A saúde mental é uma das áreas que envolve mais atenção, visto que as ações tomadas dentro da rede não podem ser reduzidas a sistemas fechados, sem comunicação com outros sistemas, mas a sistemas abertos, heterogêneos e articulados. Dessa maneira, torna-se necessário a busca de novas possibilidades para a realização do trabalho contínuo e articulado entre os diferentes níveis da rede de atenção em saúde mental. Diante deste contexto, o principal objetivo deste projeto é desenvolver e implantar um sistema de informação em saúde para gestão de pacientes que permite realizar o monitoramento do fluxo de pacientes com transtornos mentais. Para tal, o projeto contempla o desenvolvimento de um sistema web utilizando as tecnologias web PHP, HTML, JavaScript e CSS, Sistema Gerenciador de Banco de Dados MySQL e servidor web Apache. Um sistema baseado na arquitetura web, denominado SISAM 13, que permite acompanhar as consultas, solicitações de internação, internações e o movimento de pacientes na rede pública de saúde mental do Departamento Regional de Saúde XIII (DRS XIII), fornecendo relatórios de gestão, foi criado e implementado. Inicialmente, o sistema foi implantando como piloto e, após de 90 dias, entrou em funcionamento definitivo. De novembro de 2012 até outubro de 2014, foram cadastrados 4271 pacientes, 480 profissionais, 1483 agendamentos de consultas, 5938 solicitações de internação e 3239 internações. Evidenciou-se que a maioria dos municípios de procedência da solicitação de internação fazem parte do DRS XIII, confirmando a adequação da regionalização. Verificou-se que a alta proporção de solicitações provenientes dos serviços especializados em saúde mental mostrou a dificuldade de estabilização de pacientes com transtornos mentais por essas unidades, evidenciando a falta de organização desses serviços e a falta articulação com os demais serviços da rede. O sobrecarregamento da rede do DRS XIII pode ser justificado pelo alto tempo de espera por atendimento, e a redução do giro leito, prejudicando o fluxo de pacientes. A maioria da população atendida nos serviços de internação foi masculina, entre 20 a 39 anos, com diagnóstico de transtornos relacionados ao uso de substância(s) psicoativa(s) e internação com duração maior ou igual a 31 dias. O maior tempo de permanência pelas internações compulsórias em comparação com as internações voluntárias e involuntárias, ocasiona em redução no giro leito, refletindo para toda rede de saúde mental. A alta proporção de contrarreferências para serviços especializados em saúde mental pode contribuir para a continuidade do tratamento, todavia, verificou-se que apenas 54,92% das altas foram contrarreferencias. A baixa utilização da funcionalidade de consultas em conjunto com o número de ações de usuários com permissão de solicitadores menor que o de prestadores, sugere o aperfeiçoamento e/ou inclusão de funcionalidades no sistema para os serviços extra-hospitalares. O aumento de 13,16% do número total de ações de um ano para outro pode ser explicado pela incorporação do sistema no processo diário de trabalho, visto que os usuários do sistema foram vistos e reconhecidos como parte integrante na construção do sistema, permitindo o engajamento dos mesmos na sua utilização e melhoria. / Mental health is one of the areas that involves more attention, since the actions taken within the services network cannot be reduced to closed systems without communication with other systems, but with open, heterogeneous and articulated ones. Thus, a search for new possibilities for the realization of continuous and articulated work between different levels of mental health care network is necessary. Given this context, the main objective of this project is to develop and deploy a web based health information system for patient management in order to perform the monitoring of the flow of patients with mental disorders. To this end, the project will include the use of web technologies such as PHP, HTML, JavaScript and CSS, Database Management System MySQL, and Apache web server. A web based system called SISAM 13, that allows appointments, requests for hospitalizations, hospitalizations and the movement of patients in the public mental health network, providing management reports, was created. Initially, the system was implemented as a pilot, and after 90 days, it came into definitive operation. From November 2012 to October 2014, the system registered 4271 patients, 480 professionals, 1483 schedules appointments, 5938 request for hospitalizations and 3239 hospitalizations. Most origin municipalities of the requests was part of the Regional Health Department XIII (RHD XIII), confirming the adequacy of regionalization. It was found that the high proportion of requests from the mental health specialized services, showed the difficulty of stabilizing patients with mental disorders by these units, showing the lack of organization and coordination with other network services. The network overloading can be justified by the high waiting time for hospitalization, and the bed turnover decrease, damaging the network patients flow. It was shown that the majority of the population treated in hospital admissions was male, between 20 to 39 years, diagnosed with disorders related to the use of psychoactive(s) substance(s) use and length of stay more than or equal to 31 days. The longer length of stay by the compulsory admissions compared with voluntary and involuntary admissions, causes reduction in the bed turnover, reflecting on the entire mental health network. The high proportion of counter references to mental health specialist services can contribute to the continuity of care, however, it was found that only 54,92% of the discharges were counter referenced. The low level use of the appointments features along with the low number of user actions by requesters, suggests the improvement and / or inclusion of features in the system for outpatient services. The increase of 13,16% in the total number of actions from one year to another can be explained by the incorporation of the system in the daily working process, since users of the system were seen and recognized as an integral part in the system development, allowing their engagement in its use and improvement.

