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Clinical informatics, decision support for health professionals, electronic health records, and ehealth infrastructures.
JMIR Medical Informatics (JMI, ISSN 2291-9694) (Editor-in-chief: Christian Lovis MD MPH FACMI) 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 2017: 4.671), 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: Monitoring the effectiveness of the influenza vaccination programme within the UK is necessary in order to assess its clinical impact. Data are collected from general practice sentinel net...
Background: Monitoring the effectiveness of the influenza vaccination programme within the UK is necessary in order to assess its clinical impact. Data are collected from general practice sentinel network computerised medical record (CMR) systems on patients from whom virology specimens have been taken for influenza. The data collected includes demographics, comorbidities, vaccine exposure and if patients have had a virology specimen taken. Unfortunately not all virology specimens collected can be used in the vaccine effectiveness (VE) studies conducted. Objective: To describe the proportion, reasons and any trends in virology specimen data collected but not used in influenza VE analyses, with the goal of defining strategies to reduce collection of specimens ineligible for use in VE studies. Methods: We examined UK influenza VE studies from the past 10 years and identified incidences where data were labelled unusable. We categorised reasons for not using data as: (1) Vaccination history: Missing or Uncertain categories (including patient not registered with the practice at the start of the season); (2) Swab timing: Not recorded; More than 7 days (historically over 29 days) after symptom onset or within 14 days of vaccination; (3) Laboratory: Not sufficient data for processing (e.g. no age), CT values; (4) Flu or vaccination type of no interest (including pandemic years). The proportion, reasons and trends for data loss were identified through descriptive statistics and graphical representations. We included an analysis of where other data had been available at the point of analysis but not used. Results: Over 30% (13292/41337) of virology specimen data was not used across all seasons. Data loss gradually began to decrease from 2014/15 onwards. Data loss were highest for flu or vaccination type of no interest and swab timing. Retrospective and prospective actions were identified to reduce data loss in future. Around 60% of samples could have been included if identifiable data were better shared between records. Conclusions: The reasons for excluding samples and missing data varied, particularly prior to 2014; consistent categorisation was in place from 2014 onwards. Leaving aside the different issues around pandemic years, many of the virology swabs not included were due to suboptimal case selection by practices, but over half (58%) could have been included if identifiable data were better shared between data sources. Clinical Trial: N/A
Background: Major postoperative morbidity and mortality remain common despite efforts to improve patient outcomes. Health information technologies, such as decision support systems, have the potential...
Background: Major postoperative morbidity and mortality remain common despite efforts to improve patient outcomes. Health information technologies, such as decision support systems, have the potential to advance the standard of perioperative patient care. Failure to evaluate the usability of these technologies and barriers to their implementation can limit their acceptance within health systems. Objective: This manuscript describes the usability and acceptability of and systematic process for developing and adapting an innovative telemedicine based clinical support system, the Anesthesiology Control Tower. It also reports stakeholders’ perceptions of the barriers and facilitators the implementation of the intervention. Methods: Three phases of testing were conducted in an iterative manner in order to evaluate both the individual components of the Anesthesiology Control Tower and their integration as a whole. Phase 1 testing employed a “think-aloud” protocol analysis to identify surface level usability problems with individual software components of the ACT, in addition to the entirety of the structure. Phase 2 testing involved an extended qualitative and quantitative in-situ usability analysis. Phase 3 sought to identify major barriers and facilitators to implementation of the ACT through semi-structured interviews with key stakeholders. Results: Numerous usability problems with the software components of the ACT were identified in the Phase 1 and Phase 2 usability testing sessions. In response to these problems, seven iterations of the ACT software platform were developed. Initial satisfaction with the ACT, as measured by standardized measures, was below commonly accepted cutoffs for these measures. Satisfaction improved to acceptable levels over the course of revision and testing. A number of barriers to implementation were identified and addressed during the refinement of the ACT intervention. Conclusions: The Anesthesiology Control Tower system has the potential to improve the standard of perioperative anesthesia care. Through our thorough and iterative usability testing process and stakeholder assessment of barriers and facilitators, we were able to maximize the acceptability of this novel technology, thus improving our ability to implement this innovation into the model of care for perioperative medicine.
