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My Turn is software used to manage several Covid-19 mass vaccination campaigns in California. The objective of this article is to describe the use of My Turn at two points of dispensing in California and comment on process improvements to reduce manual tasks of six identified processes of vaccination–registration, scheduling, administration, documentation, follow-up, and digital vaccine record–and paper. We reviewed publicly available documents of My Turn and patients vaccinated at George R. Moscone Convention Center in San Francisco and Oakland Coliseum Community Vaccination Clinic. For publicly available documents of My Turn, we examined videos of My Turn on YouTube, and documentation from EZIZ, the website for the California Vaccines for Children Program. For patients, we examined publicly available vaccination record cards on Instagram and Google. At the George R. Moscone Convention Center, 329,608 vaccines doses were given. At the Oakland Coliseum Community Vaccination Clinic, more than 500,000 vaccine doses were administered. The use of My Turn can be used to reduce manual tasks and paper for mass vaccinating patients against Covid-19. [ABSTRACT FROM AUTHOR]

Cardiovascular Disease (CVD) is one of the most catastrophic and life threatening health issue nowadays. Early detection of CVD is an important solution to reduce its devastating effects on health. In this paper, an efficient CVD detection algorithm is identified. The algorithm uses patient demographic data as inputs, along with several ECG signal features extracted automatically through signal processing techniques. Cross-validation results show a 98.29 % accuracy for the decision tree classification algorithm. The algorithm has been integrated into a web based system that can be used at anytime by patients to check their heart health status. At one end of the system is the ECG sensor attached to the patient's body, while at the other end is the detection algorithm. Communication between the two ends is done through an Android application. [ABSTRACT FROM AUTHOR]

Embedding of diagnostic and health care information requires secure encryption and watermarking. This research paper presents a comprehensive study for the behavior of some well established watermarking algorithms in frequency domain for the preservation of stroke-based diagnostic parameters. Two different sets of watermarking algorithms namely: two correlation-based (binary logo hiding) and two singular value decomposition (SVD)-based (gray logo hiding) watermarking algorithms are used for embedding ownership logo. The diagnostic parameters in atherosclerotic plaque ultrasound video are namely: (a) bulb identification and recognition which consists of identifying the bulb edge points in far and near carotid walls; (b) carotid bulb diameter; and (c) carotid lumen thickness all along the carotid artery. The tested data set consists of carotid atherosclerotic movies taken under IRB protocol from University of Indiana Hospital, USA-AtheroPoint™ (Roseville, CA, USA) joint pilot study. ROC (receiver operating characteristic) analysis was performed on the bulb detection process that showed an accuracy and sensitivity of 100 % each, respectively. The diagnostic preservation (DP) for SVD-based approach was above 99 % with PSNR (Peak signal-to-noise ratio) above 41, ensuring the retention of diagnostic parameter devalorization as an effect of watermarking. Thus, the fully automated proposed system proved to be an efficient method for watermarking the atherosclerotic ultrasound video for stroke application. [ABSTRACT FROM AUTHOR]

The Med AppJam is a 2-week long competition where students from the University of California, Irvine School of Medicine are partnered with students from the University of California, Irvine School of Information and Computer Sciences in interprofessional teams to develop mobile health applications for use by clinicians and patients. The success of the Med AppJam comes from the unique opportunity for students to mutually contribute their content expertise to improve the clinical landscape while expanding their technology literacy and savvy. Since 2012, about 285 computer science students and over 90 medical students have collaborated to design and develop 53 iOS mHealth apps during the event. The Med AppJam model has been replicated in an Autism AppJam, a competition focused on the needs of a specific population, and with high school students in a mini Pre-Med AppJam using a paper prototyping approach. It is proposed that other medical schools consider implementation of a local Med AppJam as a viable model for engaging students in technology for healthcare. [ABSTRACT FROM AUTHOR]

Anesthesia workspaces are integral components in the chains of many intraoperative bacterial transmission events resulting in surgical site infections (SSI). Matched cohort designs can be used to compare SSI rates among operating rooms (ORs) with or without capital equipment purchases (e.g., new anesthesia machines). Patients receiving care in intervention ORs (i.e., with installed capital equipment) are matched with similar patients receiving care in ORs lacking the intervention. We evaluate statistical power of an alternative design for clinical trials in which, instead, SSI incidences are compared directly among ORs (i.e., the ORs form the clusters) at single hospitals (e.g., the 5 ORs with bactericidal lights vs. the 5 other ORs). Data used for parameter estimates were SSI for 24 categories of procedures among 338 hospitals in the State of California, 2015. Estimated statistical power was ≅8.4% for detecting a reduction in the incidence of SSI from 3.6% to 2.4% over 1 year with 5 intervention ORs and 5 control ORs. For ≅80% statistical power, >20 such hospitals would be needed to complete a study in 1 year. Matched paired cluster designs pair similar ORs (e.g., 2 cardiac ORs, 1 to intervention and 1 to control). With 5 pairs, statistical power would be even less than the estimated 8.4%. Cluster designs (i.e., analyses by OR) are not suitable for comparing SSI among ORs at single hospitals. Even though matched cohort designs are non-randomized and thus have lesser validity, matching patients by their risk factors for SSI is more practical. [ABSTRACT FROM AUTHOR]

