Background and Objective: The adoption of electronic medical records (EMRs) in the Philippines has been initiated and adjusted since the last decade through the Philippine eHealth Agenda framework. EMRs are known to improve clinical management and have been widely adopted in advanced economies. However, empirical research on EMR implementation remains limited. This study aims to determine how public primary health care facilities in the country interacted with EMRs before and during the COVID-19 pandemic to understand EMR adoption. Methods: More than 270,000 records generated from EMR usage logs in six rural primary health facilities in Western Visayas were analyzed. Average time of EMR use during work hours was estimated and compared before and during the pandemic. EMR adoption based on specific EMR features used was also determined. Results: In 2020, EMR use ranged from less than one hour to more than eight hours in selected rural health units (RHUs). There was a statistical increase and decrease in use of features during the pandemic. Some EMR users had efficient use indicated by complete adoption of EMR features although such features were not as frequently used as those pertaining to basic adoption. Conclusion This study demonstrates that for EMR use in rural settings, progressive use from basic to complete may vary among users. Public health emergencies such as a pandemic may also affect EMR use. Future research directions should explore other mechanisms which affect user behavior and encourage full adoption of technology such as use of games or non-monetary incentives.
Adoption

OBJECTIVE: CDA is a standard for the exchange and sharing of clinical documents among all entities in the healthcare domain. As it proliferates, the number of CDA documents will increase exponentially and it will require huge storage spaces to store them. The main goal of this study is to devise an efficient compression method optimized for CDA documents so that the storage requirement can be lowered. METHODS: The method proposed in this paper is based on a compression method called Xmill which has been designed specifically for XML documents at large, which requires human intervention for the effective compression, especially, of CDA. Our proposed method, CDACOM, automatically extracts type information from CDA documents to infer the data type, assigns data values of the same type to the same data container, and applies an optimized encoder to the container so that a better compression rate can be achieved. RESULTS: Experiments with various types of CDA documents were performed to evaluate the effectiveness of CDACOM over Xmill. The results show that CDACOM indeed outperforms Xmill and can decrease the output file size by about 24.1% on average, compared to Xmill. If documents are combined and compressed together, the gap gets even bigger to about 50%. CONCLUSION: The proposed compression method, CDACOM, is very effective and promising. It will help lowering the cost for systems to transmit and store CDA documents and, hence, expediting the adoption of the standard in the healthcare domain.
Adoption ; Delivery of Health Care ; Humans

No abstract available.
Adoption ; Clinical Competence ; Health Personnel ; Humans ; Licensure

No abstract available.
Adoption ; Clinical Competence ; Health Personnel ; Humans ; Licensure

BACKGROUND: Ordering an excessive quantity of blood for elective surgery beyond the actual need causes unnecessary cross-matching and wastage or shortage of blood products. To prevent this problem, a maximum surgical blood order schedule (MSBOS) is beneficial. However, the application of a MSBOS is limited due to the complexity of accurate classification based on the name of the operation alone. In this study, we introduced an automatic cancellation program, in which the assigned blood is automatically cancelled after a certain period of time, andevaluated the practicality of a revised MSBOS. METHODS: We analyzed our hospital data involving transfused RBCs for each elective surgical procedure performed between January and June 2007. The MSBOS was organized based on the average number of units of RBCs transfused for the types of surgeries that had been performed >50 times during a certain period of time. The blood cancellation ratio, blood wastage ratio, and the causes of blood wastage were compared before and after adopting the automatic cancellation program and the revised MSBOS. RESULTS: After adopting the automatic cancellation program, the blood cancellation ratio decreased from 18.3% to 17.6% and the blood wastage ratio decreased from 2.67% to 2.00%. There was no significant change with respect to the causes of blood wastage before and after adoption of the automatic cancellation program. CONCLUSION: The implementation of an automatic cancellation program facilitates the efficient use of blood products during elective surgery. It would be useful to apply a revised MSBOS continuously, which is easily applicable and practical in order to decrease the blood wastage rate.
Adoption ; Appointments and Schedules ; Surgical Procedures, Elective

Although the incidence of local recurrence after curative resection of rectal cancer has decreased due to the understanding of the anatomy of pelvic structures and the adoption of total mesorectal excision, local recurrence in the pelvis still remains a significant and troublesome complication. While surgery for recurrent rectal cancer may offer a chance for a cure, conservative management, including radiation and chemotherapy, remain widely accepted courses of treatment. Recent improvement in imaging modalities, perioperative care, and surgical techniques, including bone resection and wound coverage, have allowed for reductions in operative mortality, though postoperative morbidity still remains high. In this review, the techniques, including surgical approaches, employed for management of locally recurrent rectal cancer are highlighted.
Adoption ; Incidence ; Pelvis ; Perioperative Care ; Rectal Neoplasms ; Recurrence

