Electronic health scale PCB assembly electronic manufacturing
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    his excellent electronic scale can precisely measure your BMI, body weight, body fat, body water content, muscle density and bone density. The special Health Cloud platform supports real-time transmission of the measurement data to your phone via Bluetooth. This multi-functional scale is great for your modern bathroom.

    When patients leave the hospital after being treated for heart failure, tracking weight is key, Markson said: Sudden weight gain may mean fluid is building up throughout the body because the heart is failing to pump blood efficiently.

    Markson said the hospital aims to have patients step on a wirelessly connected scale once a day, and send that data to a someone — likely a nurse — who would track worrisome spikes in weight, catching problems before they become severe.

    “This is something that has tremendous potential,” Markson said of the mobile technology. “Traditionally, doctors see patients in the hospital. They don’t have a great window into what’s happening the rest of the time.

    Dr. Howard Wolpert, a senior physician at Joslin who is researching mobile technologies, said platforms are just now emerging to gather the data needed, but up until now, they have required a lot of work on the patient’s part.

    Eileen Hughes, who has been working with Wolpert to test a diabetes app using a monitor that continuously checks her glucose levels, said the new technology has helped her figure out which foods cause her blood sugar to spike.

    Long-term follow-up of population-based prospective studies is often achieved through linkages to coded regional or national health care data. Our knowledge of the accuracy of such data is incomplete. To inform methods for identifying stroke cases in UK Biobank (a prospective study of 503,000 UK adults recruited in middle-age), we systematically evaluated the accuracy of these data for stroke and its main pathological types (ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage), determining the optimum codes for case identification.

    Methods

    We sought studies published from 1990-November 2013, which compared coded data from death certificates, hospital admissions or primary care with a reference standard for stroke or its pathological types. We extracted information on a range of study characteristics and assessed study quality with the Quality Assessment of Diagnostic Studies tool (QUADAS-2). To assess accuracy, we extracted data on positive predictive values (PPV) and—where available—on sensitivity, specificity, and negative predictive values (NPV).

    Results

    37 of 39 eligible studies assessed accuracy of International Classification of Diseases (ICD)-coded hospital or death certificate data. They varied widely in their settings, methods, reporting, quality, and in the choice and accuracy of codes. Although PPVs for stroke and its pathological types ranged from 6–97%, appropriately selected, stroke-specific codes (rather than broad cerebrovascular codes) consistently produced PPVs >70%, and in several studies >90%. The few studies with data on sensitivity, specificity and NPV showed higher sensitivity of hospital versus death certificate data for stroke, with specificity and NPV consistently >96%. Few studies assessed either primary care data or combinations of data sources.

    Since 1919, Health o meter® Professional has provided the medical community with high quality, innovative digital and mechanical healthcare scales. Our scales are designed with healthcare professionals in mind, to offer functionality that best serves their needs. Explore our site and learn more about our product lines, EMR connectivity solutions and professional advantages. We are dedicated to providing medical professionals with the best weighing scales.

    She said this kind of technology could reduce doctor’s visits, but it shouldn’t replace them, in part because the data from the at-home sensor aren’t always correct.

    Diabetes is such a complex condition, Wolpert added, that simply transmitting data is not enough. Diabetic patients need to know a lot about nutrition, exercise, and insulin so they can adjust their dose according to their daily activities, he said.

    academics, and the public) interact in complex ways (social media, literature, lay press, guidelines, advertising, formularies, package inserts, and direct interaction) to generate choices based on a variety of inputs (indication, feasibility, preference, and cost) (11⇓⇓⇓⇓–16). Because of this complexity, actual practice can be characterized only empirically, answering questions such as what treatment choices are being made in clinical practice, how many patients experience which combination of therapies, and how patterns may change over time or across different locations and practice types. Just as sample size calculations have become standard in trial design, so large-scale characterizations of current treatment practices may become standard in the future.

