Abstract:
BACKGROUND:Electronic Consultation (e-consults) can provide improved access, enhance patient and provider satisfaction, and reduce beneficiary travel expenses. We explored how e-consults were implemented across three specialty areas, diabetes (Diab), gastroenterology (GI), and neurosurgery (Neuro), at two Veterans Affairs hospitals in terms of strategies for use and time-lines. METHODS:We conducted observations and electronically shadowed patient e-consultations submitted to a specialty care service by primary care provider(s) at the two sites during a thirteen-month period. We divided the e-consult process in each specialty into three broad milestones; Request (from primary to specialty), Response (from specialty back to primary), and Follow up (from primary to patient), and recorded the flow and time in each category. An overall hierarchy of e-consults was developed to illustrate the many ways an e-consult was used. The Kolmogorov-Smirnov test was used to compare the distribution of time across specialties. RESULTS:A total of 394 consults submitted between April 14, 2012 and May 2, 2013 were reviewed (Diab=152, GI=169, Neuro=73). Of the 152 diabetes specialty clinic e-consults, 35% required some sort of direct contact with the patient by the specialty clinic before a recommendation was provided. Overall, 58% of the e-consults were completed within 20days, while 68% were completed within 30days. The Response times between Diab and GI were significantly different (median=0 vs. 3days; p<0.0001) and so were Follow up times (median=0 vs. 4days; p<0.0001). All three stages were statistically different between Diab and Neuro; however, there was not enough evidence to suggest any differences between GI and Neuro. CONCLUSIONS:The use of an e-consult is likely to vary based on the specialty, but the often significant variations in time may continue to hinder prompt access to care. E-consult design, implementation, documentation, training, self-learning, and monitoring should be tailored to get the most benefit out of this system.
journal_name
Int J Med Informjournal_title
International journal of medical informaticsauthors
Parikh PJ,Mowrey C,Gallimore J,Harrell S,Burke Bdoi
10.1016/j.ijmedinf.2017.09.005subject
Has Abstractpub_date
2017-12-01 00:00:00pages
42-48eissn
1386-5056issn
1872-8243pii
S1386-5056(17)30228-9journal_volume
108pub_type
杂志文章abstract:PURPOSE:This report describes an ongoing transition from the HELP Hospital Information System to HELP II, a replacement Health Information System built to manage clinical information captured in a variety of medical settings. The focus of the article is on the medical decision support provided by this system and studie...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/s1386-5056(02)00110-7
更新日期:2003-03-01 00:00:00
abstract:INTRODUCTION:The rapid scale-up of HIV care and treatment in resource-limited countries requires concurrent, rapid development of health information systems to support quality service delivery. Mozambique, a country with an 11.5% prevalence of HIV, has developed nation-wide patient monitoring systems (PMS) with standar...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2016.11.002
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:Teamwork and interprofessional communication are important in addressing the comprehensive care needs of complex hospitalized patients. The objective of this study is to evaluate the impact of an electronic interprofessional communication and collaboration platform on teamwork, communication, and adverse eve...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2019.04.010
更新日期:2019-07-01 00:00:00
abstract:PURPOSE:To conduct a systematic review to examine evidence of associations between clinical leadership and successful information technology (IT) adoption in healthcare organisations. METHODS:We searched Medline, Embase, Cinahl, and Business Source Premier for articles published between January 2000 to May 2013 with k...
journal_title:International journal of medical informatics
pub_type: 杂志文章,评审
doi:10.1016/j.ijmedinf.2014.02.005
更新日期:2014-06-01 00:00:00
abstract:OBJECTIVE:Clinical problems in the Electronic Health Record that are encoded in SNOMED CT can be translated into ICD-10-CM codes through the NLM's SNOMED CT to ICD-10-CM map (NLM Map). This study evaluates the potential benefits of using the map-generated codes to assist manual ICD-10-CM coding. METHODS:De-identified ...
