Evaluating the effectiveness of web-based oral health education on enhancing mothers' awareness: a semi-experimental internet-based intervention.

Objectives: This study examined the impact of web-based education on enhancing mothers' awareness of oral health care for children aged 9 and 12 years. It focused on the crucial role of mothers in educating about oral health to prevent dental diseases and reduce long-term healthcare costs.

Methods: Mothers were divided into three groups: control, intervention with a web system, and intervention with a brochure.

Evaluating the effects of mobile application-based rehabilitation on improving disability and pain in patients with disputed thoracic outlet syndrome: A randomized controlled trial.

Background: Disputed thoracic outlet syndrome (D.TOS) stands as one of the primary global contributors to physical disability, presenting diagnostic and treatment challenges for patients and frequently resulting in prolonged periods of pain and functional impairment. Mobile applications emerge as a promising avenue in aiding patient self-management and rehabilitation for D.

Improving medication safety by cloud technology: Progression and value-added applications in Taiwan.

Objectives: To develop and implement an integrated cloud technology with the aim of ensuring medication reconciliation during transitions of care and improve medication safety in aged societies.

Methods: PharmaCloud is a new technical platform adopted by the National Health Insurance Administration of Taiwan to collect patients' medication information via cloud technology. Using this platform, healthcare providers can access patients' medication-related information with patient consent.

Validation of a Crowdsourcing Methodology for Developing a Knowledge Base of Related Problem-Medication Pairs.

Background: Clinical knowledge bases of problem-medication pairs are necessary for many informatics solutions that improve patient safety, such as clinical summarization. However, developing these knowledge bases can be challenging.

Objective: We sought to validate a previously developed crowdsourcing approach for generating a knowledge base of problem-medication pairs in a large, non-university health care system with a widely used, commercially available electronic health record.

Impact of incorporating pharmacy claims data into electronic medication reconciliation.

Purpose: The potential value of adding pharmacy claims data to the medication history in the electronic health record (EHR) to improve the accuracy of medication reconciliation was studied.

Methods: Three medication history sources were used for this evaluation: a gold-standard preadmission medication list (PAML) created by reviewing all available medication history information, an EHR-generated PAML, and pharmacy claims data. The study population consisted of patients from the Partners Medication Reconciliation Study with medication history information available from all three medication history sources.

Evaluation of intravenous medication errors with smart infusion pumps in an academic medical center.

While some published research indicates a fairly high frequency of Intravenous (IV) medication errors associated with the use of smart infusion pumps, the generalizability of these results are uncertain. Additionally, the lack of a standardized methodology for measuring these errors is an issue. In this study we iteratively developed a web-based data collection tool to capture IV medication errors using a participatory design approach with interdisciplinary experts.

The Number Needed to Remind: a Measure for Assessing CDS Effectiveness.

Background: Clinical decision support (CDS) is associated with improvement in quality and efficiency in healthcare delivery. The appropriate way to evaluate its effectiveness remains uncertain.

Methods: We analyzed data from our electronic health record (EHR) measuring the display frequency of eight reminders for Coronary Artery disease and Type 2 Diabetes and their associated performance according to a predefined methodology.

Modeling decision support rule interactions in a clinical setting.

Traditionally, rule interactions are handled at implementation time through rule task properties that control the order in which rules are executed. By doing so, knowledge about the behavior and interactions of decision rules is not captured at modeling time. We argue that this is important knowledge that should be integrated in the modeling phase.

Design of decision support interventions for medication prescribing.

Objective: Describe optimal design attributes of clinical decision support (CDS) interventions for medication prescribing, emphasizing perceptual, cognitive and functional characteristics that improve human-computer interaction (HCI) and patient safety.

Methods: Findings from published reports on success, failures and lessons learned during implementation of CDS systems were reviewed and interpreted with regard to HCI and software usability principles. We then formulated design recommendations for CDS alerts that would reduce unnecessary workflow interruptions and allow clinicians to make informed decisions quickly, accurately and without extraneous cognitive and interactive effort.

Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA.

In response to mounting evidence that use of electronic medical record systems may cause unintended consequences, and even patient harm, the AMIA Board of Directors convened a Task Force on Usability to examine evidence from the literature and make recommendations. This task force was composed of representatives from both academic settings and vendors of electronic health record (EHR) systems. After a careful review of the literature and of vendor experiences with EHR design and implementation, the task force developed 10 recommendations in four areas: (1) human factors health information technology (IT) research, (2) health IT policy, (3) industry recommendations, and (4) recommendations for the clinician end-user of EHR software.

A study of diverse clinical decision support rule authoring environments and requirements for integration.

Background: Efficient rule authoring tools are critical to allow clinical Knowledge Engineers (KEs), Software Engineers (SEs), and Subject Matter Experts (SMEs) to convert medical knowledge into machine executable clinical decision support rules. The goal of this analysis was to identify the critical success factors and challenges of a fully functioning Rule Authoring Environment (RAE) in order to define requirements for a scalable, comprehensive tool to manage enterprise level rules.

