Application of information and communication technologies designed to enhance decision making and... more Application of information and communication technologies designed to enhance decision making and communication between providers, patients, and their families will play an important role in supporting the relationship between patient and provider and will assist patients to better understand their illness experience and how their own values affect decision making [1-8].We call this tight integration of software and people in health care Collaborative Healthware [9-11]. Baby CareLink, an application of Collaborative Healthware, links NICU staff with families of medically complex newborns [12]. Using a Web browser, parents can receive daily updates and track information about their baby's health, see recent pictures of their baby, communicate with NICU staff, access a personalized knowledge base for newborn care, and provide feedback regarding the care process. Following discharge, Baby CareLink can be used to support care coordination, follow-up monitoring, and ongoing communication with parents. Baby CareLink is Collaborative Healthware that supports the relationship between parents and healthcare provider by engaging the family as full partners in the healthcare process. The birth of a child is a great joy for most families, but for families whose children require care in the Neonatal Intensive Care Unit (NICU) it is a time of great emotional distress. The care of premature infants is truly a miracle of modern medicine. Incubators for premature infants were developed in the 1930s and supported a controlled environment for the infant. For the most part, the prematurity of the lung was the limiting factor to survivability of the infant. Surfactant is a naturally occurring substance produced by the lung to decrease the surface tension in these small air sacks. Only more mature lungs produce this substance. Even modern ventilators with small rapid tidal volumes had problems expanding the small air exchanging units in the lung called alveoli until the 1970s when surfactant was introduced. As doctors attempted to resuscitate smaller and smaller infants, their success rate improved. Concomitant with the introduction of improved ventilation technology was a dramatic improvement in fertility technologies. Pharmaceuticals were developed to help stimulate ovulation and support tenuous pregnancies. Women were also able to receive already fertilized eggs to overcome biological barriers to conception. The result of these advances has been that preterm birth rate has increased 9% since 1990 and 23% since 1981.
Studies in health technology and informatics, 2017
Accessing online health content of high quality and reliability presents challenges. Laypersons c... more Accessing online health content of high quality and reliability presents challenges. Laypersons cannot easily differentiate trustworthy content from misinformed or manipulated content. This article describes complementary approaches for members of the general public and health professionals to find trustworthy content with as little bias as possible. These include the Khresmoi health search engine (K4E), the Health On the Net Code of Conduct (HONcode) and health trust indicator Web browser extensions.
Journal of the American Medical Informatics Association : JAMIA, Jan 17, 2018
Identify barriers impacting the time consuming and error fraught process of medication reconcilia... more Identify barriers impacting the time consuming and error fraught process of medication reconciliation. Design and implement an electronic medication management system where patient and trusted healthcare proxies can participate in establishing and maintaining an inclusive and up-to-date list of medications. A patient-facing electronic medication manager was deployed within an existing research project focused on elder care management funded by the AHRQ, InfoSAGE, allowing patients and patients' proxies the ability to build and maintain an accurate and up-to-date medication list. Free and open-source tools available from the U.S. government were used to embed the tenets of centralization, interoperability, data federation, and patient activation into the design. Using patient-centered design and free, open-source tools, we implemented a web and mobile enabled patient-facing medication manager for complex medication management. Patient and caregiver participation are essential to ...
Incompletely reconciled medication lists contribute to prescribing errors and adverse drug events... more Incompletely reconciled medication lists contribute to prescribing errors and adverse drug events. Providers expend time and effort at every point of patient contact attempting to curate a best possible medication list, and yet often the list is incomplete or inaccurate. We propose a framework that builds upon the existing infrastructure of a health information exchange (HIE), centralizes data and encourages patient activation. The solution is a constantly accessible, singular, patient-adjudicated medication list that incorporates useful information and features into the list itself. We aim to decrease medication errors across transitions of care, increase awareness of potential drug-drug interactions, improve patient knowledge and self-efficacy regarding medications, decrease polypharmacy, improve prescribing safety and ultimately decrease cost to the health-care system.
