Informatics in Primary Care (BCS, The Chartered Institute for IT)
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Reliability of heart rate mobile apps in young healthy adults: exploratory study and research directions
Full text linkBackground: Recently, a number of smartphone apps appeared that allow for heart rate measurements basing on the photoplethysmography principle. In fact, almost every smartphone now has a camera with flash that could be used for that. Some studies appeared on the reliability of some of those apps, with heterogeneous results.Objectives: The present study aims at adding up evidence in particular during physical activity, by comparing 3 apps on two different platforms (IOs and Android), on a broad range of heart rates. As gold standard, heart rate has been measured with a traditional heart rate monitor.Results: The results suggest that heart rate apps might be used for measuring heart rate for fitness aims for many individuals, but further research is needed to i) analyse influence of smartphone features; ii) identify personal factors hindering measurements, and iii) verify reliability on different measurement sites
Methods to Describe Referral Patterns in a Canadian Primary Care Electronic Medical Record Database: Modelling Multilevel Count Data
Full text linkBackground: A referral from a family physician (FP) to a specialist is an inflection point in the patient journey, with potential implications for clinical outcomes and health policy. Primary care electronic medical record (EMR) databases offer opportunities to examine referral patterns. Until recently, software techniques were not available to model these kinds of multi-level count data. Objective: To establish methodology for determining referral rates from FPs to medical specialists using the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) EMR database. Method: Retrospective cohort study, mixed effects and multi-level negative binomial regression modelling with 87,258 eligible patients between 2007 and 2012. Mean referrals compared by patient sex, age, chronic conditions, FP visits, and urban/rural practice location. Proportion of variance in referral rates attributable to the patient and practice levels. Results: On average, males had 0.26, and females 0.31 referrals in a 12-month period. Referrals were significantly higher for females, increased with age, FP visits, and number of chronic conditions (p<.0001). Overall, 14% of the variance in referrals could be attributed to the practice level, and 86% to patient level characteristics. Conclusions: Both patient and practice characteristics influenced referral patterns. The methodologic insights gained from this study have relevance to future studies on many research questions that utilize count data, both within primary care and broader health services research. The utility of the CPCSSN database will continue to increase in tandem with data quality improvements, providing a valuable resource to study Canadian referral patterns over time
Lack of Diversity in Personal Health Record Evaluations with Older Adult Participants: A Systematic Review of Literature
Full text linkBackground: Older adults are not adopting personal health records (PHRs) at the same rates as other adult populations. Disparities in adoption rates are also reported in older adult subgroups. The variability in adoption may be because PHRs are not designed to meet older adult users.Objective: We analyzed PHR evaluation studies to examine the characteristics and perspectives of older adult study participants to identify their self-reported needs.Method: We searched Medline, CINAHL, PsycINFO, and Embase for PHR evaluation studies that involved older adult participants.Results: 1017 abstracts were identified, and 179 publications went through full text review. 10 publications met inclusion criteria. These publications described studies conducted in 3 countries, and evaluated 7 PHRs. Homogeneity was found in the study populations and participant opinions of the systems.Discussion: Many PHR evaluations do not include diverse older adult participants. This may lead to consistency in outcomes, but it also may create gaps in identifying user needs. Additional studies, specifically targeting diverse older adult participants, are needed to gain a more comprehensive understanding of the opinions of older adults on PHRs and how these systems could benefit older adult healthcare consumers.Conclusion: The body of research shows that older adults are highly satisfied using PHRs. These outcomes may be generalizable because most PHR evaluation studies do not include diverse older adult participants. This lack of participant diversity may be contributing to the disparities observed in PHR adoption rates
Attitudes and concerns of doctors and nurses about using a translation application for in-hospital brief interactions with Korean patients
Full text linkBackground: New Zealand is becoming more ethnically diverse, with rising numbers of people with limited English language proficiency. Consequently, hospital interactions are increasing where patients have insufficient English to communicate adequately with doctors or nurses for appropriate, effective, and safe care. Translation technology is rapidly evolving, but evidence is limited regarding its usefulness to clinicians.Objective: To examine the acceptability to doctors and nurses of a translation application (app) used on a tablet, in brief interactions with Korean patients.Method: An app was developed to facilitate brief conversations between patients and clinicians as part of clinical care. We used the Technology Acceptance Model 2 to develop semi-structured interview questions for 15 junior and senior doctors and nurses in an urban hospital. Participants used the app to interact with the interviewer as part of a scenario. The interviews were analysed thematically.Results: The app was easy to use, learn to use, and to memorise for future use. It was considered useful for everyday brief interactions, urgent situations where there is no time to call an interpreter, and after hours, to augment the work of interpreters. Subject to perceived usefulness, there appears to be little need for social normalisation of a translation app, other than management support for the costs, maintenance, and implementation of the app for everyday use. Conclusion: Guidelines are required for the use of a translation app by doctors and nurses to augment the interpreter role. A larger study and future research on the patient’s perspective are required.
