical, and human resources, and improve staff performance. These systems can be designed and used for different purposes such as reducing work load, readmissions, and hospitalization. Improving access to data and better collaboration between different specialties are other benefits of using these systems. However, more research is required to evaluate the effectiveness of technology in this area.

前言最近,有几项技术被开发用于老年急诊医学领域。由于大量老年患者前往急诊科就诊,在急诊科使用医疗信息技术有助于改善患者护理和控制疾病结果。本研究旨在确定在急诊科使用各种医疗信息技术进行老年护理的机会:这项定性研究于 2020 年进行。参与者包括老年病学医生、老年病学护士、急诊医学专家以及在急诊科工作的护士。共进行了 33 次半结构式访谈,并采用框架分析法和 MAXQDA 软件对数据进行了分析:定性研究的结果包括 4 个主主题、9 个次主题和 20 个类别。主主题包括急诊科常见的老年护理流程、急诊科老年护理所需的数据、老年治疗团队以及急诊科目前用于老年护理的信息技术。总体而言,研究结果表明,急诊科没有专门的老年护理工作流程;急诊科工作量大,临床医生无法进行认知和功能评估;老年病学家没有参与护理过程;目前的信息系统都不是专门为老年患者设计的。看来,在急诊科使用专门针对老年护理的医疗信息技术有助于克服当前的挑战:结论:在急诊科为老年病人寻找使用医疗信息技术的机会,可以更好地利用财力、物力和人力资源,并提高员工的工作绩效。这些系统可以设计并用于不同的目的,如减少工作量、再入院率和住院率。使用这些系统的其他好处还包括改善数据访问和不同专科之间更好的协作。不过,要评估技术在这一领域的有效性,还需要进行更多的研究。
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引用次数: 0
Telehealth in Primary Health Care: A Scoping Review of the Literature. 初级卫生保健中的远程医疗:文献综述。
Leila Beheshti, Leila R Kalankesh, Leila Doshmangir, Mostafa Farahbakhsh

Background: The use of telehealth as a viable mobility to deliver quality services steadily increases in various levels of the health system. Despite the increasing use of telemedicine in secondary and tertiary health care services, there is a long way to go in the use of this technology in public health and primary health care (PHC). This study aimed to explore the features, approaches, and various dimensions of telehealth in PHC.

Methods: A scoping review was conducted using the Arksey and O'Malley framework. A search was conducted in three bibliographic databases including PubMed, Web of Sciences, and Scopus and in Google Scholar to collect papers published in November 2018 to 2000. Data were extracted according to a predefined form and check for completeness and accuracy by a second reviewer.

Results: Through reviewing papers, the authors extracted information on the general characteristics and features of telehealth services, kinds of PHC services delivered via telehealth, hardware and software facilities used for providing health care through telehealth services packages, as well as their benefits, outcomes and obstacles.

Conclusion: Telehealth can be used for different purposes of PHC through deploying a full range of communication channels available to the public. Due to the opportunistic use of existing devices and platforms, telehealth can provide scalable PHC services nationwide and worldwide. However, implementing telehealth in PHC faces challenges from technical, organizational, and human perspectives. Digital equity (in terms of technology access and e-health literacy) is required to expand telehealth services to the populations in underserved areas.