Broadband: A high-speed Internet connection ISDN: Integrated Services Digital Network provides hi... more Broadband: A high-speed Internet connection ISDN: Integrated Services Digital Network provides highspeed digital phone service that can be delivered through standard phone lines and facilitates videoconferencing Mb, Gb: Megabyte and gigabyte, respectively. A measure of the amount of memory contained in a computer RAM: Random access memory Shockwave Applet: A computer application used within a World Wide Web (WWW) browser to display animated and interactive content Virtual house calls: The use of videoconferencing technology to allow clinicians to check on a patient without the need for a home visit WWW browser: A program such as Microsoft Internet Explorer or Netscape Navigator that allows a computer user to view information contained on the World Wide Web Secure Sockets Layer: A standard method for encrypting data during transit across the Internet ABBREVIATIONS. NICU, neonatal intensive care unit; VLBW, very low birth weight; WWW, World Wide Web; PIN, personal identification number; ICU, intensive care unit. ABSTRACT. Objective. To evaluate an Internet-based telemedicine program designed to reduce the costs of care, to provide enhanced medical, informational, and emotional support to families of very low birth weight (VLBW) infants during and after their neonatal intensive care unit (NICU) stay. Background. Baby CareLink is a multifaceted telemedicine program that incorporates videoconferencing and World Wide Web (WWW) technologies to enhance interactions between families, staff, and community providers. The videoconferencing module allows virtual visits and distance learning from a family's home during an infant's hospitalization as well as virtual house calls and remote monitoring after discharge. Baby CareLink's WWW site contains information on issues that confront these families. In addition, its security architecture allows efficient and confidential sharing of patient-based data and communications among authorized hospital and community users. Design/Methods. A randomized trial of Baby CareLink was conducted in a cohort of VLBW infants born between November 1997 and April 1999. Eligible infants were randomized within 10 days of birth. Families of intervention group infants were given access to the Baby CareLink telemedicine application. A multimedia computer with WWW browser and videoconferencing equipment was installed in their home within 3 weeks of birth. The control group received care as usually practiced in this NICU. Quality of care was assessed using a standardized family satisfaction survey administered after discharge. In addition, the effect of Baby CareLink on hospital length of stay as well as family visitation and interactions with infant and staff were measured. Results. Of the 176 VLBW infants admitted during the study period, 30 control and 26 study patients were enrolled. The groups were similar in patient and family characteristics as well as rates of inpatient morbidity. The CareLink group reported higher overall quality of care. Families in the CareLink group reported significantly fewer problems with the overall quality of care received by their family (mean problem score: 3% vs 13%). In addition, CareLink families also reported greater satisfaction with the unit's physical environment and visitation policies (mean problem score: 13% vs 50%). The frequency of family visits, telephone calls to the NICU, and holding of the infant did not differ between groups. The duration of hospitalization until ultimate discharge home was similar in the 2 groups (68.5 ؎ 28.3 vs 70.6 ؎ 35.6 days). Among infants born weighing <1000 g (n ؍ 31) there was a tendency toward shorter lengths of stay (77.4 ؎ 26.2 vs 93.1 ؎ 35.6 days). All infants in the CareLink group were discharged directly to home whereas 6/30 (20%) of control infants were transferred to community hospitals before ultimate discharge home. Conclusions. CareLink significantly improves family satisfaction with inpatient VLBW care and definitively lowers costs associated with hospital to hospital transfer. Our data suggest the use of telemedicine and the Internet support the educational and emotional needs of families facilitating earlier discharge to home of VLBW infants. We believe that further extension of the Baby CareLink model to the postdischarge period will significantly improve the coordination and efficiency of care. Pediatrics 2000;106:1318-1324; neonatal intensive care unit, very low birth weight (infant), telemedicine, Internet, videoconferencing, randomized controlled trial, medical informatics.
The Program Requirements for Fellowship Education identify the knowledge and skills that physicia... more The Program Requirements for Fellowship Education identify the knowledge and skills that physicians must master through the course of a training program to be certified in the subspecialty of clinical informatics. They also specify accreditation requirements for clinical informatics training programs. The AMIA Board of Directors approved this document in November 2008.
