Patient-to-physician messaging: volume nearly tripled as more patients joined system, but per capita rate plateaued.

Patients want to be able to communicate with their physicians by e-mail. However, physicians are often concerned about the impact that such communications will have on their time, productivity, and reimbursement. Typically, physicians are not reimbursed for time spent communicating with patients electronically.

Reuse of clinical data.

Objectives: To provide an overview of the benefits of clinical data collected as a by-product of the care process, the potential problems with large aggregations of these data, the policy frameworks that have been formulated, and the major challenges in the coming years.

Methods: This report summarizes some of the major observations from AMIA and IMIA conferences held on this admittedly broad topic from 2006 through 2013. This report also includes many unsupported opinions of the author.

What do physicians read (and ignore) in electronic progress notes?

Objective: Several studies have documented the preference for physicians to attend to the impression and plan section of a clinical document. However, it is not clear how much attention other sections of a document receive. The goal of this study was to identify how physicians distribute their visual attention while reading electronic notes.

Acceptance and use of health information technology by community-dwelling elders.

Objectives: With the worldwide population growing in age, information technology may help meet important needs to prepare and support patients and families for aging. We sought to explore the use and acceptance of information technology for health among the elderly by reviewing the existing literature.

Methods: Review of literature using PubMed and Google Scholar, references from relevant papers, and consultation with experts.

Factors associated with ordering laboratory monitoring of high-risk medications.

Background: Knowledge about factors associated with provider ordering of appropriate testing is limited.

Objective: To determine physician factors associated with ordering recommended laboratory monitoring tests for high-risk medications.

Methods: Retrospective cohort study of patients prescribed a high-risk medication requiring laboratory monitoring in a large multispecialty group practice between 1 January 2008 and 31 December 2008.

Advantages and limitations of anticipating laboratory test results from regression- and tree-based rules derived from electronic health-record data.

Laboratory testing is the single highest-volume medical activity, making it useful to ask how well one can anticipate whether a given test result will be high, low, or within the reference interval ("normal"). We analyzed 10 years of electronic health records--a total of 69.4 million blood tests--to see how well standard rule-mining techniques can anticipate test results based on patient age and gender, recent diagnoses, and recent laboratory test results.

The 2013 symposium on pathology data integration and clinical decision support and the current state of field.

Background: Pathologists and informaticians are becoming increasingly interested in electronic clinical decision support for pathology, laboratory medicine and clinical diagnosis. Improved decision support may optimize laboratory test selection, improve test result interpretation and permit the extraction of enhanced diagnostic information from existing laboratory data. Nonetheless, the field of pathology decision support is still developing.

Meta-analysis of loci associated with age at natural menopause in African-American women.

Age at menopause marks the end of a woman's reproductive life and its timing associates with risks for cancer, cardiovascular and bone disorders. GWAS and candidate gene studies conducted in women of European ancestry have identified 27 loci associated with age at menopause. The relevance of these loci to women of African ancestry has not been previously studied.

OpenNotes: hospitalists' challenge and opportunity.

At a time of societal fascination both with transparency and the explosion of health information technologies, a growing number of hospitals are offering, or will soon offer patients and their family instantaneous access to their doctors' and nurses' notes. What will this new opportunity for patient engagement mean for the hospitalist? Today, state and federal government regulations either encourage or require healthcare providers to grant patients access to their clinical information. But despite the rules embedded in the federal Health Insurance Portability and Accountability Act (HIPAA), patients often face time-consuming obstacles in their quest for access, and many providers view compliance as a burden.

A randomized trial of population-based clinical decision support to manage health and resource use for Medicaid beneficiaries.

To determine whether a clinical decision support system can favorably impact the delivery of emergency department and hospital services. Randomized clinical trial of three clinical decision support delivery modalities: email messages to care managers (email), printed reports to clinic administrators (report) and letters to patients (letter) conducted among 20,180 Medicaid beneficiaries in Durham County, North Carolina with follow-up through 9 months. Patients in the email group had fewer low-severity emergency department encounters vs.

Patient completion of laboratory tests to monitor medication therapy: a mixed-methods study.

Background: Little is known about the contribution of patient behavior to incomplete laboratory monitoring, and the reasons for patient non-completion of ordered laboratory tests remain unclear.

Objective: To describe factors, including patient-reported reasons, associated with non-completion of ordered laboratory tests.

Design: Mixed-Methods study including a quantitative assessment of the frequency of patient completion of ordered monitoring tests combined with qualitative, semi-structured, patient interviews.

Evaluation of computer-based medical histories taken by patients at home.

