Factors Influencing the Effectiveness of Adopting Electronic Medical Record-Based Reporting Systems for Notifiable Disease Surveillance: A Quantitative Analysis.

The coronavirus disease 2019 (COVID-19) pandemic has led to greater attention being given to infectious disease surveillance systems and their notification functionalities. Although numerous studies have explored the benefits of integrating functionalities with electronic medical record (EMR) systems, empirical studies on the topic are rare. The current study assessed which factors influence the effectiveness of EMR-based reporting systems (EMR-RSs) for notifiable disease surveillance. This study interviewed staff from hospitals with a coverage that represented 51.39% of the notifiable disease reporting volume in Taiwan. Exact logistic regression was employed to determine which factors influenced the effectiveness of Taiwan's EMR-RS. The results revealed that the influential factors included hospitals' early participation in the EMR-RS project, frequent consultation with the information technology (IT) provider of the Taiwan Centers for Disease Control (TWCDC), and retrieval of data from at least one internal database. They also revealed that using an EMR-RS resulted in more timely, accurate, and convenient reporting in hospitals. In addition, developing by an internal IT unit instead of outsourcing EMR-RS development led to more accurate and convenient reporting. Automatically loading the required data enhanced the convenience, and designing input fields that may be unavailable in current databases to enable physicians to add data to legacy databases also boosted effectiveness of the reporting system.

Simulation and evaluation of increased imaging service capacity at the MRI department using reduced coil-setting times.

The wait times for patients from their appointments to receiving magnetic resonance imaging (MRI) are usually long. To reduce this wait time, the present study proposed that service time wastage could be reduced by adjusting MRI examination scheduling by prioritizing patients who require examinations involving the same type of coil. This approach can reduce patient wait times and thereby maximize MRI departments' service times. To simulate an MRI department's action workflow, 2,447 MRI examination logs containing the deidentified information of patients and radiation technologists from the MRI department of a medical center were used, and a hybrid simulation model that combined discrete-event and agent-based simulations was developed. The experiment was conducted in two stages. In the first stage, the service time was increased by adjusting the examination schedule and thereby reducing the number of coil changes. In the second stage, the maximum number of additional patients that could be examined daily was determined. The average number of coil changes per day for the four MRI scanners of the aforementioned medical center was reduced by approximately 27. Thus, the MRI department gained 97.17 min/d, which enabled them to examine three additional patients per month. Consequently, the net monthly income of the hospital increased from US$17,067 to US$30,196, and the patient wait times for MRI examinations requiring the use of flexible torso and head, shoulder, 8-inch head, and torso MRI coils were shortened by 6 d and 23 h, 2 d and 15 h, 2 d and 9 h, and 16 h, respectively. Adjusting MRI examination scheduling by prioritizing patients that require the use of the same coil could reduce the coil-setting time, increase the daily number of patients who are examined, increase the net income of the MRI department, and shorten patient wait times for MRI examinations. Minimizing the operating times of specific examinations to maximize the number of services provided per day does not require additional personnel or resources. The results of the experimental simulations can be used as a reference by radiology department managers designing scheduling rules for examination appointments.

The Association between Bodily Pain and Cognitive Impairment in Community-Dwelling Older Adults.

BACKGROUND: Bodily pain is a common condition in older adults and interferes with individuals' cognitive functioning. We aimed to evaluate the association between bodily pain and related locations and cognitive impairment among community-dwelling older adults in Taiwan. METHOD: In this retrospective, cross-sectional study, we enrolled 2022 participants aged 60‒70 years, from the Taiwan Biobank. Mini-Mental State Examination was performed to assess cognitive impairment. Further, logistic regression analyses were performed to identify the relationship between bodily pain and cognitive impairment. RESULTS: Overall, 161 participants had cognitive impairment. Multivariable analysis showed that older adults who reported bodily pain were more likely than those who did not have cognitive impairment (odds ratio 1.68). Moreover, the occurrence of cognitive impairment correlated with the presence of two or more pain locations and self-reported low back and waist pain or sciatica. CONCLUSION: Our study revealed that cognitive impairment was associated with bodily pain in community-dwelling older adults, particularly older adults with low back and waist pain or sciatica and those with two or more pain locations. To maintain the quality of older adults' life, pain and cognitive decline need to be simultaneously assessed with considerably more precise and objective markers.

The Importance of Patient's Experience and Its Impact on Health Care System for People Receiving Traditional Chinese Medicine.

