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This study sought to determine physician, specialty and practice factors influencing choice of method for electronic health record (EHR) documentation: direct typing (DT), electronic transcription (ET), human transcription (HT), and scribes. A survey assessing physician documentation practices was developed and distributed online. The primary outcome was the proportion of physicians using each method. Secondary outcomes were provider-rated accuracy, efficiency, and ease of navigation on a 1-5 Likert scale. Means were compared using linear mixed models with Bonferroni adjustment. The 818 respondents were mostly outpatient (46%) adult (79%) physicians, practiced for a mean 15.8 years, and used DT for EHR documentation (72%). Emergency physicians were more likely to use scribes (p < 0.0001). DT was rated less efficient than all other methods (p < 0.0001). ET was rated less accurate than DT (p < 0.001) and HT (p < 0.001). HT was rated less easy to navigate than DT (p = 0.002) and scribe (p < 0.001), and ET less than scribe (p = 0.002). Two hundred and forty-three respondents provided free-text comments that further described opinions. DT was the most commonly used EHR method but rated least efficient. Scribes were rated easy to navigate and efficient but infrequently used outside of emergency settings. Further innovation is needed to design systems responsive to all physician EHR needs. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the effects of web-based education in the field of drug utilization on elderly individuals’ knowledge of, concerns about and self-assessed understanding of drug utilization. The 260 included participants were randomized to a control group or an intervention group. To assess drug utilization literacy, we used a questionnaire containing 20 multiple-choice questions on drug utilization and ten statements about drug utilization (to which participants graded their response using a Likert scale: two about common concerns and eight about their self-assessed understanding of drug utilization). The Beliefs about Medicines Questionnaire-General was also used. The intervention group scored higher on the knowledge questions (p < 0.001) and on six of the eight statements about self-assessed understanding of drug utilization at the first check after 2 weeks (p < 0.05). At a second check 6 months later, the difference remained for the knowledge questions, but there was no difference in self-assessed understanding of drug utilization between the groups. There were no differences in the concerns about drug utilization or beliefs about medication at any time. We conclude that a web-based education can improve drug utilization literacy in elderly individuals and might contribute to the safer use of medications. [ABSTRACT FROM AUTHOR]

Digitalized healthcare services offer remote and cost-effective treatment of diabetes patients. Thus, the present online study analyzed the readiness to use telemonitoring among Austrian diabetes patients. We developed and validated a German version of the patient telehealth readiness assessment tool and performed quantitative context analysis of free-text comments on perceived barriers and benefits of telemonitoring. Participants (n = 41, 42.6% females) achieved a medium average readiness level for telemonitoring. The three top benefits were intensified care, shorter travel and waiting times, and better therapy adjustment. The top three barriers were data privacy issues, loss of personal communication and focus on blood sugar, and teledoctor competence. Diabetes patients represent a suitable target group for remote treatment opportunities. However, a shift from traditional face-to-face medical care to exclusive telemonitoring treatment from diagnosis to consultation and treatment requires fundamental new legal framework conditions. [ABSTRACT FROM AUTHOR]

This study sought to detect a potential safety signal of mirtazapine abuse by combining two different sources of surveillance, specifically Google Analytics (Google, Inc., Mountain View, CA, USA) and the FDA Adverse Event Reporting System database. Data from the first quarter of 2004 to the second quarter of 2017 were collected and analysed. The search interest over time, the frequencies of abuse-related terms in the search analytics domain, and the odds ratio of abuse events in FDA Adverse Event Reporting System were determined. Correlations between the two aforementioned domains using quarterly data from the timeline series were also assessed. Our results suggest a positive correlation between abuse-related searches in the Google domain and abuse-related events in FDA Adverse Event Reporting System database. These results indicate that these methods can be used in combination with each other as a pharmacovigilance supplementary tool to detect drug safety signals. [ABSTRACT FROM AUTHOR]

Health informatics applications reduce time intervals in acute coronary syndromes, but their impact on guideline adherence is unknown. This pre–post intervention study compared guideline adherence between telemedically supported (n = 101, April 2014–July 2015) and conventional on-scene care (n = 120, January 2014–March 2014) in acute coronary syndrome. A multivariate logistic regression was performed for dependent variables: adverse events 0 versus 0, p = NA; electrocardiogram 101 versus 120, p = NA; acetylic salicylic acid 91 versus 102, p = 0.21; heparin 92 versus 112, p = 0.99; morphine 96 versus 107, p = 0.33; oxygen 83 versus 102, p = 0.92; glyceroltrinitrate 55 versus 90, p = 0.038; correct destination: 100 versus 119, p = 1.0. The time from ambulance arrival to hospital arrival was prolonged with telemedicine: 48.7 ± 11 min versus 35.5 ± 8.1 min, p < 0.001. Guideline adherence showed no differences except for glyceroltrinitrate. Prolonged time requirements are critical, though explainable. However, this approach enables a timely and high-quality backup strategy if only paramedics are on-scene. [ABSTRACT FROM AUTHOR]

MedHistory is a web-based software module that graphically displays medication usage (y-axis) against time (x-axis). We set out to examine whether MedHistory would improve clinician's interactions with the medical record system. The authors invited house-officers at our institution to complete a survey about inpatient medication administration before and after using MedHistory. Detailed logs were also kept for 1 year after the study period. Compared to the pre-intervention survey, the post-intervention survey found that reviewing medication history was easier (pre: 13.2% vs post: 32.4%, p = .008), that medication review now fit within resident workflow (38.9% vs 75.7%, p < .001), and that there was increased satisfaction with the electronic health records software (2.6% vs 29.7%, p = .002). Additionally, determining the timing (29% vs 50.1%, p = .045) and dosing history (21.1% vs. 43.2%, p = .036) of inpatient medication administration was easier with MedHistory. Anti-infective agents and drugs requiring frequent adjustments were the most commonly reviewed. A graphical timeline of inpatient medications (MedHistory) was met with favorable response across multiple areas, including efficiency, speed, safety, and workflow. [ABSTRACT FROM AUTHOR]

The increased reliance on Internet use in social functions has presumably left out a part of the population: the oldest-older adults. These are people who have not kept themselves up to date with the technological developments for various reasons. There are, however, exceptions from whom we have something to learn. This study investigates the older people in Sweden who started to use the Internet over a period of 6 years. Cognition, extraversion, openness, functional disability, household economy, sex, age and education were investigated in relation to starting to use the Internet. A chi-square test, Spearman correlation and a logistic regression analysis were conducted. It was found that higher cognition, being male and being between the ages of 60 and 80 years were determining factors in starting to use the Internet for the Swedish older adult. Our results indicate that the oldest-older adults are slow to adapt to using the Internet and more attention should be paid on how to support this group. [ABSTRACT FROM PUBLISHER]