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On October 31, 2021, I learned the electronic health record in my independent, solo practice had been attacked by a Russian syndicate who was holding our data and our practice management system for 'ransom.' An encryption key could be given to our cloud provider once $5,100,000 was delivered in bitcoin to the hacking entity. After 3 long months of negotiations, with us going back to a completely paper-based system in the interim, our cloud provider paid the Russian syndicate and access was restored. There were many lessons to be learned from our experience. We were fortunate, and through the help of many of our business associates we were able to survive and live to see another day. Key words: ransomware attack; independent practice; cloud-based data storage; HIPPA violations, I have been in an independent, solo practice for 37 years. I have a staff of 9 employees which includes a nurse practitioner. My usual routine on the weekend is [...]

BACKGROUND/OBJECTIVES: Malnutrition occurs frequently in hospitalized children. We aimed to assess whether a computerized system could lead to improved clinical practices in malnourished children. SUBJECTS/METHODS: Healthcare workers (242) from six departments in a pediatric university hospital participated in a cluster randomized trial, studying 1457 malnourished children hospitalized from September 2009 to August 2011. Following a baseline observational pre-intervention period, all departments were randomized into either intervention or control arms. A computerized malnutrition-screening system was implemented in the intervention group to automatically trigger a dietetic referral in real time. Furthermore, the nutrition support team conducted an awareness campaign with healthcare workers and a leadership-based strategy to reinforce the message during the entire study period. Adherence to practice guidelines (daily weights, investigation of etiology for malnutrition, management by a dietitian and application of refeeding protocols) was compared between pre-and postintervention periods in both the intervention and trial arms. RESULTS: When compared with the pre-intervention period, the clinical practices were significantly improved within the intervention arm for every outcome (P < 0.01), whereas remained unchanged in the control arm. In addition, during the post-intervention period, malnutrition etiology investigation by physicians (adjusted odds ratio (OR) of 4.4, 95% confidence interval (CI) 1.7-11.8, P = 0.003) and management by a dietitian (OR 2.7, 95% CI 1.0-6.9, P = 0.046) occurred more frequently in the intervention clusters. CONCLUSIONS: Implementation of an electronic system to detect malnutrition in real time was associated with a rapid improvement in clinical practices for better care of hospitalized children. European Journal of Clinical Nutrition (2015) 69, 769-775; doi:10.1038/ejcn.2014.288; published online 4 February 2015, INTRODUCTION Malnutrition is frequent among hospitalized children, reaching rates of up to 20% in Europe and North America. (1-5) By altering metabolism and organ function, malnutrition increases complications and the [...]

In today's technology-filled world, we have become dependent on the Internet for everything from doing any research ('Google it'), making travel and restaurant reservations, paying our bills, managing our investments, [...]

Objective: The primary aim of this study was to develop a method of calculating paediatric injury rate from Emergency Department injury surveillance data and use this to describe trends in paediatric injury. This study also aimed to establish whether triage category could be used as an indicator of severity. Methods: Prospective observational study of paediatric injury in Brisbane, Australia from 1998 to 2005 using Emergency Department injury surveillance data. Injury incidence was calculated using postcode restriction, census data and analysis of injury surveillance data quality and alternative hospital presentations. Results: The incidence of Emergency Department injury presentation increased by 56% between 1998 and 2005. The incidence of injury (adjusted for ascertainment and other hospital presentations) increased from 5,323/100,000/year to 8,316/100,000/ year (p Conclusion: Injury incidence can be determined using Emergency Department injury surveillance data and triage category is a useful indicator of injury severity. Paediatric emergency department injury presentations, including serious injury, increased significantly between 1998 and 2005. Implications: The methodology used in this study is easily repeatable and could be used to evaluate injury prevention interventions. The prevention and management of injury should be directed by accurate injury incidence data. Key words: wounds and injuries, triage, incidence, emergencies. doi: 10.1111/j.1753-6405.2010.00524.x

Previously published work has described the development of a hospital capacity simulation tool, PROMPT. PROMPT has now been adopted by a number of hospitals in the UK and is used for both strategic and operational planning and management of key hospital resources. The work, as presented here, extends the PROMPT functionality to consider in more detail workforce issues. In particular, working with some of the current hospital users, the research has focussed on detailed planning for calculating the size and skill-mix of inpatient nursing teams. The chosen methodology utilizes both simulation and optimization. Outputs from the PROMPT three-phase discrete event simulation are fed into a stochastic programme which suggests the optimal number of nurses to employ (whole time equivalents) by skill-mix and the corresponding numbers by shift. A novel feature of the tool is the ability to predict and compare nursing needs based on different methods of capturing patient-to-nurse ratios as currently adopted across the UK National Health Service. Illustrative results from one hospital demonstrate that although the overall sizes of nursing teams on different wards are of an acceptable level and comparable to the outputs from the simulation phase of the work, often the number of nurses employed at different grades is not well matched to patient needs and the skill-mix should be reconsidered. Results from the optimization phase of the work suggest that it is cost beneficial to increase the number of permanently employed nurses to account for fluctuations in demand and corresponding high costs of temporary (agency) nurses. The scenario functionality of the tool permits for the study of changing size and skill-mix as a consequence of changes in patient volumes, patient case-mix, numbers of beds and length of stay. Journal of the Operational Research Society (2010) 61, 768- 779. doi: 10.1057/jors.2009.43 Published online 13 May 2009 Keywords: simulation; stochastic programming; healthcare modelling; nurse skill-mix