Primary care physicians (PCPPs) have been slow to implement electronic health records (EHRs), even though there is a U.S. federal requirement to implement EHRs. The purpose of this phenomenological study was to determine why PCPPs have been slow to adopt electronic health record (EHR) systems despite the potential to increase efficiency and quality of health care. The complex adaptive systems theory (CAS) served as the conceptual framework for this study. Twenty-six PCPPs were interviewed from primary care practices (PCPs) based in southwestern Ohio. The data were collected through a semistructured interview format and analyzed using a modified van Kaam method. Several themes emerged as barriers to EHR implementation, including staff training on the new EHR system, the decrease in productivity experienced by primary care practice (PCP) staff adapting to the new EHR system, and system usability and technical support after adoption. The findings may contribute to the body of knowledge regarding EHR system implementation and assist healthcare providers who are slow to adopt EHRs. Additionally, findings could contribute to social change by reducing healthcare costs, increasing patient access to care, and improving the efficacy of patient diagnosis and treatment.

During the selection and retention process in a medical record technology program, it is advantageous to identify those students who will fulfill the program's course requirements, as well as subsequently pass the accreditation examination. Graduates of such a program at Wbstern Kentucky University were studied to identify these demoaraphic and academic indicators. Using a stepwise multiple regression analysis, the variables of high school grade point average (GPA), college GPA, and composite ACT score were found to be significantly related to medical record GPA. Using the maximum Rsquare improvement technique, the variables of high school GPA, college GPA, age entering the program, English ACT score and number of credits at graduation were found to be significantly related to overall college GPA at graduation. Multiple regression analysis indicated that high school GPA and composite ACT score were found to be the best predictors of overall performance on the accreditation exam, though the relationship was not significant. Using the discriminant analysis technique, several variables were found to be significant in determining which students will pass the exam and which students will fail. Based on information age when entering the program, and number of medical record core courses repeated contributed significantly to the model. The model was applied to the actual data with a pass/fail accuracy rate of 82% for all students and a rate of 84% for those students passing the exam. Based on additional information after graduation, the variables of medical record GPA, composite ACT score, age when entering the program, and number of credits received at graduation contributed significantly to the model. The model was applied to the actual data with a pass:fail accuracy rate of 78% for all students and a rate of 89% for those students failing the exam.

With exponential growth on a daily basis, there is potentially valuable information hidden in complex electronic medical records (EMR) systems. In this thesis, several efficient data mining algorithms were explored to discover hidden knowledge in insurance claims data. The first aim was to cluster three levels of information overload(IO) groups among chronic rheumatic disease (CRD) patient groups based on their clinical events extracted from insurance claims data. The second aim was to discover hidden patterns using three renowned pattern mining algorithms: Apriori, frequent pattern growth(FP-Growth), and sequential pattern discovery using equivalence classes(SPADE). The SPADE algorithm was found to be the most efficient method for the dataset used. Finally, a prototype system named myDietPHIL was developed to manage clinical events for CRD patients’ and visualize the relationships of frequent clinical events. The system has been tested and visualization of relationships could facilitate patient education.