Objectives: Health system responsiveness is a complicated issue that guides researchers in determining an efficient methodology to enhance the understanding of health care systems' perspectives. This study examined the relationship between patients' experience profiles and their satisfaction with medical outcomes. Design: The authors used 11 items from the Taiwanese Annual National Health Insurance survey and used latent class analysis (LCA) to develop experience profiles for 2012 Traditional Chinese Medicine (TCM) patients. A logistic regression model was developed to explore differences in patients' satisfaction with their treatment outcome across four groups identified using the LCA, with adjustment for demographic factors. Subjects: Patients' experiences with medical services in TCM in 2015. Outcome measures: Patients' satisfaction with their treatment outcome. Results: Participants (N = 2012) were divided into four groups. Regardless of gender and age, Group 2 (nall) held the lowest satisfaction with treatment outcome relative to those reported by the other three groups (odds ratios with p-value: Group 1 [pall]: 7.40, Group 3 [nComm]: 1.37, Group 4 [Skip]: 2.20, p < 0.001). Respondents with a more favorable patient experience reported higher satisfaction with treatment outcome. Conclusions: An increased favorable treatment experience in TCM (such as positive accessibility and better interpersonal relationships with providers) is associated with higher satisfaction with treatment outcome. The World Health Organization emphasizes that traditional medicine integrated with Western medicine can play an important role in achieving the goal of "Health for All." Health authorities should develop strategies aimed at enhancing patients' experiences in TCM to contribute to a positive care process.

Better Self-report Health Status and Provider-Patient Communication in Dental Service Can Improve the Patient Experience: A Cross-year Comparison from the NHI Survey.

Several factors, including healthcare outcomes and quality, influence patients' expectations of healthcare services. Currently, as patients have more understanding about dental care services, patient satisfaction is essential for continually improving the services being provided. The purpose of this study is to analyze the multiyear annual National Health Insurance (NHI) patient experience survey in Taiwan to explore the factors associated with the satisfaction rate from 2012-2016. This study used the annual NHI survey to explore patients' experiences of receiving medical service in dental care from 2012 to 2016. There were over 40 major items in the survey each year; however, we only selected suitable items that followed the Andersen model. We ran a logistics regression testing the relationship between the covariates and the items related to satisfaction in outcomes in different years. Patients who received health education from a provider in most time, self-reported better health status, felt that cost of care was not expensive, did not wait too long for counseling time and found it easy to make an appointment, had two to ten times greater satisfaction in outcomes compared with those who did not (OR: 1.83-10.06). Individuals working in the healthcare industry should implement communication strategies to improve patients' experience in the care process by including easy-to-understand explanations or sharing decision-making with patients. Furthermore, in patient experience surveys in dental care, less attention should be paid to whether patients can provide meaningful quality measures and more attention to ways in which patient experiences can be improved. This can be achieved by providing easy-to-understand explanations, giving patients an opportunity to express their concerns, and by sharing decision-making with patients.

Assessment of patient experience profiles and satisfaction with expectations of treatment effects by using latent class analysis based on a national patient experience survey in Taiwan.

OBJECTIVES: Health system responsiveness is a complicated issue that guides researchers wishing to design an efficient methodology for enhancing understanding of perspectives regarding healthcare systems. This study examined the relationship between patient experience profiles and satisfaction with expectations of treatment effects. DESIGN: This was a cross-sectional study. We used eight items obtained from latent class analysis to develop patient experience profiles. SETTING: Primary care users in Taiwan. PARTICIPANTS: This study conducted an annual National Health Insurance survey in Taiwan and sampled from those who had experience with the medical service in primary care clinics in 2015. PRIMARY OUTCOME MEASURE: Respondents were asked to indicate the extent of their satisfaction with their expectation of treatment effects (or symptom improvement). RESULTS: The proportions of participants in groups 1-4 were 34%, 24%, 29% and 12%, respectively. Patients in good health were more satisfied with their expectations of treatment effects (OR 1.639, p=0.007). Furthermore, group 4 (-eAll) were less satisfied with their expectations of treatment effects than those in the other three groups (ORs: group 1 (+eAll): 9.81, group 2 (-CwR): 4.14 and group 3 (-CnR): 4.20). CONCLUSIONS: The results revealed that experiences of poor accessibility and physician-patient relationships affected the patients' expectations. Therefore, greater accessibility and more positive physician-patient relationships could lead to higher patient satisfaction with their expectations of treatment effects. Furthermore, the findings could assist authorities in targeting specific patients, with the objective of improving their healthcare service experience. They could also serve as a mechanism for improving the quality of healthcare services and increase accountability in healthcare practices.