Methods: The authors evaluated RAEs in active use across Partners Healthcare, including enterprise wide, ambulatory only, and system specific tools, with a focus on rule editors for reminder and medication rules.

Interface design principles for usable decision support: a targeted review of best practices for clinical prescribing interventions.

Developing effective clinical decision support (CDS) systems for the highly complex and dynamic domain of clinical medicine is a serious challenge for designers. Poor usability is one of the core barriers to adoption and a deterrent to its routine use. We reviewed reports describing system implementation efforts and collected best available design conventions, procedures, practices and lessons learned in order to provide developers a short compendium of design goals and recommended principles.

Policies for patient access to clinical data via PHRs: current state and recommendations.

Objective: Healthcare delivery organizations are increasingly using online personal health records (PHRs) to provide patients with direct access to their clinical information; however, there may be a lack of consistency in the data made available. We aimed to understand the general use and functionality of PHRs and the organizational policies and decision-making structures for making data available to patients.

Materials And Methods: A cross-sectional survey was administered by telephone structured interview to 21 organizations to determine the types of data made available to patients through PHRs and the presence of explicit governance for PHR data release.

Tailored prevention of inpatient falls: development and usability testing of the fall TIPS toolkit.

Patient falls and fall-related injuries are serious problems in hospitals. The Fall TIPS application aims to prevent patient falls by translating routine nursing fall risk assessment into a decision support intervention that communicates fall risk status and creates a tailored evidence-based plan of care that is accessible to the care team, patients, and family members. In our design and implementation of the Fall TIPS toolkit, we used the Spiral Software Development Life Cycle model.

Scales for assessing self-efficacy of nurses and assistants for preventing falls.

Aim: This paper is a report of the development and testing of the Self-Efficacy for Preventing Falls Nurse and Assistant scales.

Background: Patient falls and fall-related injuries are traumatic ordeals for patients, family members and providers, and carry a toll for hospitals. Self-efficacy is an important factor in determining actions persons take and levels of performance they achieve.

Tailored prevention of inpatient falls: development and usability testing of the fall TIPS toolkit.

Patient falls and fall-related injuries are serious problems in hospitals. The Fall TIPS application aims to prevent patient falls by translating routine nursing fall risk assessment into a decision support intervention that communicates fall risk status and creates a tailored evidence-based plan of care that is accessible to the care team, patients, and family members. In our design and implementation of the Fall TIPS toolkit, we used the Spiral Software Development Life Cycle model.

Effectiveness of interruptive alerts in increasing application functionality utilization: a controlled trial.

Medical applications frequently contain a wide range of functionalities. Users are often unaware of all of the functionalities available. More effective ways of delivering information about available functionalities to the users are needed.

Complementary methods of system usability evaluation: surveys and observations during software design and development cycles.

Poor usability of clinical information systems delays their adoption by clinicians and limits potential improvements to the efficiency and safety of care. Recurring usability evaluations are therefore, integral to the system design process. We compared four methods employed during the development of outpatient clinical documentation software: clinician email response, online survey, observations and interviews.

USB-based Personal Health Records: an analysis of features and functionality.

Purpose: To determine the features of commercially available USB-based Personal Health Records (PHR) devices, and compare the commercial state of the art to recommendations made by certification committees.

Methods: Thirteen USB-based PHRs were identified and analyzed based on data elements used and features provided. Marketing techniques used by the companies were also explored.

Assessment of pictographs developed through a participatory design process using an online survey tool.

Background: Inpatient discharge instructions are a mandatory requirement of the Centers for Medicare and Medicaid Services and Joint Commission on Accreditation of Healthcare Organizations. The instructions include all the information relevant to post-discharge patient care. Prior studies show that patients often cannot fully understand or remember all the instructions.

Comparison of information content of structured and narrative text data sources on the example of medication intensification.

OBJECTIVE To compare information obtained from narrative and structured electronic sources using anti-hypertensive medication intensification as an example clinical issue of interest. DESIGN A retrospective cohort study of 5,634 hypertensive patients with diabetes from 2000 to 2005. MEASUREMENTS The authors determined the fraction of medication intensification events documented in both narrative and structured data in the electronic medical record.

Survey analysis of patient experience using a practice-linked PHR for type 2 diabetes mellitus.

Patient experience was assessed by survey as part of a large, randomized controlled trial of a secure, practice-linked personal health record called Patient Gateway at Partners HealthCare in Boston, MA. The subjects were patients with Type 2 diabetes who prepared for their upcoming primary care visit using a previsit electronic journal. The journal generated a diabetes care plan using patient chart information and patient responses to questions in preparation for a scheduled office visit.