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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: Efforts in the United States to improve patient engagement and communication with health care providers have led to the creation of the meaningful use program.  The Centers for Medicare...
Background: Efforts in the United States to improve patient engagement and communication with health care providers have led to the creation of the meaningful use program.  The Centers for Medicare and Medicaid Services have created a three-stage process to encourage the adoption and use of electronic health records (EHR). Benefits of EHR use include the ability to provide accurate, up-to-date, legible, and complete information about patients at the point of care. One important component of EHR is the patient portal. Patient portals provide 24-hour access to portions of a patient medical record as well as a secure pathway to send messages to providers, ask for refills of medications, and schedule appointments. Objective: To assess if patients who have not used the patient portal will engage in using the portal after an in-office orientation on how to access and the benefits of using the patient portal. Methods: A quality improvement project was performed using a convenience sample of 60 participants who were scheduled for an appointment in an outpatient cardiology office and had not accessed the patient portal in the past 12 months. The participants were given a survey regarding their computer and internet access as well as their level of comfort using a computer. Each participant was assisted in creating a username and password as well as a security question and answer. The participant then accessed the portal and navigated through the portal with the guidance of the nurse practitioner. They also sent a message via the portal to the provider they were assigned to that day. Each participant was given a pamphlet and a printed power point to reinforce what they had learned. After two months, the nurse practitioner accessed the portal to determine if the enrolled participants had accessed the portal. The reasons for access and frequency were recorded. If there was no access, the participant was called by the nurse practitioner to determine the reason they had not accessed the portal. Results: Of the 60 participants, 54% were women, 46% men, 93% were Caucasian. Fifty-six point seven accessed the portal from home. Reasons for access included: 85% reviewed labs, 53% reviewed messages sent to them from the office and 23% sent messages to the office. Twenty-four participants did not access the portal. Of those participants, 33% stated that they had no clear reason to access the portal, 25% stated that they forgot their login information and 17% stated they no interest in the portal. Conclusions: Patient portals are a useful tool for communication between patients and their providers. Providing an in-office orientation to the portal increased patient access to the portal.
Background: Gay and bisexual men are disproportionately affected by HIV and other sexually transmissible infections (STIs) yet opportunities for STI testing of this population are often missed or inco...
Background: Gay and bisexual men are disproportionately affected by HIV and other sexually transmissible infections (STIs) yet opportunities for STI testing of this population are often missed or incomplete in general practice settings. Strategies are needed for improving the uptake and completeness of sexual health testing in this setting. Objective: We evaluated an intervention centred around integrated decision support software and routine data feedback to improve the collection of sexual orientation data and increase sexual health screening among gay and bisexual men attending general practice. Methods: A study using before/after and case/comparison methods was undertaken to assess the interventions impact in seven Australian general practice clinics. The software was introduced in 2012 and used patient records to prompt clinicians to record sexual orientation and, along with pathology testing history, generated prompts when sexual health testing was overdue or incomplete. It also facilitated the routine extraction of clinical data, which was regularly reported to clinicians. We calculated summary rate ratios (SRRs) based on quarterly trends in the 12-month before and 24-month intervention periods and compared those to four comparison clinics that did not receive the intervention. Results: Among 32,276 attending male patients, sexual orientation recording increased 19% (from 47% to 56%) during the intervention period (SRR=1.10, P<0.001). Comprehensive STI testing increased by 89% during the intervention (26-49%; SRR=1.38, P<0.001). While comprehensive testing increased slightly in comparison sites, the increase was comparatively greater in intervention sites (SRR=1.12, P<0.001). There was also an increase in detection of chlamydia and gonorrhoea after the intervention’s introduction, which was not observed in the comparison sites. Conclusions: Integrated decision support software and data feedback were associated with modest increases in sexual orientation recording, comprehensive screening among gay and bisexual men, and the detection of STIs. Decision support software can be utilised to enhance the delivery of sexual health care in general practice. Clinical Trial: N/A
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Background: It is feasible that patients who are more aware of cancer screening guidelines may be more likely to adhere to them. Objective: In this study, we aimed to determine if screening knowledge...