背景:在各级卫生系统中,使用远程医疗作为提供优质服务的一种可行的流动方式正在稳步增加。尽管在二级和三级卫生保健服务中越来越多地使用远程医疗,但在公共卫生和初级卫生保健中使用这一技术还有很长的路要走。本研究旨在探讨初级保健医院远程医疗的特点、方法和各个维度。方法:使用Arksey和O'Malley框架进行范围审查。检索PubMed、Web of Sciences、Scopus等3个书目数据库和b谷歌Scholar,收集2018年11月至2000年发表的论文。根据预先定义的格式提取数据,并由第二审稿人检查数据的完整性和准确性。结果:通过文献综述,作者提取了远程医疗服务的一般特征和特点,通过远程医疗提供的初级保健服务种类,通过远程医疗服务包提供医疗保健的硬件和软件设施,以及它们的好处、结果和障碍。结论:远程医疗可用于不同目的的初级保健,通过部署全面的沟通渠道提供给公众。由于机会性地利用现有设备和平台,远程保健可以在全国和全世界范围内提供可扩展的初级保健服务。然而,在初级保健中实施远程医疗面临着技术、组织和人员方面的挑战。要将远程保健服务扩大到服务不足地区的人口,就需要数字公平(在获取技术和电子保健知识方面)。
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引用次数: 0
Barriers and Facilitators to Automated Self-Scheduling: Consensus from a Delphi Panel of Key Stakeholders. 自动化自我调度的障碍和促进因素:来自关键利益相关者德尔菲小组的共识。
Elizabeth Woodcock
<p><strong>Introduction: </strong>Automated self-scheduling may benefit healthcare organizations, yet uptake has been slow. The aim of this study was to develop a consensus statement regarding the organizational-level determinants of implementation success based on the collective knowledge of experts. A three-stage modified Delphi method was used to reach consensus on the top determinants of implementation of self-scheduling solutions by healthcare organizations. A panel of 53 experts representing 41 academic health systems identified barriers and facilitators involving the organization's inner and outing settings, as well as the characteristics of the intervention and the individuals engaged in the solution. Offering convenience for patients is the leading enabler for organizations to implement the technology. The consensus may aid healthcare organizations and suppliers engaged in adopting and developing self-scheduling technology to improve implementation success. Further research is recommended to diagnose and examine each barrier and facilitator and how these factors interact.</p><p><strong>Objective: </strong>The aim of this study was to develop a consensus statement regarding the determinants of implementation success based on the collective knowledge of experts working in the field.</p><p><strong>Methods: </strong>A Delphi panel was constructed based on selected participants employed by academic health systems and experienced with self-scheduling implementation. Panelists were recruited based on participation in an educational event that featured the topic. Purposive and snowball sampling were used. Panelists participated in surveys collected over three rounds. An 80 percent agreement among panelists and interquartile range (IQR) <1 determined the barriers and facilitators. The top-10 determinants were presented in rank order.</p><p><strong>Results: </strong>Between January 6, 2021, and May 26, 2021, 53 panelists representing 41 academic health systems participated in three rounds of surveys to reach consensus on the barriers and facilitators to implementation of self-scheduling by healthcare organizations in the United States. In round one, panelists documented 530 determinants. In round two, the determinants were grouped into 72 barriers and 85 facilitators, each of which participants rated on a five-point Likert scale. Fifteen determinants met the 80 percent threshold and 1.0 IQR. The final round concluded with a top-10, rank-ordered listing of determinants (seven facilitators and three barriers) that also incorporated a median rating score using five-point Likert scale.</p><p><strong>Conclusion: </strong>A three-stage modified Delphi method was used to reach consensus on the top determinants of implementation of self-scheduling solutions by academic health systems. The consensus may aid healthcare organizations and suppliers engaged in adopting and developing self-scheduling technology to improve implementation success. Further researc
导读:自动化的自我调度可能使医疗保健组织受益,但采用速度缓慢。这项研究的目的是根据专家的集体知识,就实施成功的组织层面决定因素制定一项共识声明。采用三阶段修正德尔菲法对医疗机构实施自我调度解决方案的主要决定因素达成共识。代表41个学术卫生系统的53名专家组成的小组确定了涉及组织内部和外部环境的障碍和促进因素,以及干预措施和参与解决方案的个人的特征。为患者提供便利是组织实施该技术的主要推动力。该共识可以帮助医疗保健组织和供应商采用和开发自调度技术,以提高实施的成功率。建议进一步研究以诊断和检查每个障碍和促进因素以及这些因素如何相互作用。目的:本研究的目的是根据在该领域工作的专家的集体知识,制定关于实施成功的决定因素的共识声明。方法:选取在学术卫生系统工作并具有自我调度实施经验的参与者,构建德尔菲小组。小组成员是根据参加以该主题为特色的教育活动而招募的。采用目的抽样和滚雪球抽样。小组成员参与了三轮收集的调查。小组成员和四分位范围(IQR)结果之间达成80%的协议:在2021年1月6日至2021年5月26日期间,代表41个学术卫生系统的53名小组成员参加了三轮调查,以就美国卫生保健组织实施自我安排的障碍和促进因素达成共识。在第一轮中,小组成员记录了530个决定因素。在第二轮中,决定因素被分成72个障碍和85个促进因素,每一个参与者都用5分的李克特量表打分。15个决定因素达到80%的阈值和1.0 IQR。最后一轮以排名前10的决定因素(7个促进因素和3个障碍)结束,这些决定因素还采用了李克特五点量表的中位数评分。结论:采用改进的三阶段德尔菲法对学术卫生系统实施自调度方案的主要决定因素达成共识。该共识可以帮助医疗保健组织和供应商采用和开发自调度技术,以提高实施的成功率。建议进一步研究以诊断和检查每个障碍和促进因素以及这些因素如何相互作用。
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引用次数: 0
FACTORS FOR SUCCESSFULLY PASSING CERTIFICATION EXAMS: A SYSTEMATIC REVIEW. 成功通过认证考试的因素:系统的复习。
Renae Spohn, William Schweinle Iii, Patti Berg-Poppe, Carole South-Winter, David DeJong

