Sharing of clinical data in a maternity setting: How do paper hand-held records and electronic health records compare for completeness?

Background Historically, the paper hand-held record (PHR) has been used for sharing information between hospital clinicians, general practitioners and pregnant women in a maternity shared-care environment. Recently in alignment with a National e-health agenda, an electronic health record (EHR) was introduced at an Australian tertiary maternity service to replace the PHR for collection and transfer of data. The aim of this study was to examine and compare the completeness of clinical data collected in a PHR and an EHR. Methods We undertook a comparative cohort design study to determine differences in completeness between data collected from maternity records in two phases. Phase 1 data were collected from the PHR and Phase 2 data from the EHR. Records were compared for completeness of best practice variables collected The primary outcome was the presence of best practice variables and the secondary outcomes were the differences in individual variables between the records. Results Ninety-four percent of paper medical charts were available in Phase 1 and 100% of records from an obstetric database in Phase 2. No PHR or EHR had a complete dataset of best practice variables. The variables with significant improvement in completeness of data documented in the EHR, compared with the PHR, were urine culture, glucose tolerance test, nuchal screening, morphology scans, folic acid advice, tobacco smoking, illicit drug assessment and domestic violence assessment (p = 0.001). Additionally the documentation of immunisations (pertussis, hepatitis B, varicella, fluvax) were markedly improved in the EHR (p = 0.001). The variables of blood pressure, proteinuria, blood group, antibody, rubella and syphilis status, showed no significant differences in completeness of recording. Conclusion This is the first paper to report on the comparison of clinical data collected on a PHR and EHR in a maternity shared-care setting. The use of an EHR demonstrated significant improvements to the collection of best practice variables. Additionally, the data in an EHR were more available to relevant clinical staff with the appropriate log-in and more easily retrieved than from the PHR. This study contributes to an under-researched area of determining data quality collected in patient records.

Combined Jewish Philanthropies (Boston, Mass.) records, undated, 1865-1989 (bulk 1942-1979)

The Combined Jewish Philanthropies (CJP) of Boston, Massachusetts is the oldest federated Jewish philanthropy in the United States. The current incarnation of CJP was formed in 1960, when two separate federated philanthropies – the Combined Jewish Appeal and Associated Jewish Philanthropies – merged to create a single organization dedicated to serving the needs of Boston’s Jewish community. CJP’s records contain the history of several other organizations, from the forerunners of the current Federation to the Jewish institutions supported by CJP. Their beginnings can be traced to the founding of the United Hebrew Benevolent Association (UHBA) in 1864 at the Pleasant Street Synagogue (now Temple Israel.) This collection contains meeting minutes, correspondence, photographs, scrapbooks, financial documents and ledgers, appeal information, publicity, programs, brochures and other written documents relating CJP’s history.

Board of Delegates of American Israelites records 1859-1881, 1887, 1932

Contains printed copies of the 1860 constitution and by-laws, copies of proceedings and annual reports, 1859-1877, of the Board of Delegates; report on Jews in Roumania, an 1874 annual report of the Hebrew Benevolent and Orphan Asylum Society, manuscript minute books and minutes of meetings, 1859-1876, resolutions, executive, financial, ritual slaughtering and other special committee reports, newspaper clippings and correspondence with synagogues and organizations in the U.S. who constitute the membership of the Board of Delegates, with the Union of American Hebrew Congregations with whom they later merged, the Union's Board of Delegates of Civil and Religious Rights, and with individuals and organizations in foreign countries including the Alliance Israelite Universelle, the Anglo-Jewish Association, the Board of Deputies of British Jews, the Committee for the Roumanian Jews (Berlin), the Koenigsberg Committee, and the London Roumanian Committee.

North American Jewish Students Appeal records, undated, 1962, 1964-1996 (bulk 1971-1995)

The records of the North American Jewish Students Appeal (NAJSA or APPEAL) contains documents on two levels of concern: those documents dealing with the NAJSA as a student-run organization promoting Jewish identity among college-aged youth; and those documents dealing with the APPEAL as a fundraising organization for several well-known student constituent organizations. The Constituents were: the Jewish Student Press Service, Lights in Action, the North American Jewish Students Network, the Progressive Zionist Caucus, Response: A Contemporary Jewish Review, Yavneh Religious Students Organization, and Yugntruf Youth for Yiddish. Documents include correspondence, financial records, minutes, press releases, information on grants awarded to student organizations for programming and publishing, student journals, and newspapers, photographs, and ephemera.