    To carry out this systematic characterization on a very large scale, observational research will have several requirements: a multinational collaboration, common data standards, access to clinical data, compliance with regulatory and privacy laws in multiple nations, and appropriate methods and tools to implement the

    characterization. Observational Health Data Sciences and Informatics (OHDSI, pronounced “Odyssey”) (17) is an international collaboration of more than 120 researchers from 12 countries that contributes expertise at all levels, from infrastructure to clinical research, ensuring that the developed infrastructure meets clinical research needs. OHDSI’s Common Data Model (18), originally developed as part of the Observational Medical Outcomes Partnership (19), is a deep information model that specifies how to encode and store clinical data at a fine-grained level, ensuring that the same query can be applied consistently to databases around the world. OHDSI has chosen data integration standards that dovetail with those of the United States government and the international community, and it also supplies tools and mapping tables for converting data from other standards.

    Third, although there is increased safety associated with integrating free text, dictated reports, radiographic images, and other test results into EHRs (including improved legibility and rapid access),46 many institutions are not currently coding some of the critical data needed to maximize safety. The lack of structured or coded data prevents the system from being able to provide the user with meaningful feedback or interpretation (i.e., an alert regarding the use of lisinopril will not be generated if a patient's history of captopril-related angioedema has not been entered as coded allergen data). Therefore, to realize the full safety benefits of complex CDS tools47 (e.g., checks for drug allergies,48 automatic notification of abnormal test results,28 or reminders related to drug-condition interactions29 [e.g., a warning on the use of isotretinoin in patients who are pregnant]), another e-PSG could focus on ensuring that critical data on medications, allergies, diagnostic test results, and clinical problems are entered as structured or coded data in the EHR.49

    The implementation of EHR programs is complex and involves many user groups (e.g. physicians, healthcare professionals, health information professionals, managers, and patients).

    Understanding users’ perspectives of EHR implementation is essential to the effective implementation of EHRs and to the successful integration of EHRs into the healthcare system.

    What this study added to our knowledge
    Amongst all barriers and facilitators to EHR implementation identified in a previous systematic review, ten were prioritized in the context of the Canadian healthcare system through this Delphi study.
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    How do we determine whether individuals have the capacity to engage with eHealth programs and interventions? Health practitioners, eHealth developers, and researchers alike need to know if electronic health tools are suitable methods for effectively promoting population health and aiding health care. An often unmentioned assumption underlying the deployment of eHealth resources intended for public consumption is that consumers have the skills to use such resources to their optimal level. Yet, with over 40% of US and Canadian adults having basic (or prose) literacy levels below what is considered necessary to optimally participate in civil society [1,2], it is unlikely that eHealth will provide population-level benefits as it requires much more than just prose literacy. Consumer-directed eHealth requires the ability to seek out, find, evaluate and appraise, integrate, and apply what is gained in electronic environments toward solving a health problem, or eHealth literacy [3]. This composite skill requires that people are able to work with technology, critically think about issues of media and science, and navigate through a vast array of information tools and sources to acquire the information necessary to make decisions.

    We extracted and tabulated information from each included study on: first author and publication year; geographic setting (country); age (mean and/or range) of included cases (coded events); data source (hospital, death certificates, primary care); coding system and version; codes used to identify cases; diagnostic position of these codes in the electronic health record (primary versus secondary); number of cases (coded events) compared against the reference standard; reference standard used; PPV and, where reported or calculable, sensitivity, specificity, and negative predictive value (NPV) of codes. We only extracted sensitivity, specificity and NPV values where the reference standard was a population-based stroke register which had clearly aimed to include all stroke cases in the population under study.

    Scale (N people), phenotypic and omic resolution of population-based, hospital-based and disease-based exemplar data resources relevant to cardiovascular disease research (for further details see Boxes 1 and 2). AF, atrial fibrillation; AFGen, AF Consortium; CHD, coronary heart disease; ESC, European Society of Cardiology; EPIC, European Prospective Investigation into Cancer and Nutrition; ERFC, Emerging Risk Factors Collaboration; eMERGE, Electronic Medical Records and Genomics; HF, heart failure; PMI, precision medicine initiative; MVP, Million Veterans Programme; NICOR, National Institute for Cardiovascular Outcomes Research; NIHR, National Institute for Health Research; RPGEH, Research Programme on Genes, Environment, and Health; UCLEB, University College, London School of Hygiene and Tropical Medicine, Edinburgh, Bristol.