This study explored possible success factors for health information management certification exams. Based on the American Health Information Management Association (AHIMA) website, in 2018 and 2019, only 70 percent of first-time test takers passed the Registered Health Information Administrator (RHIA) exam; 26 percent passed the Certified Health Data Analyst (CHDA) exam in 2018; and only 10 percent passed the Certified Health Data Analyst exam in 2019. A quantitative systematic review and meta-analysis offered insight into factors related to passing certification exams. Sources included existing, relevant peer-reviewed and published literature since 1990 within 87 educational and health/medicine databases and 62 other articles and journal databases available at the University of South Dakota library. Outcomes from the systematic review include illumination of factors for passing health information management, healthcare, and education certification exams. Ultimately, this new information will help improve pass rates on certification exams.

本研究探讨健康信息管理认证考试成功的可能因素。根据美国健康信息管理协会(AHIMA)网站,2018年和2019年,只有70%的首次参加考试的人通过了注册健康信息管理员(RHIA)考试;26%的人在2018年通过了注册健康数据分析师(CHDA)考试;2019年,只有10%的人通过了注册健康数据分析师考试。定量系统回顾和荟萃分析提供了对通过认证考试相关因素的见解。资料来源包括自1990年以来87个教育和保健/医学数据库中现有的相关同行评议和发表的文献,以及南达科他州大学图书馆提供的62篇其他文章和期刊数据库。系统回顾的结果包括阐明通过健康信息管理、医疗保健和教育认证考试的因素。最终,这些新信息将有助于提高认证考试的通过率。
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引用次数: 0
RHIA CERTIFICATION EXAM SUCCESS FACTORS. 利亚认证考试成功的因素。
Renae Spohn, William Schweinle Iii, Patti Berg-Poppe, Carole South-Winter, David DeJong

This study explored possible success factors for passing the Registered Health Information Administration (RHIA) certification exam. According to the American Health Information Management Association (AHIMA), only 70 percent of first-time test-takers passed the RHIA exam in 2019. A literature review offered insight into factors related to passing certification exams. Sources included existing, relevant peer-reviewed and published literature since 1990 within 87 educational and health/medicine databases and 62 other articles and journal databases available at the University of South Dakota library. A correlational design was used in the study. Data was retrieved from AHIMA, cleaned, and binary logistic regression analysis was completed. A significant relationship was identified between having a prior credential, such as the Registered Health Information Technician (RHIT) credential and passing the RHIA exam. This new information will help improve pass rates, advance the HIM field research base, and help students improve their odds of passing the RHIA exam.

本研究探讨通过注册健康资讯管理局(RHIA)认证考试的可能成功因素。根据美国健康信息管理协会(AHIMA)的数据,2019年只有70%的首次参加考试的人通过了RHIA考试。一篇文献综述提供了对通过认证考试相关因素的见解。资料来源包括自1990年以来87个教育和保健/医学数据库中现有的相关同行评议和发表的文献,以及南达科他州大学图书馆提供的62篇其他文章和期刊数据库。本研究采用相关设计。从AHIMA中检索数据,进行清理,并完成二元logistic回归分析。研究发现,拥有注册医疗信息技术人员(RHIT)证书和通过RHIA考试之间存在显著关系。这一新信息将有助于提高通过率,推进HIM实地研究基地,并帮助学生提高通过RHIA考试的几率。
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引用次数: 0
THE SYMBIOTIC RELATIONSHIP BETWEEN HEALTH INFORMATION MANAGEMENT AND HEALTH INFORMATICS: OPPORTUNITIES FOR GROWTH AND COLLABORATION. 卫生信息管理和卫生信息学之间的共生关系:成长和合作的机会。
Dasantila Sherifi, Memory Ndanga, Thomas Tj Hunt, Shankar Srinivasan

Health information management (HIM) and health informatics (HI) are two similar but distinct disciplines. They share a common goal in terms of using information technologies and information power to improve the quality and efficiency of patient care; contribute to disease prevention and treatment; and improve overall population health. HIM professionals are primarily focused on managing health information, and HI professionals are primarily focused on the technologies and systems that make health information management possible. The right combination of the breadth of knowledge HIM professionals possess and the depth of knowledge HI professionals bring into the various areas constituting the scopes of the two disciplines can strengthen an organization's potential and growth in a complex, fast-changing healthcare environment.