Bespoke automation of medical workforce rostering using Google’s free cloud applications
Full text linkBackground: Providing safe and consistent care requires optimal deployment of medical staff. Ensuring this happens is a significant administrative burden due to complex working patterns.Objective: To describe a pilot feasibility study of the automation of medical duty rostering in a busy tertiary Ophthalmology department.Methods: A cloud based web application was created using Google’s free cloud services. Users access the system via a website which hosts live rosters, and use electronic forms to submit requests which are automatically handled by Google App Scripts.Results: Over a 2-year period (8/2014-6/2016), the system processed 563 leave requests and 300 on call swaps automatically. 3,300 emails and 1,000 forms were automatically generated. User satisfaction was 100% (n=24).Discussion: Many time consuming aspects of roster management were automated with significant time savings to all parties, allowing increased clinical time for doctors involved in administration. Planning for safe staffing levels was supported.
Integration of Slack, a cloud-based team collaboration application, into research coordination
Full text linkBackground: Practitioners of epidemiology require efficient real-time communication and shared access to numerous documents in order to effectively manage a study. Much of this communication involves study logistics and does not require use of Protected Health Information. Slack is a team collaboration app; it archives all direct messages and group conversations, hosts documents internally, and integrates with the Google Docs application. Slack has both desktop and mobile applications, allowing users to communicate in real-time without the need to find email addresses or phone numbers or create contact lists. Method: We piloted the integration of Slack into our research team of one faculty member, one research coordinator, and approximately 20 research assistants. Statistics describing the app’s usage were calculated twelve months after its implementation. Results: Results indicating heavy usage by both research professionals and assistants are presented. our Slack group included a cumulative 51 users. Between October 2015 and November 2016, approximately 10,600 messages were sent through Slack; 53% were sent by RA’s and 47% were sent by us. Of the 106 files stored on Slack, 82% were uploaded by research staff. In a January 2016 survey, 100% of RA’s agreed or strongly agreed that Slack improved communication within the team. Conclusion: We demonstrate a model for integration of communication technology into academic activities by research teams. Slack is easily integrated into the workflow at an urban, academic medical center and is adopted by users as a highly effective tool for meeting research teams’ communication and document management needs.
Addendum to Informatics for Health 2017: Advancing both science and practice
Full text linkThis article presents presentation and poster abstracts that were mistakenly omitted from the original publication
An Informatics Approach to Interprofessional Management of Low Back Pain: A Feasibility Study using the Omaha System
Full text linkBackground: Low back pain (LBP) is a complex health care issue that often involves multiple providers across various care settings. Health information technology (HIT) holds promise to improve care delivery by providing infrastructure for communication, clinical documentation, and management of patient data. Standardized terminology is essential for interoperability and enables evaluation of clinical data generated by documentation in an electronic health record (EHR).Objective: The purpose of this study was to demonstrate the feasibility of mapping evidence-based practice for conservative management of low back pain to the Omaha System and foster inter-professional communication and collaboration among diverse practitioners and patients.Methods: Evidence-based practice (EBP) guidelines for non-invasive treatment of low back pain were mapped to the Omaha System using a clinical expert approach with attention to content feasibility, linguistic validity, and granularity of terms. Results: A clinical guideline for low back pain management was developed consisting of 13 interventions for Pain and Neuro-musculo-skeletal problems. The most common intervention categories were Case management followed by Treatments and procedures, Teaching, guidance, and counseling and Surveillance. Scope of practice overlap was identified between primary care, chiropractic, and physical therapy practice.Conclusion: Use of the guideline may facilitate clinical documentation using the Omaha System for low back pain management, and has potential to generate meaningful data to evaluate clinical effectiveness and promote quality research. The use of encoded EBP evidence within an EHR can increase use of available evidence, enable interprofessional communication, improve quality of care, and enhance usability of data across care settings