Congregation Shearith Israel (New York, N.Y.) records, undated, 1755-1996.

Contains published and manuscript material relating to the activities and administration of the congregation and its subsidiary organizations including reports and weekly bulletins, early financial records and lists of those honored at religious services, copies of resolutions and forms of service and prayers for various occasions in manuscript form. Contains also material relating to the cemetery photographs, the Hebra Hased Va-Amet (the congregational burial society) and to later clergy in the congregation, Henry Pereira Mendes, David de Sola Pool and Louis Coleman Gerstein including published copies of their sermons.

National Council of Jewish Women, New York Section records, undated, 1895-2004.

These records document New York Section’s early history to the present, representing a significant portion of its work in community programming and advocacy, as well as its supporting administrative, fundraising, membership, and public relations activities. As a section of the National Council, its records also include a substantial amount of material regarding the National Organization’s programs, events, publications, and reports, dating from 1896 through 1999.

Noah Benevolent Society records, undated, 1852-1979.

Collection consists of several versions of the constitution; minute books of the membership meetings (1852-1856, 1868-1907, 1914-1971; until 1907 in German, afterwards in English); minute books of meetings of the trustees (1852-1858, 1876-1974, until 1912 in German); an index to and summary of the trustees minutes (1927-1944); several anniversary journals starting with the 50th, which was also "the first extant history of the Noah Benevolent Society"; membership books (1861-1892, 1930-1965, until 1892 in German; the books after 1930 contain detailed information concerning each member's age, occupation, family, military service, etc.); financial records (1862-1870, 1964-1967, 1972); quarterly accountant's reports (bound with the membership minutes); monthly financial and statistical reports of the Mordechai Federal Credit Union (March 1959-June 1960) established by the Society; lists and addresses of members; newsletters (1927-1979) and other material and photographs reflecting the Society's activities.

Synagogue Council of America records 1935-1974

Contains the constitution, by-laws, correspondence, papers, and minutes of the Synagogue Council of America (1935-1958), an incomplete set of the minutes of the Plenum, (1949-1965), the minutes of the Executive Committee (1946-1969), Officers' (Summit) Meetings (1955-1967) and the minutes and reports of the Budget Committee (1946-1966), financial reports and statements for 1942-1965 and fundraising activities (1958-1968).

American Jewish Committee. Office of Jewish War Records, undated, 1918-1921, 1962.

The records consist of documentation of the American Jewish Committee's project to describe Jewish participation in the United States Armed Forces during World War I. The bulk of the material consists of questionnaires that the AJC sent to servicemen to determine Jewish identity, which contain information on personal identification and details of military service. Responses to the questionnaire come from both Jews and non-Jews. In addition, the collection contains office papers concerning the project and a ledger of manuscripts. The manuscripts document the distribution of records the Office of Jewish War Records collected, as well as list Jews who died or were given military honors.

The Ragfish, Icosteus aenigmaticus Lockington, 1880: A Synthesis of Historical and Recent Records From the North Pacific Ocean and the Bering Sea

Knowledge of the distribution and biology of the ragfish, Icosteus aenigmaticus, an aberrant deepwater perciform of the North Pacific Ocean, has increased slowly since the first description of the species in the 1880’s which was based on specimens retrieved from a fish monger’s table in San Francisco, Calif. As a historically rare, and subjectively unattractive appearing noncommercial species, ichthyologists have only studied ragfish from specimens caught and donated by fishermen or by the general public. Since 1958, I have accumulated catch records of >825 ragfish. Specimens were primarily from commercial fishermen and research personnel trawling for bottom and demersal species on the continental shelves of the eastern North Pacific Ocean, Gulf of Alaska, Bering Sea, and the western Pacific Ocean, as well as from gillnet fisheries for Pacific salmon, Oncorhynchus spp., in the north central Pacific Ocean. Available records came from four separate sources: 1) historical data based primarily on published and unpublished literature (1876–1990), 2) ragfish delivered fresh to Humboldt State University or records available from the California Department of Fish and Game of ragfish caught in northern California and southern Oregon bottom trawl fisheries (1950–99), 3) incidental catches of ragfish observed and recorded by scientific observers of the commercial fisheries of the eastern Pacific Ocean and catches in National Marine Fisheries Service trawl surveys studying these fisheries from 1976 to 1999, and 4) Japanese government research on nearshore fisheries of the northwestern Pacific Ocean (1950–99). Limited data on individual ragfish allowed mainly qualitative analysis, although some quantitative analysis could be made with ragfish data from northern California and southern Oregon. This paper includes a history of taxonomic and common names of the ragfish, types of fishing gear and other techniques recovering ragfish, a chronology of range extensions into the North Pacific and Bering Sea, reproductive biology of ragfish caught by trawl fisheries off northern California and southern Oregon, and topics dealing with early, juvenile, and adult life history, including age and growth, food habits, and ecology. Recommendations for future study are proposed, especially on the life history of juvenile ragfish (5–30 cm FL) which remains enigmatic.