卫生信息管理(HIM)和卫生信息学(HI)是两个相似但不同的学科。他们在利用资讯科技和资讯力量改善病人护理的质素和效率方面有共同的目标;促进疾病的预防和治疗;提高总体人口健康水平。卫生信息系统专业人员主要侧重于管理卫生信息,卫生保健专业人员主要侧重于使卫生信息管理成为可能的技术和系统。HIM专业人员拥有的知识广度和HI专业人员对构成这两个学科范围的各个领域的知识深度的正确结合,可以增强组织在复杂、快速变化的医疗保健环境中的潜力和增长。
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引用次数: 0
UPCODING MEDICARE: IS HEALTHCARE FRAUD AND ABUSE INCREASING? 升级医疗保险:医疗欺诈和滥用正在增加吗?
Alberto Coustasse, Whitney Layton, Laykin Nelson, Victoria Walker

Medicare fraud has been the cause of up to $60 billion in overpaid claims in 2015 alone. Upcoding occurs when a healthcare provider has submitted codes for more severe conditions than diagnosed for the patient to receive higher reimbursement. The purpose of this study was to assess the impact of Medicare and Medicaid fraud to determine the magnitude of upcoding inpatient and outpatient claims throughout reimbursements. The methodology for this study utilized a literature review. The literature review analyzed physician upcoding throughout present on admission infections, diagnostic related group upcoding, emergency department, and clinic upcoding. It was found that upcoding has had an impact on Medicare payments and fraud. Medicare fraud has been reported to be the magnitude of upcoding inpatient and outpatient claims throughout Medicare reimbursements. In addition, fraudulent activity has increased with upcoding for ambulatory inpatient and outpatient charges for patients with Medicare and Medicaid.

仅在2015年,医疗保险欺诈就造成了高达600亿美元的超额索赔。当医疗保健提供者为患者提交了比诊断更严重的疾病的代码以获得更高的报销时,就会发生编码升级。本研究的目的是评估医疗保险和医疗补助欺诈的影响,以确定在报销过程中住院和门诊索赔的升级编码程度。本研究采用文献综述的方法。文献综述分析了住院感染、诊断相关组、急诊科和诊所的医生升级编码。研究发现,升级编码对医疗保险支付和欺诈产生了影响。据报道,医疗保险欺诈是整个医疗保险报销中住院和门诊索赔的幅度。此外,随着医疗保险和医疗补助患者住院和门诊门诊费用的升级编码,欺诈活动也有所增加。
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引用次数: 0
EVALUATION OF A TELEHEALTH APPLICATION (SEHHA) USED DURING THE COVID-19 PANDEMIC IN SAUDI ARABIA: PROVIDER EXPERIENCE AND SATISFACTION. 对沙特阿拉伯2019冠状病毒病大流行期间使用的远程医疗应用程序(sehha)的评估:提供者经验和满意度。
Mohanad M Alsaleh, Valerie J M Watzlaf, Dilhari R DeAlmeida, Andi Saptono

Introduction: COVID-19 has drastically transformed healthcare delivery and forced many to utilize telehealth. This study aimed to comprehensively evaluate the telehealth service "Sehha" used during COVID-19 in Saudi Arabia and assess the provider experience and satisfaction with Sehha.

Methods: A questionnaire was distributed by the Ministry of Health (MoH) to 362 physicians using Sehha. The questionnaire items were adapted from previous studies and then tested for content validity and reliability (α = 0.88).

Results: The findings showed that most of the physicians improved their experience in telehealth because of COVID-19. The majority of the physicians (67.6 percent) reported being satisfied with Sehha. However, the most commonly perceived challenge by the physicians was difficulty in providing accurate medical assessments.

Conclusion: COVID-19 has remarkably uncovered numerous benefits of telehealth. Therefore, telehealth should remain a permanent model of healthcare delivery with consideration of further telehealth development initiatives.