Hydropathic molecular modeling is a computer-aided molecular design technique for obtaining, representing, and understanding the properties and interactions of biomacromolecular complexes in the biological environment. Hydropathic INTeraction (HINT) is a novel empirical force field to calculate the free energy of intermolecular interaction based on experimentally determined partition coefficients (log Po/w). It includes all the expected interactions between molecules such as hydrogen bonding, hydrophobic, electrostatic, acid-base, and Coulombic interactions, entropy, solvation and others. HINT tools were used to determine, evaluate, and analyze protein-ligand interactions in different research projects: 1) We used these tools to discover small molecule inhibitors of PsaA, a potential target for Streptococcus pneumoniae. We screened and scored potential molecules to obtain hits. After the growth conditions for both the wild type and PsaA mutant of S. pneumoniae were optimized, we then tested our hits. A few compounds passed through the three-stage assay protocol and confirmed the inhibition of PsaA with MICs between 125-250 μM. 2) The SAR of C-3 and C-5 pyrrole-based antitubulin agents at the colchicine-binding site with explicitly solvated models was performed. After docking with GOLD at the colchicine site, post-docking scoring and evaluation were performed with HINT. The total HINT score correlates with binding and activity; similarly, the significance of individual functional groups, protein residues and interactions amongst a collection of compounds can be quantitated. The possibility of water-mediated interactions in a way solvent accessible part of the pocket was considered by subjecting molecular models to MD simulations. Several water molecules were identified to be contributing to the binding and were confirmed by HINT scoring. Finally, using hydropathic molecular modeling tools helped us to understand, evaluate, analyze, and improve protein-ligand interactions in different biological systems.

The aim of this study is to examine the impact of a cloud-based CDS alerting system for SIRS, a precursor to sepsis, and sepsis itself, on adult patient and process outcomes at VCU Health System. The two main hypotheses are: 1) the implementation of cloud-based SIRS and sepsis alerts will lead to lower sepsis-related mortality and lower average length of stay, and 2) the implementation of cloud-based SIRS and sepsis alerts will lead to more frequent ordering of the Sepsis PowerPlan and more recording of sepsis diagnoses. To measure these outcomes, a pre-post study was conducted. A pre-implementation group diagnosed with sepsis within the year leading up to the alert intervention consisted of 1,551 unique inpatient visits, and the three-year post-implementation sample size was 9,711 visits, for a total cohort of 11,262 visits. Logistic regression and multiple linear regression were used to test the hypotheses. Study results showed that sepsis-related mortality was slightly higher after the implementation of SIRS alerts, but the presence of sepsis alerts did not have a significant relationship to mortality. The average length of stay and the total number of recorded sepsis diagnoses were higher after the implementation of both SIRS and sepsis alerts, while ordering of the Sepsis Initial Resuscitation PowerPlan was lower. There is preliminary evidence from this study that more sepsis diagnoses are made as a result of alert adoption, suggesting that clinicians can consider the implementation of these alerts in order to capture a higher number of sepsis diagnoses.

The United States is one of the last countries to transition to the 10th edition of the International Classification of Diseases (ICD-10) coding system. The move from the 35-year-old system, ICD-9, to ICD-10, represents a milestone in the transformation of the 21st century healthcare industry. All covered healthcare entities were mandated to use the ICD-10 system on October 1, 2015, to justify medical necessity, an essential component in determining whether a service is payable or not. Despite the promising outcomes of this shift, more than 70% of healthcare organizations identified concerns related to education efforts, including lack of best practices for the ICD-10 transition. Lack of preparation for the implementation of ICD-10 undermines the clinical, technological, operational, and financial processes of healthcare organizations. This study was an exploration of implementation strategies used to overcome barriers to transition to ICD-10. A single case study was conducted, grounded by the conceptual framework of the technology acceptance model, to learn about ways to mitigate the barriers of this new coding system. Data were gathered from the review of documents, observations, and semistructured interviews with 9 participants of a public healthcare organization in Florida. Data were coded to identify themes. Key themes that emerged from the study included (a) in-depth ICD-10 training, (b) the prevalence of ICD-10 cheat sheets, (c) lack of system readiness, and (d) perception of usefulness of job performance. The results of the study may contribute to social change by identifying successful implementation strategies to mitigate operational disruptions that will allow providers to capture more detailed health information about the severity of patients' conditions.

