Applied clinical informatics
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Effective communication is essential to safe and efficient patient care. Additionally, many health information technology (HIT) developments, innovations, and standards aim to implement processes to improve data quality and integrity of electronic health records (EHR) for the purpose of clinical information exchange and communication. ⋯ Electronic documentation tools that, in real time, capture information that is currently verbally communicated may increase the effectiveness of communication.
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To document the perceived frequency, type, and impact of unavailable ("missing") clinical information during pediatric emergency and general ambulatory encounters. ⋯ Pediatric physicians more commonly experience missing information at general ambulatory visits than emergency visits and report that missing information adversely impacts quality, efficiency, their confidence in care, patient and family satisfaction, and leads to potentially redundant resource utilization.
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This study tested the hypothesis that lactate testing in ED sepsis patients could be increased using a computer alert that automatically recognizes systemic inflammatory response syndrome (SIRS) criteria and recommends lactate testing in cases of sepsis defined as ≥2 SIRS criteria plus physician suspicion of infection. Secondary outcomes included the effect of the alert on lactate testing among admitted sepsis patients, the proportion of admitted patients with lactate ≥4.0 mmol/L identified and the in-patient mortality difference before and after alert implementation. ⋯ The proportion of ED patients who had lactate tested and the number of admitted patients identified with a lactate level ≥4.0 mmol/L improved significantly after the implementation of a computer alert identifying sepsis patients with >2 SIRS criteria while mortality among admitted sepsis patients remained unchanged.
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Spain's health services have undertaken a number of important projects aimed at the creation of Electronic Health Records (EHR) through the incorporation of Information and Communication Technologies (ICT) into patient care practices. The objective of this endeavor is to improve care quality and efficiency and increase responsiveness to the population's needs and demands. Between 2006-2009 over 300 million Euro were invested in projects of this type. ⋯ All of Spain's health services are currently carrying out projects involving ICT application in healthcare, and a priori the benefits of ICT are not questioned. However, the costs and time frames required for these projects are clearly surpassing initial expectations, while the benefits perceived by both professionals and institutions remain limited. This situation may be due in part to the absence of a project management culture in the health services, which has led them to pay insufficient attention to the main difficulties and key issues related to the implementation of EHR.