Browsing by Author "Lopetegui, Marcelo"
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Item A Novel Approach to Create a Machine Readable Concept Model for Validating SNOMED CT Concept Post-coordination(2015) Lopetegui, Marcelo; Mauro, AlejandroPost-coordination provides the means to achieve an appropriate content coverage, which is critical in successfully adopting clinical reference terminologies, and thus represent clinical information consistently. However, one of the major problems of post-coordination corresponds with ensuring only clinically sensible concepts can be constructed. In this poster, we present the development of a novel approach to generate a MRCM computationally, in order to facilitate the adherence to the existing guidelines and improve the quality of postcoordination in SNOMED CT.Item A Review of Clinical Workflow Studies and Methods(2019) Payne, Philip; Lopetegui, Marcelo; Yu, SeanIt has been well established that the optimization of workflow can have substantial impact on the feasibility, efficiency, quality, safety, and outcomes of healthcare delivery. The process of studying and understanding workflow in support of such optimization has existed for some time, originally developed in the business and industrial research domains, and has been variably applied within the healthcare domain to date. In this chapter, we introduce the basic nomenclature and methods that encapsulate such workflow studies in the healthcare setting and provide a series of examples that demonstrate how such methods can be applied to solving critical problems. We conclude by reviewing open and active areas of inquiries concerning the current and future use of such workflow analysis methodologies.Item Electronic health record-based assessment of cardiovascular health: The stroke prevention in healthcare delivery environments (SPHERE) study(Elsevier, 2016) Foraker, Randi; Shoben, Abigail; Kelley, Marjorie; Lai, Albert; Lopetegui, Marcelo; Jackson, Rebecca; Langan, Michael; Payne, Philip< 3% of Americans have ideal cardiovascular health (CVH). The primary care encounter provides a setting in which to conduct patient-provider discussions of CVH. We implemented a CVH risk assessment, visualization, and decision-making tool that automatically populates with electronic health record (EHR) data during the encounter in order to encourage patient-centered CVH discussions among at-risk, yet under-treated, populations. We quantified five of the seven CVH behaviors and factors that were available in The Ohio State University Wexner Medical Center's EHR at baseline (May–July 2013) and compared values to those ascertained at one-year (May–July 2014) among intervention (n = 109) and control (n = 42) patients. The CVH of women in the intervention clinic improved relative to the metrics of body mass index (16% to 21% ideal) and diabetes (62% to 68% ideal), but not for smoking, total cholesterol, or blood pressure. Meanwhile, the CVH of women in the control clinic either held constant or worsened slightly as measured using those same metrics. Providers need easy-to-use tools at the point-of-care to help patients improve CVH. We demonstrated that the EHR could deliver such a tool using an existing American Heart Association framework, and we noted small improvements in CVH in our patient population. Future work is needed to assess how to best harness the potential of such tools in order to have the greatest impact on the CVH of a larger patient population. Abbreviations: 95% CI, 95% confidence interval; ACC, American College of Cardiology; AHA, American Heart Association; CDS, clinical decision support; CVH, cardiovascular health; EHR, electronic health record; GEE, generalized estimation equation; OSUWMC, Ohio State University Wexner Medical Center; SD, standard deviation; SPHERE, stroke prevention in healthcare delivery environments.Item Emergency Department Information System Education and Training for Clinicians: Lessons Learned(2015) Lopetegui, Marcelo; Oberpaur, Bernd; Vivent, Macarena; Carrasco, Cecilia; Mauro, AlejandroOf all the potential barriers to a successful Electronic Health Record (EHR) adoption, the importance of training is often underestimated, potentially jeopardizing the implementation. Following best practices recommendations, we designed and implemented a comprehensive EHR training framework. The aim of this poster is to describe our experience with such a framework in the implementation of our home-grown Emergency Department Information System (EDIS), report lessons learned and provide recommendations for other institutions facing EHR adoptions in Chile and Latin America.Item Foundations for Studying Clinical Workflow: Development of a Composite Inter-Observer Reliability Assessment for Workflow Time Studies(2019) Lopetegui, Marcelo; Yen, Po-Yin; Embi, Peter; Payne, PhilipThe ability to understand and measure the complexity of clinical workflow provides hospital managers and researchers with the necessary knowledge to assess some of the most critical issues in healthcare. Given the protagonist role of workflow time studies on influencing decision makers, major efforts are being conducted to address existing methodological inconsistencies of the technique. Among major concerns, the lack of a standardized methodology to ensure the reliability of human observers stands as a priority. In this paper, we highlight the limitations of the current Inter-Observer Reliability Assessments, and propose a novel composite score to systematically conduct them. The composite score is composed of a) the overall agreement based on Kappa that evaluates the naming agreement on virtually created one-seconds tasks, providing a global assessment of the agreement over time, b) a naming agreement based on Kappa, requiring an observation pairing approach based on time-overlap, c) a duration agreement based on the concordance correlation coefficient, that provides means to evaluate the correlation concerning tasks duration, d) a timing agreement, based on descriptive statistics of the gaps between timestamps of same-task classes, and e) a sequence agreement based on the Needleman-Wunsch sequence alignment algorithm. We hereby provide a first step towards standardized reliability reporting in workflow time studies. This new composite IORA protocol is intended to empower workflow researchers with a standardized and comprehensive method for validating observers' reliability and, in turn, the validity of their data and results.Item