The adoption rate of health information technology (HIT) remains low in developing countries, where healthcare institutions experience high operating costs and loss of revenue, which are related to systems and processes inefficiency. The purpose of this case study was to explore strategies leaders in Zimbabwe used to implement HIT. The conceptual framework of the study was Davis's technology acceptance model (TAM). Data were gathered through observations, review of organizational documents (i.e., policies, procedures, and guidelines), and in-depth interviews with a purposive sample of 10 healthcare leaders and end-users from hospitals in Zimbabwe who had successfully implemented HIT. Transcribed interview data were coded and analyzed for emerging themes. Implementation strategies, overcoming barriers to adoption, and user acceptance emerged as the themes most healthcare leaders associated with successful HIT projects. Several subthemes also emerged, including: (a) the importance of stakeholder involvement, (b) the importance of management buy-in, and (c) the low level of IT literacy among healthcare workers. The strategies identified in this study may provide a foundation on which healthcare leaders in developing countries can successfully adopt and implement HIT. The recommendations from this study could lead to positive social change by providing leaders with knowledge and skills to use information technology strategies to deliver better healthcare at lower costs while creating employment for local communities.

Currently, C Hospital lacks a standardized nursing informatics competency program to validate nurses' skills and knowledge in using electronic medical records (EMRs). At the study locale, the organization is about to embark on the implementation of a new, more comprehensive EMR system. All departments will be required to use the new EMR, unlike the current policy that allows some areas to still document on paper. The Institute of Medicine, National League of Nursing, and American Association of Colleges of Nursing support and recommend that information technology be an essential core competency for nurses. Evidence of the need for nursing informatic competencies was found through a literature search using CINHAL, Proquest Nursing, Medline, and Pubmed search lines. Concepts searched were competencies, nursing informatics, health information technology, electronic health record, information technology literacy, nursing education, information technology training, and curriculum. The Staggers Nursing Computer Experience Questionnaire was distributed to 300 nurses practicing within the hospital setting to obtain baseline data on current nursing computer knowledge and skill level. This validated tool was created by Nancy Staggers in 1994 and used in other process improvement efforts similar to this one. The assumption was that nursing competency levels with computers were varied through the hospital. The data obtained from the questionnaire, through Zoho Survey tool, confirmed this assumption and were used to help create the education, support, and competency plan for the future. Data was analyzed through the built-in reports and interactive charts that the Zoho survey tool provides. The new EMR and all the new processes that come with it will be the framework of nursing care. Having competent nurses in the use of the EMR will optimize the quality of patient care delivered.

Despite defibrillation as the only effective treatment for sudden cardiac arrest (SCA), less than 15% of homes and public facilities have access to an automated external defibrillator (AED). In the United States, ineffective response to SCA cases occurring each year classifies it as a business problem for medical device manufacturing leaders, emergency responders, and bystanders. The purpose of this multicase study was to explore the marketing strategies AED manufacturing leaders use to expand their consumer customer base. Data were collected via in-depth interviews with a purposive sample of participants from 2 U.S. AED manufacturers on the east coast, 2 AED distributors, and 2 healthcare corporations in Texas, as well as a review of company materials. The framework for this study was product life cycle theory. Initial findings for expanding the U.S. AED market indicated that the market was not led by its manufacturers but by its distributors. This finding became an important theme noted from AED manufacturers in considering the consumer segment, an aftermarket from commercial marketing strategies. A common concern for the security of strategic marketing was evident across the AED manufacturer participants with reluctance to discuss business models and marketing plans. A congruent theme was the curtailment of open discussions regarding AED marketing strategies because of security and confidentiality risk. Also, limited number of approved AED manufacturers by the Federal Drug Administration minimizes AED access. Residual outcomes include improving the quality of life for the aging population while reducing the loss of the lives and costs of healthcare. Social implications include preventing sudden cardiac death by providing more accessibility of AEDs to baby boomers.