    Conflict of interest: J.D. reports grants from UK Medical Research Council, grants from British Heart Foundation, grants from UK National Institute of Health Research, grants from European Commission, during the conduct of the study; personal fees and non-financial support from Merck Sharpe & Dohme UK Atherosclerosis, personal fees and non-financial support from Novartis Cardiovascular and Metabolic Advisory Board, personal fees and non-financial support from Pfizer Population Research Advisory Panel, grants from British Heart Foundation, grants from European Research Council, grants from Merck, grants from National Institute of Health Research, grants from NHS Blood and Transplant, grants from Novartis, grants from Pfizer, grants from UK Medical Research Council, grants from Wellcome Trust, outside the submitted work. A.M. reports personal fees from Novartis, personal fees from Bayer, personal fees from Cardiorentis, personal fees from Fresenius, outside the submitted work. M.C. reports personal fees from Vifor Int. G.B. reports personal fees from Bayer. P.V. reports grants and personal fees from Bayer,

    grants and personal fees from Servier, grants and personal fees from Pfeizer, grants and personal fees from Menarini, grants and personal fees from Boehringer, during the conduct of the study. S.D.A. receives honoraria for speaking or consultancy from Bayer, Boehringer Ingelheim, Novartis, Servier and Vifor Int, as well as grant support for clinical trial research from Abbott Vascular and Vifor Int.

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    We assessed study-level quality with a modified version of the Quality Assessment of Diagnostic Studies tool (QUADAS-2),[24] adapted from a recent systematic review of the validity of myocardial infarction diagnoses in administrative databases.[25] We used this to assess reporting quality, generalisability to the UK population (because we sought to recommend codes for UK Biobank), and risk of bias. The study protocol (S1 Appendix) provides a detailed list of questions and scoring methods. An overall quality score (0–14) was derived by combining scores for reporting quality, generalisability, and low risk of bias. We did not exclude studies on the basis of quality assessments.

    Proponents herald a new era of connected health that will transform medicine. But critics caution that hospitals need to make sure the influx of patient data on their every step and heartbeat is secure, reliable, meaningful, and doesn’t overwhelm medical staff.

    “Most primary care doctors I know, if they get one more piece of data, they’re going to quit,” said Dr. Bob Wachter, a professor of medicine at the University of California, San Francisco.

    We found wide variation in the performance of ICD codes for stroke and its main types, reflecting the heterogeneity of codes assessed and variation in study settings and methods. Our data also show a lack of consensus among stroke epidemiology studies about which codes should be used for identifying stroke outcomes. We have demonstrated that with appropriate selection of stroke-specific codes, PPVs of close to or >90% can be achieved for stroke and each of its main pathological types. Such PPVs will be adequate for many large scale epidemiological studies of the determinants of stroke. However, we found very few studies of the accuracy for stroke of Read-coded primary care data or of two or more overlapping data sources. Furthermore, the few available studies of ICD-coded data sources for identification of ischaemic stroke subtypes found that the majority of ischaemic subtype codes were ‘unspecified’[42], and reliability of ischaemic subtype classification was limited [74, 75]. We found no studies of the accuracy of coded data for identification of subtypes of ICH or SAH.

    Last month, scientists published yet another study about the modern genetic legacy of prehistoric interbreeding between humans and Neanderthals. The study presented new evidence that genetic variants inherited from Neanderthals affect the health of people today, by increasing their risk for medical conditions ranging from depression to skin lesions. While the story about how our distant ancestors shape who we are today is fascinating, the study's most important result isn't really about Neanderthals.

    The study's true significance involves something that may sound mundane, but is, in fact, a powerful new tool in biomedical research: electronic health records. Though not explicitly designed for research, electronic health records promise to solve a tough problem in medical genetics—as long as we figure out how to use them securely and ethically.

    The Farr Institute is funded from the Medical Research Council, Arthritis Research UK, British Heart Foundation, Cancer Research UK, Chief Scientist Office, Economic and Social Research Council, Engineering and Physical Sciences Research Council, NIHR, National Institute for Social Care and Health Research, and Wellcome Trust (grant MR/K006584/1). The BigData@Heart Consortium is funded by the Innovative Medicines Initiative-2 Joint Undertaking under grant agreement No. 116074. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA; it is chaired, by DE Grobbee and SD Anker, partnering with 20 academic and industry partners and ESC.