The authors developed a computer-based general medical history to be taken by patients in their homes over the internet before their first visit with their primary care doctor, and asked six doctors and their participating patients to assess this history and its effect on their subsequent visit. Forty patients began the history; 32 completed the history and post-history assessment questionnaire and were for the most part positive in their assessment; and 23 continued on to complete their post-visit assessment questionnaire and were for the most part positive about the helpfulness of the history and its summary at the time of their visit with the doctor. The doctors in turn strongly favored the immediate, routine use of two modules of the history--the family and social histories--for all their new patients.

Using Digital Crumbs from an Electronic Health Record to identify, study and improve health care teams.

We have developed a novel approach, the Digital Crumb Investigator, for using data collected as a byproduct of Electonic Health Record (EHR) use to help define care teams and care processes. We are developing tools and methods to utilize these routinely collected data to visualize and quantify care networks across acute care and ambulatory settings We have chosen a clinical care domain where clinicians use EHRs in their offices, on the maternity wards and in the neonatal intensive care units as a test paradigm for this technology. The tools and methods we deliver should readily translate to other health care settings that collect behind-the-scenes electronic metadata such as audit trails.

Development and evaluation of an ontology for guiding appropriate antibiotic prescribing.

Objectives: To develop and apply formal ontology creation methods to the domain of antimicrobial prescribing and to formally evaluate the resulting ontology through intrinsic and extrinsic evaluation studies.

Methods: We extended existing ontology development methods to create the ontology and implemented the ontology using Protégé-OWL. Correctness of the ontology was assessed using a set of ontology design principles and domain expert review via the laddering technique.

A quantitative analysis of optimal treatment capacity for perinatal asphyxia.

Objective: In centers electing to offer therapeutic hypothermia for treating hypoxic-ischemic encephalopathy (HIE), determining the optimal number of cooling devices is not straightforward. The authors used computer-based modeling to determine the level of service as a function of local HIE caseload and number of cooling devices available.

Methods: The authors used discrete event simulation to create a model that varied the number of HIE cases and number of cooling devices available.

Online access and literacy in Maori New Zealanders with diabetes.

Introduction: Online web-based interventions can be effective ancillary tools for managing diabetes. There is a high prevalence of diabetes in New Zealand Maori, and yet this group has generally been a low priority for web-based interventions due to perceptions of low Internet access and Internet literacy.

Aim: To assess Internet access and literacy in New Zealanders with diabetes, especially high-risk Maori.

Integrating direct electronic collection of data from patients into the process of care for eye care professionals.

Enabling collection of clinical data directly from patients has the potential to increase data accuracy and augment patient engagement in the care process. Most patient data entry systems have been created independent of electronic health records, and few studies have explored how patient entered data can be integrated in the documentation of a clinical encounter. In this paper we describe a formative evaluation study using three different methodologies through which we identified requirements for direct data entry by patients and the subsequent incorporation of these data into the documentation process.

Improving Medication Adherence in a Regional Healthcare Information Exchange using a Scalable, Claims-Driven, and Service-Oriented Approach.

Evidence-based pharmacotherapy is a central aspect of optimal patient care for many chronic conditions. However, medication non-adherence frequently inhibits the attainment of optimal pharmacotherapy regimens. In this study, we designed, developed, and implemented a multifaceted clinical decision support (CDS) intervention that supports evidence-based pharmacotherapy and enhanced medication adherence through the use of a scalable, claims-driven, and service-oriented approach.

Clinical and economic results from a randomized trial of clinical decision support in a rural health network.

Background: Replication studies evaluate technologies in usual use settings.

Methods: We conducted a clinical trial to determine whether reductions in clinical and economic results observed in a previous study could be replicated in a larger setting. Subjects were randomized to receive intervention (email notifications for sentinel health events sent to their care managers) or control.

Test-retest reliability in a computer-based medical history.

The authors developed a computer-based medical history for patients to take in their homes via the internet. The history consists of 232 'primary' questions asked of all patients, together with more than 6000 questions, explanations, and suggestions that are available for presentation as determined by a patient's responses. The purpose of this research was to measure the test-retest reliability of the 215 primary questions that have preformatted, mutually exclusive responses of 'Yes,' 'No,' 'Uncertain (Don't know, Maybe),' 'Don't understand,' and 'I'd rather not answer.

Diagnostic, surgical judgment, and systems issues leading to reoperation: mining administrative databases.

Background: Underreporting of surgical adverse events limits the ability to identify quality and safety issues. Automated screening of the clinical information system (CIS) can improve case capture and reduce dependency on self-reporting. We compared screening of a CIS to self-reporting for identifying unplanned reoperation and also examined the relationship between causality and probability of reporting.