Proceedings Amia Annual Symposium Amia Symposium, Feb 1, 1999
We have created a clinical performance support system that transforms surgical informed consent i... more We have created a clinical performance support system that transforms surgical informed consent into an interactive process capable ofevolving in response to institution-specified, provider-specified and patientspecified needs. The system functions in several capacities, including: (1) a source ofstandardized and
Proceedings the Annual Symposium on Computer Application Sic in Medical Care Symposium on Computer Applications in Medical Care, Feb 1, 1993
Electronic mail has been in use for almost 20 years at Boston's Beth Israel Hospital and is an in... more Electronic mail has been in use for almost 20 years at Boston's Beth Israel Hospital and is an integral part of the clinical information system. Through a study of usage patterns during a one-week period, we found that 1247 persons sent 7482 messages to 1302 different recipients. Each category of user (attending physician, house officer, nurse, etc.) sent the most e-mail to others of the same user category. Through an electronically administered questionnaire, we found that self-reported usage patterns had a high correlation (r = 0.6) with measured use. Sixty-six percent of respondents used e-mail daily or weekly, and 58% used it for issues of patient care; nearly all users found this useful for communicating about patient care issues. Ninety percent of respondents felt e-mail made their lives easier and 61% felt it had a humanizing influence on their lives. We conclude that the e-mail system is well-utilized by clinical personnel and felt to be useful in both patient care and nonpatient care situations.
Studies in Health Technology and Informatics, 1998
With the advent of Integrated Healthcare Delivery Systems, medical records are increasingly distr... more With the advent of Integrated Healthcare Delivery Systems, medical records are increasingly distributed across multiple institutions. Timely access to these medical records is a critical need for healthcare providers. The CareWeb project provides an architecture for World Wide Web-based retrieval of electronic medical records from heterogeneous data sources. Using Health Level 7 (HL7), web technologies and readily available software components, we consolidated the electronic records of Boston's Beth Israel and Deaconess Hospitals. We report on the creation of CareWeb (freya.bidmc.harvard.edu/careweb.htm) and propose it as a means to electronically link Integrated Health Care Delivery Systems and geographically distant information resources.
Elders in retirement communities face many challenges concerning information and communication. W... more Elders in retirement communities face many challenges concerning information and communication. We know little about whether or how online technologies help meet their medical and social needs. The objective of this study was to gain insights into how these elders and their families manage health information and communication. Qualitative analysis of 10 focus groups with elders and family members. Participants were 30 elders at least 75 years of age residing in 5 senior living communities in and near Boston, MA, and 23 family members. Elders and families turned first to their personal networks when they needed information or help. They stayed informed about elders' health primarily by talking directly with providers. They used online resources infrequently, including portal access to medical records. They wanted online access to medication lists and visit notes, up-to-date information about local services and social activities, and a way to avoid the overwhelming nature of Inter...
We developed an on-line medical record (OMR) and integrated it into a mature hospital information... more We developed an on-line medical record (OMR) and integrated it into a mature hospital information system. The OMR provides a number of information resources for the care of patients infected with the human immuno-deficiency virus (HIV), including drug information, an on-line version of a newsletter on AIDS, an on-line version of a textbook on HIV, and an index of research protocols that actively enrolls patients. As part of an 18-month clinical trial of this system, we monitored the use of the information resources and whether or not the resources were being used at the time of a patient&#39;s visit. During 16% of office visits of HIV-infected patients, clinicians viewed some HIV-related information. Forty-four of 70 clinicians looked at drug information (the most popular resource) 347 times (eight times per person). Two thirds of each clinician&#39;s use of the information was through a patient&#39;s electronic record, and about half of those (or one third of each clinician&#39;s use) were at the time of a patient&#39;s visit. Use of other information resources was somewhat less, but the proportion of uses during a patient&#39;s visit was similar. Because of this high level of use, we conclude that clinicians need information resources at the point of patient care and that the electronic medical record is an ideal medium through which to convey this information to providers.
To help clinicians care for patients with HIV infection, we developed an interactive knowledge-ba... more To help clinicians care for patients with HIV infection, we developed an interactive knowledge-based electronic patient record that integrates rule-based decision support and full-text information retrieval with an online patient record. This highly interactive clinical workstation now allows the clinicians at a large primary care practice (30,000 ambulatory visits per year) to use online information resources and fully electronic patient records during all patient encounters. The resulting practice database is continually updated with outcome data on a cohort of 700 patients with HIV infection. As a byproduct of this integrated system, we have developed improved statistical methods to measure the effects of electronic alerts and reminders.
