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

BACKGROUND AND OBJECTIVES

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.

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.

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.

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.

INTRODUCTION: Effectiveness of COVID-19 control interventions relies significantly on behavioural modifications of its population. Differing adoption rates impacts subsequent COVID-19 control. Hence, positive and sustained behavioural modification is essential for disease control. We describe the adoption rates of behavioural modifications for Singapore's "circuit-breaker" (CB), the national public health response to the COVID-19 crisis, among the general population in the community. METHODS: We conducted an interrupted-time series study using retrospective secondary data. We compared the proportion of Singaporeans who reported adopting specific behaviour modifications before, during and after CB. Behaviours of interest were working from home, performing hand hygiene, using face mask in public, and avoiding crowded areas. We compared change in incidence rates for community COVID-19 cases among the general population across the same time periods. RESULTS: There was an increase in face mask usage (+46.9%, 95% confidence interval [CI] 34.9-58.8, CONCLUSION Community incidence of COVID-19 in Singapore decreased during CB and remained low after CB. Use of face masks and social-distancing compliance through working from home increased during CB. However, it is unlikely to influence other sources of COVID-19 such as imported cases or within foreign worker dormitories.
Adoption ; COVID-19 ; Humans ; Retrospective Studies ; SARS-CoV-2 ; Singapore/epidemiology*

BACKGROUND: The usefulness of cerebrospinal fluid (CSF) concentrations of amyloid beta protein 1-42 (Abeta42), phosphorylated tau (pTau) and total tau (tTau) have been increasing in Alzheimer's disease (AD). However, the direct adoption of previously reported standard values is not appropriate due to interlaboratory variability. We started this study to set up an accessible system to measure CSF biomarkers in our country with high reproducibility and validity. METHODS: Including CSFs from four different institutes the levels of Abeta42, pTau181 and tTau were measured in one lab. The intertest variability and difference in the levels of biomarkers depending on diseases were assessed. Through analysis of receiver operating characteristic cut points and binary logistic regression the cut-off values of Abeta42, pTau and tTau level were obtained, and their validity was evaluated. RESULTS: The intertest consistency was high in measuring CSF biomarkers. The value of Abeta42 was markedly decreased in AD (n= 17) and other dementia (n= 9) compared to normal control (n= 12). The levels of pTau181 and tTau were high in AD, but not in other dementia and normal control. The threshold values of Abeta42, pTau181 and tTau were 290.3 pg/mL, 54.3 pg/mL, and 320.7 pg/mL in differentiating AD from normal control showing high sensitivity and specificity. Especially, the ratios of pTau181/Abeta42 (> 0.16) and tTau/Abeta42 (> 0.76) showed the prime validity. CONCLUSIONS: Our data of CSF Abeta42, pTau181, and tTau levels were highly reproducible. PTau181/Abeta42 and tTau/Abeta42 ratios were the greatly helpful in differentiating AD from normal control.
Academies and Institutes ; Adoption ; Alzheimer Disease ; Amyloid beta-Peptides ; Biomarkers ; Dementia ; Enzyme-Linked Immunosorbent Assay ; Logistic Models ; Pyridines ; ROC Curve ; Sensitivity and Specificity ; Thiazoles

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

BACKGROUND: Tissues for transplantation can save lives or restore essential functions. According to national policies and regulations, access to suitable transplantation, as well as the level of safety, quality, efficacy of donation, and transplantation of tissues, differ significantly between countries. We reviewed a few guidelines on tissue banking from the aspect of screening tests. In addition, four-year experience with screening panels for donated bones and donors at a tertiary hospital is introduced. METHODS: Seven national and international guidelines for screening tests for donors and donated tissues were reviewed. At our institution, screening tests for donation involve two steps. At retrieval, the first screening panel, including ABO/Rh typing, unexpected antibody screening, VDRL, HBsAg, anti-HBs, anti-HBc IgM, anti-HCV, anti-HIV, and microbiological cultures was performed. The second screening panel, including the same tests, except culture studies, was performed after 90 days. From 2008 to 2011, a total of 245 retrievals of bone tissue were performed and the screening panel results were analyzed. RESULTS: Mandatory screening serologic tests for living donors can differ according to local law or regulation and/or screening for endemic diseases. At our institution, among 245 donated bones for a period of four years, 61 bone tissues were discarded due to noncompliance for the second screening (n=32), contamination or no culture study results (n=9), abnormal serologic test results (n=8), and so on. CONCLUSION: Donor screening policies for tissue banking are various according to national laws or endemic disease status. Second screening tests with consideration of the window period should be adopted.
Adoption ; Bone and Bones ; Donor Selection ; Endemic Diseases ; Hepatitis B Surface Antigens ; Humans ; Immunoglobulin M ; Jurisprudence ; Living Donors ; Mandatory Testing ; Mass Screening ; Serologic Tests ; Social Control, Formal ; Tertiary Care Centers ; Tissue Banks ; Tissue Donors ; Transplants

