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Clinicians utilize electronic health record (EHR) systems during time-constrained patient encounters where large amounts of clinical text must be synthesized at the point of care. Qualitative methods may be an effective approach for uncovering cognitive processes associated with the synthesis of clinical documents within EHR systems. We utilized a(More)
Automated approaches to measuring semantic similarity and relatedness can provide necessary semantic context information for information retrieval applications and a number of fundamental natural language processing tasks including word sense disambiguation. Challenges for the development of these approaches include the limited availability of validated(More)
The purpose of this study was to understand the factors which promoted the demand for iPads by physicians in two Emergency departments (ED) prior to a system wide implementation of an electronic medical record (EMR). A grounded theory design was employed and 14 semi-structured interviews conducted with ED physicians. Analysis of the interview transcripts(More)
The concept of the minimum dataset (MDS) is taking on an increasingly important role in healthcare. In the current environment of health information exchange and universal implementation of electronic health records, work related to the development of one specific type of MDS, the minimum clinical dataset (MCDS), is beginning to permeate the literature.(More)
Psychometric instruments, inventories, surveys, and questionnaires are widely accepted tools in the field of behavioral health. They are used extensively in primary and clinical research, patient care, quality measurement, and payor oversight. To accurately capture and communicate instrument-related activities and results in electronic systems, existing(More)
The impact of implementing a Computerized Provider Order Entry System on ordering patterns is unknown. This study evaluated ordering patterns for CBC, ECG, chest x-ray, BMP, and cardiac enzymes in randomly selected chest pain patients in an adult Emergency Department pre- and post-implementation. The average number of orders documented was significantly(More)
OBJECTIVE The objective of this study is to understand physicians' usage of inpatient notes by (i) ascertaining different clinical note-entry and reading/retrieval styles in two different and widely used Electronic Health Record (EHR) systems, (ii) extrapolating potential factors leading to adoption of various note-entry and reading/retrieval styles and(More)
Adverse drug event identification and management are an important patient safety problem given the potential for event prevention. Previous efforts to provide structured data methods for population level identification of adverse drug events have been established, but important gaps in coverage remain. ADE identification gaps contribute to suboptimal and(More)
Introduction Surgery is a frequent health care intervention with an estimated 6 million non-cardiac surgical procedures performed every year in the United States, with progressive growth in the number of procedures noted each subsequent year(1). Preoperative medical evaluations have been a cornerstone of pre-surgical care planning and patient management.(More)
Herbal and dietary supplement consumption has rapidly expanded in recent years. Due to pharmacological and metabolic characteristics of some supplements, they can interact with prescription medications, potentially leading to clinically important and potentially preventable adverse reactions. Electronic health record (EHR) system provides a valuable source(More)