    A three-round Delphi study was held with representatives of 4 Canadian EHR user groups defined as partners of the implementation process who use or are expected to use EHR in their everyday activity. These groups are: non-physician healthcare professionals, health information professionals, managers, and physicians. Four bilingual online questionnaire versions were developed from factors identified by the systematic review. Participants were asked to rate the applicability and the importance of each factor. The main outcome measures were consensus and priority. Consensus was defined a priori as strong (≥ 75%) or moderate (≥ 60-74%) according to user groups’ level of agreement on applicability and importance, partial (≥ 60%) when participants agreed only on applicability or importance, or as no consensus (< 60%). Priority for decision-making was defined as factors with strong consensus with scores of 4 or 5 on a five-point Likert scale for applicability and importance.

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    Informed decision making requires that people can adequately access, understand, and process health information to meet their needs. Access refers both to the literal ability to access information resources like health websites, but also the quality of this access. This includes the quality of the technology (eg, Internet connection speed, hardware, software) and the conditions of use, such as whether people have the privacy or time to properly engage eHealth resources. Access in the Internet age also requires an ability to derive meaning from text. As basic literacy skills rise, so does the ability to use computers effectively to solve problems, regardless of age, income, or education [4].

    There is currently a strong focus worldwide on the potential of EHRs to reduce healthcare costs and significantly improve the quality of healthcare provided.

    Second, the implementation and use of complex clinical-decision support (CDS) systems embedded in EHRs are prone to human error and cognitive constraints.38,39 Consequently, decisions related to various aspects of CDS interventions must be evaluated periodically.40 For example, although point-of-care CDS interventions are necessary to achieve the full benefits of EHRs and stages 1 and 2 of the meaningful use payments, outlined by the Centers for Medicare and Medicaid Services (CMS),41 alerts that interrupt the clinician's workflow or thought process must be used judiciously. Many organizations turn on alerts with low specificity, which results in high rates of clinician override.24 Frequent overrides are associated with “alert fatigue,” which can lead clinicians to inadvertently ignore important information. Thus, another potential e-PSG could be to reduce alert fatigue.

    Alerts with override rates above a certain threshold should be discontinued or modified to increase their specificity.42 Similarly, hard stops (i.e., when users cannot proceed with the desired action) must be used only for the most egregious errors.43 Having such a goal will stimulate a multidisciplinary approach to reducing alerts that involves engaging cognitive scientists, human-factors engineers, and informaticians (i.e., scientists trained to work on the sociotechnical issues of information and communications technologies44,45) to work on these complex issues with clinicians (Table 1).

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    The recent Neanderthal study demonstrates how powerful this approach can be. Earlier studies had suggested that genetic variants inherited from Neanderthals might affect certain health-related traits among certain populations today, but these studies lacked the data to show this conclusively. To get the necessary data, the researchers turned to an existing project—led by scientists at Vanderbilt University—that is piloting the use of electronic medical records in research. The scientists used medical billing codes in the electronic health records of nearly 30,000 volunteers to gather information on more than 1,000 different health conditions. Because these volunteers had also contributed DNA data to the project, the researchers could efficiently look for links between Neanderthal genes and health conditions in their subjects. They found statistically significant associations between the genes and several health conditions, including nicotine addiction, skin lesions, a blood coagulation disorder, depression, and urinary tract problems.

    Cohorts of millions of people's health records, whole genome sequencing, imaging, sensor, societal and publicly available data present a rapidly expanding digital trace of health. We aimed to critically review, for the first time, the challenges and potential of big data across early and late stages of translational cardiovascular disease research.

    The exact results of this study are mainly of interest to biologists who study the role of Neanderthals in recent human evolution. But the general idea of combining electronic health records with genetic data will soon play a big role in a much, much larger biomedical research project—the current administration's new Precision Medicine Initiative, the centerpiece of which is a giant study cohort of one million people. The National Institutes of Health has announced that it plans to recruit the first 79,000 participants this year. This enormous biomedical research project will necessarily rely heavily on electronic health records to track the long-term health of the participants.