Background: It is feasible that patients who are more aware of cancer screening guidelines may be more likely to adhere to them. Objective: In this study, we aimed to determine if screening knowledge was associated with documented screening participation. We also assessed the feasibility and acceptability of linking electronic survey data with clinical data in the primary care setting. Methods: An electronic survey was conducted at two sites in Toronto, Canada. At one site, eligible patients were approached in the waiting room to complete the survey; at the second site, eligible patients were sent an email inviting them to participate. Participants were asked to consent to linkage of their survey results with their electronic medical record. Results: Overall, 1683 participants responded to the survey: 1436 responded via email (response rate 24.8%) whereas 247 responded to the survey in the waiting room (response rate 67.5%). The majority of patients consented to linking their survey data to their medical record. Knowledge of cancer screening guidelines was generally low. Although the majority of participants were able to identify the recommended tests for breast and cervical screening, very few participants correctly identified the recommended age and frequency of screening, with a maximum of 22% of screen-eligible women answering all three questions correctly for breast cancer screening. However, this low level of knowledge among patients was not significantly associated with screening uptake, particularly after adjustment for sociodemographic characteristics. Conclusions: Although knowledge of screening guidelines was low among patients in our study, this was not associated with screening participation. Participants were willing to link self-reported data with their medical record data, which has significant implications for future research.
Abstract: In this paper there is a discussion on providing a standard system for health care service providers and patients. We have carried out the detailed study of guidelines provided by ministry o...
Abstract: In this paper there is a discussion on providing a standard system for health care service providers and patients. We have carried out the detailed study of guidelines provided by ministry of health and family welfare to adopt the electronic health record system. The major aim is to eliminate the conventional health record system. The major focus in this research is to propose the interoperable electronic health Record system (IEHR), and test the feasibility and acceptance of the EHR. Further there is a scope to promote the services in select locations such as hospitals and primary health centres. Medical centres can store patient’s health information with minimal efforts.
Objective: The timely and managed intervention reduces the consequences due to disease and sudden death of patients in emergency conditions. Monitoring and caring for the patients in emergency conditi...
Objective: The timely and managed intervention reduces the consequences due to disease and sudden death of patients in emergency conditions. Monitoring and caring for the patients in emergency conditions requires the rapid and correct decisions to maintain their lives. The present study aimed at modeling the wearable smart blanket system for monitoring the patients in the emergency conditions of ambulance. Method: The present study was applied and descriptive-developmental. Firstly, the requirements and features of wearable smart blanket system were elicited and secondly a smart blanket system was modeled by using the UML charts and elicited requirements. Finally, the designed architecture was evaluated by using ARID scenario-based method. Results: The functional requirements of wearable smart blanket system with its data elements and physical-structural features of this system as well as non-functional requirements were elicited. Based on the requirements and data elements elicited from the questionnaire, class diagram, activity, use case diagram, sequence, deployment, and component were drawn. Then, the ARID scenario-based evaluation method was used to show that the designed architecture can provide the expected scenarios from the proposed system by using the UML and the relationships between components, systems, and users from the structural and behavioral perspectives. Conclusion: wearable smart blanket system collects the data related to medical signals by the sensors installed on the blanket and such data are processed by the smart system. The obtained data about the conditions of patient help the physician in ambulance to intervene timely and rapidly without any delay.
Background: Electronic recording of vital sign observations (e-Obs) has become increasingly prevalent in hospital care. The evidence of clinical impact for these systems is mixed. Objective: To assess...
Background: Electronic recording of vital sign observations (e-Obs) has become increasingly prevalent in hospital care. The evidence of clinical impact for these systems is mixed. Objective: To assess the effect of e-Obs versus paper documentation (paper) on length of stay (time between trauma unit admission and ‘fit to discharge’) for trauma patients. Methods: A single centre randomised stepped-wedge study of e-Obs against paper in two 26-bed trauma wards at a medium-sized UK teaching hospital. Randomisation of the phased intervention order to the 12 study areas was computer-generated. The primary outcome was length of stay. Results: 1232 patient episodes were randomised (paper: 628, e-Obs: 604). There were 37 deaths in hospital, 21 in the Paper arm and 16 in the e-Obs arm. For discharged patients the median length of stay was 5.4 days (range: 0.2 to 79.0) on paper and 5.6 days (range: 0.1 to 236.7) on e-Obs arm. Competing risks regression analysis for time to discharge showed no difference between the treatment arms, subhazard ratio: 1.05 (0.82, 1.35) P=.68. More patient episodes contained an EWS≥3 using the e-Obs system than paper, subhazard ratio 1.63 (95% CI 1.28, 2.09 P<0.001). However, there was no difference in the time to the subsequent observation (‘escalation time’) hazard ratio 1.05 (95% CI 0.80, 1.38 P=.70). Conclusions: The phased introduction of an e-Obs documentation system was not associated with a change in length of stay. More patient episodes contained an EWS≥3 using the e-Obs system, but this was not associated with a change in ‘escalation time’. Clinical Trial: ISRCTN91040762