Studies in Health Technology and Informatics, 2010
We have designed and deployed a novel approach to protecting Personal Healthcare Information in e... more We have designed and deployed a novel approach to protecting Personal Healthcare Information in environments where a data center is remote and its physical security cannot be assured. Our &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;KeyServer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; methodology uses a server-client-server architecture to dynamically serve keys from a distant server in a separate secure data center in the US. The approach combines pre-existing and novel techniques into a layered protective barrier around compromise of patient data. We describe how this technology provides scalable security that makes security breaches highly unlikely. With some careful planning a Clinical Data Repositories fed by Electronic Health Records can be placed in relatively insecure settings, with a high-level of security surrounding data theft, even in the event of hardware theft. Such security architecture is ideal for not only developing nations, but for the evolution of health information to cloud computing platforms.
Journal of the American Medical Informatics Association, 2015
Health care proxy (HCP) documentation is suboptimal. To improve rates of proxy selection and docu... more Health care proxy (HCP) documentation is suboptimal. To improve rates of proxy selection and documentation, we sought to develop and evaluate a web-based interview to guide patients in their selection, and to capture their choices in their electronic health record (EHR). Methods We developed and implemented a HCP interview within the patient portal of a large academic health system. We analyzed the experience, together with demographic and clinical factors, of the first 200 patients who used the portal to complete the interview. We invited users to comment about their experience and analyzed their comments using established qualitative methods. Results From January 20, 2015 to March 13, 2015, 139 of the 200 patients who completed the interview submitted their health care proxy information for their clinician to review in the EHR. These patients had a median age of 57 years (IQR 45-67) and most were healthy. The 99 patients who did not previously have health care proxy information in their electronic health record were more likely to complete and then submit their information than the 101 patients who previously had a proxy in their health record (Odds Ratio 2.4, P= 0.005). Qualitative analysis identified several ways in which the portal-based interview reminded, encouraged, and facilitated patients to complete their HCP. Discussion and conclusion Patients found our online interview convenient and helpful in facilitating selection and documentation of an HCP. Our study demonstrates that a web-based interview to collect and share a patient's HCP information is both feasible and useful.
Application of information and communication technologies designed to enhance decision making and... more Application of information and communication technologies designed to enhance decision making and communication between providers, patients, and their families will play an important role in supporting the relationship between patient and provider and will assist patients to better understand their illness experience and how their own values affect decision making [1-8].We call this tight integration of software and people in health care Collaborative Healthware [9-11]. Baby CareLink, an application of Collaborative Healthware, links NICU staff with families of medically complex newborns [12]. Using a Web browser, parents can receive daily updates and track information about their baby's health, see recent pictures of their baby, communicate with NICU staff, access a personalized knowledge base for newborn care, and provide feedback regarding the care process. Following discharge, Baby CareLink can be used to support care coordination, follow-up monitoring, and ongoing communication with parents. Baby CareLink is Collaborative Healthware that supports the relationship between parents and healthcare provider by engaging the family as full partners in the healthcare process. The birth of a child is a great joy for most families, but for families whose children require care in the Neonatal Intensive Care Unit (NICU) it is a time of great emotional distress. The care of premature infants is truly a miracle of modern medicine. Incubators for premature infants were developed in the 1930s and supported a controlled environment for the infant. For the most part, the prematurity of the lung was the limiting factor to survivability of the infant. Surfactant is a naturally occurring substance produced by the lung to decrease the surface tension in these small air sacks. Only more mature lungs produce this substance. Even modern ventilators with small rapid tidal volumes had problems expanding the small air exchanging units in the lung called alveoli until the 1970s when surfactant was introduced. As doctors attempted to resuscitate smaller and smaller infants, their success rate improved. Concomitant with the introduction of improved ventilation technology was a dramatic improvement in fertility technologies. Pharmaceuticals were developed to help stimulate ovulation and support tenuous pregnancies. Women were also able to receive already fertilized eggs to overcome biological barriers to conception. The result of these advances has been that preterm birth rate has increased 9% since 1990 and 23% since 1981.