导言:COVID-19彻底改变了医疗保健服务,并迫使许多人使用远程医疗。本研究旨在全面评估沙特阿拉伯在COVID-19期间使用的远程医疗服务“Sehha”,并评估提供者对Sehha的体验和满意度。方法:由卫生部向362名使用Sehha的医生发放问卷。问卷内容改编自前人研究,经内容效度和信度检验(α = 0.88)。结果:调查结果显示,大多数医生因新冠肺炎疫情而提高了远程医疗体验。大多数医生(67.6%)对Sehha表示满意。然而,医生最常见的挑战是难以提供准确的医疗评估。结论:2019冠状病毒病揭示了远程医疗的诸多好处。因此,在考虑进一步的远程保健发展举措的同时,远程保健应继续作为一种永久性的保健服务模式。
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引用次数: 0
DEFINING THE MEDICAL RECORD: RELATIONSHIPS OF THE LEGAL MEDICAL RECORD, THE DESIGNATED RECORD SET, AND THE ELECTRONIC HEALTH RECORD. 定义病案:法定病案、指定病案集和电子病案的关系。
Phyllis T Floyd, Jim C Oates, Julie W Acker, Robert W Warren

Not so long ago, defining the "medical record" was simple. It was the paper chart-volume upon volume that captured the serial, dutifully recorded events of a person's health care at a hospital or physician's office. Entries were typically handwritten, dated and timed, and signed in ink with title (i.e., authenticated). Errors were easily identified by an authenticated strike-through. Similarly, the paper chart was synonymous with the legal medical record (LMR). In other words, a patient's paper chart was that patient's LMR by definition, even if critical data was omitted or irrelevant data was included. Fast-forward to 2021 and the use of technology for capturing the record of a patient's care. Technology has brought new challenges as well as successes. For example, pervasive and persistent mythologies include that 1) a patient's electronic health record (EHR) is the LMR, and 2) patient-specific EHR printouts to paper or disc-or displays on monitors-are necessarily equivalents to the paper chart of the 1980s. Neither are true. We now must define at the outset what is included in the LMR/designated record set to ensure the accuracy of what is retained and released.

不久前,定义“医疗记录”还很简单。这是一卷接一卷的纸质图表,它记录了一个人在医院或医生办公室里连续、尽职尽责地记录的医疗事件。条目通常是手写的,注明日期和时间,并以带有标题的墨水签名(即经过认证)。错误很容易通过经过验证的穿透识别出来。同样,纸质病历也是法律医疗记录(LMR)的同义词。换句话说,即使忽略了关键数据或包含了无关数据,患者的纸质图表也就是患者的LMR。快进到2021年,利用技术捕捉患者的护理记录。技术在带来成功的同时也带来了新的挑战。例如,普遍和持久的神话包括:1)患者的电子健康记录(EHR)是LMR,以及2)打印到纸上或磁盘上(或显示器上显示)的特定于患者的EHR必须等同于20世纪80年代的纸质图表。两者都不对。我们现在必须在一开始就定义LMR/指定记录集中包含的内容,以确保保留和发布的内容的准确性。
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引用次数: 0
CHDA CERTIFICATION EXAM SUCCESS FACTORS. Chda认证考试成功的因素。
Renae Spohn, William Schweinle Iii, Carole South-Winter, David DeJong

This study explored possible success factors for passing the Certified Health Data Analyst Administration (CHDA) certification exam. According to the American Health Information Management Association (AHIMA), in 2019, only 10 percent of first-time test-takers passed the CHDA exam. Literature review offered insight into factors related to passing certification exams. Sources included existing, relevant peer-reviewed, and published literature since 1990 within 87 educational and health/medicine databases and 62 other articles and journal databases available at the University of South Dakota library. A correlational design was used in the study. Data was retrieved from AHIMA, cleaned, and data analysis was completed using binary logistic regression analysis. The CHDA study results indicate that candidates between ages 30 and 49 are less likely to pass the exam than those ages 50 and above, and those candidates with a master's degree are more likely to pass the exam than those with an associate or bachelor's degree. This new information will help improve the exam pass rates, provide a foundation for CHDA exam research, and add new knowledge in the HIM professional body of research.

本研究探讨通过注册健康数据分析师管理局(CHDA)认证考试的可能成功因素。根据美国健康信息管理协会(AHIMA)的数据,2019年,只有10%的首次参加考试的人通过了CHDA考试。文献综述提供了对通过认证考试的相关因素的见解。来源包括自1990年以来在87个教育和卫生/医学数据库中现有的、相关的同行评审和发表的文献,以及南达科他州大学图书馆提供的62篇其他文章和期刊数据库。本研究采用相关设计。从AHIMA中检索数据,进行清理,并使用二元逻辑回归分析完成数据分析。CHDA的研究结果表明,30岁至49岁的考生通过考试的可能性低于50岁及以上的考生,硕士学位的考生通过考试的可能性高于副学士或学士学位的考生。这些新信息将有助于提高考试通过率,为CHDA考试研究提供基础,并为HIM专业研究机构增加新知识。
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引用次数: 0
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Perspectives in health information management / AHIMA, American Health Information Management Association
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