Background: Telemonitoring (TM) of heart failure patients in a clinic setting has been shown to be effective if properly implemented, but little is known about the feasibility and impact of implementi...
Background: Telemonitoring (TM) of heart failure patients in a clinic setting has been shown to be effective if properly implemented, but little is known about the feasibility and impact of implementing TM through a home care nursing agency. Objective: The goal of this study was to determine the feasibility of implementing a smartphone-based TM system through a home care nursing agency, and to explore the feasibility of conducting a future effectiveness trial. Methods: A feasibility study was conducted, aiming to recruit 10-15 heart failure patients who would use the TM system for 4 months by taking daily measurements of weight and blood pressure, and recording symptoms. Home care nurses responded to alerts generated by the TM system either through a phone call and/or home visit. Results: Only six patients were recruited over a six-month period due to lack of referrals from physicians. Potential benefits of TM through a home care nursing agency were indicated, including through improved patient education, providing nurses with a better understanding of the patient’s health status, and reductions in home visits. Barriers to implementation included challenges in nurses contacting patients and physicians, retention issues, and integrating the TM system into a complex home care nursing workflow. Conclusions: Lessons learned included the need to incentivize physicians, to ensure streamlined processes for recruitment and communication, to target appropriate patient populations, and to create a core clinical group. Barriers encountered in this feasibility trial should be considered to determine their applicability when deploying innovations into different service delivery models.
Background: Telehealth has been shown to improve access to healthcare and to reduce costs to the patient and healthcare system, especially for patients living in rural settings. However, unique challe...
Background: Telehealth has been shown to improve access to healthcare and to reduce costs to the patient and healthcare system, especially for patients living in rural settings. However, unique challenges arise when implementing telehealth in remote communities. Objective: The objectives of this evaluation were to understand the current use, challenges, and opportunities of the Yukon Telehealth System. The lessons learned from this case study were used to determine important factors to consider when attempting to advance and expand telehealth programs in remote communities. Methods: A mixed-methods approach was used to evaluate the Yukon Telehealth System and to determine possible future advances. Quantitative data were obtained through usage logs. In addition, online questionnaires were administered to nurses in each of the 14 Yukon community health centres outside of Whitehorse, and patients who had used telehealth were also asked to complete a questionnaire. Qualitative data included focus groups and semi-structured interviews with a total of 36 telehealth stakeholders. Results: Since 2008, there have been a consistent total number of telehealth sessions of about 1000 per year, with the main use being for clinical care (70% of all sessions in 2015). From the questionnaire data (11 community nurses, 10 patients) and interview data, there was a consensus among the clinicians and patients that the System provided timely access and cost savings from reduced travel. However, they believed that it was underutilized and the equipment was outdated. The challenges and opportunities discovered led to the identification of four factors that should be considered when trying to advance and expand a telehealth program. 1) Patient and clinician buy-in: Past telehealth experiences should be considered when advancing the system, such as negative clinician experiences with outdated technology. Expansion of services in orthopaedics, dermatology, and psychiatry were found to have particular benefit in Yukon by clinicians specializing in these areas. 2) Workflow: The use and scheduling of telehealth should be streamlined and automated as much as possible to reduce dependencies on the single Yukon Telehealth Coordinator. 3) Access to telehealth technology: Clinicians and patients should have easy access to telehealth technology, whether it is telehealth units or alternative desktop applications. The use of consumer products, such as mobile technology, should be leveraged as appropriate. 4) Infrastructure: The required human resources and technology need to be established when expanding and advancing telehealth. Conclusions: While clinicians and patients have generally positive perceptions of the Yukon Telehealth System, there was consensus that it was underutilized. Many opportunities exist to significantly expand the types of telehealth services and the number of telehealth sessions. The lessons learned from this evaluation can be applied to other remote communities to realize telehealth’s potential as a means for efficient, safe, convenient, and cost-effective care delivery.
