Abstract:
BACKGROUND:Hospitals across the country are investing millions of dollars to adopt new Health Insurance Portability and Accountability Act (HIPAA)-compliant secure text messaging systems. However, in nearly all cases, these implementations are occurring without evaluation of their impact on patient care. OBJECTIVE:To evaluate perceived impact on patient care and workflow of new text messaging system implemented in obstetrics at Yale-New Haven Hospital and to inform guidelines for future implementations in emergent settings. METHODS:A new HIPAA-compliant texting system was implemented in obstetrics in 2016. Before implementation of the new system, residents and nurses were surveyed on perceived effect of communication system (pagers with text receiving, service mobile phones, personal cell phones) on clinical workflow and patient care using 5-point Likert scale and open-ended questions. Following roll-out (1 and 6 months), both teams were surveyed with same questions. Results were compared using Wilcoxon-Mann-Whitney test (0-1 months and then 0-6 months). Open-ended question results were qualitatively compared for recurrent unifying themes. RESULTS:In both nursing and resident domains, 1 month after implementation, the new communication system was perceived to significantly improve efficiency and patient care across all metrics. After 6 months, this effect decayed in nearly all categories (including efficiency, real-time communication, and knowledge of covering provider). The exception was nurse's knowledge of which resident to contact and resident's timely evaluation of patient, for which we observed sustained improvements. System shortcomings identified included interrupted connection (i.e., dropped calls), dysfunctional and inaccurate alert system, and unclear identification of the covering provider. CONCLUSION:A new text-messaging-based communication system may improve efficiency and patient care in emergent settings, but system shortcomings can substantially erode potential benefits over time. We recommend implementers evaluate new systems for a set of specific functional requirements to increase probability of sustained improvement and decrease risk of poor patient outcomes.
journal_name
Appl Clin Informjournal_title
Applied clinical informaticsauthors
Feinberg J,Shaw S,Kashyap N,Illuzzi J,Campbell K,Hsiao AL,Pettker CMdoi
10.1055/s-0039-1700868subject
Has Abstractpub_date
2019-10-01 00:00:00pages
879-887issue
5issn
1869-0327journal_volume
10pub_type
杂志文章abstract:BACKGROUND:Accurate prediction of future patient census in hospital units is essential for patient safety, health outcomes, and resource planning. Forecasting census in the Neonatal Intensive Care Unit (NICU) is particularly challenging due to limited ability to control the census and clinical trajectories. The fixed a...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2015-09-RA-0127
更新日期:2016-05-04 00:00:00
abstract:BACKGROUND:Discrepancies in controlled substance documentation are common and can lead to legal and regulatory repercussions. We introduced a visual analytics dashboard to assist in a quality improvement project to reduce the discrepancies in controlled substance documentation in the operating room (OR) of our free-sta...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0039-1693688
更新日期:2019-05-01 00:00:00
abstract::Web 2.0 technologies, known as social media, social technologies or Web 2.0, have emerged into the mainstream. As they grow, these new technologies have the opportunity to influence the methods and procedures of many fields. This paper focuses on the clinical implications of the growing Web 2.0 technologies. Five deve...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2010-01-CR-0003
更新日期:2010-04-21 00:00:00
abstract:BACKGROUND:In 2015, the German Federal Ministry of Education and Research initiated a large data integration and data sharing research initiative to improve the reuse of data from patient care and translational research. The Observational Medical Outcomes Partnership (OMOP) common data model and the Observational Healt...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0037-1617452
更新日期:2018-01-01 00:00:00
abstract:OBJECTIVES:An important challenge for biomedical informatics researchers is determining the best approach for healthcare providers to use when generating clinical notes in settings where electronic health record (EHR) systems are used. The goal of this qualitative study was to explore healthcare providers' and administ...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2013-10-RA-0081
更新日期:2014-02-26 00:00:00
abstract:OBJECTIVE:The use of text messaging in clinical care has become ubiquitous. Due to security and privacy concerns, many hospital systems are evaluating secure text messaging applications. This paper highlights our evaluation process, and offers an overview of secure messaging functionalities, as well as a framework for ...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0039-1678607