The Economic Costs of Health Service Treatments for Asbestos-Related Mesothelioma Deaths

This article explores the complex and neglected picture of occupational and environmental disease healthcare costs specifically relating to asbestos. Diagnosed mesothelioma cases in Scotland in one calendar year were used to investigate the subject in greater depth. Data from UK sources on asbestos disease types recorded in 2000 and their disease treatment costs were obtained. Acute care economic costs of these diseases are estimated. One hundred and twenty diagnosed, recorded, and treated cases of asbestos-related diseases occurred in 2000 in Scotland. Mesothelioma accounted for 100 cases and directly cost Scottish National Health Service hospitals an estimated 942,038 pounds. The estimated UK figure in 2000 was at least 16,014,646 pounds because official figures for diagnosed and recorded deaths from mesothelioma are running at over 1700 a year with rises predicted for 2010 of 2000 deaths. By 2003, 50,000 people in the UK had died from diagnosed and recorded mesothelioma since records began. Earlier disease treatment costs would have been significantly lower than those in 2000 but, at 2000 prices, cost to the UK was roughly 471,019,000 pounds in acute hospital expenditure. Figures for primary care costs, including caregiver costs, are incomplete or unknown. These disease costs are substantial and have some international generalizability. Treatment patterns and costs vary greatly. Many lung cancer cases due to asbestos exposure occur globally for each mesothelioma case. Hence figures provided in this article are certain to be gross underestimates of the total health service and personal economic costs of asbestos illness and treatment in Scotland.

Substituting home care for hospitalization:The role of a quick response service for the elderly

The purpose of the present study was to examine the role of a rapid access home-based service as a means for the elderly to avoid admission to an acute-care hospital. The setting for the study included emergency departments in three acute care hospitals and a home care program in a mid-size Canadian city. Multiple sources of information were obtained to evaluate the service. Hospital emergency department records and home care records were reviewed. Patients who participated in the service (n=96) and physicians and nurses (n =119) who had involvement with the service were surveyed appraising the service in terms of relevance, access, quality and coordination. Study results revealed that elderly women with multiple health problems who lived alone were the most frequent users of the service. The majority of the patients admitted to the service presented with problems of a functional nature that were the result of a fall or mobility problems. The results indicated that the service did avert hospital admissions and facilitated a process by which patients could avoid the intermediate step of hospitalization before placed in a higher level of care or returning to previous levels of functioning. Economic analysis indicated that the value of the service stemmed from the benefits to patients and caregivers rather than from cost savings offered to acute care hospitals.