Studies in health technology and informatics, 2017
Accessing online health content of high quality and reliability presents challenges. Laypersons c... more Accessing online health content of high quality and reliability presents challenges. Laypersons cannot easily differentiate trustworthy content from misinformed or manipulated content. This article describes complementary approaches for members of the general public and health professionals to find trustworthy content with as little bias as possible. These include the Khresmoi health search engine (K4E), the Health On the Net Code of Conduct (HONcode) and health trust indicator Web browser extensions.
Journal of the American Medical Informatics Association : JAMIA, Jan 17, 2018
Identify barriers impacting the time consuming and error fraught process of medication reconcilia... more Identify barriers impacting the time consuming and error fraught process of medication reconciliation. Design and implement an electronic medication management system where patient and trusted healthcare proxies can participate in establishing and maintaining an inclusive and up-to-date list of medications. A patient-facing electronic medication manager was deployed within an existing research project focused on elder care management funded by the AHRQ, InfoSAGE, allowing patients and patients' proxies the ability to build and maintain an accurate and up-to-date medication list. Free and open-source tools available from the U.S. government were used to embed the tenets of centralization, interoperability, data federation, and patient activation into the design. Using patient-centered design and free, open-source tools, we implemented a web and mobile enabled patient-facing medication manager for complex medication management. Patient and caregiver participation are essential to ...
Incompletely reconciled medication lists contribute to prescribing errors and adverse drug events... more Incompletely reconciled medication lists contribute to prescribing errors and adverse drug events. Providers expend time and effort at every point of patient contact attempting to curate a best possible medication list, and yet often the list is incomplete or inaccurate. We propose a framework that builds upon the existing infrastructure of a health information exchange (HIE), centralizes data and encourages patient activation. The solution is a constantly accessible, singular, patient-adjudicated medication list that incorporates useful information and features into the list itself. We aim to decrease medication errors across transitions of care, increase awareness of potential drug-drug interactions, improve patient knowledge and self-efficacy regarding medications, decrease polypharmacy, improve prescribing safety and ultimately decrease cost to the health-care system.
Broadband: A high-speed Internet connection ISDN: Integrated Services Digital Network provides hi... more Broadband: A high-speed Internet connection ISDN: Integrated Services Digital Network provides highspeed digital phone service that can be delivered through standard phone lines and facilitates videoconferencing Mb, Gb: Megabyte and gigabyte, respectively. A measure of the amount of memory contained in a computer RAM: Random access memory Shockwave Applet: A computer application used within a World Wide Web (WWW) browser to display animated and interactive content Virtual house calls: The use of videoconferencing technology to allow clinicians to check on a patient without the need for a home visit WWW browser: A program such as Microsoft Internet Explorer or Netscape Navigator that allows a computer user to view information contained on the World Wide Web Secure Sockets Layer: A standard method for encrypting data during transit across the Internet ABBREVIATIONS. NICU, neonatal intensive care unit; VLBW, very low birth weight; WWW, World Wide Web; PIN, personal identification number; ICU, intensive care unit. ABSTRACT. Objective. To evaluate an Internet-based telemedicine program designed to reduce the costs of care, to provide enhanced medical, informational, and emotional support to families of very low birth weight (VLBW) infants during and after their neonatal intensive care unit (NICU) stay. Background. Baby CareLink is a multifaceted telemedicine program that incorporates videoconferencing and World Wide Web (WWW) technologies to enhance interactions between families, staff, and community providers. The videoconferencing module allows virtual visits and distance learning from a family's home during an infant's hospitalization as well as virtual house calls and remote monitoring after discharge. Baby CareLink's WWW site contains information on issues that confront these families. In addition, its security architecture allows efficient and confidential sharing of patient-based data and communications among authorized hospital and community users. Design/Methods. A randomized trial of Baby CareLink was conducted in a cohort of VLBW infants born between November 1997 and April 1999. Eligible infants were randomized within 10 days of birth. Families of intervention group infants were given access to the Baby CareLink telemedicine application. A multimedia computer with WWW browser and videoconferencing equipment was installed in their