Nurses’ Stress Associated with Nursing Activities and Electronic Health Records: Data Triangulation from Continuous Stress Monitoring, Perceived Workload, and a Time Motion Study(2019) Yen, Po-Yin; Pearl, Nicole; Jethro, Cierra; Cooney, Emily; McNeil, Brittany; Chen, Ling; Lopetegui, Marcelo; Maddox, Thomas M.; Schallom, MarilynAs health IT has become overloaded with patient information, provider burnout and stress has accelerated. Studies have shown that EHR usage leads to heightened cognitive workload for nurses, and increases in cognitive workload can result in stronger feelings of exhaustion and burnout. We conducted a time motion study in an oncology division to examine the relationships between nurses’ perceived workload, stress measured by blood pulse wave (BPw), and their time spent on nursing activities, and to identify stress associated with EHR use. We had a total of 33 observations from 7 nurses. We found that EHR-related stress is associated with nurses’ perceived physical demand and frustration. We also found that nurses’ perceived workload is a strong predictor of nurses’ stress as well as how they spent time with their patients. They also experienced higher perceived mental demand, physical demand, and temporal demand when they were assigned to more patients, regardless of patient acuity. Our study presents a unique data triangulation approach from continuous stress monitoring, perceived workload, and a time motion study.Item Paro cardiorrespiratorio extrahospitalario. Realidad de un hospital terciario chileno(2017) Lara, Bárbara; Valdés, María José; Saavedra, Raimundo; Vargas, José; Chuecas, Joaquín; Opazo, Cristhofer; Neilb, Emily; Lopetegui, Marcelo; Acuña, David; Aguilera, PabloBackground: The incidence of out of hospital cardiac arrest (OHCA) is approximately 20 to 140 per 100.000 inhabitants. International registries, based on Utstein criteria have allowed standardized reporting of OHCA profiles and outcomes in different countries. We proposed to create a local OHCA registry. Aim: To assess the quality of the information about OHCA currently recorded in medical records according to Utstein guidelines. Material and Methods: A retrospective analysis of medical records of patients arriving in the emergency room of a public hospital with OHCA during a 3-year period. Data regarding the patient characteristics, event and outcomes were analyzed. Results: During the revision period, 317 patients arrived with an OHCA. None of the medical records had complete data on items that are considered a minimum requirement by Utstein guidelines. Mean age of patients was 63 years old, 60% were men, the most common arrest rhythm was asystole (43%) and 8% of patients were discharged alive. Conclusions: Data recorded in medical records is insufficient to inform the profile of OHCA. A prospective registry is currently being imple- mented based on the information provided by this study. This registry should optimize reporting and data analysis.Item Textual inference for eligibility criteria resolution in clinical trials.(Elsevier Inc, 2015) Shivade, Chaitanya; Hebert, Courtney; Lopetegui, Marcelo; De Marneffe, Marie-Catherine; Fosler-Lussier, Eric; Lai, AlbertClinical trials are essential for determining whether new interventions are effective. In order to determine the eligibility of patients to enroll into these trials, clinical trial coordinators often perform a manual review of clinical notes in the electronic health record of patients. This is a very time-consuming and exhausting task. Efforts in this process can be expedited if these coordinators are directed toward specific parts of the text that are relevant for eligibility determination. In this study, we describe the creation of a dataset that can be used to evaluate automated methods capable of identifying sentences in a note that are relevant for screening a patient's eligibility in clinical trials. Using this dataset, we also present results for four simple methods in natural language processing that can be used to automate this task. We found that this is a challenging task (maximum F-score=26.25), but it is a promising direction for further research.Item Usability and Workflow Evaluation of “RhEumAtic Disease Activity” (READY) A Mobile Application for Rheumatology Patients and Providers(2016) Yen, Po-Yin; Lara, Bárbara; Lopetegui, Marcelo; Bharat, Aseem; Ardoin, Stacy; Johnson, Bernardette; Mathur, Puneet; Embi, Peter J; Curtis, Jeffrey RBackground: RhEumAtic Disease activitY (READY) is a mobile health (mHealth) application that aims to create a shared platform integrating data from both patients and physicians, with a particular emphasis on arthritis disease activity. Methods: We made READY available on an iPad and pilot implemented it at a rheumatology outpatient clinic. We conducted 1) a usability evaluation study to explore patients’ and physicians’ interactions with READY, and 2) a time motion study (TMS) to observe the clinical workflow before and after the implementation. Results: A total of 33 patients and 15 physicians participated in the usability evaluation. We found usability problems in navigation, data entry, pain assessment, documentation, and instructions along with error messages. Despite these issues, 25 (75,76%) patients reported they liked READY. Physicians provided mixed feedback because they were concerned about the impact of READY on clinical workflow. Six physicians participated in the TMS. We observed 47 patient visits (44.72 hours) in the pre-implementation phase, and 42 patient visits (37.82 hours) in the post-implementation phase. We found that patients spent more time on READY than paper (4.39mins vs.2.26mins), but overall, READY did not delay the workflow (pre = 52.08 mins vs. post = 45.46 mins). This time difference may be compensated with READY eliminating a workflow step for the staff. Conclusion: Patients preferred READY to paper documents. Many found it easier to input information because of the larger font size and the ease of ‘tapping’ rather than writing-out or circling answers. Even though patients spent more time on READY than using paper documents, the longer usage of READY was mainly due to when troubleshooting was needed. Most patients did not have problems after receiving initial support from the staff. This study not only enabled improvements to the software but also serves as good reference for other researchers or institutional decision makers who are interested in implementing such a technology.