Biomedical subjects

Paul G Biondich

Publications and source records attributed to Paul G Biondich.

9 recordsLinked to original sources

PubMed2006

Shortcomings in infant iron deficiency screening methods.

BACKGROUND: Screening for iron deficiency anemia is a well-established practice in pediatrics, but numerous challenges surrounding current recommendations raise questions about the effectiveness of this strategy. OBJECTIVE: To evaluate iron deficiency anemia screening approaches, by assessing rates of follow-up testing and resolution among patients meeting screening criteria in a primary care setting. METHODS: A retrospective cohort study was performed. We extracted electronic medical record data on complete blood counts for infants who received primary care in our clinics in the past 10 years. We calculated rates of positive screening results with 9 different measurement criteria and determined rates of follow-up testing and of documented correction of iron deficiency among those who screened positive. RESULTS: Our cohort consisted of 4984 children who were screened at 9 to 15 months of age, between 1994 and 2004. There was a wide distribution of positive detection rates (range: 1.5-14.5%) among the 9 screening criteria. Follow-up testing rates were low. No more than 25% of infants who screened positive by any criterion underwent a repeat complete blood count within 6 months. Moreover, no more than 11.6% (range: 4.4-11.6%) had documented correction of their laboratory abnormalities. CONCLUSIONS: Significant shortcomings exist in current iron deficiency anemia screening practices. A widely agreed-on, specific, and inexpensive screening criterion, with increased emphasis on systems-based approaches to iron deficiency screening, is needed.

Anemia, Iron-Deficiency↗

PubMed2005

Human and system errors, using adaptive turnaround documents to capture data in a busy practice.

Capturing coded clinical data for clinical decision support can improve care, but cost and disruption of clinic workflow present barriers to implementation. Previous work has shown that tailored, scannable paper forms (adaptive turnaround documents, ATDs) can achieve the benefits of computer-based clinical decision support at low cost and minimal disruption of workflow. ATDs are highly accurate under controlled circumstances, but accuracy in the setting of busy clinics with untrained physician users is untested. We recently developed and implemented such a system and studied rates of errors attributable to physician users and errors in the system. Prompts were used in 63% of encounters. Errors resulting from incorrectly marking forms occurred in 1.8% of prompts. System errors occurred in 7.2% of prompts. Most system errors were failures to capture data and may represent human errors in the scanning process. ATDs are an effective way to collect coded data from physicians. Further automation of the scanning process may reduce system errors.

Ambulatory Care Information Systems↗

PubMed2005

How disease surveillance systems can serve as practical building blocks for a health information infrastructure: the Indiana experience.

Although many organizations are beginning to develop strategies to implement and study regional and national health information exchanges, there are few operational examples to date. The Indiana Network for Patient Care (INPC) is an example of a currently operational Regional Health Information Organization (RHIO) built upon a foundation of open, robust healthcare information standards. Having demonstrated the scalability of this design, the Indiana State Department of Health (ISDH) contracted with the Regenstrief Institute to implement a statewide disease surveillance system incorporating encounter data from all 114 Indiana hospitals with emergency departments. We describe the 4-year implementation plan, including our design rationale and how we plan to address the specific implementation challenges of data collection, connectivity in diverse environments and current hospital buy-in. To date, 36 hospitals are in various stages of engagement, with 19 hospitals actively providing real-time surveillance data. We will discuss how this project creates the foundation for a potential statewide health information exchange.

Computer Communication Networks↗

PubMed2005

AMPATH Medical Record System (AMRS): collaborating toward an EMR for developing countries.

Millions of people are either living with or dying from HIV/AIDS; most of this living and dying is taking place in developing countries. There is an immediate need for electronic medical record systems to help scale up HIV/AIDS prevention and treatment programs, reduce critical human errors, and support the research necessary to guide future efforts. Several groups are working on this problem, but most of this work is occurring within silos. To be more effective, we must find ways to collaborate. We describe a system built on the 30+ years of experience at Regenstrief Institute to serve as the seed for building toward a common infrastructure. We discuss the design goals, data model, and implementation of a data entry component. Further details are available online at amrs.iukenya.org.

Developing Countries↗

PubMed2005

A call for collaboration: building an EMR for developing countries.

Developing Countries↗

PubMed2004

Child Health Improvement through Computer Automation: the CHICA system.

Clinical guidelines are prevalent but frequently not used. Computer reminder systems can improve adherence to guidelines but have not been widely adopted. We present a computer-based decision support system that combines these elements: 1) pediatric preventive care guidelines encoded in Arden Syntax; 2) a dynamic, scannable paper user interface; and 3) a HL7-compliant interface to existing electronic medical record systems. The result is a system that both delivers "just in time" patient-relevant guidelines to physicians during the clinical encounter and accurately captures structured data from all who interact with the system. The system performs these tasks while remaining sensitive to the workflow constraints of a busy outpatient pediatric practice.

Algorithms↗

PubMed2004

The Indiana network for patient care: an integrated clinical information system informed by over thirty years of experience.

Presented in this article is the Indiana Network for Patient Care, an integrated citywide medical record system that promotes health quality by enabling efficient access to clinical information. It begins with a description of the system's infrastructure, which includes an explanation of how the system accomplishes data integration. This is followed by a series of descriptions and rationales behind the many clinical applications that interface these data. In doing so, some of the factors that we feel contribute to the success of the system are illustrated.

Databases, Factual↗

PubMed2003

Using adaptive turnaround documents to electronically acquire structured data in clinical settings.

We developed adaptive turnaround documents (ATDs) to address longstanding challenges inherent in acquiring structured data at the point of care. These computer-generated paper forms both request and receive patient tailored information specifically for electronic storage. In our pilot, we evaluated the usability, accuracy, and user acceptance of an ATD designed to enrich a pediatric preventative care decision support system. The system had an overall digit recognition rate of 98.6% (95% CI: 98.3 to 98.9) and a marksense accuracy of 99.2% (95% CI: 99.1 to 99.3). More importantly, the system reliably extracted all data from 56.6% (95% CI: 53.3 to 59.9) of our pilot forms without the need for a verification step. These results translate to a minimal workflow burden to end users. This suggests that ATDs can serve as an inexpensive, workflow-sensitive means of structured data acquisition in the clinical setting.

Ambulatory Care Information Systems↗

PubMed2002

A modern optical character recognition system in a real world clinical setting: some accuracy and feasibility observations.

Advances in optical character recognition (OCR) software and computer hardware have stimulated a reevaluation of the technology and its ability to capture structured clinical data from preexisting paper forms. In our pilot evaluation, we measured the accuracy and feasibility of capturing vitals data from a pediatric encounter form that has been in use for over twenty years. We found that the software had a digit recognition rate of 92.4% (95% confidence interval: 91.6 to 93.2) overall. More importantly, this system was approximately three times as fast as our existing method of data entry. These preliminary results suggest that with further refinements in the approach and additional development, we may be able to incorporate OCR as another method for capturing structured clinical data.

Electronic Data Processing↗