INTRODUCTION: While mobile device use by physicians increases, there is an increased risk that errors committed while using mobile devices can lead to harm. This mixed-method study evaluates the effects of screen size on clinical users’ perceptions of medical application usability and safety when interfacing to critical patient information. In this research, two mobile devices are examined: iPhone® and the iPad®. METHOD: Eleven physicians and one nurse practitioner participated in a chart-review simulation using an app that was an end-point to an electronic health record. Screen-recording, video-recording and a think-aloud protocol were used to gather data during the simulation. Additionally, participants completed Likert-based questionnaires and engaged in semi-structured interviews. RESULTS: A total of 105 usability, usefulness and safety problems were recorded and analysed. A strong preference was found for the larger screen when reviewing patient data due to the large quantity of data and the increased display size. The smaller device was preferred due to the devices portability when participants needed to remain informed when they were away from the point of care. CONCLUSION: There is an association between screen size and the perceived safety of the handheld device. The iPad was perceived to be safer to use in clinical practice. Participants preferred the iPad® because of the larger size, not because they thought it was safer or easier to use. The iPhone® was preferred for its portability and its usefulness was perceived to increase with greater distance from the point of care. / Graduate

Submitted by Valquíria Barbieri (kikibarbi@hotmail.com) on 2017-08-31T21:13:33Z No. of bitstreams: 1 DISS_2014_Celso Ricardo Ferreira.pdf: 1783174 bytes, checksum: 82b8c0325e782245e6514d32fb632075 (MD5) / Approved for entry into archive by Jordan (jordanbiblio@gmail.com) on 2017-09-01T14:11:36Z (GMT) No. of bitstreams: 1 DISS_2014_Celso Ricardo Ferreira.pdf: 1783174 bytes, checksum: 82b8c0325e782245e6514d32fb632075 (MD5) / Made available in DSpace on 2017-09-01T14:11:36Z (GMT). No. of bitstreams: 1 DISS_2014_Celso Ricardo Ferreira.pdf: 1783174 bytes, checksum: 82b8c0325e782245e6514d32fb632075 (MD5) Previous issue date: 2014-05-14 / A hanseníase é uma doença que representa um grave problema de saúde pública em todo o mundo, no Brasil e em Mato Grosso, onde é endêmica. O tratamento da hanseníase é realizado com a Poliquimioterapia proposta pela Organização Mundial da Saúde (PQT/OMS) e oferecida gratuitamente nas unidades do Sistema Único de Saúde (SUS). A poliquimioterapia pode ocasionar efeitos adversos a medicamentos que podem interferir no tratamento. Há poucos estudos sobre os efeitos medicamentosos das drogas componentes da PQT/OMS. Objetivo – Caracterizar os pacientes em poliquimioterapia para hanseníase quanto aos aspectos sociodemográficos, frequência de efeitos adversos e completude do preenchimento de seus prontuários em serviços de saúde de Cuiabá (MT), 2013. Método – Estudo de abordagem descritiva e delineamento transversal. A coleta de dados foi realizada em prontuários de todos os pacientes em tratamento ativo para hanseníase em uso da PQT/OMS no município de Cuiabá durante os meses de junho a agosto de 2013. Resultados – Foram estudados 275 pacientes em tratamento para hanseníase no município de Cuiabá no período da pesquisa, sendo 160 (58,2%) do sexo masculino, e 115 (41,8%) do sexo feminino, com maior frequência de adultos 209 (76%) que de idosos 66 (24%), de Multibacilares 226 (82,2%) que de Paucibacilares 48 (17,5%) e um paciente (0,3%) não teve sua classificação operacional registrada no prontuário. A forma clínica Dimorfa foi registrada em 130 (47,3%) dos prontuários, seguida de 52 (18,9%) Virchowiana, 35 (12,7%) Tuberculóide, 15 (5,5%) Indeterminada e 43 (15,6%) cuja forma clínica não estava disponível nos registros dos prontuários. Todas essas frequências foram corroboradas pela literatura e pelos indicadores nacionais de hanseníase. A presença de efeitos adversos foi registrada em 31 (11,3%) dos prontuários, menor que a de estudos que abordam esse objeto. Nenhum dos prontuários apresentou completude dos registros, mesmo quanto a informações compulsórias. A alta frequência de prontuários com dados incompletos, mesmo considerando apenas as informações compulsórias, impossibilitou análises estatísticas mais aprofundadas, como a verificação de associações entre as variáveis. Conclusão – Os dados mostram que os registros nos prontuários de pacientes em tratamento para hanseníase em Cuiabá, em sua maioria, são incompletos, mesmo considerando as variáveis de registros compulsórios e que o perfil sociodemográfico da população em tratamento para hanseníase é semelhante ao descrito pela literatura. / Leprosy is a disease that is a serious public health problem worldwide, in Brazil and Mato Grosso, where it is endemic. The treatment of leprosy is accomplished through Multidrug therapy proposed by the Word Health Organization (WHO/MDT) and it is offered free of charge in units of the Unified Health System. Chemotherapy can cause adverse drug that can interfere with treatment effects. There are few studies on the medicinal effects of the component drugs of WHO / MDT. Objective - Characterize patients on multidrug therapy for leprosy regarding sociodemographic characteristics, frequency of adverse effects and completeness of completing their medical records in health services Cuiabá (MT), 2013. Method - Study of descriptive and cross-sectional approach. Data collection was performed on medical records of all patients in active treatment for leprosy in use of WHO / MDT in the city of Cuiabá during the months from June to August 2013. Results - 275 patients were studied in leprosy treatment in the city of Cuiabá during the study period, with 160 (58.2%) males and 115 (41.8%) females, with a higher frequency of 209 adults (76%) than elderly 66 (24%), of 226 multibacillary (82.2%) than paucibacillary 48 (17.5%) and one patient (0.3%) did not have its operational classification in the medical record . The borderline clinical form was recorded in 130 (47.3%) of the charts, followed by 52 (18.9%) Lepromatous, 35 (12.7%) Tuberculoid, 15 (5.5%) and Unspecified 43 (15.6%) whose clinical presentation was not available in the medical records. Literature and national indicators of leprosy corroborated all these frequencies. The presence of adverse effects was recorded in 31 (11.3%) of the medical records, less than studies that address this subject. None of the medical records submitted completeness of records, even as compulsory information. The high frequency of medical records with incomplete data, even considering only the compulsory information, precluded more in-depth statistical analyzes, such as checking for associations between variables. Conclusion - The data show that the charts of patients treated for leprosy in Cuiabá, in their majority, are incomplete, even considering the variables of compulsory records and that the demographic profile of the population in leprosy treatment is similar to that described in the literature.