The Epic electronic health record (EHR) platform supports structured data entry systems (SDES), which allow developers, with input from users, to create highly customized patient-record templates in order to maximize data completeness and to standardize structure. There are many potential advantages of using discrete data fields in the EHR to capture data for secondary analysis and epidemiological research, but direct data acquisition from clinicians remains one of the largest obstacles to leveraging the EHR for secondary use. Physician resistance to SDES is multifactorial. A 35-item questionnaire based on Unified Theory of Acceptance and Use of Technology, was used to measure attitudes, facilitation, and potential incentives for adopting SDES for clinical documentation among 25 pediatric specialty physicians and surgeons. Statistical analysis included chi-square for categorical data as well as independent sample t-tests and analysis of variance for continuous variables. Mean scores of the nine constructs demonstrated primarily positive physician attitudes toward SDES, while the surgeons were neutral. Those under 40 were more likely to respond that facilitating conditions for structured entry existed as compared to the two older age groups ( p = .02). Pediatric surgeons were significantly less positive than specialty physicians about SDES effects on Performance ( p = .01) and the effect of Social Influence ( p = .02); but in more agreement that use of forms was voluntary ( p = .02). Attitudinal differences likely reflect medical training, clinical practice workflows, and division specific practices. Identified resistance indicate efforts to increase SDES adoption should be discipline-targeted rather than a uniform approach. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the costs and benefits of joining a nascent health information exchange (HIE) from the perspective of potential provider organization participants. Topics covered include the concerns about HIE increasing the risk of data security breaches, the need for state and federal governments to consider subsidies to sustain HIE and the importance of coordinating HIE policies with those of founding organizations.

The article discusses a study which described lessons on the early implementation of one Nationwide Health Information Network (NHIN) site in Long Beach, California during its first year of operation. Topics covered include the inefficiency of patient information sharing methods, the opportunity provided by the Long Beach Network for Health (LBNH) to examine the factors influencing health information exchanges and the conduct of interviews among organizations that participate in LBNH.

The article presents a study which developed a Picture Exchange Communicating System (PECS) that can be used as a part of therapy for children with autism spectrum disorders (ASD). Topics covered include the special features of the PixTalk Communication System developed by the researchers, details relating to the touch-screen smart-phone application and companion website of PixTalk, and the findings obtained after comparing PixTalk with traditional PECS.

Hospital competition and managed care have negatively affected hospital profitability. In the current turbulent health care environment in the U.S., hospitals in California have argued that the rate of increase in hospital costs is faster than the rate of increase in hospital revenues. By employing Medicare case mix indexes (CMIs) as a primary policy variable, this study found that the coefficients for CMIs in hospital costs for Medicare patients were smaller than those in hospital revenues in the years of 1986, 1989 and 1998. However, the coefficients for CMIs in hospital costs for Medicare patients were greater than those in hospital revenues in the years of 1992 and 1995. Although there were some differences between the coefficients for CMIs in hospital costs and revenues for Medicare patients, those differences found to be statistically insignificant. In spite of claims on behalf of Californian hospitals, the rate of increase in hospital costs for Medicare patients had not been greater than that of hospital revenues for Medicare patients. [ABSTRACT FROM AUTHOR]

Competition among hospitals and managed care have forced hospital industry to be more efficient. With higher degrees of hospital competition and managed care penetration, hospitals have argued that the rate of increase in hospital cost is greater than the rate of increase in hospital revenue. By developing a payer-specific case mix index (CMI) for third-party patients, this paper examined the effect of hospital case mix on hospital cost and revenue for third-party patients in California using the hospital financial and utilization data covering 1986-1998. This study found that the coefficients for CMIs in the third-party hospital revenue model were greater than those in the hospital cost model until 1995. Since 1995, however, the coefficients for CMIs in the third-party hospital revenue model have been less than those in hospital cost models. Over time, the differences in coefficients for CMIs in hospital revenue and cost models for third-party patients have become smaller and smaller although those differences are statistically insignificant.

As hardware and software developments make medical information systems increasingly available to physicians office practices and outpatients facilities, there is a need to focus on systems installation and conversion issues. In addition to the detailed step-by-step implementation plan, the overall impact of the new system should be anticipated. The purchasers should consider such issues as new information flow and user communication patterns between patient care and ancillary and support departments; restructuring of fundamental approaches to work allocation for either batch or real-time systems; and new emphasis on any departments vital to problem-spotting and solving. At California Primary Physicians (CPP), an awareness of these changes did not develop until well after the official "live" data had passed and the staff had been successfully using the system for several months. This paper explains how the above issues have emerged and the impact they have had on CPP, and provides a framework for anticipating such matters in any system installation.

This paper presents an overview of a systems approach being implemented within the Kaiser-Permanente Medical Care Program (KPMCP) for the planning of large-scale, integrated health care facilities. This approach was motivated by the increasing change and complexity of factors, both external and internal to KPMCP, that now require more systematic treatment and that before were handled by more intuitive approaches. Among others, these factors include dealing with increasing regulation from government agencies and accommodating the active participation of knowledgeable personnel to ensure the continuation of a progressive and innovative system. Described within, along with more general issues, are various computer models, based upon Kaiser concepts and data that have been developed to facilitate the effective allocation of resources.

A demonstration implementation of a distributed data-processing hospital information system using an intelligent local area communications network (LACN) technology is described. This system is operational at the UCSF Medical Center and integrates four heterogeneous, stand-alone minicomputers. The applications systems are PID/Registration, Outpatient Pharmacy, Clinical Laboratory, and Radiology/Medical Records. Functional autonomy of these systems has been maintained, and no operating system changes have been required. The LACN uses a fiber-optic communications medium and provides extensive communications protocol support within the network, based on the ISO/OSI Model. The architecture is reconfigurable and expandable. This paper describes system architectural issues, the applications environment, and the local area network.