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The adequate management of patients' genomic information is essential for any health institution pursuing the Precision Medicine model. Here we approach a bioinformatic architecture that allows the Institution to store its whole genetic test data in a scalable database, and also the integration of that genetic data with the Electronic Health Record through a Clinical Decision Support System. The system complements patient care by suggesting referral to genetic counseling for patients who are potentially at risk of hereditary breast/ovarian cancer, and allowing for proper follow-up of patients with pathogenic variants in BRCA1 or BRCA2 genes. The implemented solution uses the FHIR standard and genetic nomenclatures from the Human Genome Variation Society and the HUGO Gene Nomenclature Committee. The architecture is flexible enough to allow any other health institution to integrate -to their information ecosystem- the whole solution or some of the modules according to its degree of digitization progress. [ABSTRACT FROM AUTHOR]

Creating notes in the EHR is one of the most problematic aspects for health professionals. The main challenges are the time spent on this task and the quality of the records. Automatic speech recognition technologies aim to facilitate clinical documentation for users, optimizing their workflow. In our hospital, we internally developed an automatic speech recognition system (ASR) to record progress notes in a mobile EHR. The objective of this article is to describe the pilot study carried out to evaluate the implementation of ASR to record progress notes in a mobile EHR application. As a result, the specialty that used ASR the most was Home Medicine. The lack of access to a computer at the time of care and the need to perform short and fast evolutions were the main reasons for users to use the system. [ABSTRACT FROM AUTHOR]

Dermatology is one of the medical fields outside the radiology service that uses image acquisition and analysis in its daily medical practice, mostly through digital dermoscopy imaging modality. The acquisition, transfer, and storage of dermatology images has become an important issue to resolve. We aimed to describe our experience in integrating dermoscopic images into PACS using DICOM as a guide for the health informatics and dermatology community. During 2022 we integrated the video dermoscopy equipment through a strategic plan with an 8-step procedure. We used the DICOM standard with Modality Worklist and Storage commitment. Three systems were involved (video dermoscopy software, the EHR, and PACS). We identified critical steps and faced many challenges, such as the lack of a final model of DICOM standard for dermatology images. [ABSTRACT FROM AUTHOR]

Precision medicine seeks to improve the prevention, diagnosis and treatment of patients based on genetic characteristics unique to each person. In oncology, therapeutic decisions have been established based on the genomic characteristics of each patient's tumor. Data integration is key for the successful implementation of precision medicine since it is necessary for both studying a large volume of data from different sources and working with an interdisciplinary and translational vision. In this work, a bioinformatic process was successfully implemented that allows the integration of patients' genomic data, from two molecular biology laboratories, with their clinical data provided by their electronic medical records. For this, the REDCap data capture software, the cBioPortal visualization and analysis software, and a computer tool developed to automate the processing and annotation of the information in REDCap were used to be included in cBioPortal, for the "Map of Tumor Genomic Actionability of Argentina" project. [ABSTRACT FROM AUTHOR]

Breast cancer represents 23% of all cancers diagnosed among women each year. BRCA1 and BRCA2 are tumor suppressor genes related to the most frequent form of hereditary breast and ovarian cancer, as well as other types of cancer. The aim of this work is to describe the development of Clinical Decision Support Systems (CDSS) for referral to genetic counseling in patients at increased risk of pathogenic variants in BRCA1 and BRCA2, and to describe results during the pilot study implementation (from January 5, 2021 to March 5, 2021). To achieve integration and system interoperability, we used FHIR and CDS-Hooks within the CDSS development. A total of 142 alerts were triggered by the system for 72 physicians in 98 patients. Results showed an acceptance rate for the recommendation of 2.1%, which could improve using intrusive alerts in all of the hooks. [ABSTRACT FROM AUTHOR]

Younger generations are extensive users of digital devices; these technologies have always existed and have always been a part of their lives. Video games are a big part of their digital experience. User-centered design is an approach to designing systems informed by scientific knowledge of how people think, act, and coordinate to accomplish their goals. There is an emerging field of intervention research looking into using these techniques to produce video games that can be applied to healthcare. Games with the purpose of improving an individual's knowledge, skills, or attitudes in the "real" world are called "Serious Games". Before doctors and patients can consider using Serious Games as a useful solution for a health care-related problem, it is important that they first are aware of them, have a basic understanding of what they are, and what, if any, claims on their effectiveness exist. In order to bridge that gap, we have produced this concise overview to introduce physicians to the subject at hand. [ABSTRACT FROM AUTHOR]

In 2020, a pandemic forced the entire world to adapt to a new scenario. The objective of this study was to know how Health Information Systems were adapted driven by the pandemic of COVID. 12 CIOS of healthcare organizations were interviewed and the interviews were classified according to the dimensions of a sociotechnical model: Infrastructure, Clinical Content, Human Computer Interface, People, Workflow and Communication, Organizational Characteristics and Internal Policies, Regulations, and Measurement and Monitoring. Adaptation to the Pandemic involved social, organizational and cultural rather than merely technical aspects in private organizations with mature and stable Health Information Systems. [ABSTRACT FROM AUTHOR]

The use of next-generation sequencing technologies in clinical practice has increased the volume of information that must be stored, processed, and interpreted. In this work, a description of the implementation of a genomic communication and archiving system (GACS) is presented. This GACS will allow us to store, share and search the genomic files and genetic variants obtained as a result of genetic laboratory tests. [ABSTRACT FROM AUTHOR]

An accurate and updated problem's list is critical in a problemoriented Electronic Health Record (EHR). The lack of organization and maintenance of the problems limits its value. Certain problems have a larger effect on the clinical evolution of the patient, these are known as Comorbidities. The aim of this paper is to evaluate the impact of the automatic loading of comorbidities in the organization and maintenance of inpatient problem's list using a comorbidities subset. [ABSTRACT FROM AUTHOR]

The infobuttons allows the solving of information needs. In our study, the use of Infobuttons is described, analyzing the number of queries to UpToDate® from the problem list of an Electronic Health Record. There were 26419 requests in 8 months. The highest average use occurred in June. The links to knowledge bases can help to solve information needs, even before they occur. [ABSTRACT FROM AUTHOR]

Communication between users and technicians is crucial for improving Help Desk performance. The objective of this study is to know and understand perceptions, and needs of users and help desk technicians. A qualitative study based on interviews was performed. The emergent topics were communication, workload and misperceptions between end-users and technicians. There are false perceptions between them that affect their interaction and work dynamics. [ABSTRACT FROM AUTHOR]

Problem oriented medical record (POMR) was born in late sixties. Expecting an ordered, complete and updated medical record were some of the goals of its founder. Several healthcare institutions have included problem list into their clinical records but some concerns have been reported. These concerns are in reference to their voluminosity, incompleteness and outdatedness. This study attempts to understand how healthcare professionals are using the problem list at Hospital Italiano de Buenos Aires (HIBA). We believe it is essential to understand the local reality applied to our own applications and cultural instances of documentation. This report is the basis from which several improvements could be made in order to meet the goals of Weed's proposal. [ABSTRACT FROM AUTHOR]