OBJETIVO. O objetivo deste estudo foi verificar a variação entre observadores, com diferentes graus de treinamento em RM das mamas, na aplicação dos critérios morfológicos e cinéticos propostos pelo BI-RADS® para descrever os realces na RM. Também, buscou-se avaliar a importância desta variação sobre a categorização final e a conduta sugerida, antes e após o conhecimento dos dados clínicos e dos demais exames de imagem pertinentes a cada caso. MÉTODOS. 109 realces, sendo 36 malignos, em 96 mulheres, foram interpretados por quatro radiologistas, divididos em duas duplas de acordo com a experiência em RM das mamas. Cada realce foi descrito seguindo os critérios de interpretação propostos pelo BI-RADS® para RM, sendo posteriormente informada a categoria final e a recomendação sugerida para cada caso. Tanto a categoria final quanto a conduta sugerida foram informadas duas vezes por cada observador, uma vez antes do conhecimento dos dados clínicos e dos demais exames de imagem e outra vez após o conhecimento dos mesmos. A concordância entre os membros de cada uma das duplas quanto à aplicação dos critérios de descrição morfológicos e dinâmicos utilizados na caracterização dos realces foi medida, seguida pela mensuração da concordância quanto à classificação final e a conduta recomendada, tanto antes quanto após o conhecimento dos dados clínicos. O teste kappa foi usado para estimar a concordância entre os observadores além daquela esperada pelo acaso. Visando determinar se as taxas de concordância de uma dupla de observadores eram superiores a da outra dupla, tanto para os critérios de descrição quanto para as categorias finais e condutas sugeridas, o teste de Wilcoxon foi utilizado. RESULTADOS. A concordância entre observadores experientes foi substancial (0,64) para categoria final após o conhecimento dos dados clínicos, moderada para forma dos nódulos (0,44), realce interno dos nódulos (0,41) e recomendação sugerida após o conhecimento dos dados clínicos (0,52). Concordância razoável foi obtida para todos os critérios entre os observadores não experientes, assim como para os demais critérios para os observadores experientes. Os observadores com maior experiência apresentaram maiores taxas de concordância entre si na aplicação dos critérios de descrição morfológicos e dinâmicos propostos pelo BI-RADS®, assim como para categoria final e conduta sugerida. CONCLUSÃO. Experiência prévia em RM das mamas aumenta a concordância entre observadores na aplicação dos critérios propostos pelo BI-RADS® para RM. Conhecimento dos dados clínicos e dos demais exames de imagem também aumenta a concordância para a categoria final e recomendação sugerida, especialmente entre os observadores experientes. / OBJECTIVE. The purpose of this study was to assess the variability among observers with different degree of breast MR expertise in the use of the Breast Imaging Reporting and Data System (BI-RADS®) standardized MR lexicon and to evaluate if the variability in lesion description has any implication over lesion final category and management recommendation before and after the knowledge of clinical and other imaging modalities information. MATERIALS AND METHODS. In 96 women, 109 enhancements, including 36 malignant, were interpreted independently by four radiologists divided in pairs according to their experience in breast MR. Each lesion was described using morphologic and dynamic features from the MR BI-RADS® lexicon. A final category and an overall impression were suggested in two occasions, one before and the other after the information about other breast imaging modalities and clinical examination. The agreement between the two members of each pair was measured concerning the description of the enhancement and both final category and recommendation. Kappa statistics were calculated as measures of agreement beyond chance. In order to determine if the rates of agreement in a group were superior then in the other group, the Wilcoxon statistics were used. RESULTS. The experienced interobserver agreement was substantial (0.64) for BI-RADS® final category after the knowledge of clinical information, moderate for mass shape (0.44), mass enhancement (0.41) and management recommendation after clinical knowledge (0.52). Fair agreement was observed for all descriptors among the observer with less experience and for the other descriptors among the experienced ones. The observers with more experience agreed more between themselves for image descriptors and final assessment and recommendation than did the observers with less experience in breast MR. CONCLUSION. Prior experience in breast MRI decreases variability between observers in the application of the criteria proposed by the BI-RADS for MR. Knowledge of relevant information about clinical and other imaging modalities also increased agreement for final category and management recommendation, especially among the experienced radiologists.

