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Clinical informatics, decision support for health professionals, electronic health records, and ehealth infrastructures.
JMIR Medical Informatics (JMI, ISSN 2291-9694) is a top-rated, tier A journal which focuses on clinical informatics, big data in health and health care, decision support for health professionals, electronic health records, ehealth infrastructures and implementation. It has a focus on applied, translational research, with a broad readership including clinicians, CIOs, engineers, industry and health informatics professionals.
Published by JMIR Publications, publisher of the Journal of Medical Internet Research (JMIR), the leading eHealth/mHealth journal (Impact Factor 2016: 5.175), JMIR Med Inform has a slightly different scope (emphasizing more on applications for clinicians and health professionals rather than consumers/citizens, which is the focus of JMIR), publishes even faster, and also allows papers which are more technical or more formative than what would be published in the Journal of Medical Internet Research.
JMIR Medical Informatics journal features a rapid and thorough peer-review process, professional copyediting, professional production of PDF, XHTML, and XML proofs (ready for deposit in PubMed Central/PubMed). The site is optimized for mobile and iPad use.
JMIR Medical Informatics adheres to the same quality standards as JMIR and all articles published here are also cross-listed in the Table of Contents of JMIR, the worlds' leading medical journal in health sciences / health services research and health informatics (http://www.jmir.org/issue/current).
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Background: A goal of effective EMR provider documentation platforms is to provide an efficient, concise and comprehensive notation system that will effectively reflect the clinical course, including...
Background: A goal of effective EMR provider documentation platforms is to provide an efficient, concise and comprehensive notation system that will effectively reflect the clinical course, including the diagnoses, treatments and interventions. Objective: Fully redesign and standardize the provider documentation process, seeking improvement in documentation based upon ongoing APR-DRG-based coding records, while maintaining non-inferiority comparing provider satisfaction to our existing documentation process. We estimated the fiscal impact of improved documentation based upon changes in expected hospital payments. Methods: Employing a multidisciplinary collaborative approach, we created an integrated clinical platform that captures data entry from the obstetrical suite, delivery room, NICU nursing and respiratory therapy staff. It provides the sole source for hospital provider documentation in the form of a history and physical exam, daily progress notes, and discharge summary. Health maintenance information, follow-up appointments and running contemporaneous updated hospital course information have selected shared entry and common viewing by the NICU team. Interventions: (1) Improve provider awareness of appropriate documentation through a provider education hand-out and follow-up group discussion. (2) Fully redesign and standardize the provider documentation process building from the native Epic-based software. Measures: (1) Hospital coding department review of all NICU admissions and 3M APR-DRG based calculations of Severity of illness (SOI), risk of mortality (ROM) and case mix index (CMI) scores. (2) Balancing measure: Provider time utilization case study and survey; (3) Average expected hospital payment based upon acuity-based clinical logic algorithm and Payor mix. Results: We compared Pre-intervention (October 2015-October 2016) to Post-intervention (November 2016-May 2017) time-periods and demonstrated: (1) Significant improvement in APR-DRG derived SOI, ROM, CMI: Monthly average SOI scores increased by 11.1% (p = 0.008); Monthly average ROM scores increased by 13.5% ((p = 0.007); Monthly average CMI scores increased by 7.7% (p=0.009). (2) Time study showed increased time to complete H&P and progress notes and decreased time to complete discharge summary: H&P: time allocation increased by 47% (p = 0.053); Progress Note time allocation significantly increased by 91% (p < 0.001); Discharge summary time allocation significantly decreased by 41% (p = 0.032). (3) Survey of all providers: Overall there was positive provider perception of the new documentation process based upon a survey of the provider group. (4) Significantly increased hospital average expected payments: Comparing the PRE- and POST-intervention study periods, there was a $14,020/ month/ patient increase in Average Expected Payment for hospital charges (p < 0.001). There was no difference in payer mix during this time-period. Conclusions: A problem-based NICU documentation EMR more effectively improves documentation, without dissatisfaction by the participating providers, and improves hospital estimations of APR-DRG-based revenue.
Background: In response to the increased use of computers and technology in health-care settings and the development of communication technologies, nursing educators are constantly seeking ways to imp...
Background: In response to the increased use of computers and technology in health-care settings and the development of communication technologies, nursing educators are constantly seeking ways to improve the informatics competencies, skills, and knowledge of undergraduate nurses. Indeed, informatics competencies impact quality of care and patient safety. Objective: We assessed informatics competencies among nursing undergraduates in Saudi Arabia and provided recommendations to improve informatics training for nurses. Methods: We conducted a cross-sectional survey of 108 female fourth-year undergraduate nurses using the 30-item Self-Assessment of Nursing Informatics Competencies Likert Scale, which evaluated basic computer knowledge and skills, attitudes to clinical informatics, and wireless device skills. Data were collected between October and December 2016, and analyzed using descriptive statistics. The response rate was 100%. Most respondents (98%) were aged 20–22 years. Results: All students reported that they used the computer several times a day, and that they had more than 2 years of computer experience. They reported competencies in attitudes to clinical informatics (mean: 4.6 ± 0.71), basic computer knowledge and skills (mean: 4.4 ± 0.69), and wireless device skills (mean: 4.3 ± 0.41). They exhibited least competency in applied computer skills (mean: 4.03 ± 0.9), which include the collection, interpretation, and extraction of patient care data. Conclusions: Our results highlight the informatics competencies of undergraduate nurses, and reveal how medical technologies and informatics applications can improve their future working experience. Improving informatics competencies will lead to a better, error-free service and a safer environment for patients.