The possibility to predict in vivo the histology of colorectal polyps by advanced endoscopic imaging has resulted in the implementation of a more conservative management for diminutive lesions detected at colonoscopy. In detail, a predict-and-do-not-resect strategy has been proposed for diminutive lesions located in the rectosigmoid tract, whilst a predict-resect-and-discard policy has been advocated for nonrectosigmoid diminutive polyps. Recently, the American Society for Gastrointestinal Endoscopy set required thresholds to be met, before allowing the adoption of these policies in the clinical field. The ability of current endoscopic imaging in reaching these thresholds would depend on a complex interaction among the accuracy of advanced endoscopic imaging in differentiating between adenomatous and hyperplastic lesions, the prevalence of (advanced) neoplasia within diminutive lesions, and the type of surveillance intervals recommended. Aim of this review is to summarize the data supporting the application of both a predict-and-do-not-resect and a predict-resect-and-discard policies, also addressing the potential pitfalls associated with these strategies.
Adoption ; Colonoscopy ; Endoscopy, Gastrointestinal ; Narrow Band Imaging ; Polyps ; Prevalence

OBJECTIVES: The purpose of this study is to identify the role of individual innovation to demographic variables for determining IT adoption behaviors. This study also examines the effect of individual innovation on IT adoption behaviors across IT types. METHODS: To verify the invariant effect of individual innovativeness, two groups of persons working in the health care field were surveyed. The first study subject group was radiologists and their adoption of e-purchasing the second group was emergency rescue crews and their adoption of GPS. RESULTS: Adopter categories in innovations (ACI) as the measurement of individual innovation were a significant variable in both studies. Innovative adopters were more likely to use new IT tools than the majority of early adopters, and the early majority was more likely to adopt IT than the laggards. After merging the two data sets into one for testing the role of IT types as a moderator, the significance of ACI did not change, compared to the two separate analyses. In the merged data set, innovative adopters were 2.34 times more likely to be adopters than the early majority. The early majority was 2.32 times more likely to be adopters than laggards. Moreover, there were no moderating effects of IT types. Thus, there were no reversed adoption rates according to levels of ACI and demographic variables. CONCLUSIONS: ACI has invariant effects on IT adoption behaviors regardless of IT types and demographic differences. To implement a new innovation, understanding individual innovativeness will provide more sophisticated implementation strategies for health care organizations and appropriate education programs for their employees.
Adoption ; Delivery of Health Care ; Diffusion of Innovation ; Emergencies ; Humans

Endoscopic retrograde cholangiopancreatography (ERCP) is associated with a spectrum of complications such as pancreatitis, hemorrhage, perforation, and cardiopulmonary events. These complications can range from mild to severe resulting in extended hospitalization, requiring surgical intervention, and leading to permanent disability or even death. Complications of ERCP have been better understood in the past decade, with adoption of standardized consensus-based definitions of complications and introduction of new recommendations to minimize risks of ERCP. Adequate selection of patients undergoing ERCP, skilled operators using novel techniques and prompt identification and treatment are key to successful prevention and management.
Adoption ; Cholangiopancreatography, Endoscopic Retrograde ; Hemorrhage ; Hospitalization ; Humans ; Pancreatitis

There has been a recent increase in attention focused on the potential risk of radiation-induced carcinogenesis from diagnostic radiology, with a particular emphasis on computed tomography (CT). After the rapid adoption of multidetector CT (MDCT), radiation doses from CT are now the single largest source of diagnostic radiation exposure to patients, and the carcinogenesis risk from diagnostic CT radiation dose exposure can no longer be ignored by physicians. To understand the exposure risk and monitor radiation dose exposure, an understanding and interest in CT dose reports is necessary. Almost all MDCTs now show and allow storage of the volume CT dose index (CTDIvol), dose length product (DLP), and effective dose estimations on dose reports, which are essential to assess patient radiation exposure and risks. To decrease these radiation exposure risks, the principles of justification and optimization should be followed. Justification means that the examination must be medically indicated and useful. Optimization means that the imaging should be performed using doses that are as low as reasonably achievable (ALARA), consistent with the diagnostic task. Optimization includes understanding and changing CT protocols to perform the same diagnostic task with the minimal amount of radiation exposure while maintaining diagnostic accuracy. Physicians and radiologists must be aware of the radiation risks associated with CT exams, and understand and implement the principles for patient radiation dose reduction.
Adoption ; Cone-Beam Computed Tomography ; Humans ; Organothiophosphorus Compounds