This document discusses EHR adoption trends in Michigan and nationwide based on data from the HIMSS Analytics Database. It finds that Michigan hospitals have a higher average EMR adoption score than the national average, with 4.0458 compared to 3.6500. The top issues impacting healthcare according to the HIMSS Leadership Survey are healthcare reform and financial considerations. The primary clinical IT focus for most hospitals is improving quality outcomes and reducing medical errors. Radiology PACS installations are nearly universal in Michigan hospitals at 89.74%. Ambulatory EMR adoption in Michigan is lower than the national average at 61.97% versus 65.84% nationwide.
Panel: Transitions of Care and ADT (without Rachel Sherman)mihinpr
This document discusses using automated data feeds from hospitals to promote care coordination between primary care practices and hospitals. It describes a pilot program that implemented automated data feeds from local hospitals to notify primary care physicians and care coordinators of patient admissions and discharges. The pilot aimed to improve care coordination through increased communication and awareness of hospital utilization. Initial lessons showed the potential for improved workflows but also challenges in integrating new data and processes into clinical practice. Next steps focused on refining processes and expanding the pilot program.
Michigan Health Information Network Shared Services MiHIN ADT Admit Discharge Transfer ONC Office of the National Coordinator for Health Information Technolgy HIT HIE
MiHIN Statewide Consumer Directory Overview - Direct Workgroup v4 03-09-15mihinpr
The document proposes a Statewide Consumer Directory (SCD) to give consumers more control over their personal health information by providing a single location for consumers to:
1) Identify their care team members and preferred providers.
2) Specify their preferences for consenting to how and where their health data is shared.
3) Define where their health data is stored across different systems and records.
The SCD would also benefit providers by allowing them to find a patient's care team, understand a patient's consent preferences, locate important documents like advance directives, and identify where to send patient data. The SCD aims to address current fragmentation of health information across different personal health records, provider portals, and specialty systems.
MiHIN Direct Webinar for EHR Intelligence v10 11 12-14mihinpr
Direct Secure Messaging is a secure email system for exchanging protected health information. It uses encryption and digital certificates to securely transmit messages between known parties like providers, hospitals, and public health agencies. The document discusses how Direct is used for care coordination and public health reporting such as submitting immunization or quality data. It also reviews governance organizations like DirectTrust and NATE that work to expand Direct use and interoperability.
Panel: Understanding Michigan's HIE Landscapemihinpr
• Susan Hubbard, SEMHIE
Board of Directors
• Robert Jackson, MD, CMM
(Western Wayne Physicians)
• Jeanette Klanow, (St. John Providence
Health System)
• Helen Hill, MiHIN Board Rep., Director
Public-Private Initiatives
• Michael (Mick) Talley, Treasurer
(University Bank)
• John Vismara, President (Ingenium)
• Terrisca Des Jardins, Director (SEMBC)
• Doug Dietzman, Executive Director
(Macomb County HIE)
• Paula Johnson, Director (UPHIE)
• Aaron Wootton, Director
Health IT and Public Policy Issues Dr. Rich Hodgemihinpr
The document provides an overview of current public policy issues related to health information technology in the United States. It discusses HIMSS' role in advocating for health IT and outlines their public policy process. Key points include:
- HIMSS advocates for health IT through establishing annual policy principles, priorities, and statements to guide their work.
- The top congressional affairs priorities for 2013 are preserving HITECH EHR incentive funding, advancing patient data matching, and educating Congress on health IT issues.
- Federal legislative and regulatory activity around topics like meaningful use, interoperability, privacy/security, and medical device regulation will impact the health IT field.
MiHIN Health Provider Directory Demo Slides with CQMRR v43 02 18-15mihinpr
The document provides an overview of the Michigan Statewide Health Provider Directory (HPD) service. The HPD service allows for the storage and sharing of electronic provider information to support use cases like transitions of care. It utilizes Salesforce platform for a production-quality deployment and supports integration through APIs. The HPD also focuses on routing health records via electronic service information and supports quality reporting through clinical quality measurement portals.
MiHIN Overview - Health Information Exchange Meet and Greet v7 10 22-14mihinpr
The document provides an overview of MiHIN, which is a statewide health information exchange network in Michigan. It describes how MiHIN connects various healthcare organizations across the state through a common framework to enable the secure sharing of patient health information. MiHIN uses a "use case" approach where specific clinical scenarios define how data will be shared for different purposes, such as care coordination, public health reporting, and quality improvement. It also outlines MiHIN's governance structure and stakeholder groups that help guide its operations.
Mark Frisse gave a keynote address covering four main topics: the turbulence in healthcare due to various forces driving change; the current confusion from uncertainties in the evolving healthcare system; some vital elements that could help forge solutions; and the need for an emergent, incremental approach to progress. He argued that meaningful change requires renewed focus on critical goals through a systematic, component-based approach with tangible early results.
FTC Spring Privacy Series: Consumer Generated and Controlled Health DataBrian Ahier
Increasingly, consumers are taking a more active role in managing and generating their own health data. For example, consumers are researching their health conditions and diagnosing themselves online. Consumers are also uploading their information into personal health records and apps that allow them to manage and analyze their data, and utilizing connected health and fitness devices that regularly collect information about them and transmit this information to other entities.
The movement of health data outside the traditional medical provider context has many potential benefits; however, it also raises potential privacy concerns. The seminar will address questions such as:
What types of websites, products, and services are consumers using to generate and control their health data, and how are consumers using them?
Who are the companies behind these websites, products, and services, what are their business models, and what does the current marketplace look like?
How can consumers benefit from these companies’ websites, products, and services?
What actions are these companies taking to protect consumers’ privacy and security?
What do consumers expect from these companies regarding privacy and security protections?
Do consumers differentiate between these companies and those that offer traditional medical products and services that are covered by HIPAA?
What restrictions, if any, do advertising networks and others impose on tracking of health data?