home within 3 weeks of birth. The control group received care as usually practiced in this NICU. Quality of care was assessed using a standardized family satisfaction survey administered after discharge. In addition, the effect of Baby CareLink on hospital length of stay as well as family visitation and interactions with infant and staff were measured. Results. Of the 176 VLBW infants admitted during the study period, 30 control and 26 study patients were enrolled. The groups were similar in patient and family characteristics as well as rates of inpatient morbidity. The CareLink group reported higher overall quality of care. Families in the CareLink group reported significantly fewer problems with the overall quality of care received by their family (mean problem score: 3% vs 13%). In addition, CareLink families also reported greater satisfaction with the unit's physical environment and visitation policies (mean problem score: 13% vs 50%). The frequency of family visits, telephone calls to the NICU, and holding of the infant did not differ between groups. The duration of hospitalization until ultimate discharge home was similar in the 2 groups (68.5 ؎ 28.3 vs 70.6 ؎ 35.6 days). Among infants born weighing <1000 g (n ؍ 31) there was a tendency toward shorter lengths of stay (77.4 ؎ 26.2 vs 93.1 ؎ 35.6 days). All infants in the CareLink group were discharged directly to home whereas 6/30 (20%) of control infants were transferred to community hospitals before ultimate discharge home. Conclusions. CareLink significantly improves family satisfaction with inpatient VLBW care and definitively lowers costs associated with hospital to hospital transfer. Our data suggest the use of telemedicine and the Internet support the educational and emotional needs of families facilitating earlier discharge to home of VLBW infants. We believe that further extension of the Baby CareLink model to the postdischarge period will significantly improve the coordination and efficiency of care. Pediatrics 2000;106:1318-1324; neonatal intensive care unit, very low birth weight (infant), telemedicine, Internet, videoconferencing, randomized controlled trial, medical informatics.
The Program Requirements for Fellowship Education identify the knowledge and skills that physicia... more The Program Requirements for Fellowship Education identify the knowledge and skills that physicians must master through the course of a training program to be certified in the subspecialty of clinical informatics. They also specify accreditation requirements for clinical informatics training programs. The AMIA Board of Directors approved this document in November 2008.
Proceedings Amia Annual Symposium Amia Symposium, Feb 1, 1999
We have created a clinical performance support system that transforms surgical informed consent i... more We have created a clinical performance support system that transforms surgical informed consent into an interactive process capable ofevolving in response to institution-specified, provider-specified and patientspecified needs. The system functions in several capacities, including: (1) a source ofstandardized and
Proceedings the Annual Symposium on Computer Application Sic in Medical Care Symposium on Computer Applications in Medical Care, Feb 1, 1993
Electronic mail has been in use for almost 20 years at Boston's Beth Israel Hospital and is an in... more Electronic mail has been in use for almost 20 years at Boston's Beth Israel Hospital and is an integral part of the clinical information system. Through a study of usage patterns during a one-week period, we found that 1247 persons sent 7482 messages to 1302 different recipients. Each category of user (attending physician, house officer, nurse, etc.) sent the most e-mail to others of the same user category. Through an electronically administered questionnaire, we found that self-reported usage patterns had a high correlation (r = 0.6) with measured use. Sixty-six percent of respondents used e-mail daily or weekly, and 58% used it for issues of patient care; nearly all users found this useful for communicating about patient care issues. Ninety percent of respondents felt e-mail made their lives easier and 61% felt it had a humanizing influence on their lives. We conclude that the e-mail system is well-utilized by clinical personnel and felt to be useful in both patient care and nonpatient care situations.
Studies in Health Technology and Informatics, 1998
With the advent of Integrated Healthcare Delivery Systems, medical records are increasingly distr... more With the advent of Integrated Healthcare Delivery Systems, medical records are increasingly distributed across multiple institutions. Timely access to these medical records is a critical need for healthcare providers. The CareWeb project provides an architecture for World Wide Web-based retrieval of electronic medical records from heterogeneous data sources. Using Health Level 7 (HL7), web technologies and readily available software components, we consolidated the electronic records of Boston's Beth Israel and Deaconess Hospitals. We report on the creation of CareWeb (freya.bidmc.harvard.edu/careweb.htm) and propose it as a means to electronically link Integrated Health Care Delivery Systems and geographically distant information resources.