    The Agitated Behavior Scale was effectively implemented in the electronic health record and was found to be usable in the assessment of agitation.

    “What we have not done is sort out the workflow. Where is the data going to go? Who is going to intervene?” he said.

    Conducting this study as part of a larger trial did pose problems for test-retest reliability; therefore, these results should be interpreted with caution. The lower than expected test-retest correlations between administrations of the eHEALS is attributed to a rise in eHealth literacy scores from baseline to post-intervention follow-ups, attributed to the smoking prevention intervention used in collecting the data [20]. Although unanticipated, one potential explanation for this increase is that the control intervention was designed based on the principles advocated by the eHealth literacy intervention itself (eg, user-friendly and audience-specific language, easy to read and navigate), which could have influenced participants’ eHealth literacy scores. This may explain the relatively modest correlations (.68 to .70) compared with what was expected.

    If you are on a personal connection, like at home, you can run an anti-virus scan on your device to make sure it is not infected with malware.
    If you are at an office or shared network, you can ask the network administrator to run a scan across the network looking for misconfigured or infected devices.

    Additional studies are required to longitudinally examine the eHEALS in study conditions that are not susceptible to influence of the characteristics of a specific intervention. Testing the eHEALS with a population that has high rates of information technology presents a limitation; however, it also provides an opportunity to understand the robustness of the measure within a specific population. Further research needs to consider the eHEALS’ application to other populations as well as groups with highly variable levels of technology familiarity.

    Without sufficiently broad databases available in the first stage, randomized trials are designed without explicit knowledge of actual disease status and treatment practice. Literature reviews are restricted to the population choices of previous investigations, and pilot studies usually are limited in scope. By exploiting the ClinicalTrials.gov national trial registry (9) and electronic health records, researchers already have demonstrated the discrepancy between targeted populations and populations available for study (10), raising the concern that designs may not be optimal. Designs cannot be based simply on current treatment recommendations. Local stakeholders (patient, family, physician, and consultant) and global stakeholders (industry, regulators,

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    EHRs differ from electronic medical records (EMRs) and personal health records (PHRs) most notably on the basis of the completeness of the information the record contains and the designated custodian of the information [3]. A PHR is often described as being a complete or partial health record under the custodianship of a person(s) (e.g. a patient or family member) that holds all or a portion of the relevant health information about that person over their lifetime. This is a person-centric health record. An EMR may be characterized as a partial health record under the custodianship of a health care provider(s) that holds a portion of the relevant health information about a person over their lifetime. This is often described as a provider-centric or health organization-centric health record of a person. In contrast, an EHR may be defined as a complete health record under the custodianship of a healthcare provider(s) that holds all relevant health information about a person over their lifetime. This is often described as a person-centric health record, which can be used by many approved healthcare providers or health care organizations.

    In Canada, a network of interoperable electronic health record (EHR) network is however currently being implemented. Canada Health Infoway was created by Canada’s First Ministers in 2001 with the goal to foster and accelerate the building of a pan-Canadian electronic health record network which will manage Canadians’ health information. According to Canada Health Infoway, EHR solutions will link clinics, hospitals, pharmacies and other points of care. They hold the promise of helping to improve Canadians’ access to health services, enhance the quality of care and patient safety, and help the health care system becoming more efficient [4].

    Recent systematic reviews show that EMR/EHR systems have not yet demonstrated clinical and economic benefits [1][5][6]. Other recent results indicate that computerized clinical decision support systems (CCDSSs), a feature that is often linked to the EHR, inconsistently improved process of care measures and seldom improved patient outcomes. Lack of clear patient benefit and lack of data on harms and costs precluded a recommendation to adopt CCDSSs for drug therapy management [7]. Moreover, it is possible that harms may neutralize many of the benefits expected from EMR, EHR or CCDSS [7]. The vision of Canada Health Infoway is to provide a secure and private EHR lifetime record of health history and care within the health system, available to authorized health providers and individuals. It is believed that EHRs will facilitate the sharing of data across the continuum of care, the healthcare delivery organizations, and geographical areas [8]. The Canadian Medical Association has called for government investment in health information systems such as EHRs with the goal of improving patient outcomes and system efficiency [9, 10]. Nevertheless, the Canadian healthcare system remains paper-laden and EHR implementation lags behind many other industrial countries