HXR 2016: The Health IoT: Remote Care and Mobile Solutions -Manu Varma, PhilipsHxRefactored
The digital transformation of healthcare is collecting millions of data points from connected devices that monitor patients. Chronic conditions are increasing globally and healthcare spending is rising unsustainably. Digital technologies enable moving from reactive to proactive health by providing a longitudinal personalized overview of patients through monitoring, informatics and connected care. Philips partners with healthcare organizations to implement telehealth programs that have led to faster discharge rates from hospitals and ICUs, as well as significant cost savings through reduced readmissions. Digital technologies are transforming healthcare delivery from reactive to proactive models through connected health across settings.
Meaningful Use Stage 1 establishes the basic concepts and requirements for using electronic health records to qualify for incentive payments, including: establishing core measures of meaningful use; requiring the use of certified EHR systems; and outlining the stages of meaningful use that focus on data capture, clinical processes, and improved outcomes. It also describes the eligible providers, certified EHR criteria, Medicare and Medicaid program differences, and recommendations to familiarize oneself with the requirements to receive incentive payments.
Health Information System: Interoperability and Integration to Maximize Effec...MEASURE Evaluation
This document summarizes a presentation on health information system (HIS) interoperability and integration given by Manish Kumar and Sam Wambugu of MEASURE Evaluation. It describes issues with HIS in low and middle income countries like weak systems, lack of standards and data quality. It discusses the importance of interoperability, data standards, and collaboration. Country experiences from Liberia and Swaziland show efforts to develop HIS strategies, integrate systems, and use data for decision making. Key messages are promoting country ownership, stakeholder collaboration, agreed information architecture and standards, and institutional data use.
This presentation discusses Bangladesh's health information system for collecting and analyzing data on health issues like coronary heart disease. It describes the 4-step process: 1) data collection from health facilities using DHIS2 and OpenMRS software, 2) ensuring data accuracy through validation rules, 3) converting data into information for health decision-making, and 4) making health information available nationwide. Challenges include inadequate ICT infrastructure, financial problems, resistance to change, and lack of clear eHealth policies. The presentation recommends developing a comprehensive national eHealth policy and providing more training to improve usage and acceptance of the health information system.
The document discusses the progress and ongoing challenges of health information technology (HIT) in the United States. It provides updates on HITECH incentive programs, noting high rates of EHR adoption among providers but ongoing issues with interoperability and information blocking. It also discusses privacy and security concerns among patients. Looking ahead, the document emphasizes the need for coordinated HIT governance, improved standards for clinical data sharing, and addressing disparities in access to and use of HIT.
Sajid Ahmed presented on the implementation of an EHR system at Martin Luther King Jr Community Hospital on a limited budget and tight timeline. The hospital was established through a public-private partnership between LA County and UCLA. Key strategies for successful implementation included aligning the culture, processes and people; allowing the processes to drive the EHR design rather than the other way around; and focusing on the hospital's mission when facing challenges. Through extensive planning and vendor management, the EHR went live on time and on budget to support the hospital's opening.
Sri Lanka is well known for its better health indices when compared with other countries in South Asia. However, the burdens of Non Communicable Diseases (NCD) have increased rapidly during last two decades. NCDs such as neoplasms, cardiovascular diseases, diabetes and chronic respiratory pathologies recorded were 10.2, 41.7, 13.3 (related deaths per 100,000 population) respectively during the year 1990. However by 2009, the same NCDs recorded 18.5, 60.6, and 21.9 (related deaths per 100,000 populations) respectively according to the Annual Health Bullatin released by the Medical Statistics Unit - Ministry of Healthcare & Nutrition [1]. Most communicable diseases have been controlled successfully (e.g. Malaria, Polio) several infective diseases, such as, Tuberculosis and Leprosy has been re-emerged due to various reasons. Dengue is also still remains a major crisis in Sri Lankan health sector.
Health Information Systems have been shown an integral role in health systems in facing double burden of disease, specially quantifying the cost of care. Also, Health Information Systems are one of WHO's 6 building blocks for health system strengthening. This work investigates the Sri Lankan scenario empirically based on selected electronic health information systems to evaluate the effect of reducing uncertainty and promoting coordination in the clinical care pathway.
1) The document analyzes the costs of two approaches to obtaining clean data from electronic medical records (EMRs) - data discipline and data cleansing - and applies this to diabetes management in Canada.
2) A budget impact analysis finds that data cleansing would be quicker to implement and estimated to cost less at $21.6 million compared to $65.5 million for data discipline.
3) The analysis recommends considering a combination of the two approaches to improve data quality for diabetes management, which could save hundreds of millions to the healthcare system and billions to patients through reduced costs and improved health.
The document discusses various topics related to information systems in healthcare, including electronic medical records, hospital information systems, intranets, telemedicine, picture archiving and communication systems, and clinical decision support systems. It provides details on the objectives, capabilities and benefits of these systems, highlighting how they can improve various aspects of healthcare delivery such as quality, efficiency, cost and accessibility.
Data science has significantly changed the healthcare industry by enabling more informed decision making, better diagnostics, and predictive analysis. It has helped structure large amounts of medical data and allows doctors to make more educated decisions about patient health. Data science provides the foundation for drug development in the pharmaceutical sector by discovering statistical relationships between patient attributes and compounds. When applied to medical imaging, deep learning can detect small abnormalities that help doctors develop effective treatment plans. While data science holds great potential for improving healthcare, challenges remain around standardizing data and management practices.
Health IT Summit Houston 2014 - Case Study "EHR Optimization for Organizational Value in a Changing Healthcare Environment"
Luis Saldana, MD, MBA, FACEP
CMIO
Texas Health Resources
iHT2 case studies and presentations illustrate challenges, successes and various factors in the outcomes of numerous types of health IT implementations. They are interactive and dynamic sessions providing opportunity for dialogue, debate and exchanging ideas and best practices. This session will be presented by a thought leader in the provider, payer or government space.
1) The role of health care data analysts is evolving as the volume of available data grows exponentially. With zettabytes of data being generated, analysts must make sense of both structured and unstructured information.
2) Data analytics can provide insights to improve patient outcomes, lower costs, and enhance the health care experience. Examples show how visualizing data helps health systems better understand utilization and identify at-risk patients.
3) As incentives shift from fee-for-service to value-based models, health systems must transform to focus on population health. Advanced analytics and predictive modeling will be crucial to achieving the goals of better care, lower costs, and improved health.