Background: E-health is the use of information and communication technology to treat patients. It has many benefits like cost reduction (e.g., health delivery cost), convenience for users, and health...
Background: E-health is the use of information and communication technology to treat patients. It has many benefits like cost reduction (e.g., health delivery cost), convenience for users, and health policy system improvement. Several literature reviews have included one part or the other of the field, but an overall review is lacking possibly due to the field’s constant evolution. An overview of E-health research is needed. Objective: To show an over view of E-health research and lay a foundation for futhers research on health IT policy. Methods: We selected the related literature on E-health downloaded from Web of Science as data source and used the visualization analysis function of CiteSpace. Literature information would be converted into precise mapping knowledge domain. Through further analysis of mappings, we explored the theoretical framework and the forefront in the field of E-health. Results: Over the past 15 years, USA, England, and Australia were the top three countries that published the largest number of papers. Researches about Internet technology, telemedicine,m-health, and healthcare lay the basis of E-health research development. Particularly, m-health, health system management, and experimental intervention have emerged and formed the new study frontier in recent 3-5 years. With the advancement of E-health projects, an increasing number of scholars have been studying the commercialization of E-health. Conclusions: We analyzed the international studies from the aspects of the references’ quantity, country, author, keywords, and co-cited references. This paper provides a reference for scholars working on this field and lays a foundation for further research on health IT policy.
Background: Inclusion of information technology into nursing is rising. Furthermore, technological advancements lead to an increased attention for Augmented Reality (AR). As AR is implemented on smart...
Background: Inclusion of information technology into nursing is rising. Furthermore, technological advancements lead to an increased attention for Augmented Reality (AR). As AR is implemented on smart devices and therefore part of a pervasive system, it can highly influence the daily working process. Thus, values should be taken into account when designing and implementing an AR application for nursing. Objective: The aim of this review is to provide an overview about the current research on AR in nursing with special focus on design and evaluation methods as well as on the integration of values. This led to the following research question: “Which research according to the topic of AR in nursing exists?” With focus on the topics use cases, evaluation, devices used, and ethics. Methods: We searched eight databases of the areas of nursing and informatics including PubMed, Web of Science and ACM. We used the keywords ‘Nurs’, ‘Care’ OR ‘Caring’ in combination with the phrasings ‘Augmented Reality’, ‘AR device’, ‘AR glass’, ‘Smart device’, ‘Smart glass’, ‘Smart watch’ OR ‘Google glass’. We included studies concerning the topic of AR in nursing. Quantitative as well as qualitative and mixed methods studies were included. We conducted a critical interpretive synthesis to synthesize the results. Results: The search led to 434 articles of which 13 were then included into the final analysis. According to our research question we defined four topics deductively and identified nine subtopics inductively. The subtopics are use case identification, setting/use case description, requirements elicitation, evaluation goals, evaluation methods, evaluation outcome, technical challenges, ethical approval, and values. Whereas reviewed publications evaluated the use of AR in nursing as merely positive they identified technical challenges as well. Usage of devices varies and values are hardly considered in application design and evaluation. Conclusions: Our results show, that research according to AR in nursing exists. Methods to identify use cases and to evaluate applications differ between the studies. Furthermore, devices used vary. Examples are smart glasses, tablets, and smart watches. Reviewed studies predominantly evaluated usage of google glass. Results provided show that design and evaluation of smart devices for nursing to date is conducted without explicitly taking values into account. Furthermore, evaluation does not consider framing conditions. Our study findings are important and informative to the nurses and technicians who are included in the development of new technologies. They can use this review to reflect on their own design of use case identification, requirements elicitation and evaluation.
Background: “COMPASS” (“Capturing and Analyzing Sensor and Self-Report Data for Clinicians and Researchers) is an eHealth platform designed to improve cancer care delivery through passive monito...
Background: “COMPASS” (“Capturing and Analyzing Sensor and Self-Report Data for Clinicians and Researchers) is an eHealth platform designed to improve cancer care delivery through passive monitoring of patients’ health status and delivering customizable reports to clinicians. Based on data from sensors and context-driven administration of patient-reported outcome (PRO) measures, key indices of patients’ functional status can be collected between regular clinic visits, supporting clinicians in the delivery of patient care. Objective: The aim of the first phase of this project was to systematically collect input from oncology providers and patients on potential clinical applications for COMPASS in order to refine the system. Methods: Ten clinicians representing various oncology specialties and disciplines completed semi-structured interviews designed to solicit clinician input on how COMPASS can best support clinical care delivery. Three cancer patients tested a prototype of COMPASS for 7 days and provided feedback. Interview data was tabulated using thematic content analysis (TCA) to identify the most clinically relevant objective and PRO domains. Results: TCA revealed that clinicians were most interested in monitoring vital statistics, symptoms and functional status, including physical activity level (n=9), weight (n=5), fatigue (n=9), sleep quality (n=8) and anxiety. Patients (2 in active treatment, 1 in remission) reported that they would use such a device, were enthusiastic about their clinicians monitoring their health status, especially the tracking of symptoms, and felt knowing their clinicians were monitoring and reviewing their health status provided valuable reassurance. Patients would however like to provide some context to their data. Conclusions: Clinicians and patients both articulated potential benefits of the COMPASS system in improving cancer care. From a clinician standpoint, data needs to be easily interpretable and actionable. The fact that patients and clinicians both see potential value in eHealth systems suggests wider adoption and utilization could prove to be a useful tool for improving care delivery.