Journal of the American Medical Informatics Association : JAMIA
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J Am Med Inform Assoc · Jul 2013
The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals.
Effective clinical communication is critical to providing high-quality patient care. Hospitals have used different types of interventions to improve communication between care teams, but there have been few studies of their effectiveness. ⋯ Interventions that aimed to improve clinical communications solved some but not all problems, and unintended effects were seen with all systems.
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J Am Med Inform Assoc · Jul 2013
Multicenter StudyComputerized provider documentation: findings and implications of a multisite study of clinicians and administrators.
Clinical documentation is central to the medical record and so to a range of healthcare and business processes. As electronic health record adoption expands, computerized provider documentation (CPD) is increasingly the primary means of capturing clinical documentation. Previous CPD studies have focused on particular stakeholder groups and sites, often limiting their scope and conclusions. To address this, we studied multiple stakeholder groups from multiple sites across the USA. ⋯ CPD has dramatically changed documentation processes, impacting clinical understanding, decision-making, and communication across multiple groups. The need for easy and rapid, yet structured and constrained, documentation often conflicts with the need for highly reliable and retrievable information to support clinical reasoning and workflows. Current CPD systems, while better than paper overall, often do not meet the needs of users, partly because they are based on an outdated 'paper-chart' paradigm. These findings should inform those implementing CPD systems now and future plans for more effective CPD systems.
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J Am Med Inform Assoc · Jul 2013
Predicting complications of percutaneous coronary intervention using a novel support vector method.
To explore the feasibility of a novel approach using an augmented one-class learning algorithm to model in-laboratory complications of percutaneous coronary intervention (PCI). ⋯ The OP-SVM algorithm based on an augmented one-class learning problem improved discrimination and calibration across different PCI complications relative to LR and traditional support vector machine classification. Such an approach may have value in a broader range of clinical domains.