This document provides an overview of the healthcare industry in Sri Lanka. It discusses how the industry is categorized globally and the professionals it employs. The presentation covers changes in the global healthcare industry and how they impact Sri Lanka. It performs a SWOT, PESTLE and marketing mix analysis of Sri Lanka's healthcare sector. Recommendations are provided on how the industry can address future challenges.
John Rayner, the Regional Director for Healthcare Advisory Services Group in Europe, will be giving a presentation at the 5th Annual ICT Conference for Badalona Healthcare Services. The presentation will discuss challenges of integrated care, measuring digital maturity, and allow time for questions. It will include an overview of the history of healthcare in Harrogate including the discovery of spa waters in the 16th century and the development of hydrotherapy. The presentation will also cover the HIMSS vision to improve health through better use of technology and information as well as the Continuity of Care Maturity Model for measuring integrated care across settings. Integrated care requires integrated information systems.
> HTA and Real World Evidence (RWE)
> Why RWE? - Limitations with RCT
> RCT v/s RWE
> Definition of RWE
> Sources of RWE
> Advantages of RWE
> Application of Real World Data (RWD) in RWE
> Benefits of RWD in RWE
> Why Data Sharing is Important?
> Important Stakeholders
> How to Encourage Data Sharing?
> Benefits of Data Sharing
> Case Studies
> Data Privacy Scenario
> Data Security in India
> Regulatory Perspectives Around RWD/RWE
> Way Forward
This document discusses how information and communication technologies (ICT) can be used to enhance healthcare delivery in Nigeria. It provides background on e-Health and describes Nigeria's Health Management Information System (HMIS), which collects routine health data from over 5,400 facilities. The document proposes strengthening e-Health through coordinated investment in application software to improve availability and use of timely health information. It describes the key components of an electronic health record system and how physicians, nurses, and other staff would benefit from improved access to patient information and order entry/results.
IT trends in the US healthcare sector are driven by incentives to cut costs while improving care integration. Spending on healthcare IT is projected to grow from $54 billion in 2010 to $80 billion in 2017. Emerging technologies like mobile health, bring your own device (BYOD), big data analytics, and interoperable electronic health records aim to enhance care delivery and lower costs. Adoption of standards like ICD-10, HL7, and meaningful use incentives also promote IT-enabled transformation across providers, payers, and life sciences organizations.
Evaluation of a Clinical Information Systemnrodrock
The document discusses electronic health records (EHRs) and clinical information systems. It defines an EHR as a digital version of a patient's paper medical record that contains the patient's medical history and treatment. EHRs allow clinicians to securely access patient data and improve care coordination. The document also examines eight components of EHRs including health information, order entry, decision support, and administrative processes. It notes that effective EHR implementation depends on involving end-users such as nurses and physicians. Proper training and education is also essential for a successful transition to EHR.
The document discusses the physician voice in adopting new technologies like electronic medical records (EMRs). It notes that the physician voice has both an external role advocating for patients and an inner role considering personal impacts. Successful adoption requires addressing physician concerns about privacy, workload, and local needs through collaboration between physicians and other stakeholders. It outlines models used in Vancouver Coastal Health to engage physicians through user groups and champions to provide feedback and guide implementation.
This document discusses healthcare challenges in Ghana and India and potential eHealth solutions. In Ghana, there is a focus on increasing healthcare access but physical infrastructure, medical personnel, and unequal rural/urban access remain problems. In India, high private spending, low insurance coverage, and unequal rural/urban access are issues. Potential eHealth solutions discussed include mobile health programs for communication, disease surveillance, and mother/child tracking in Ghana as well as a tele-radiology program and sickle cell screening in India. The document advocates for integrated, patient-centric care delivered across institutional and telehealth solutions to help bridge global healthcare access divides.
An electronic health record is the systematized collection of patient and population electronically stored health information in a digital format. These records can be shared across different health care settings.
This document discusses clinical information systems and their role in healthcare. It begins with background on healthcare and how information technology has helped address issues with declining resources and rapid knowledge growth. It then defines and discusses hospital information systems, clinical information systems, clinical decision support systems, and electronic medical records. It explains how these systems help with tasks like data management, decision making, and improving quality of care. The document also covers healthcare strategy making and how clinical information systems are developed and integrated.
Telemedicine and remote patient monitoring provide various benefits such as better access to healthcare, reduced costs, and increased convenience. It allows remote collection of health data to monitor patients and verify their response to treatments. Remote monitoring also helps keep elderly and disabled individuals healthy and living independently longer. While wearable technology benefits healthcare, issues around security, integration, and scalability must be addressed through proper infrastructure support.
Decision Support System Enabled Data Warehouses for Improving the Analytic Ca...MEASURE Evaluation
“Decision Support Systems for Improving the Analytic Capacity of HIS in Developing Countries”
Mike Edwards (MEASURE Evaluation), Presenter. Co-author: Theo Lippeveld (MEASURE Evaluation)
Presentation given
Case Study “Investment in a Health IT Infrastructure, the Future Quality Imperative”
Steven Anderman
Chief Operating Officer & SVP, Operations
Bronx-Lebanon Hospital Center
Evaluation of A Clinical Information Systemnrodrock
The document discusses clinical information systems and electronic health records. It defines clinical information systems, clinical decision making systems, and their key components. It also discusses implementing electronic health records, including choosing a system, education and training needs, and costs. Concerns about privacy and security with electronic health records are addressed. The future of electronic health records is promising but continued work is needed to address privacy and security challenges.
Healthcare Technology & Medical InnovationsS A Tabish
The document discusses how technology has changed and impacted healthcare. It covers several key areas:
1) Technology has transformed how clinicians perform their jobs and expanded options for medical treatments through improvements in networking and computers.
2) As demands on healthcare organizations increase, technology solutions are helping to improve performance, increase collaboration, manage costs, streamline processes, automate tasks and improve workflows.
3) Technologies like AI, blockchain, cloud computing, telehealth, and interoperability solutions are further helping to improve patient care, experiences and outcomes while reducing costs.
Optum Stratethon - United Healh Group - UHGArush Sharma
1. The document discusses chronic disease management in smart homes. Smart home technologies like wearables, smart appliances, and connected devices can monitor vitals, medication adherence, diet, activity, and more to help manage chronic conditions.