journal_title:International journal of medical informatics
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ijmedinf.2019.03.002
更新日期:2019-06-01 00:00:00
abstract:OBJECTIVE:To develop a comprehensive instrument assessing quality of health-related web sites. METHODS:Phase I consisted of a literature review to identify constructs thought to indicate web site quality and to identify items. During content analysis, duplicate items were eliminated and items that were not clear, mean...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2005.07.034
更新日期:2006-01-01 00:00:00
abstract::The present computer system is the first of its kind based on problem-oriented medical record (POMR) design developed and operated in a hospital in Hong Kong. It went live in May 1996 with two workstations installed in the medical record office (MRO). Doctors have no direct access to it. They dictate medical notes on ...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/s1386-5056(99)00019-2
更新日期:1999-07-01 00:00:00
abstract:OBJECTIVE:To assess problem list completeness using an objective measure across a range of sites, and to identify success factors for problem list completeness. METHODS:We conducted a retrospective analysis of electronic health record data and interviews at ten healthcare organizations within the United States, United...
journal_title:International journal of medical informatics
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ijmedinf.2015.06.011
更新日期:2015-10-01 00:00:00
abstract::In this paper we describe Tagged Information Management System (TIMS), an integrated knowledge management system for the domain of molecular biology and biomedicine, in which terminology-driven literature mining, knowledge acquisition (KA), knowledge integration (KI), and XML-based knowledge retrieval are combined usi...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/s1386-5056(02)00055-2
更新日期:2002-12-04 00:00:00
abstract::Clinical evidence has indicated the effectiveness of computer-based systems for preventing and reducing diagnostic errors. Our study aimed to evaluate the effectiveness of UpToDate, a computer-based clinical knowledge management system, for reducing diagnostic errors. We retrospectively identified 100 patients who vis...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2017.09.010
更新日期:2018-01-01 00:00:00
abstract:OBJECTIVE:To compare how nurses in two different paper-based systems perceive the impact of a computerized physician order entry (CPOE) system on their medication-related activities. SETTING:13 non-surgical, adult inpatient wards in a Dutch academic hospital. METHODS:Questionnaire survey of 295 nurses before and 304 ...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2008.06.012
更新日期:2009-03-01 00:00:00
abstract:INTRODUCTION:Improving outpatient resource utilization significantly enhances the efficiency of healthcare organizations. Substantial number of walk-in patients (average of 72% in our study) to outpatient services is a universal characteristic of Taiwan's healthcare organizations. Consequently, scheduling becomes extre...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/s1386-5056(03)00008-x
更新日期:2003-04-01 00:00:00
abstract:OBJECTIVES:The intent of this paper is in the examination of health IT implementation processes - the barriers to and facilitators of successful implementation, identification of a beginning set of implementation best practices, the identification of gaps in the health IT implementation body of knowledge, and recommend...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2013.10.009
更新日期:2014-07-01 00:00:00
abstract:BACKGROUND:Evidence-based therapy for heart failure remains underutilized at hospital discharge, particularly for patients with heart failure who are hospitalized for another cause. We developed clinical decision support (CDS) to recommend an angiotensin converting enzyme (ACE) inhibitor during hospitalization to promo...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2019.103956
更新日期:2019-11-01 00:00:00
abstract::With the growing concern about health issues and the emergence of online communities based on user-generated content (UGC), more and more people are participating in online health communities (OHCs) to exchange opinions and health information. This paper aims to examine whether and how male and female users behave dif...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2017.12.019
更新日期:2018-03-01 00:00:00
abstract:INTRODUCTION:The PropeR EHR system (PropeRWeb) is a multidisciplinary electronic health record (EHR) system for multidisciplinary use in extramural patient care for stroke patients. DESIGN:The system is built using existing open source components and is based on open standards. It is implemented as a web application u...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2004.07.004
更新日期:2005-03-01 00:00:00
abstract:BACKGROUND:Clinical pathways (CPs) increase in popularity and are known to lead to several benefits in the hospital environment. Clinical pathways can be either paper-based or software-based. It is known that paper-based CPs can result in more paperwork instead of simplifying daily routines of healthcare workers. Insuf...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2019.104052
更新日期:2020-03-01 00:00:00
abstract:UNLABELLED:Health care is moving toward a team effort, with patients as partners. This requires effective communication between physicians and patients, who have different understandings of health and illness. These understandings in turn guide their decisions about management of health and illness. With the introducti...