Submitted by Viviane Lima da Cunha (viviane@biblioteca.ufpb.br) on 2015-05-26T12:53:02Z No. of bitstreams: 1 arquivototal.pdf: 2980634 bytes, checksum: 4c7ccb2e54be16c1b0bcb01cfa7a50f5 (MD5) / Made available in DSpace on 2015-05-26T12:53:02Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 2980634 bytes, checksum: 4c7ccb2e54be16c1b0bcb01cfa7a50f5 (MD5) Previous issue date: 2015-02-27 / The Patient Safety has been, in the last decades a thematic evidenced in the Brazilian and world scenario. There are cases that refer to bad prescription, errors in medication administration , stress and professional disillusion. Attached to concerns regarding the quality of medical records, Patient Safety becomes a study of high importance for Risk Reduction, both for patients as for professionals and health services. Therefore, this study concerned to better understand the reality of management of records of Alcides Carneiro University Hospital (ACUH) a federal public institution in the city of Campina Grande, Paraíba. The aspirations for improvements in service hospital records, along with initial actions of ACUH Management Risk and Patient Safety Center, were the main indicators for this study to have its start up. The focus of this work was to understand the situation seen as problematic by the institution Hospital Records Division and, through observations and systemic reviews, identify opportunities for improvement. The methodology used was the Soft Systems Methodology (SSM), recognized worldwide in the management of public health services, especially in studies carried out in National Health Service (NHS) in Britain. The application of SSM had allowed greater understanding of how the records management is conducted in ACUH, and the main obstacles for attendance to Brazilian national guidelines Risk Management and Patient Safety. In addition to organizational learning, this study led to the construction of a project named the Medical Records Management Improvement Program (MRMIP), which may be applied by the administration of ACUH. / A Segurança do Paciente tem sido, nas últimas décadas, uma temática evidenciada no cenário nacional brasileiro e mundial. São casos que se referem à má prescrição, à administração de medicamentos de forma equivocada, ao estresse e à desilusão profissional. Atrelada à preocupação referente à qualidade dos registros médicos, a Segurança do Paciente é um estudo de suma importância para a Redução de Riscos, tanto para os pacientes quanto para os profissionais e serviços de saúde. Este estudo teve a preocupação de compreender melhor a realidade da gestão de prontuários do Hospital Universitário Alcides Carneiro (HUAC), instituição pública federal da cidade de Campina Grande, na Paraíba. Os anseios por melhorias no serviço de registros hospitalares, aliados às ações iniciais da Gerência de Risco e Núcleo de Segurança do Paciente do HUAC, foram os principais indicadores para que este estudo tivesse início. O foco foi compreender a situação tida como problemática pela Divisão de Registro Hospitalar da instituição e, por meio de observações e avaliações sistêmicas, identificar oportunidades de melhoria. A metodologia utilizada foi a Soft Systems Methodology (SSM), reconhecida mundialmente no âmbito da gestão em serviços de saúde pública, principalmente em estudos realizados pelo National Health Service (NHS), o serviço de saúde pública do Reino Unido. A aplicação da SSM ampliou o entendimento sobre a gestão de prontuários no HUAC, bem como apresentou os principais obstáculos para que sejam atendidas as diretrizes nacionais brasileiras de Gestão de Riscos e Segurança do Paciente. Além do aprendizado organizacional, este estudo propiciou a construção do Programa de Melhorias da Gestão de Prontuários (PMGP), que poderá ser aplicado pela administração do HUAC.