2. Data from these devices is analyzed with AI and shared with care providers, families, and patients to provide insights and coordinated care. This helps with education, engagement, treatment compliance, and care management.
3. The smart home aims to support the entire patient care process including monitoring, interventions, medication management, and integrating with electronic health records. This can help improve health outcomes and quality of life for chronic disease patients.
Similar to Jennifer Horowitz EHR Adoption in Michigan & Nationwide (20)
The document summarizes a presentation on the national health information exchange (HIE) landscape. It defines different types of HIEs including enterprise, regional, and state HIEs. It discusses findings from the eHealth Initiative's 2012 survey of HIEs which found that data exchange is increasing, more HIEs are supporting accountable care organizations and patient-centered medical homes, and federal funding still supports many HIEs. The presentation also provides an overview of the growth in use of the Direct secure messaging protocol and the ONC's governance guidance for trusted HIE. The personal perspective section notes that data exchange will increase outside institutional "boxes" and more sustainable HIE models will emerge while others struggle.
The document summarizes new rules from the Department of Health and Human Services (HHS) regarding the Health Insurance Portability and Accountability Act (HIPAA) privacy and security regulations. Key points include:
- The final rules were released in January 2013 and take effect in March 2013, with 180 days for compliance.
- The rules expand the definition of a business associate and hold business associates directly accountable for certain privacy and security provisions.
- Covered entities and business associates must update privacy policies, business associate agreements, and compliance plans regarding new provisions for uses of protected health information, breach notification, and enforcement.
- The rules establish new definitions for "unsecured protected health information" and clarify requirements for breach
Panel Cyber Security and Privacy without Carrie Waggonermihinpr
The panel discussed security and privacy in healthcare. Some key points:
- 43% of all 2011 security breaches began in healthcare according to Symantec.
- Medical records are valued at $50 each on the black market, much more than credit cards.
- Top threats to healthcare security are malware, automatic log-off not being used, and removable media.
- HIPAA compliance does not ensure security. Access must be controlled and critical data identified.
- Presenters provided overviews of trust frameworks, Direct secure messaging between providers, and the role of digital certificates in authentication. Ensuring security requires addressing both technical and human factors.
This document discusses important privacy issues related to sharing health information electronically. It identifies the key questions that must be answered to determine sharing requirements, such as who is sharing what information with whom and for what purpose. It also outlines important privacy issues like HIPAA compliance, mobile devices, and coordination with security. Specific issues for health information exchanges are discussed, including mental health, substance abuse, and public trust.
The document discusses Meaningful Use Stage 2 and beyond. It outlines the goals of Meaningful Use to improve health outcomes using electronic health records. Stage 2 focuses on advancing clinical processes, increasing requirements for data exchange between providers and public health agencies. Preparing for Stage 2 involves meeting 2014 certified EHR technology standards and connecting to health information exchanges. The conclusion reaffirms the goal of an information-rich, connected health care system.
This document provides an overview of health information exchange (HIE) and the Michigan Health Information Network (MiHIN). It defines HIE as the electronic sharing of health information and organizations that enable this sharing. Benefits of HIE include improved patient outcomes, fewer medical errors, and lower healthcare costs. MiHIN facilitates HIE across Michigan through a network of connected organizations. It provides shared services to enable the secure electronic sharing of clinical summaries, lab results, immunization records and other health data to improve care coordination.
The document discusses the current state of health information exchange and the desired solution of implementing a Health Information Exchange (HIE). It presents Michigan's HIE model which includes connecting various health systems, providers, and state agencies through a centralized HIE system. The SOM HIE implementation is outlined in three phases, with the goals of enabling secure data sharing and developing a master person index to link individual health records across different data sources.
UPHIE provides a value proposition for rural healthcare by addressing the unique demands of small, distributed practices with limited resources through a community-focused implementation. The scope of services includes a regional patient index, results lookup for labs and radiology, order entry, and connectivity to state registries through a certified EHR solution. Major milestones are an implementation kick-off in July 2012, populating the patient index and results lookup in August, and exchanging lab and immunization data starting in September 2012.
SEMHIE Overview for MIHIN Sub-State HIE Panelmihinpr
SEMHIE has been selected as one of 12 national organizations to provide electronic health information to the Social Security Administration to support their disability claims process. This contract will allow SEMHIE to build out its clinical data exchange infrastructure to quickly and securely share patients' demographics, medications, problems, and test results with SSA. It is expected to dramatically reduce the time needed to determine disability claims from over a year to under two weeks. The contract also provides ongoing funding to support SEMHIE's operations and allows it to expand its health information exchange services regionally.
An EHR/HIE system in Jackson, Michigan connects about 50% of the local providers including hospitals, private practices, FQHCs, and health departments since 2005. It allows for shared patient records including medications, allergies, notes, orders, and results across all connected practices to improve care coordination and reduce duplicative tests. The system serves over 140,000 patients and processes hundreds of thousands of lab, radiology, and hospital reports each month.
The Great Lakes HIE (GLHIE) started in 2011 as a pilot program and is now fully operational. It connects over 40 organizations including hospitals, long term care facilities, and community health organizations. The GLHIE facilitates the sharing of clinical data such as admission/discharge/transfer information, lab results, radiology reports, and transcriptions among participating providers. Over 6.4 million messages have been exchanged to date, representing clinical information for 65% of the population in the state of Michigan. The GLHIE provides interfaces to connect to provider EMR systems and a virtual health record to query patient data. Developing use cases include public health reporting, immunization registry integration, and sharing medication and lab order information
This document outlines the agenda for a cyber security panel discussion focused on health information technology. The agenda includes: an introduction with statistics on cyber security; opening remarks from panelists; challenges for the panel to discuss, including the worst aspect of a breach, important security issues, emerging trends, standards, and testing; audience questions; and closing remarks. The panelists are security experts from various organizations who will discuss challenges and answer audience questions about cyber security in health IT.
EXPERIMENTAL STUDY DESIGN- RANDOMIZED CONTROLLED TRIALRishank Shahi
Randomized controlled clinical trial is a prospective experimental study.