更新日期:2019-01-01 00:00:00
abstract:OBJECTIVE:With the increasing prevalence of type 2 diabetes (T2D) in youth, primary care providers must identify patients at high risk and implement evidence-based screening promptly. Clinical decision support systems (CDSSs) provide clinicians with personalized reminders according to best evidence. One example is the ...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0040-1710024
更新日期:2020-03-01 00:00:00
abstract:OBJECTIVES:The authors investigated the impact of computerized provider order entry (CPOE) on the delivery times of analgesia and subsequent patient outcomes. We hypothesized that patients would report less pain and use less pain medications compared with the previous paper-based system. METHODS:Two groups of patients...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2014-12-RA-0114
更新日期:2015-09-23 00:00:00
abstract:BACKGROUND: Poor self-management of heart failure (HF) has contributed to poor health outcomes. Sensor-controlled digital games (SCDGs) integrates data from behavior-tracking sensors to trigger progress, rewards, content, and positive feedback in a digital game to motivate real-time behaviors. OBJECTIVES: To assess th...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0040-1721399
更新日期:2020-10-01 00:00:00
abstract:OBJECTIVES:Transitions in patient care pose an increased risk to patient safety. One way to reduce this risk is to ensure accurate medication reconciliation during the transition. Here we present an evaluation of an electronic medication reconciliation module we developed to reduce the transition risk in patients refer...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2015-11-RA-0154
更新日期:2016-05-25 00:00:00
abstract:BACKGROUND:Prescribers' inappropriate use of the free-text Notes field in new electronic prescriptions can create confusion and workflow disruptions at receiving pharmacies that often necessitates contact with prescribers for clarification. The inclusion of inappropriate patient direction (Sig) information in the Notes...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2014-03-CR-0022
更新日期:2014-08-06 00:00:00
abstract:BACKGROUND: Electronic health records (EHRs) are used in long-term care to document the patients' condition, medication, and care, thereby supporting communication among caregivers and counteracting adverse drug events. However, the use of EHRs in long-term care has lagged behind EHR use in hospitals. In addition, most...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0040-1721013
更新日期:2021-01-01 00:00:00
abstract:OBJECTIVE:Efforts to promote adoption of electronic health records (EHRs) have focused on primary care physicians, who are now expected to exchange data electronically with other providers, including specialists. However, the variation of EHR adoption among specialists is underexplored. METHODS:We conducted a retrospe...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2013-02-RA-0015
更新日期:2013-05-22 00:00:00
abstract:: ...
journal_title:Applied clinical informatics
pub_type: 社论
doi:10.1055/s-0038-1676332
更新日期:2018-10-01 00:00:00
abstract:OBJECTIVE:This article aimed to evaluate the effectiveness of newly established innovative smart home healthcare and health informatics laboratories, and a novel laboratory course that focuses on experiential health informatics training, and determine students' self-confidence to operate wireless home health monitoring...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2017-08-RA-0136
更新日期:2017-10-01 00:00:00
abstract:BACKGROUND:Asthma exacerbations are one of the most common medical reasons for children to be brought to the hospital emergency department (ED). Various prediction models have been proposed to support diagnosis of exacerbations and evaluation of their severity. OBJECTIVES:First, to evaluate prediction models construct...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2013-04-RA-0029
更新日期:2013-08-07 00:00:00
abstract:BACKGROUND:Although patients who work and have related health issues are usually first seen in primary care, providers in these settings do not routinely ask questions about work. Guidelines to help manage such patients are rarely used in primary care. Electronic health record (EHR) systems with worker health clinical ...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0040-1715895
更新日期:2020-08-01 00:00:00
abstract:BACKGROUND:Early detection and efficient management of sepsis are important for improving health care quality, effectiveness, and costs. Due to its high cost and prevalence, sepsis is a major focus area across institutions and many studies have emerged over the past years with different models or novel machine learning...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0040-1710525
更新日期:2020-05-01 00:00:00