The rapid pace of technological change has caused many competitive challenges for hospitals. The emergence of sophisticated technologies in the health care industry determines the important need for continuous and quick changes in organizational activities. New clinical Information Technology is supposed to improve the quality of health care delivery as an innovation. But it is fully naive if any new technology simply considered as an innovation. New technologies flourish as an innovation if the process of introduction and implementation is managed successfully. Also, if a new technology can change the process of health care delivery, it can emerge as an innovation and provides a competitive advantage for hospitals. Otherwise all the effort and investment are doomed to failure. This research as a conceptual study highlights how new clinical IT systems can contribute to organizational performance in hospitals., INTRODUCTION Managers, policy makers, and researchers have paid much attention to the important role of new technologies and innovations for competitiveness and growth. Yet, all new technologies and innovations don't [...]

Objectives. We studied how health information exchange systems are established by examining the decisions (and thus, indirectly, the values) of key stakeholders (health care providers) participating in a health information exchange pilot project in 3 Massachusetts communities. Our aim was to understand how these kinds of information exchanges can be made viable. Methods. We used semistructured interviews to assess health care providers' decision-making processes in selecting technical architectures and vendors for the pilot projects to uncover their needs, expectations, and motivations. Results. Our interviews indicated that, after extensive evaluations, health care providers in all 3 communities eventually selected a hybrid architecture that included a central data repository. However, the reasons for selecting this architecture varied considerably among the 3 communities, reflecting their particular values. Plans to create a community patient portal also differed across communities. Conclusions. Our findings suggest that, to become established, health information exchange efforts must foster trust, appeal to strategic interests of the medical community as a whole, and meet stakeholder expectations of benefits from quality measurements and population health interventions. If health information exchange organizations cannot address these factors, sustainability will remain precarious. doi:10.2105/AJPH.2008.144873)

Objectives. We tested telephone-based disease surveillance systems in local health departments to identify system characteristics associated with consistent and timely responses to urgent case reports. Methods. We identified a stratified random sample of 74 health departments and conducted a series of unannounced tests of their telephone-based surveillance systems. We used regression analyses to identify system characteristics that predicted fast connection with an action officer (an appropriate public health professional). Results. Optimal performance in consistently connecting callers with an action officer in 30 minutes or less was achieved by 31% of participating health departments. Reaching a live person upon dialing, regardless of who that person was, was the strongest predictor of optimal performance both in being connected with an action officer and in consistency of connection times. Conclusions. Health departments can achieve optimal performance in consistently connecting a caller with an action officer in 30 minutes or less and may improve performance by using a telephone-based disease surveillance system in which the phone is answered by a live person at all times.

Byline: Gunnar Ellingsen (Department of Telemedicine and eHealth University of Tromso (UiTo) 9037 Tromso, Norway, gunnar.ellingsen@unn.no); Eric Monteiro (Norwegian University of Science and Technology (NTNU), eric.monteiro@idi.ntnu.no) Keywords: case study; implementation; [...]

This paper describes a new approach for laser bone treatment according to a preoperative plan. The advantages of using laser systems are the free choice of the cutting geometry and the possibility of bone treatment without any severe thermal damage. On the other hand, the control of bone removal depth is difficult. Due to the lack of haptical feedback, it is only possible to control the bone removal visually. In addition, by selecting wrong laser parameters and incorrect handling, the tissue can sustain thermal damage. To solve this problem, an approach of navigated and model-based calculation of depth ablation has been investigated. The focus of this paper was to verify the feasibility of precise and safe laser bone removal by combining navigation information with mathematical and volumetric modeling. For the mathematical modeling, known approaches are used. On the basis of CT data, cavities in a bovine bone were planned with a navigation system. With an optical measurement system, the position of the laser handpiece was calculated relative to the bone. Using a mathematical model, the theoretical cavity depth was calculated for each laser pulse and displayed on the navigation screen. Thereby, the material removal was determined in a volume model. With this information, five cavities were created by the laser using constant energy settings. A final measurement of the cavities' depths showed an error of less than 1 mm. Index Terms--Bone treatment, medical information system, medical laser and medical navigation, medical treatment, power control.