Doctors can experience difficulty in accessing medical information of new patients. One reason for this is that the management of medical records is mostly institution-centred. The lack of access to medical information may negatively affect patients in several ways. These include new medical tests that may need to be carried out at a cost to the patient and doctors prescribing drugs to which the patient is allergic. This research investigates how patients can play an active role in sharing their personal health records (PHRs) with doctors located in geographically separate areas. In order to achieve the goal of this research, existing literature concerning medical health records and standards was reviewed. A literature review of techniques that can be used to ensure privacy of health information was also undertaken. Interview studies were carried out with three medical practices in Port Elizabeth with the aim of contextualising the findings from the literature study. The Design Science Research methodology was used for this research. A Hybrid Model for Managing Personal Health Records in South Africa is proposed. This model allows patients to view their PHRs on their mobile phones and medical practitioners to manage the patients’ PHRs using a web-based application. The patients’ PHR information is stored both on a cloud server and on mobile devices hence the hybrid nature. Two prototypes were developed as a proof of concept; a mobile application for the patients and a web-based application for the medical practitioners. A field study was carried out with the NMMU health services department and 12 participants over a period of two weeks. The results of the field study were highly positive. The successful evaluation of the prototypes provides empirical evidence that the proposed model brings us closer to the realisation of ubiquitous access to PHRS in South Africa.

No description available.

The digitalization process in healthcare services has gained momentum nowadays. This study aims to explore how digitalization in the healthcare sector is perceived by doctors and patients. In addition, our thesis objective is to make a comparison between 4 countries with different levels of digitalization. These countries are Egypt, Turkey, Italy, and Sweden.  In our thesis, we conducted an exploratory study depending on both qualitative and quantitative data with the purpose of investigating doctors and patients’ perspectives.  Based on the results of our study we can conclude that Sweden might be considered the most digitalized country out of the four studied countries while Egypt might be addressed as the least digitalized country. For Italy and Turkey, many steps were taken towards digitalization, however, the digitalization process still needs to be further developed. Patients from the four countries ensured the reliability and effectiveness of the digital tools in healthcare. Nevertheless, concerns and questions regarding privacy and data security have been highlighted in our research.  Regarding Covid-19, doctors and patients from all the four countries agreed on the fact that the digital healthcare system markedly improved, and the importance of using digital tools has been highlighted during the pandemic.