OBJECTIVES: The objective of this study was to create a new measure for clinical information technology (IT) adoption as a proxy variable of clinical IT use. METHODS: Healthcare Information and Management Systems Society (HIMSS) data for 2004 were used. The 18 clinical IT applications were analyzed across 3,637 acute care hospitals in the United States. After factor analysis was conducted, the clinical IT adoption score was created and evaluated. RESULTS: Basic clinical IT systems, such as laboratory, order communication/results, pharmacy, radiology, and surgery information systems had different adoption patterns from advanced IT systems, such as cardiology, radio picture archiving, and communication, as well as computerized practitioner order-entry. This clinical IT score varied across hospital characteristics. CONCLUSIONS: Different IT applications have different adoption patterns. In creating a measure of IT use among various IT components in hospitals, the characteristics of each type of system should be reflected. Aggregated IT adoption should be used to explain technology acquisition and utilization in hospitals.
Adoption ; Cardiology ; Delivery of Health Care ; Humans ; Information Systems ; Medical Informatics ; Pharmacy ; Proxy ; United States

OBJECTIVES: Although Electronic Medical Record (EMR) systems provide various benefits, there are both advantages and disadvantages regarding its cost-effectiveness. This study analyzed the economic effects of EMR systems using a cost-benefit analysis based on the differential costs of managerial accounting. METHODS: Samsung Medical Center (SMC) is a general hospital in Korea that developed an EMR system for outpatients from 2006 to 2008. This study measured the total costs and benefits during an 8-year period after EMR adoption. The costs include the system costs of building the EMR and the costs incurred in smoothing its adoption. The benefits included cost reductions after its adoption and additional revenues from both remodeling of paper-chart storage areas and medical transcriptionists' contribution. The measured amounts were discounted by SMC's expected interest rate to calculate the net present value (NPV), benefit-cost ratio (BCR), and discounted payback period (DPP). RESULTS: During the analysis period, the cumulative NPV and the BCR were US$3,617 thousand and 1.23, respectively. The DPP was about 6.18 years. CONCLUSIONS: Although the adoption of an EMR resulted in overall growth in administrative costs, it is cost-effective since the cumulative NPV was positive. The positive NPV was attributed to both cost reductions and additional revenues. EMR adoption is not so attractive to management in that the DPP is longer than 5 years at 6.18 and the BCR is near 1 at 1.23. However, an EMR is a worthwhile investment, seeing that this study did not include any qualitative benefits and that the paper-chart system was cost-centric.
Adoption ; Cost-Benefit Analysis ; Electronic Health Records ; Electronics ; Electrons ; Hospitals, General ; Humans ; Investments ; Korea ; Outpatients ; Tertiary Healthcare

In Korea, many medical schools have adapted their curricula to the recent paradigm shift introducing a professional graduate school system with universal accreditation criteria for medical education. This rapid transformation has driven the new adoption of system-based integrated curriculum, problem-based learning, team-based learning, and competency-based assessment. In the hundred years since the publication of Flexner's report that suggested a two-phase educational structure consisting of a basic science didactic curriculum followed by the practicum of clinical clerkships, there have been many advancements in curriculum development for medical education. Medical education is undergoing a major paradigm shift from structure- and process-based to competency-based education utilizing outcome-based assessments. The authors reviewed the existing medical literature to provide practical insight into the clinical presentation curriculum introduced by University of Calgary in 1994, developing a roadmap to accomplish full implementation and evaluation. In the clinical presentation based curriculum, schemata (schemes) are organized by experts from terminal objectives, and are considered to have two functions: first, to serve as frameworks around which students can learn new information and secondly, to provide an approach to clinical problem solving. We conclude that there should be further meticulous review of this new system and a prospective evaluation of the students' ability to benefit from it before launching a program based on the indiscreet adoption of a fashionable curricular reform.
Accreditation ; Adoption ; Clinical Clerkship ; Collodion ; Competency-Based Education ; Curriculum ; Decision Support Techniques ; Education, Medical ; Humans ; Korea ; Learning ; Problem Solving ; Problem-Based Learning ; Publications ; Schools, Medical

PURPOSE: Emergency departments (ED) are always overcrowded. Overcrowding is an important problem associated with emergency department treatment and patient satisfaction. Overcrowding can be caused by specific and complex issues and is affected by multiple influences. In an effort to reduce the degree of overcrowding, we evaluated relationships within the SMS (short message service) specialist's notification system. METHODS: This study involved establishment of a SMS specialist's notification system and other activity for resolution of emergency department overcrowding. We conducted a comparative analysis of ED patients from January 2010 to December 2010, before establishment of the system, and from January 2011 to December 2011, after establishment of the system. Data on ED patients were obtained from electronic medical records and the clinical data warehouse. Data were compared for mean length of stay and patient admission number. RESULTS: Results of comparison showed that the mean length of stay for discharge, admission, operation, and transfer had been effectively reduced. Mean residence time for patients in each administration sector was reduced 80.3, 462.3, 127.3, and 89.3 minutes, respectively, after overcrowding had been diminished. Significant differences for mean residence time were observed in each sector (p<0.001). In addition, comparison of before and after adoption of the SMS specialist's notification system for each clinical department showed that mean length of stay of patients admitted to the emergency department was significantly shorter after its adoption. CONCLUSION: By establishing a SMS specialist notification system, overcrowding can be resolved and length of stay can be shortened, which would result in improved satisfaction of both patients and emergency department professionals.
Adoption ; Electronic Health Records ; Emergencies ; Humans ; Length of Stay ; Patient Admission ; Patient Satisfaction ; Specialization