Design and Evaluation on the Mobile Application of Transcutaneous Electrical Nerve Stimulation (TENS).

This study aims to design a transcutaneous electrical nerve stimulation Application (TENS App) according to the suggestions from potential users. To the best of our knowledge, this is the first App including meridian and acupoints for TENS. After its development, there are eight participants recruited for evaluating the usability. Despite two out of eight users reporting that the typical TENS system requires lower cost and has better functionality than TENS App, the results show that almost seventy percent of participants have a better perception of TENS App on price, functionality, convenience, operational ability, and quality. However, participants still reported concerns about the safety issue of adopting TENS App. Therefore, for people who are the first time or unfamiliar with TENS App, instructions from occupational or physical therapists are recommended. We conclude that by using TENS App, users can not only use the portable electrotherapy devices at anyplace, but also reduce their outpatient visits.

A multi-part matching strategy for mapping LOINC with laboratory terminologies.

OBJECTIVE: To address the problem of mapping local laboratory terminologies to Logical Observation Identifiers Names and Codes (LOINC). To study different ontology matching algorithms and investigate how the probability of term combinations in LOINC helps to increase match quality and reduce manual effort. MATERIALS AND METHODS: We proposed two matching strategies: full name and multi-part. The multi-part approach also considers the occurrence probability of combined concept parts. It can further recommend possible combinations of concept parts to allow more local terms to be mapped. Three real-world laboratory databases from Taiwanese hospitals were used to validate the proposed strategies with respect to different quality measures and execution run time. A comparison with the commonly used tool, Regenstrief LOINC Mapping Assistant (RELMA) Lab Auto Mapper (LAM), was also carried out. RESULTS: The new multi-part strategy yields the best match quality, with F-measure values between 89% and 96%. It can automatically match 70-85% of the laboratory terminologies to LOINC. The recommendation step can further propose mapping to (proposed) LOINC concepts for 9-20% of the local terminology concepts. On average, 91% of the local terminology concepts can be correctly mapped to existing or newly proposed LOINC concepts. CONCLUSIONS: The mapping quality of the multi-part strategy is significantly better than that of LAM. It enables domain experts to perform LOINC matching with little manual work. The probability of term combinations proved to be a valuable strategy for increasing the quality of match results, providing recommendations for proposed LOINC conepts, and decreasing the run time for match processing.

Development of a semantic-based search system for immunization knowledge.

This study developed and implemented a children's immunization management system with English and Traditional Chinese immunization ontology for semantic-based search of immunization knowledge. Parents and guardians are able to search vaccination-related information effectively. Jena Java Application Programming Interface (API) was used to search for synonyms and associated classes in this domain and then use them for searching by Google Search API. The searching results do not only contain suggested web links but also include a basic introduction to vaccine and related preventable diseases. Compared with the Google keyword-based search, over half of the 31 trial users prefer using semantic-based search of this system. Although the search runtime on this system is not as fast as well-known search engines such as Google or Yahoo, it can accurately focus on searching for child vaccination information to provide search results that better conform to the needs of users. Furthermore, the system is also one of the few health knowledge platforms that support Traditional Chinese semantic-based search.

Design of a Personal Health Record and Health Knowledge Sharing System using IHE-XDS and OWL.

Personal Health Record systems (PHRs) provide opportunities for patients to access their own PHR. However, PHRs are teeming with medical terminologies, such as disease and symptom names, etc. Patients need readily understandable and useful health knowledge in addition to their records in order to enhance their self-care ability. This study describes a Personal Health Record and Health Knowledge Sharing System (PHR&HKS) whereby users not only can maintain and import their PHR, but also can collate useful health Web resources that are related to their personal diseases. Furthermore, they can share the collated Web resources with any user with the same diseases and vice versa. To fulfill these objectives, IHE Cross-Enterprise Document Sharing (XDS) architecture was adopted to share and integrate the PHR. A registry ontology, consisting of part of the XDS document metadata attributes, the ICD-9-CM code, and part of the Dublin Core Metadata Element Set (DCMES), was created to enhance the health knowledge collating and sharing functions. The system was then tested and evaluated by 30 users. Among these individuals, 24 (81 %) held positive views on the ease of use and usefulness of the system while the remainder, who held either neutral (14 %) or negative (5 %) attitudes, were identified as individuals who were somewhat unwilling to maintain any PHR or share any information with others.