It essentially involves comparing the outcomes in two groups of patients treated with a test treatment and a control treatment, both groups are followed over the same period of time. Prepare a plan of study or protocol
a. Define clear objectives
b. State the inclusion and exclusion criteria of case
c. Determine the sample size, place and period of study
d. Design of trial (single blind, double blind and triple blind method)
2. Define study population: Most often the patients are chosen from hospital or from the community. For example, for a study for comparison of home and sanatorium treatment, open cases of tuberculosis may be chosen.
3. Selection of participants by defined criteria as per plan:
Selection of participants should be done with precision and should be precisely stated in writing so that it can be replicated by others. For example, out of open cases of tuberculosis those who fulfill criteria for inclusion may be selected (age groups, severity of disease and treatment taken or not, etc.)
Randomization ensures that participants have an equal chance to be assigned to one of two or more groups:
One group gets the most widely accepted treatment (standard treatment/ gold standard)
The other gets the new treatment being tested, which researchers hope and have reason to believe will be better than the standard treatment
Subject variation: First, there may be bias on the part of the participants, who may subjectively feel better or report improvement if they knew they were receiving a new form of treatment.
Observer bias: The investigator measuring the outcome of a therapeutic trial may be influenced if he knows beforehand the particular procedure or therapy to which the patient has been subjected.
Evaluation bias: There may be bias in evaluation - that is, the investigator(Analyzer) may subconsciously give a favorable report of the outcome of the trial.
Co-intervention:
participants use other therapy or change behavior
Study staff, medical providers, family or friends treat participants differently.
Biased outcome ascertainment:
participants may report symptoms or outcomes differently or physicians
Investigators may elicit symptoms or outcomes differently
A technique used to prevent selection bias by concealing the allocation sequence from those assigning participants to intervention groups, until the moment of assignment.
Allocation concealment prevents researchers from influencing which participants are assigned to a given intervention group.
All clinical trials must be approved by Institutional Ethics Committee before initiation
It is mandatory to register clinical trials with Clinical Trials Registry of India
Informed consent from all study participants is mandatory.
A preclinical trial is a stage of research that begins before clinical trials, and during which important feasibility and drug safety data are collected.
Following points high.
Causes Of Tooth Loss
PERIODONTAL PROBLEMS ( PERIODONTITIS, GINIGIVITIS)
Systemic Causes Of Tooth Loss
1. Diabetes Mellitus
2. Female Sexual Hormones Condition
3. Hyperpituitarism
4. Hyperthyroidism
5. Primary Hyperparathyroidism
6. Osteoporosis
7. Hypophosphatasia
8. Hypophosphatemia
Causes Of Tooth Loss
CARIES/ TOOTH DECAY
Causes Of Tooth Loss
CAUSES OF TOOTH LOSS
Consequence of tooth loss
Anatomic
Loss of ridge volume both height and width
Bone loss :
mandible > maxilla
Posteriorly > anteriorly
Anatomic consequences
Broader mandibular arch with constricting maxilary arch
Attached gingiva is replaced with less keratinised oral mucosa which is more readily traumatized.
Anatomic consequences
Tipping of the adjacent teeth
Supraeruption of the teeth
Traumatic occlusion
Premature occlusal contact
Anatomic Consequences
Anatomic Consequences
Physiologic consequences
Physiologic Consequences
Decreased lip support
Decreased lower facial height
Physiologic Consequences
Physiologic consequences
Education of Patient
Diagnosis, Treatment Planning, Design, Treatment, Sequencing, and Mouth Preparation
Support for Distal Extension Denture Bases
Establishment and Verification of Occlusal Relations and Tooth Arrangements
Initial Placement Procedures
Periodic Recall
Education of Patient
Informing a patient about a health matter to
secure informed consent.
Patient education should begin at the initial
contact with the patient and should continue throughout treatment.
The dentist and the patient share responsibility for the ultimate success of a removable partial denture.
This educational procedure is especially important when the treatment plan and prognosis are discussed with the patient.
Diagnosis, Treatment Planning, Design, Treatment, Sequencing, and Mouth Preparation
Begin with thorough medical and dental histories.
The complete oral examination must include both clinical and radiographic interpretation of:
caries
the condition of existing restorations
periodontal conditions
responses of teeth (especially abutment teeth) and residual ridges to previous stress
The vitality of remaining teeth
Continued…..
Occlusal plan evaluation
Arch form
Evaluation of Occlusal relationship through mounting the diagnostic cast
The dental cast surveyor is an absolute necessity in which patients are being treated with removable partial dentures.
Mouth preparations, in the appropriate sequence, should be oriented toward the goal of
providing adequate support, stability,
retention, and
a harmonious occlusion for the partial denture.
Support for Distal Extension Denture Bases
A base made to fit the anatomic ridge form does not provide adequate support under occlusal loading.
The base may be made to fit the form of the ridge when under function.
Support for Distal Extension Denture Bases
This provides support
Chair and Presenter, Stephen V. Liu, MD, Benjamin Levy, MD, Jessica J. Lin, MD, and Prof. Solange Peters, MD, PhD, prepared useful Practice Aids pertaining to NSCLC for this CME/MOC/NCPD/AAPA/IPCE activity titled “Decoding Biomarker Testing and Targeted Therapy in NSCLC: The Complete Guide for 2024.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD/AAPA/IPCE information, and to apply for credit, please visit us at https://bit.ly/4bBb8fi. CME/MOC/NCPD/AAPA/IPCE credit will be available until July 1, 2025.
Why Does Seminal Vesiculitis Causes Jelly-like Sperm.pptxAmandaChou9
Seminal vesiculitis can cause jelly-like sperm. Fortunately, herbal medicine Diuretic and Anti-inflammatory Pill can eliminate symptoms and cure the disease.
POTENTIAL TARGET DISEASES FOR GENE THERAPY SOURAV.pptxsouravpaul769171
Theoretically, gene therapy is the permanent solution for genetic diseases. But it has several complexities. At its current stage, it is not accessible to most people due to its huge cost. A breakthrough may come anytime and a day may come when almost every disease will have a gene therapy Gene therapy have the potential to revolutionize the practice of medicine.