abstract:BACKGROUND:Unique characteristics of nursing homes (NHs) contribute to high rates of inappropriate antibiotic use for asymptomatic bacteriuria (ASB), a benign condition. A mobile clinical decision support system (CDSS) may support NH staff in differentiating urinary tract infections (UTI) from ASB and reducing antibiot...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2016-12-RA-0209
更新日期:2017-06-20 00:00:00
abstract:BACKGROUND:Electronic prescribing (e-prescribing) technology was introduced as an alternative to handwritten prescriptions allowing health care professionals to send prescriptions directly to pharmacies. While the technology has many advantages, such as improving pharmacy workflow and reducing medication errors, some l...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0039-1691840
更新日期:2019-05-01 00:00:00
abstract:BACKGROUND:We previously demonstrated that a general purpose text mining system, the Vaccine adverse event Text Mining (VaeTM) system, could be used to automatically classify reports of an-aphylaxis for post-marketing safety surveillance of vaccines. OBJECTIVE:To evaluate the ability of VaeTM to classify reports to th...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2012-11-RA-0049
更新日期:2013-02-27 00:00:00
abstract:BACKGROUND:Semantic interoperability between routine healthcare and clinical research is an unsolved issue, as information systems in the healthcare domain still use proprietary and site-specific data models. However, information exchange and data harmonization are essential for physicians and scientists if they want t...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2012-03-RA-0011
更新日期:2012-07-11 00:00:00
abstract:BACKGROUND:In 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) released a revised guideline on statin therapy initiation. The guideline included a 10-year risk calculation based on regression modeling, which made hand calculation infeasible. Compliance to the guideline has been su...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0039-1692186
更新日期:2019-05-01 00:00:00
abstract:BACKGROUND:Care plan concordance among patients and clinicians during hospitalization is suboptimal. OBJECTIVE:This article determines whether an electronic health record (EHR)-integrated patient portal was associated with increased understanding of the care plan, including the key recovery goal, among patients and cl...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0039-1688831
更新日期:2019-05-01 00:00:00
abstract:OBJECTIVES:Telemonitoring of vital signs is an established option in treatment of patients with chronic heart failure (CHF). In order to allow for early detection of atrial fibrillation (AF) which is highly prevalent in the CHF population telemonitoring programs should include electrocardiogram (ECG) signals. It was th...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2010-12-RA-0078
更新日期:2011-11-23 00:00:00
abstract:BACKGROUND:Smartphones are increasingly important for clinical decision support, but smartphone and Internet use are limited by cost or coverage in many settings. txt2MEDLINE provides access to published medical evidence by text messaging. Previous studies have evaluated this approach, but we found no comparisons with ...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2012-06-RA-0024
更新日期:2012-09-06 00:00:00
abstract:BACKGROUND:Routine implementation of instruments to capture patient-reported outcomes could guide clinical practice and facilitate health services research. Audio interviews facilitate self-interviews across literacy levels. OBJECTIVES:To evaluate time burden for patients, and factors associated with response times fo...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2014-09-RA-0073
更新日期:2015-03-18 00:00:00
abstract:UNLABELLED:Nationwide Children's Hospital established an i2b2 (Informatics for Integrating Biology & the Bedside) application for sleep disorder cohort identification. Discrete data were gleaned from semistructured sleep study reports. The system showed to work more efficiently than the traditional manual chart review ...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.4338/ACI-2014-11-RA-0106
更新日期:2015-05-27 00:00:00
abstract:BACKGROUND:Advances in technology and access to expanded genetic testing have resulted in more children and adolescents receiving genetic testing for diagnostic and prognostic purposes. With increased adoption of the electronic health record (EHR), genetic testing is increasingly resulted in the EHR. However, this lead...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0040-1718753
更新日期:2020-10-01 00:00:00
abstract:OBJECTIVES:More patients are receiving their test results via patient portals. Given test results are written using medical jargon, there has been concern that patients may misinterpret these results. Using sample colonoscopy and Pap smear results, our objective was to assess how frequently people can identify the corr...
journal_title:Applied clinical informatics
pub_type: 杂志文章
doi:10.1055/s-0039-1679960
更新日期:2019-03-01 00:00:00