Healthcare Technology Systems

Within Wisconsin, our residents experience some of the worst health disparities in the nation. Public reporting on disparities in the quality of care is important to achieving accountability for reducing disparities over time and has been associated with improvements in care. Disparities reporting using statewide electronic health records (EHR) data would allow efficient and regular reporting, but there are significant challenges with missing data and data harmonization. We report our experience in creating a statewide, centralized EHR data repository to support health systems in reducing health disparities through public reporting. We partnered with the Wisconsin Collaborative for Healthcare Quality (the “Collaborative”), which houses patient-level EHR data from 25 health systems including validated metrics of healthcare quality. We undertook a detailed assessment of potential disparity indicators (race and ethnicity, insurance status and type, and geographic disparity). Challenges for each indicator are described, with solutions encompassing internal (health system) harmonization, central (Collaborative) harmonization, and centralized data processing. Key lessons include engaging health systems in identifying disparity indicators, aligning with system priorities, measuring indicators already collected in the EHR to minimize burden, and facilitating workgroups with health systems to build relationships, improve data collection, and develop initiatives to address disparities in healthcare.

Patient Journey Mapping (PJM) is an emerging method to describe complex health care processes from the patient perspective. In this paper we describe a novel PJM method that integrates the SEIPS model, in particular the five work system elements (i.e., person, tasks, tools/technology, environment, and organization). The SEIPS-based PJM method supports the integration of multiple perspectives (e.g., patient, clinician) throughout the design and development process, and helps to represent non-linear health care processes, such as those experienced by patients who present to the emergency department.

Studies over the last half century have shown that a diet rich in fish, especially the intake of n-3 fatty acids, is effective in preventing cardiovascular disease. Determining the eicosapentaenoic acid/arachidonic acid (EPA/ARA) ratio is useful for assessing the quality of dietary habits; however, the convenience of measurements is an issue. We examined the gas chromatography (GC) method of dried blood spot (DBS) as a method to improve the user-friendliness of blood collection. The EPA/ARA ratio of DBS showed a high correlation with that of serum obtained from venous blood, but the value was slightly lower. We developed a rapid GC method capable of making determinations in 11.0 min, shortening the analysis time from 49.3 min in the conventional method. Our new methodology eases the burden on both subjects and healthcare professionals, facilitates large clinical trials, and accelerates routine EPA/ARA ratio measurement.

Antibiotic use is often the target of interventions in health care organizations that aim to decrease healthcare-associated infections (HAI) such as Clostridioides difficile (CDI); this is particularly important for fluoroquinolones (FQ), which are frequently used in critical care settings. In this study, using a multiple case study research approach, we conduct an in-depth analysis of an intervention aimed at limiting ICU prescriber access to FQ in two ICUs of two hospitals. The data collection and analysis were guided by a human factors engineering approach based on the SEIPS (Systems Engineering Initiative for Patient Safety) model and evidence-based implementation principles. Our results show some differences in the implementation of the FQ intervention between the two ICUs, such as level and method of FQ restriction, and training and communication with physicians and pharmacists. In both ICUs, several organizational learning mechanisms helped to quickly identify problems with the intervention and ensure that changes were made in a just-in-time manner (e.g. just-in-time training, removal of FQ in order set for pneumonia). Despite their organizational differences, both sites developed strategies to successfully implement the FQ intervention.

Older adults frequently visit the emergency department (ED) and participate in multiple transitions of care following an ED visit. These transitions of care, e.g. to hospital, long-term care facility or home, represent patient safety risks because of communication and coordination failures between the various roles involved, but also provide opportunities for error detection and recovery and, therefore, resilience. The objective of this study was to identify and describe the multiple roles involved in older adult care transitions during an ED visit. As part of a large research project, we conducted patient-centered observations and interviewed ED clinicians and hospital administrators. We identified 16 ED roles involved in older adult care transitions out of the ED, including 4 roles solely focused on coordinating transitions. By better understanding the roles involved in ED care transitions, we can improve the design of team processes and technologies to support care of older adults throughout their care transitions.

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Excessive salt intake significantly affects high blood pressure. According to the 2017 National Health and Nutrition Survey, the average daily salt intake for adults is 10.8 g for men and 9.1 g for women. This indicates that the benchmark set by the Ministry of Health, Labor and Welfare (8.0 g for men and 7.0 g for women) has not been reached. Fruit Granola cereals （Frugra® by Calbee Co., Ltd.） have a low salt content of 0.5 g per meal and are expected to reduce the average salt intake by about 3 g if a general breakfast is replaced by granola. Therefore, the present study examined the effects of replacing breakfast with granola on salt intake and blood pressure.

The incorporation of mobile devices into the delivery of healthcare, known as mHealth, is changing the way care is delivered in the 21st century. The impact of mHealth is particularly salient in low and middle income countries (LMICs), where mHealth poses the opportunity to increase access and quality of healthcare in systems where supportive infrastructure is otherwise lacking. This approach is well-suited to target issues of maternal and child health, permitting an increase in health education, communication, monitoring, and care to what are often vulnerable and hard-to-access populations. Employing mHealth tactics that target such populations can improve the overall access and quality of maternal and child health in the developing world - a priority for the United Nations as reflected in the Millennium Development Goals (MDGs). While the field of mHealth is new and still developing, many programs and thought-leaders have already successfully applied mHealth strategies in interventions to improve maternal and child health through health education, preventive care, emergency response, biometric data collection, and training healthcare workers.