Service composition for biomedical applications

A exigente inovação na área das aplicações biomédicas tem guiado a evolução das tecnologias de informação nas últimas décadas. Os desafios associados a uma gestão, integração, análise e interpretação eficientes dos dados provenientes das mais modernas tecnologias de hardware e software requerem um esforço concertado. Desde hardware para sequenciação de genes a registos electrónicos de paciente, passando por pesquisa de fármacos, a possibilidade de explorar com precisão os dados destes ambientes é vital para a compreensão da saúde humana. Esta tese engloba a discussão e o desenvolvimento de melhores estratégias informáticas para ultrapassar estes desafios, principalmente no contexto da composição de serviços, incluindo técnicas flexíveis de integração de dados, como warehousing ou federação, e técnicas avançadas de interoperabilidade, como serviços web ou LinkedData. A composição de serviços é apresentada como um ideal genérico, direcionado para a integração de dados e para a interoperabilidade de software. Relativamente a esta última, esta investigação debruçou-se sobre o campo da farmacovigilância, no contexto do projeto Europeu EU-ADR. As contribuições para este projeto, um novo standard de interoperabilidade e um motor de execução de workflows, sustentam a sucesso da EU-ADR Web Platform, uma plataforma para realizar estudos avançados de farmacovigilância. No contexto do projeto Europeu GEN2PHEN, esta investigação visou ultrapassar os desafios associados à integração de dados distribuídos e heterogéneos no campo do varíoma humano. Foi criada uma nova solução, WAVe - Web Analyses of the Variome, que fornece uma coleção rica de dados de variação genética através de uma interface Web inovadora e de uma API avançada. O desenvolvimento destas estratégias evidenciou duas oportunidades claras na área de software biomédico: melhorar o processo de implementação de software através do recurso a técnicas de desenvolvimento rápidas e aperfeiçoar a qualidade e disponibilidade dos dados através da adopção do paradigma de web semântica. A plataforma COEUS atravessa as fronteiras de integração e interoperabilidade, fornecendo metodologias para a aquisição e tradução flexíveis de dados, bem como uma camada de serviços interoperáveis para explorar semanticamente os dados agregados. Combinando as técnicas de desenvolvimento rápidas com a riqueza da perspectiva "Semantic Web in a box", a plataforma COEUS é uma aproximação pioneira, permitindo o desenvolvimento da próxima geração de aplicações biomédicas.

Electronic health records for mobile citizens: a secure and collaborative architecture

Durante as ultimas décadas, os registos de saúde eletrónicos (EHR) têm evoluído para se adaptar a novos requisitos. O cidadão tem-se envolvido cada vez mais na prestação dos cuidados médicos, sendo mais pró ativo e desejando potenciar a utilização do seu registo. A mobilidade do cidadão trouxe mais desafios, a existência de dados dispersos, heterogeneidade de sistemas e formatos e grande dificuldade de partilha e comunicação entre os prestadores de serviços. Para responder a estes requisitos, diversas soluções apareceram, maioritariamente baseadas em acordos entre instituições, regiões e países. Estas abordagens são usualmente assentes em cenários federativos muito complexos e fora do controlo do paciente. Abordagens mais recentes, como os registos pessoais de saúde (PHR), permitem o controlo do paciente, mas levantam duvidas da integridade clinica da informação aos profissionais clínicos. Neste cenário os dados saem de redes e sistemas controlados, aumentando o risco de segurança da informação. Assim sendo, são necessárias novas soluções que permitam uma colaboração confiável entre os diversos atores e sistemas. Esta tese apresenta uma solução que permite a colaboração aberta e segura entre todos os atores envolvidos nos cuidados de saúde. Baseia-se numa arquitetura orientada ao serviço, que lida com a informação clínica usando o conceito de envelope fechado. Foi modelada recorrendo aos princípios de funcionalidade e privilégios mínimos, com o propósito de fornecer proteção dos dados durante a transmissão, processamento e armazenamento. O controlo de acesso _e estabelecido por políticas definidas pelo paciente. Cartões de identificação eletrónicos, ou certificados similares são utilizados para a autenticação, permitindo uma inscrição automática. Todos os componentes requerem autenticação mútua e fazem uso de algoritmos de cifragem para garantir a privacidade dos dados. Apresenta-se também um modelo de ameaça para a arquitetura, por forma a analisar se as ameaças possíveis foram mitigadas ou se são necessários mais refinamentos. A solução proposta resolve o problema da mobilidade do paciente e a dispersão de dados, capacitando o cidadão a gerir e a colaborar na criação e manutenção da sua informação de saúde. A arquitetura permite uma colaboração aberta e segura, possibilitando que o paciente tenha registos mais ricos, atualizados e permitindo o surgimento de novas formas de criar e usar informação clínica ou complementar.

Automatic classification of scientific records using the German Subject Heading Authority File (SWD)

The following paper deals with an automatic text classification method which does not require training documents. For this method the German Subject Heading Authority File (SWD), provided by the linked data service of the German National Library is used. Recently the SWD was enriched with notations of the Dewey Decimal Classification (DDC). In consequence it became possible to utilize the subject headings as textual representations for the notations of the DDC. Basically, we we derive the classification of a text from the classification of the words in the text given by the thesaurus. The method was tested by classifying 3826 OAI-Records from 7 different repositories. Mean reciprocal rank and recall were chosen as evaluation measure. Direct comparison to a machine learning method has shown that this method is definitely competitive. Thus we can conclude that the enriched version of the SWD provides high quality information with a broad coverage for classification of German scientific articles.