Studies have identified the importance of hospitals' organisational culture in clinical information system diffusion, but few have quantified its role. This study measured organisational culture in two Australian hospitals to explore whether clinicians' perceptions of culture related to their attitudes to, and satisfaction with, a computerised provider order entry system (CPOE). Data were collected using the Organisational Culture Inventory and a user-satisfaction survey administered to a population of 249 clinicians from the two hospitals. One hospital used CPOE to order clinical laboratory and radiology tests and view results, and the other used the test viewing function only, the ordering facility being planned for later implementation. We found a relationship between culture and clinicians' attitudes, with those in the constructive culture hospital more likely to express positive attitudes towards CPOE, whereas those in the agressive/defensive hospital were more likely to be negative. The relationship between culture and attitudes towards clinical information systems should be taken into account when planning for their adoption. Keywords: Australia; Organisational culture; Hospital information systems; Clinical information systems; Computerised provider order entry systems (CPOE)

The ability to collect and disseminate individually identifiable microdata is becoming increasingly important in a number of arenas. This is especially true in health care and national security, where this […]

WE ARE writing in to the article "Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System" by Han et al. (1) The authors are to [...]

Federal law requires hospitals and permits other entities to seek information from the National Practitioner Data Bank (NPDB) but places no requirements on how that information should be used. Our [...]

INTRODUCTION David B. Nash, MD, MBA Internationally recognized for his work in outcomes management, medical staff development, and quality-of-care improvement, David B. Nash is the Dr Raymond C. and Doris [...]

The purpose of this study was to review the state of the art of private sector internal error-reporting systems and to begin to develop a classification system for comparing systems. [...]

Emergency medical care is not a luxury for rich countries or rich individuals in poor countries. This paper makes the point that emergency care can make an important contribution to reducing avoidable death and disability in low- and middle-income countries. But emergency care needs to be planned well and supported at all levels--at the national, provincial and community levels--and take into account the entire spectrum of care, from the occurrence of an acute medical event in the community to the provision of appropriate care at the hospital. The mix of personnel, materials, and health-system infrastructure can be tailored to optimize the provision of emergency care in settings with different levels of resource availability. The misconception that emergency care cannot be cost effective in low-income settings is demonstrably inaccurate. Emergencies occur everywhere, and each day they consume resources regardless of whether there are systems capable of achieving good outcomes. With better planning, the ongoing costs of emergency care can result in better outcomes and better cost-effectiveness. Every country and community can and should provide emergency care regardless of their place in the ratings of developmental indices. We make the case for universal access to emergency care and lay out a research agenda to fill the gaps in knowledge in emergency care. Keywords Emergency medical services/organization and administration; Emergency treatment/organization and administration; Triage; Transportation of patients; Allied health personnel/education; Cost-benefit analysis; Evidence-based medicine; Developing countries (source: MeSH, NLM). Mots cles Service medical urgences/organisation et administration; Traitement urgence/organisation et administration; Orientation patients; Transport sanitaire; Personnel sante auxiliaire/enseignement; Analyse cout benefice; Medecine factuelle; Pays en developpement (source: MeSH, INSERM). Palabras clave Servicios medicos de urgencia/organizacion y administracion; Tratamiento de urgencia/organizacion y administracion; Triaje; Transporte de pacientes; Tecnicos medios en salud/educacion; Analisis de costo-beneficio; Medicina basada en evidencia; Paises en desarrollo (fuente: DeCS, BIREME)., Introduction The goal of an effective emergency medical system should be to provide universal emergency care--that is, emergency care should be available to all who need it. However, there are [...]