Coronary Circulation and Ischemic Heart Disease_AntiCopy.pdfMedicoseAcademics
In this lecture, we delve into the intricate anatomy and physiology of the coronary blood supply, a crucial aspect of cardiac function. We begin by examining the physiological anatomy of the coronary arteries, which lie on the heart's surface and penetrate the cardiac muscle mass to supply essential nutrients. Notably, only the innermost layer of the endocardial surface receives direct nourishment from the blood within the cardiac chambers.
We then explore the specifics of coronary circulation, including the dynamics of blood flow at rest and during strenuous activity. The impact of cardiac muscle compression on coronary blood flow, particularly during systole and diastole, is discussed, highlighting why this phenomenon is more pronounced in the left ventricle than the right.
Regulation of coronary circulation is a complex process influenced by autonomic and local metabolic factors. We discuss the roles of sympathetic and parasympathetic nerves, emphasizing the dominance of local metabolic factors such as hypoxia and adenosine in coronary vasodilation. Concepts like autoregulation, active hyperemia, and reactive hyperemia are explained to illustrate how the heart adjusts blood flow to meet varying oxygen demands.
Ischemic heart disease is a major focus, with an exploration of acute coronary artery occlusion, myocardial infarction, and subsequent physiological changes. The lecture covers the progression from acute occlusion to infarction, the body's compensatory mechanisms, and the potential complications leading to death, such as cardiac failure, pulmonary edema, fibrillation, and cardiac rupture.
We also examine coronary steal syndrome, a condition where increased cardiac activity diverts blood flow away from ischemic areas, exacerbating the condition. The long-term impact of myocardial infarction on cardiac reserve is discussed, showing how the heart's capacity to handle increased workloads is significantly reduced.
Angina pectoris, a common manifestation of ischemic heart disease, is analyzed in terms of its causes, presentation, and referred pain patterns. We identify factors that exacerbate anginal pain and discuss both medical and surgical treatment options.
Finally, the lecture includes a case study to apply theoretical knowledge to a practical scenario, helping students understand the real-world implications of coronary circulation and ischemic heart disease. The role of biochemical factors in cardiac pain and the interpretation of ECG changes in myocardial infarction are also covered.
JMML is a rare cancer of blood that affects young children. There is a sustained abnormal and excessive production of myeloid progenitors and monocytes.
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Chemical kinetics is the study of the rates at which chemical reactions occur and the factors that influence these rates.
Importance in Pharmaceuticals: Understanding chemical kinetics is essential for predicting the shelf life of drugs, optimizing storage conditions, and ensuring consistent drug performance.
Rate of Reaction: The speed at which reactants are converted to products.
Factors Influencing Reaction Rates:
Concentration of Reactants: Higher concentrations generally increase the rate of reaction.
Temperature: Increasing temperature typically increases reaction rates.
Catalysts: Substances that increase the reaction rate without being consumed in the process.
Physical State of Reactants: The surface area and physical state (solid, liquid, gas) of reactants can affect the reaction rate.
Ontotext’s Clinical Trials Eligibility Design Assistant helps with one of the most challenging tasks in study design: selecting the proper patient population.
3. INDUSTRY TRENDS
• Federal Initiatives
» 2009 American Recovery and Reinvestment Act
» 2010 Patient Protection and Affordable Care Act
» Conversion to ICD-10
• Patient Care Focus
» Improved Quality Outcomes
» Reduced Medical Errors
» Standardized Clinical Care
5. BUSINESS ISSUE WITH MOST IMPACT ON
HEALTHCARE
0%
2%
3%
3%
5%
3%
8%
23%
14%
40%
1%
2%
4%
4%
4%
7%
8%
14%
16%
37%
Hospital Infrastructure Needs
Staffing Issues
Privacy/Security Issues
Consumer Considerations
Technology Considerations
Shifting Healthcare Landscape
Health Information Exchange
Policy Mandates
Financial Considerations
Healthcare Reform
2013
2012
N = 298
6. 0%
1%
2%
1%
1%
3%
11%
15%
13%
12%
38%
1%
1%
2%
2%
2%
6%
9%
11%
17%
20%
28%
Integration of IT and Medical Devices
Securing Patient Information
Focus on Ambulatory Systems
Healthcare Consumer Issues
Exchange Info with Other Entities
Interoperability
Completing ICD-10 Conversion
Focus On Clinical Systems
Leveraging Information
Optimizing Use of Current Systems
Achieving Meaningful Use
2013
2012
N = 298
TOP IT PRIORITY IN THE NEXT TWO
YEARS
7. 2%
1%
2%
4%
2%
3%
0%
9%
16%
15%
16%
25%
2%
2%
2%
2%
2%
3%
3%
7%
10%
10%
16%
16%
19%
Focus on Nursing Systems
Focus on Consumer Technology
Installing/Upgrading Ancillary
Installing/Upgrading CDR
Certification of EHR
Establishing Clinical Protocols
Closed Loop Medication Administration
Creating Continuity of Care Record
Data Warehouse/Clinical Analytics
Installing CPOE
Linking Clinical Systems to Quality Measures
Focus on Physician Systems
Fully Operational EHR in Place
2013
2012
Not Applicable
N = 298
PRIMARY CLINICAL IT FOCUS
8. 0%
0%
6%
3%
5%
7%
16%
22%
38%
1%
2%
3%
4%
5%
7%
8%
12%
25%
31%
Ensuring that Data is Secure/Private
Improving Patient Access to Information
Providing Remote Monitoring of Patients
Providing Competitive Advantage
Enabling Remote Access of Data
Sharing Information Externally
Supporting Staff Productivity
Standardizing Clinical Care
Reducing Medical Errors
Improving Quality Outcomes
2013
2012
Not Applicable
N = 298
AREA THAT IT CAN MOST IMPACT
PATIENT CARE
10. HIMSS ANALYTICS® DATABASE
• Company founded in 2004
» Market research arm of HIMSS
• HIMSS Analytics collects information on over 100
IT applications in the healthcare environment
• Data collected by dedicated team of market
research associates (MRAs)
• All data is cleansed by our quality team
• Data is published on an annual rolling basis
» Data for each hospital is published once per year
11. HIMSS ANALYTICS EMRAMSM MODEL
• Model established in 2006 to track hospitals’
adoption of EMR technology
• Eight-stage model
» Stage 0 – hospitals that don’t have all basic ancillary
applications (lab, pharmacy, radiology)
» Stage 7 – hospitals no longer use paper charts to deliver
and manage patient care
• Ambulatory EMRAM Model Introduced in 2012
» Stage 0 – paper chart based environment
» Stage 7 – organizations do not rely on paper charts to
deliver and manage patient care
13. HIMSS ANALYTICS EMRAMSM MODEL: MICHIGAN
EMR Adoption ModelSM (EMRAM)
Average Median Min Max
Entire HIMSS Analytics® Database 3.6500 3.4300 0.0000 7.0710
East North Central Region (N=847) 3.9757 3.5260 0.0000 7.0710
Indiana (N=149) 3.9391 3.5400 0.0000 7.0550
Michigan (N=156)) 4.0458 4.1810 0.0050 6.0710
Ohio (N=208) 3.6553 3.4030 0.0000 7.0710
Wisconsin (N=136) 4.3042 4.1845 1.0950 7.0710
East North Central region includes Illinois, Indiana, Michigan, Ohio, and Wisconsin
Source HIMSS Analytics® Database (N= 5,441) First Quarter 2013
16. GETTING ROI OUT OF CLINICAL
SYSTEMS - KAISER PERMANENTE
• Kaiser Permanente serves 8.6 million members across nine
states. The EMR in use is Epic.
