The Emergency Medical Team Operating System: design, implementation, and evaluation of a field hospital information management system.

In case of sudden-onset disasters (SODs), the World Health Organization deploys specialized emergency medical teams (EMTs); yet, the coordination and operation of such teams pose significant challenges. One issue is the lack of digital information systems and standards. We developed a highly customizable and scalable electronic medical record (EMR) system, tailored to EMT requirements, called the "Emergency Medical Team Operating System" (EOS). EOS was successfully tested through 9 realistic clinical tasks during a full-scale EU Module Exercise. During the initial evaluation, 21 team members from 9 countries evaluated the system positively, stressing the urgent need for an EMR for EMTs. EMTs face unique challenges during disaster relief missions. To provide an effective and coordinated delivery of care, there is a great need for an EMR tailored to the specific needs of EMTs. EOS may serve as an effective EMR during SOD missions.

Evaluating Electronic Health Record Limitations and Time Expenditure in a German Medical Center.

OBJECTIVES: This study set out to obtain a general profile of physician time expenditure and electronic health record (EHR) limitations in a large university medical center in Germany. We also aim to illustrate the merit of a tool allowing for easier capture and prioritization of specific clinical needs at the point of care for which the current study will inform development in subsequent work. METHODS: Nineteen physicians across six different departments participated in this study. Direct clinical observations were conducted with 13 out of 19 physicians for a total of 2,205 minutes, and semistructured interviews were conducted with all participants. During observations, time was measured for larger activity categories (searching information, reading information, documenting information, patient interaction, calling, and others). Semistructured interviews focused on perceived limitations, frustrations, and desired improvements regarding the EHR environment. RESULTS: Of the observed time, 37.1% was spent interacting with the health records (9.0% searching, 7.7% reading, and 20.5% writing), 28.0% was spent interacting with patients corrected for EHR use (26.9% of time in a patient's presence), 6.8% was spent calling, and 28.1% was spent on other activities. Major themes of discontent were a spread of patient information, high and often repeated documentation burden, poor integration of (new) information into workflow, limits in information exchange, and the impact of such problems on patient interaction. Physicians stated limited means to address such issues at the point of care. CONCLUSION: In the study hospital, over one-third of physicians' time was spent interacting with the EHR, environment, with many aspects of used systems far from optimal and no convenient way for physicians to address issues as they occur at the point of care. A tool facilitating easier identification and registration of issues, as they occur, may aid in generating a more complete overview of limitations in the EHR environment.

Humming Facilitates a Gradual Increase in Vocal Intensity by Alleviating the Enhancement of Vocal Fold Contact and Supraglottic Constriction.

OBJECTIVES: This study aimed to assess whether or not humming can help increase vocal intensity gradually with only a slight increase in the glottal contact and supraglottic compression. METHODS: Seventeen healthy nondysphonic speakers were asked to perform two phonatory tasks in order: gradually increasing vocal loudness (crescendo) during sustained phonation of a vowel or production of a hum (vowel- or humming-crescendo task: VCT or HCT, respectively), while the sound pressure levels (SPL), electroglottographic (EGG) signals and high-speed laryngeal movies were simultaneously recorded. The glottal contact parameter of the EGG signals and the glottal opening and laryngeal outlet parameters as well as the duration of prephonatory transient glottal closure on the laryngeal movies were calculated. RESULTS: With a gradual SPL increase during both tasks, most participants showed a progressive decrease in the LO, but no discernible change in the EGG glottal contact. In comparisons between tasks, an HCT produced a significantly lower SPL, greater laryngeal outlet parameter value and shorter prephonatory transient glottal closure duration than a VCT. A significant difference between tasks was found in the proportion of failed task performance due to an abrupt SPL increase (41% and 6% in VCT and HCT, respectively; P = 0.011), and the failed VCTs showed a significantly higher EGG contact parameter value than the successful VCTs. CONCLUSION: These results demonstrate that during an gradual increase in vocal intensity, humming alleviates the enhancement in both the glottal contact and supraglottic compression, leading to the prevention of an abrupt increase in vocal intensity instead of adequate vocal output.