Health information systems (HIS) in emergencies face a double dilemma: the information necessary to understand and respond to humanitarian crises must be timely and detailed, whereas the circumstances of these crises makes it challenging to collect it. Building on the technical work of the Health Metrics Network on HIS and starting with a systemic definition of HIS in emergencies, this paper reviews the various data-collection platforms in these contexts, looking at their respective contributions to providing what humanitarian actors need to know to target their intervention to where the needs really are. Although reporting or sampling errors are unavoidable, it is important to identify them and acknowledge the limitations inherent in generalizing data that were collected in highly heterogeneous environments. To perform well in emergencies, HIS require integration and participation. In spite of notable efforts to coordinate data collection and dissemination practices among humanitarian agencies, it is noted that coordination on the ground depends on the strengths and presence of a lead agency, often WHO, and on the commitment of humanitarian agencies to investing resources in data production. Poorly integrated HIS generate fragmented, incomplete and often contradictory statistics, a situation that leads to a misuse of numbers with negative consequences on humanitarian interventions. As a means to avoid confusion regarding humanitarian health statistics, this paper stresses the importance of submitting statistics to a rigorous and coordinated auditing process prior to their publication. The audit trail should describe the various steps of the, data production chains both technically and operationally, and indicate the limits and assumptions under which each number can be used. Finally emphasis is placed on the ethical obligation for humanitarian agencies to ensure that the necessary safeguards on data are in place to protect the confidentiality of victims and minority groups in politically sensitive contexts. Keywords Information systems/organization and administration/standards; Information dissemination; Emergencies; Relief work; Statistics/standards; Data collection/methods; Confidentiality; Interinstitutional relations (source: MeSH, NLM). Mots cles Systeme information/organisation et administration; Diffusion de l&apos;information; Urgences; Aide humanitaire; Statistique/ normes; Collecte donnees/methodes; Confidentialite; Evaluation besoins; Relation interinstitutionnelle (source: MeSH, INSERM). Palabras clave Sistemas de informacion/organizacion y administracion/normas; Diseminacion de la informacion; Urgencias medicas; Sistemas de socorro; Estadistica/normas; Recoleccion de datos/metodos; Confidencialidad; Evaluacion de necesidades; Relaciones interinstitucionales (fuente: DeCS, BIREME)., Introduction The production of health information is an important function of a health system. It has been said that, "health information is what holds a health system together" (1). The [...]

Medication errors are common and harm hospitalized patients. The authors designed and implemented an automated system to complement an existing computerized order entry system by detecting the administration of excessive [...]

The authors used a real-time survey instrument and subsequent focus group among primary care clinicians at a large healthcare system to assess usefulness of automated drug alerts. Of 108 alerts [...]

Electronic prescribing (E-RX) is a component of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). The objective of this study was to identify factors related to physicians' [...]

ABSTRACT The evaluation of new technology in today's health care environment has become a very important issue for hospitals and other health care providers. Much has been written in the [...]

Byline: M. Apkon (1), P. Singhaviranon (2) Keywords: User-computer interface Hospital information systems Task performance and analysis Time and motion studies Abstract: Objective: To test the hypotheses that: (1) integrating information processing tasks using an electronic clinical information system (ECIS) decreases time to complete these tasks by hand and (2) structured data entry encourages generation of more detailed records and capture of specific data elements even when entry is voluntary. Design: Prospective observational time analysis during medical documentation tasks. Retrospective analysis of clinical documentation completed by hand or electronically. Setting: Eleven bed pediatric intensive care unit within an academic medical center. Participants: Five pediatric intensive care medicine attending physicians. Measurements: Compared handwritten and electronic documentation to determine: (1) time spent entering data or composing notes (2) number of descriptors documenting patients' physical exams (3) users' preferences for structured or unstructured data entry (4) frequency of documenting specific data elements related to nutritional support. Results: Documentation time varied by user but not charting method: it took 13% less time to document using the ECIS but this was not significant. Electronic documents were more detailed than handwritten containing 50% more descriptors (17.8+-1.4 vs 11.6+-1.4) overall and some data elements that were not handwritten: information related to nutritional supplementation was recorded in 13% of electronic documents but in none of 89 handwritten documents. Conclusions: Electronic and handwritten documentation consumed equal amounts of time. Structured entry, compared to handwriting, may encourage recording of specific or otherwise unincorporated data elements resulting in a more detailed record. This suggests that user interfaces and decision support components may influence both the types and complexity of clinical data recorded by caregivers. Author Affiliation: (1) Pediatrics and Cellular and Molecular Physiology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520-8064, USA (2) Bronx Lebanon Hospital, Bronx, NY, USA Article History: Received Date: 18/04/2000 Accepted Date: 16/10/2000 Article note: Final revision received: 4 October 2000 Electronic Publication

Byline: Jakob Bardram (1) Keywords: scenario-based design; analysis patterns; computer supported cooperative work; Hospital Information Systems; collaborative scenarios Abstract: Over the past few years, scenario-based design has attained a growing interest as a way to incorporate a focus on the future use of an application into the construction of software. Scenarios have, however, mostly been used in the design of user-interfaces and hence focused on single-user situations. Based on experiences from applying scenarios in the re-design of an Hospital Information System in the Danish healthcare sector, this paper describes how collaborative scenarios can be used in the design of cooperative computer systems and what such col-laborative scenarios should contain. The paper concludes that such scenarios were useful in bridging the gab between understanding collaborative work practices and designing collaborative computer systems. Author Affiliation: (1) Computer Science Department, Aarhus University, Ny Munkegade 116, Bldg. 540, DK-8000, Arhus C., Denmark Article History: Registration Date: 09/10/2004