    We calculated 95% confidence intervals for PPV, sensitivity, specificity and NPV values in Stata (version 12) using the Wilson method for binomial proportions [26]. For stroke and each of its main pathological types, we assessed the influence on PPV (and, where available, sensitivity) of the codes used to identify stroke cases, and of other study characteristics, using visual inspection of tabulated data and forest plots, and making within-study comparisons where possible to minimise bias. We did not undertake formal meta-analyses or meta-regression because of the substantial heterogeneity between studies in their settings, methods and reporting.

    Electronic health records (EHRs) contain data about a person’s health history. Increasingly, EHRs have the characteristics of big data in terms of their volume, velocity, and variety (the 3 “V”s). Volume is a major concern for EHRs especially due to the presence of huge amount of null data, i.e., for storing sparse data that leads to storage wastage. Reducing storage wastage due to sparse values requires amendments to the storage mechanism that stores only non-null data, and also allows faster data retrieval and supports multidimensional heterogeneous data. Another area of concern regarding EHRs data is standardization. Standardization can aid in semantic interoperability that resolves the discrepancies in interpretation of health records among different medical organizations or persons involved. Various proposals have been made at the logical layer of relational database management system for managing large-scale standardized records in terms of data volume, velocity, and variety. Every proposed modification to logical layer has its pros and cons. In this chapter, we will discuss various aspects of the solutions proposed for managing standardized EHRs, and the approaches to adopt these standards. After efficient management of EHR data, analytics can be applied to minimize the overall cost of healthcare.

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    Continuous glucose manufacturing monitors and diabetes apps “are great tools, but unless patients have the insights and the guidance to use the information,” he said, “they’re not going to realize the benefit.”

    Congestive heart failure has emerged as a prime first target as hospitals experiment with remote monitoring. Ochsner, a large not-for-profit health system in Louisiana, says it saw manufacturing a significant drop in readmission rates after equipping congestive heart failure patients with wireless scales for 30 days following hospitalization, according to Dr. Richard Milani, chief clinical transformation officer.

    This paper focuses on one of the first efforts to implement large-scale Electronic Patient Records (EPRs) in Western hospitals conforming to the international openEHR architecture. A key aim with the openEHR architecture is to offer clinical users the possibility to define structured content of the EPR themselves. This is supposed to contribute to manufacturing interoperability across various health care systems. The paper manufacturing contributes with empirical insight in the first two years of the process and argues that establishing working systems in this area entails huge socio-technical challenges to make such systems work.

    Several hundred patients have used the wireless scales in that way, he said. Ochsner started the initiative before Apple’s HealthKit came out and then switched over in 2014. HealthKit is a developer’s tool that makes it easy for third-party apps to access health data that users collect, and choose to share, on their iPhones.

    The eHEALS is an 8-item measure of eHealth literacy developed to measure consumers’ combined knowledge, comfort, and perceived skills at finding, evaluating, and applying electronic health manufacturing information to health problems. The objective of the study was to manufacturing psychometrically evaluate the properties of the eHEALS within a population context. A youth population was chosen as the focus for the initial development primarily because they have high levels of eHealth use and familiarity with information technology tools.

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    This study manufacturing provides some key findings that corroborate and expand current knowledge of the factors influencing EHR implementation in Canada. We conclude that the perspectives and priorities concerning the barriers and facilitating factors to EHR implementation in Canada could vary greatly between and within user groups and present a challenge to successful implementation of EHR programs [39].

    In summary, we would like to invite EHR implementation researchers to further explore the list of priority factors specific to Canadian user groups that were identified in this Delphi study. Although important recruitment efforts have been made, it was not possible to recruit sufficient patient representatives and the patient Delphi study was thus cancelled. This limitation should be taken into account in future research.