Elders in retirement communities face many challenges concerning information and communication. W... more Elders in retirement communities face many challenges concerning information and communication. We know little about whether or how online technologies help meet their medical and social needs. The objective of this study was to gain insights into how these elders and their families manage health information and communication. Qualitative analysis of 10 focus groups with elders and family members. Participants were 30 elders at least 75 years of age residing in 5 senior living communities in and near Boston, MA, and 23 family members. Elders and families turned first to their personal networks when they needed information or help. They stayed informed about elders' health primarily by talking directly with providers. They used online resources infrequently, including portal access to medical records. They wanted online access to medication lists and visit notes, up-to-date information about local services and social activities, and a way to avoid the overwhelming nature of Inter...
We developed an on-line medical record (OMR) and integrated it into a mature hospital information... more We developed an on-line medical record (OMR) and integrated it into a mature hospital information system. The OMR provides a number of information resources for the care of patients infected with the human immuno-deficiency virus (HIV), including drug information, an on-line version of a newsletter on AIDS, an on-line version of a textbook on HIV, and an index of research protocols that actively enrolls patients. As part of an 18-month clinical trial of this system, we monitored the use of the information resources and whether or not the resources were being used at the time of a patient&#39;s visit. During 16% of office visits of HIV-infected patients, clinicians viewed some HIV-related information. Forty-four of 70 clinicians looked at drug information (the most popular resource) 347 times (eight times per person). Two thirds of each clinician&#39;s use of the information was through a patient&#39;s electronic record, and about half of those (or one third of each clinician&#39;s use) were at the time of a patient&#39;s visit. Use of other information resources was somewhat less, but the proportion of uses during a patient&#39;s visit was similar. Because of this high level of use, we conclude that clinicians need information resources at the point of patient care and that the electronic medical record is an ideal medium through which to convey this information to providers.
To help clinicians care for patients with HIV infection, we developed an interactive knowledge-ba... more To help clinicians care for patients with HIV infection, we developed an interactive knowledge-based electronic patient record that integrates rule-based decision support and full-text information retrieval with an online patient record. This highly interactive clinical workstation now allows the clinicians at a large primary care practice (30,000 ambulatory visits per year) to use online information resources and fully electronic patient records during all patient encounters. The resulting practice database is continually updated with outcome data on a cohort of 700 patients with HIV infection. As a byproduct of this integrated system, we have developed improved statistical methods to measure the effects of electronic alerts and reminders.
Studies in Health Technology and Informatics, 2010
We have designed and deployed a novel approach to protecting Personal Healthcare Information in e... more We have designed and deployed a novel approach to protecting Personal Healthcare Information in environments where a data center is remote and its physical security cannot be assured. Our &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;KeyServer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; methodology uses a server-client-server architecture to dynamically serve keys from a distant server in a separate secure data center in the US. The approach combines pre-existing and novel techniques into a layered protective barrier around compromise of patient data. We describe how this technology provides scalable security that makes security breaches highly unlikely. With some careful planning a Clinical Data Repositories fed by Electronic Health Records can be placed in relatively insecure settings, with a high-level of security surrounding data theft, even in the event of hardware theft. Such security architecture is ideal for not only developing nations, but for the evolution of health information to cloud computing platforms.
Journal of the American Medical Informatics Association, 2015
Health care proxy (HCP) documentation is suboptimal. To improve rates of proxy selection and docu... more Health care proxy (HCP) documentation is suboptimal. To improve rates of proxy selection and documentation, we sought to develop and evaluate a web-based interview to guide patients in their selection, and to capture their choices in their electronic health record (EHR). Methods We developed and implemented a HCP interview within the patient portal of a large academic health system. We analyzed the experience, together with demographic and clinical factors, of the first 200 patients who used the portal to complete the interview. We invited users to comment about their experience and analyzed their comments using established qualitative methods. Results From January 20, 2015 to March 13, 2015, 139 of the 200 patients who completed the interview submitted their health care proxy information for their clinician to review in the EHR. These patients had a median age of 57 years (IQR 45-67) and most were healthy. The 99 patients who did not previously have health care proxy information in their electronic health record were more likely to complete and then submit their information than the 101 patients who previously had a proxy in their health record (Odds Ratio 2.4, P= 0.005). Qualitative analysis identified several ways in which the portal-based interview reminded, encouraged, and facilitated patients to complete their HCP. Discussion and conclusion Patients found our online interview convenient and helpful in facilitating selection and documentation of an HCP. Our study demonstrates that a web-based interview to collect and share a patient's HCP information is both feasible and useful.
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Papers by Charles Safran