This dissertation investigates how healthcare provider networks are formed and their effects on patient health outcomes. The first chapter explores three types of hospital networks that are intended to improve coordination of patient care across different hospitals: integrated delivery systems, accountable care organizations, and electronic health records. Using 2007-2017 Healthcare Information and Management Systems Society IT data and Medicare data on accountable care organizations and hospital quality, I document several interesting patterns regarding the formation and potential effects of these networks in the United States. I find correlations consistent with assortative matching where higher quality hospitals match with higher quality groups, which may be inefficient if there are peer effects that mean higher quality groups could have more substantial influence on lower quality hospitals that have more room to improve. I show that accountable care organizations appear to be strategic about the network formation process, omitting hospitals that are natural members. They may do so for anticompetitive reasons–ordinary least square regressions find that accountable care organization market concentration is negatively correlated with hospital quality. These regressions additionally point to the need for caution in advocating for a unified electronic health record, as hospital quality is positively correlated with regional electronic health record market concentration–which is related to coordination abilities–but negatively correlated with national concentration–which is related to competition. The second chapter takes inspiration from the descriptive results of the first chapter and establishes a causal effect of electronic health record networks at the patient level. I hypothesize that systematic, reliable transfer of patient medical history can improve clinical decisions and thus health outcomes, especially during medical emergencies. Thus, I identify patients who had emergency cardiovascular episodes in 2007-2014 Medicare claims and use a difference-in-differences strategy to estimate the causal effect of their primary care and emergency hospitals being in the same electronic health record network. I find that electronic health record compatibility decreases the mortality rate but increases the rate of other bad health outcomes by approximately the same amount, suggesting that compatibility makes it easier for patients to survive given poor health but does not overall improve health otherwise. This result highlights the importance of analyzing the effects of healthcare treatments on both the rates of mortality and negative outcomes in survivors. Only looking at the rate of negative outcomes in survivors, electronic health record compatibility would have appeared to be a harmful treatment, while it was actually reducing mortality. The third chapter moves from hospital networks, which have only one type of agent, to look at physician-insurer networks, represented by a two-sided many-to-many matching market. I use Healthgrades and National Committee for Quality Assurance consumer ratings data to collect physician and insurance plan characteristics, respectively. Descriptive statistics indicate that higher quality physicians are in more insurance networks, while higher quality plans tend to be more restricted in the numbers of physicians they accept. There is a mild correlation between physician and plan quality, but there are many possible explanations for it. To test if it is due to assortative matching and to better understand how physicians and insurers decide with whom to contract, I estimate a structural many-to-many matching model using the matching maximum score estimator. Data quality and quantity appear to be obstacles in obtaining precise estimates, so I leave further exploration of this topic to future research.

This project explored using human-centered design methods how can we change the way healthcare delivers information to people about their health so that they feel empowered and educated about their health. It also investigates how to create a space that allows for reflection about own health without falling into worry and unnecessary stress. Primar focus on the project was to investigate the end-user side and explore what value drawn from the medical records can be provided for people using healthcare. For this reason, empowerment in the healthcare context became the aim and important aspect of this project. Based on the research a set of empowerment guidelines was created that helped navigating design processes and decisions. The result is a design proposal - Health sphere - platform in a form of an app provided by the healthcare system, that gives an overview of current health status and communicates healthcare records in a way that empowers people by using progressive disclosure that gives the user the choice on how much they would like to learn. It also helps to organize and keep all medical records in one place and helps to understand their content with visuals and smart definitions of medical language.

Complex patient are becoming more and more of a challenge to the health care system given the amount of care they require and the amount of documentation needed to keep track of their state of health and treatment. Record keeping using the EHR makes this easier but mounting amounts of patient data also means that clinicians are faced with information overload. Information overload has been shown to have deleterious effects on care, with increased safety concerns due to missed information. Patient record summarization has been a promising mitigator for information overload. Subsequently, a lot of research has been dedicated to record summarization since the introduction of EHRs. In this dissertation we examine whether unsupervised inference methods can derive patient problem-oriented summaries, that are robust to different patients. By grounding our experiments with HIV patients we leverage the data of a group of patients that are similar in that they share one common disease (HIV) but also exhibit complex histories of diverse comorbidities. Using a user-centered, iterative design process, we design an interactive, longitudinal patient record summarization tool, that leverages automated inferences about the patient's problems. We find that unsupervised, joint learning of problems using correlated topic models, adapted to handle the multiple data types (structured and unstructured) of the EHR, is successful in identifying the salient problems of complex patients. Utilizing interactive visualization that exposes inference results to users enables them to make sense of a patient's problems over time and to answer questions about a patient more accurately and faster than using the EHR alone.