    Within- and between-study comparisons revealed several consistent patterns. First, for stroke of any pathological type, PPV is increased by use of stroke-specific rather than general cerebrovascular codes, making it preferable to use stroke-specific codes to manufacturing maximise PPV if no further adjudication of outcomes is planned after identification using ICD codes. Limited evidence suggests that sensitivity is poor when only death certificate data are used as a data source and is markedly increased by including data from hospital admissions, without compromising PPV.[45, 64] Based on one study, using general cerebrovascular rather than stroke-specific codes also seems likely to increase sensitivity, albeit perhaps by only a small amount and at the expense of a lower PPV.[48] To reduce the number of false positives,

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    this method of identifying stroke outcomes is, therefore, probably best used in combination with further steps to confirm which cases are true positives. The best approach for this confirmation process requires further manufacturing investigation, but could potentially use combinations of ICD codes with coded data from primary care or other sources, or more detailed medical record review. Second, for ischaemic stroke, a greater number of outcomes are identified with little reduction in PPV by manufacturing using a combination of ischaemic and unspecified stroke codes to identify outcomes. Third, specific codes for ICH and SAH were found to have generally high PPVs (range 71 to 96%). Fourth, across a range of codes for cerebrovascular disease, stroke and pathological stroke types, identification of stroke outcomes using only codes in the primary position increased PPV, but generally by only a modest amount and at the expense of missing true positive outcomes. Furthermore, the relevant studies were of ICD-9 codes only, which are now rarely used outside the USA.[31, 32, 34, 37, 40, 43, 49, 52] Thus, use of appropriately selected codes in both the primary and secondary positions would seem appropriate for most purposes.

    “We have bypassed technical problems,” added Wachter, author of the best-selling book “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age.”

    A quality improvement project was conducted in the brain injury unit at a large rehabilitation hospital with registered nurses as participants, using convenience sampling.
    Methods

    Recruitment occurred at a Senior Organization located in a largely Hispanic neighbourhood in New York City (N = 100). Participants completed eHEALS and selected items from the Health Information National Trends Survey (HINTS) which assesses how adults use different communication channels, including the Internet, to obtain vital health information. Data from the US HINTS sample (N = 162) were matched to the Senior Organization sample on age range and Hispanic ethnicity. The average Senior Organization participant was 68 years old, female, born in one of six different Spanish-language countries, and completed high school while the average HINTS participant was 67 years old, female and had high school or less education.
    Results

    Although there was no relationship with the two HINTS subscales and electronic health literacy, there were significant relationships between electronic health literacy and health status and confidence in self-care.
    Conclusions

    Inadequate electronic health literacy is a barrier to positive health outcomes. The Spanish version of eHEALS could be used as a screening instrument to identify gaps and tailored interventions could be developed to increase consumer confidence in using the Internet for reliable health-related information.

    The project consisted of three phases and included education, implementation of the scale in the electronic health record, and administration of the survey questionnaire, which utilized the system usability scale.
    Findings

    The Agitated Behavior Scale was found to be usable and there was 92.2% compliance with the use of the electronic agitated behavior scale.
    Conclusion

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    For the first time, care teams can now access patient-generated data along a comprehensive set of health metrics on a secure and easy to interpret dashboard. Metrics include key vital signs such as weight, blood pressure, heart rate and even pulse wave velocity in addition to traditional health metrics such as activity and sleep. The care team sets custom flags to take action quickly and avoid unnecessary hospitalizations.

    For example, a care team can choose to see when patients with congestive heart failure gain more than three pounds in one day, or five pounds in three days. Such weight gain is typically an early sign of cardiac decompensation and requires a provider-led intervention. With Nokia’s new Patient Care Dashboard, care teams would be able to adjust the patient’s care plan and outreach accordingly.

    Users’ perspectives of barriers and facilitators are complex and each user group has unique professional priorities and roles in the EHR implementation process.

    We recommend that decision-makers integrate the perspectives specific to each user group, and consider the elements of consensus that emerged from this Delphi study, when implementing future EHR projects.

    Given issues of access and literacy, health practitioners in clinical and public health settings require an understanding of what abilities their patients/clients have before recommending eHealth resources. This article describes the development and psychometric evaluation of a measure of eHealth literacy designed for broad use in supporting consumer eHealth in public health and clinical care.


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