• ROI has been demonstrated across a variety of metrics:
» One Kaiser Permanente region saved more than
$120,000 in dictation costs in just one year post
implementation
» Reduced the rate of medication errors by 57 percent one
hospital site using barcode scanning
» Trimmed by 12 percent outpatient lab utilization two
years after the implementation of KP HealthConnect
» 54 percent reduction of archival storage space
» Vacated more than 22,000 square feet at 15 medical
facilities when medical records centralized in one region
with estimated savings between $0.4 and $3.3 million
17. GETTING ROI OUT OF CLINICAL
SYSTEMS - CITIZENS MEMORIAL
• CMH is a 74-bed hospital with 10 rural health clinics located
in Bolivar, MO. The EMR in use is MEDITECH.
• ROI has been demonstrated across a variety of metrics:
» Reduction in re-admission rate for home care patients by
35 percent
» Use of in-home tele-management has reduced number
of home care visits by an average of two.
» 70 percent reduction in reported medication errors in the
hospital
» Elimination of all medical records filming costs
» Adjusted Occupied Beds (a measure of in and outpatient
volume), have increased from 101 to 138 and net
patient revenues have increased by 23% since in the
implementation of Project Infocare.
19. CPOE AUTOMATION AND PLAN ANALYSIS
63%
56%
19%
13%
12%
11%
6%
17%
2013
(N=156)
2013
(N=5445)
Automated Replacement Purchases Contracted - Not Yet Installed
Contracted - Installation In Process First Time Purchase Not Automated, No Plans to Purchase
Source: HIMSS Analytics® Database
National
Michigan
Adoption in 2007 = 19%
20. DATA WAREHOUSING/MINING – CLINICAL
AUTOMATION AND PLAN ANALYSIS
40%
41%
54%
55%
2013
(N=156)
2013
(N=5321)
Automated Replacement Purchases Contracted - Not Yet Installed
Contracted - Installation In Process First Time Purchase Not Automated, No Plans to Purchase
National
Source: HIMSS Analytics® Database
Michigan
Adoption in 2007 = 16%
21. DATA WAREHOUSING/MINING – FINANCIAL
AUTOMATION AND PLAN ANALYSIS
58%
51% 24%
38%
46%
2013
(N=156)
2013
(N=5318)
Automated Replacement Purchases
Contracted - Not Yet Installed Contracted - Installation In Process
Source: HIMSS Analytics® Database
National
Michigan
Adoption in 2007 = 22%
22. PERCENT OF HOSPITALS USING BAR
CODE TECHNOLOGY IN THE PHARMACY
Current
• National – 72.45%
• Michigan – 84.62%
Planned
• National – 14.93%
• Michigan – 15.39%
National N = 5,445
Michigan N = 156
Adoption in 2007 = 9%
23. PERCENT OF HOSPITALS PARTICIPATING IN
INFORMATION EXCHANGE ORGANIZATION
Current
• National – 29.53%
• Michigan – 35.90%
Planned
• National – 23.14%
• Michigan – 23.08%
National N = 5,445
Michigan N = 156
Adoption in 2007 = 11%
This is a critical time for health IT. Hospitals and other eligible providers have until 2015 to demonstrate meaningful use of certified Electronic Medical Record (EMR) technology before being penalized. In order to qualify for incentive payments under ARRA, providers must use certified EMRs. Vendors of EMR systems or EMR modules must ensure their products have the features and functionality to be certified, and to enable meaningful use.Primary goal of ARRA – incentivize people to meet meaningful use Stage One – first time to qualify for incentives in 2012. Stage Two – first time to incentivize in 2014. Primary goal of the PPACA -- PPACA is aimed primarily at decreasing the number of uninsured Americans and reducing the overall costs of health care. Section 3022 of the Patient Protection and Affordable Care Act (ACA) authorizes Center for Medicare and Medicaid Services (CMS) to create the Medicare Shared Savings program (MSSP), which allows for the establishment of ACO contracts with Medicare by January 2012
The EMR environment is a complex and sophisticated environment. Its foundation is the clinical data repository (CDR), a real-time transaction processing database of patient clinical information for practitioners. The controlled medical vocabulary (CMV) is critical because it ensures that the practitioners who use the EMR are accessing accurate and comparable data. The CMV normalizes data from a relational and definitional hierarchy that enables other components of the EMR to optimally operate. Without a functional CMV, the clinical decision support system (CDSS) and workflow components of the EMR will not perform as expected by the clinicians in the environment.The applications of the EMR environment are clinical documentation for all clinicians/practitioners, computerized provider order entry (CPOE) for all clinicians/practitioners, and pharmacy management. We believe that the pharmacy management application has transitioned from a departmental system to an application of the EMR due to the influence of patient safety/medical error reduction concerns. A foundation of EMR applications, required to improve patient safety and reduce or eliminate medical errors, is composed of the CDR, CPOE, pharmacy management system, and the electronic medication administration record (eMAR), functionality normally found in the electronic clinical documentation systems of most vendors. These are surrounded by an enterprise master person index (EMPI), portals, and interface engine connectivity to supporting systems.A little about the EMRAM model:All application capabilities within each stage must be operational before that stage can be achieved.All lower stages must have been achieved before a higher level will be considered as achieved.A hospital can achieve Stages 3-6 if it has met all of the application requirements for a single patient care service (e.g. single nursing floor, cardiology service). Using the rules above, additional points are given for the implementation of applications in stages higher than the one fully achieved by the healthcare organization. In this fashion, other implementation paths than those prescribed by the stages can be taken into consideration for correlation with quality and financial research.