journal_title:International journal of medical informatics
pub_type: 临床试验,杂志文章
doi:10.1016/s1386-5056(98)00111-7
更新日期:1998-08-01 00:00:00
abstract:PURPOSE:Shared Electronic Health Record (EHR) systems, which provide a health information exchange (HIE) within a community of care, were found to be a key enabler of informational continuity of diabetes mellitus (DM) care. Quantitative analyses of the actual contribution of Shared EHR systems to informational continui...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2016.05.001
更新日期:2016-08-01 00:00:00
abstract::It is becoming increasingly essential for individuals to be able uniquely to identify themselves and each other, even where they may never meet. Access to and use of privileges of membership, whether of a professional association, computer network or health insurance policy depends upon the 'members' being able to pro...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/s1386-5056(00)00119-2
更新日期:2000-11-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:Hypoglycemia is a common safety event when attempting to optimize glycemic control in diabetes (DM). While electronic medical records provide a natural ground for detecting and analyzing hypoglycemia, ICD codes used in the databases may be invalid, insensitive or non-specific in detecting new h...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2019.06.020
更新日期:2019-09-01 00:00:00
abstract:OBJECTIVE:To build a machine-learning model that predicts laboratory test results and provides a promising lab test reduction strategy, using spatial-temporal correlations. MATERIALS AND METHODS:We developed a global prediction model to treat laboratory testing as a series of decisions by considering contextual inform...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2020.104282
更新日期:2020-12-01 00:00:00
abstract::This paper introduces the topic of this special issue: challenges for medical informatics in the 21st century. This paper discusses the nature of medical informatics. Some descriptions and definitions of medical informatics are reviewed. Then the research aspects of medical informatics are discussed. It is argued that...
journal_title:International journal of medical informatics
pub_type: 杂志文章,评审
doi:10.1016/S1386-5056(97)01253-7
更新日期:1997-03-01 00:00:00
abstract::The working group on technology assessment and quality development in health informatics was established as a follow-up to the recommendations made at the IMIA-ISTAHC working conference in 1990. The working group was approved by the IMIA General Assembly at Kyoto, September, 1993. The working group aims to further dev...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/s1386-5056(99)00030-1
更新日期:1999-12-01 00:00:00
abstract:PURPOSE:Documentation of medical treatment and observation of patients during evacuation from the point of injury to definitive treatment is important both for optimizing patient treatment and managing the evacuation process. The current practice in military medical field documentation uses paper forms and voice commun...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2007.01.006
更新日期:2008-02-01 00:00:00
abstract::Many studies on the physiology of the cardiovascular system revealed that nonlinear chaotic dynamics govern the generation of the heart rate signal. This is also valid for the fetal heart rate (FHR) variability, where however the variability is affected by many more factors and is significantly more complicated than f...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/s1386-5056(98)00102-6
更新日期:1999-01-01 00:00:00
abstract:INTRODUCTION:Electronic medical records (EMRs) may address the need for decision and language support for Western clinicians on mobile medical service trips (MSTs) in low resource settings abroad, while providing improved access to records and data management. However, there has yet to be a review of this emerging tech...
journal_title:International journal of medical informatics
pub_type: 杂志文章,评审
doi:10.1016/j.ijmedinf.2016.11.008
更新日期:2017-02-01 00:00:00
abstract:OBJECTIVES:To investigate (1) Finnish pharmacy customers' familiarity with My Kanta, the national online service for viewing electronic prescriptions (ePrescriptions), (2) how commonly My Kanta is used, (3) who the typical users are, and (4) users' experiences of the usability of My Kanta. METHOD:A survey was conducte...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2016.10.014
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:It is conjectured that providing feedback on physicians' prescribing behavior improves quality of drug prescriptions. However, the effectiveness of feedback provision and mode of feedback delivery is not well understood. The objective of this study was to assess and compare the effect of traditional paper le...
journal_title:International journal of medical informatics
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ijmedinf.2015.12.008
更新日期:2016-03-01 00:00:00
abstract:BACKGROUND:Diagnosis coding percentages in the specialty training of general practitioners (GPs) are generally high, but not perfect, indicating barriers against coding still exist, possibly influencing the validity of data based on electronic patient records (EPRs). OBJECTIVE:To study the relationship between barrier...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2013.02.002
更新日期:2013-08-01 00:00:00