Background: Routinely recorded electronic health records (EHRs) from general practitioners (GPs) are increasingly available and provide valuable data for estimating incidence and prevalence rates of d...
Background: Routinely recorded electronic health records (EHRs) from general practitioners (GPs) are increasingly available and provide valuable data for estimating incidence and prevalence rates of diseases in the population. Objective: This paper describes how we developed an algorithm to construct episodes of illness based on EHR data to calculate morbidity rates. Methods: The algorithm was developed in discussion rounds with two expert groups and tested with data from NIVEL Primary Care Database, which consisted of a representative sample of 219 general practices, covering a total population of 867,140 listed patients in 2012. Morbidity data were used from EHRs in the period 2010-2012, including recorded ICPC coded episodes of care, encounters and prescriptions. Results: All 685 symptoms and diseases of ICPC-1 were categorized as acute symptoms/diseases, long-lasting reversible diseases, and chronic diseases. Based on knowledge of the duration of a disease, for each category an algorithm was developed to construct episodes of illness. Compared with recorded episodes of care, for acute and long-lasting diseases, applying the algorithm resulted in a reduction of both the number and average duration of the episodes up to 53% and 94%, respectively. On the other hand, for chronic diseases, the algorithm resulted in a slight increase in the number of episodes as well as the episode duration. Conclusions: An algorithm was developed to construct episodes of illness based on routinely recorded EHR data to estimate morbidity rates. The algorithm constitutes a simple and uniform way of using EHR data and can easily be applied in other registries.
Background: In the past, dental patient satisfaction has been measured by the dentist's technical competence and mechanical precision2. Patient's opinion played no part in this method of measuring qua...
Background: In the past, dental patient satisfaction has been measured by the dentist's technical competence and mechanical precision2. Patient's opinion played no part in this method of measuring quality. Consequently, consideration of patient's satisfaction became an integral part of providing dental services3. Some patients want a dentist who listens to them, has a friendly caring attitude, discuses treatment options and procedures, and gives confidence7. Communication skills, a component of empathy, have been shown to be important in limiting patient's dissatisfaction12. The self-rated oral health status might be considered as the key factor of patient’s satisfaction and positive feedback. Objective: To achieve high levels of patient's satisfaction, it is crucial to find out which items patients consider important and how they operationalize these items 17. Finally, medical care cannot be of high quality, unless patients’ satisfaction is observed. Methods: A 22-item patient's satisfaction questionnaire was designed. The questionnaire was used to obtain data from patients who were then currently receiving care in the College of Dentistry, Qassim University, KSA after minimum of three visits to the dental chair. Two hundred and fifty copies of the questionnaire were distributed equally in both male and female sections over four months period (March-August 2017). Results: A total of 250 questionnaire papers were distributed of which 215 were returned for a response rate of 86%. The response rate in male section was (94%) higher than that in female section (78%) at College of Dentistry, Qassim University, KSA. Overall ranking of factors related to satisfaction was done by calculating the mean percentage of agreement regarding the different disciplines of satisfaction among the studied group. The mean percentage of agreement for the 3 disciplines was 82.5% denoting a high level of satisfaction. Conclusions: Results indicated that the majority of patients were satisfied with the provided dental service at College of Dentistry, Qassim University, KSA. Patient dentist interaction and Technical competency had the most significant effect on patient satisfaction levels in this study . On the other hand, Administrative efficiency (AE) and Clinical setup environment (CS) were the factor that had the most impact on levels of dissatisfaction. In this study, no significant differences were observed between the satisfaction score and Nationality of the patients. The only significant finding observed for the satisfaction score was gender .While there was a significant differences regarding satisfaction between both genders . Clinical Trial: The Research Ethics Committee and Research & Presentation Skills Supervision Committee at College of Dentistry, Qassim University, KSA approved this study (Code #:EA/203/2017) and (SRPSSC #: M-5003-17) . The waiver of the informed consent process was approved on the basis of the questionnaires being anonymous and self-administered and containing no identifiers.