John – just included some notes on Kaiser below:HIMSS Analytics Stage 7 Award Winner 2011 HIMSS Enterprise Davies Award WinnerStaff of 159,000 More than 14,000 physicians Serves 8.6 million members Operates 36 hospitals with 34 in California, one in Hawaii and one in Oregon with more than 430 medical offices across nine states and the District of Columbia As a large integrated care delivery system, Kaiser Permanente serves members with a full spectrum of needs, from sick care to well care. Reimbursement for care includes commercial health plans, individual health plans, Medicare, Medicaid, and charity care. Recognizing the ROI of EMR ImplementationIt is important to note that this effort was undertaken to improve the quality of care delivered to patients of Kaiser Permanente.Examples of return-on-investment follow.One Kaiser Permanente region saw 95 percent reduction in dictation costs resulting from the implementation of KP HealthConnect. Another region saved more than $120,000 in dictation costs in just one year post-implementation. Saved costs for printed forms almost immediately after implementing the EMR with a $1.4 million decrease in one region on printing expenses of annual outpatient forms alone. Vacated more than 22,000 square feet at 15 medical facilities when medical records centralized in one region with estimated savings between $0.4 and $3.3 million in 2001. Kaiser Permanente is now building new hospitals without medical record storage areas. Saved $200,000 in one year with the implementation of electronic medical records resulting in a 54 percent reduction of archival storage space. Provide patients with test results within two days instead of a week or longer. Reduced the rate of medication errors by 57 percent one hospital site using barcode scanning linked to KP HealthConnect CPOE and electronic medication administration. Trimmed by 12 percent outpatient lab utilization two years after the implementation of KP HealthConnect, illustrating the reduction in duplicate tests.
John – just included some notes on Citizens below: (Please note that bottom two bullets on this slide were taken from the Davies award application completed in 2006)Citizens Memorial Healthcare (CMH)Bolivar, MissouriAnnual revenues of $100 million Staff of 1,550 125 affiliated physicians, including 60 physicians employed by CMH in 10 rural health clinics and 15 specialty clinics. CMH provides services across the continuum of care, including acute care, emergency services, home care, hospice, long term care, assisted living, ambulatory surgery, cancer care, rural health clinics and specialty physician practices. Challenge: During organizational strategic planning in 1999, CMH recognized that the system had grown to include a variety of services across a broad continuum of care for the community including the hospital, home care, long term care and physician practices - from cradle to grave.Additionally, the organization wanted to promote seamless care across the continuum to the community. Unfortunately, the care wasn’t seamless. Patients were asked for demographic and billing information repeatedly and the more important clinical information needed for care delivery was recorded on paper records located in 33 different locations. From that analysis and a strategic planning effort, CMH committed to this vision for health information technology:Enable a patient to enter anywhere into the continuum of care and have a personal identity that is maintained across that continuum. Physicians and other caregivers will have access to all of that patient’s medical information within the healthcare continuum. Providers will be able to document efficiently within the software system, which will free them to have more time to spend with patients. The investment of time, talent and money will enable CMH to be a technologically advanced healthcare organization poised to grow and offer new services to our patients and the community at large. The system is known as Project Infocare.Implementation Solutions: CMH began implementing the Project Infocare EMR in 2002 and had eliminated the paper medical record in the hospital by December 2003. Paper records were eliminated throughout the system, including long term care, home care and physician clinics by 2007. CPOE is utilized in all locations. Since that time, CMH has added emergency services, barcoding for medication administration, in-home telemanagement, ePrescribing, additional physician practices and a patient portal to the EMR system.EMR Solution: MeditechRecognizing the ROI of EMR ImplementationContinuity of care: More than 95% of patients presenting for care in the CMH system already have a record in the system. Their demographics, medications, history and allergies only need to be updated. The medication, patient history and allergy lists are common across the EMR system. Any update from any location is immediately reflected for all users accessing a record.Patient safety & quality: Medication safety/closed medication loop. Computerized provider order entry, pharmacy, nursing and barcoding all have contributed to a 70% reduction in reported medication errors in the hospital. Clinical quality measures show marked improvement. Across the CMH system, there are over 30 publicly reported quality measures from acute care, long term care and home health. CMH has made a tremendous improvement in those measures since implementing the EMR through the use of clinical decision support.Financial ROI: CMH has reduced clerical and transcription costs and kept total employee costs down – all while increasing revenue significantly since the EMR implementation. In-home tele-management is integrated into the CMH EMR. For example, blood pressure measures that a patient takes at home this morning will be in the EMR...well, this morning. This information availability has enabled CMH to reduce costs while simultaneously improving care and outcomes. Patients with in-home tele-management require two fewer home care visits, but also have a lower rate of re-admission to the hospital. Overall, CMH has been able to reduce the re-admission rate for home care patients by 35%.
Radiology PACS installation is calculated where at least 1 of the 10 modalities tracked has an automation status of Live and Operational, Contracted/Not Yet Installed or Installation In Process.
Two-thirds of ambulatory facilities in Michigan are in Stage 0. Only 5 are at a Stage 5 (none are higher). 0 = 67.7%1 = 11.40%2 = 11.27%3 = 8.8%5 = less than one percent
Only one percent of those that don’t have an ambulatory EMR plan to purchase a solution