[Who will kick off the digital transformation of health?] / Qui initiera la transformation digitale de la santé?

Over the past few years, numerous medical digital initiatives have blossomed, displaying tangible signs of efficacy in improving, for example, medication adherence or lifestyle. Such patient-centered solutions free themselves, at least conceptually, from the silos between the major players in healthcare (pharmaceutical industry, health authorities, hospitals, payers). The lack of a global rethinking of patient care has resulted in structural fragility. This could provide fertile ground for the arrival of players from the digital world, called "pure players", who could radically rethink and disrupt business models by proposing personalized digital solutions based on patients' needs. Thus, in the management of chronic disease, such as cardiovascular disease or type 2 diabetes, "pure players" could bring about a paradigm shift via a commitment to achieve results which are driven by real-world outcome assessment rather than being means-driven.

Assessment of US Hospital Compliance With Regulations for Patients' Requests for Medical Records.

Importance: Although federal law has long promoted patients' access to their protected health information, this access remains limited. Previous studies have demonstrated some issues in requesting release of medical records, but, to date, there has been no comprehensive review of the challenges that exist in all aspects of the request process. Objective: To evaluate the current state of medical records request processes of US hospitals in terms of compliance with federal and state regulations and ease of patient access. Design, Setting, and Participants: A cross-sectional study of medical records request processes was conducted between August 1 and December 7, 2017, in 83 top-ranked US hospitals with independent medical records request processes and medical records departments reachable by telephone. Hospitals were ranked as the top 20 hospitals for each of the 16 adult specialties in the 2016-2017 US News & World Report Best Hospitals National Rankings. Exposures: Scripted interview with medical records departments in a single-blind, simulated patient experience. Main Outcomes and Measures: Requestable information (entire medical record, laboratory test results, medical history and results of physical examination, discharge summaries, consultation reports, physician orders, and other), formats of release (pick up in person, mail, fax, email, CD, and online patient portal), costs, and request processing times, identified on medical records release authorization forms and through telephone calls with medical records departments. Results: Among the 83 top-ranked US hospitals representing 29 states, there was discordance between information provided on authorization forms and that obtained from the simulated patient telephone calls in terms of requestable information, formats of release, and costs. On the forms, as few as 9 hospitals (11%) provided the option of selecting 1 of the categories of information and only 44 hospitals (53%) provided patients the option to acquire the entire medical record. On telephone calls, all 83 hospitals stated that they were able to release entire medical records to patients. There were discrepancies in information given in telephone calls vs on the forms between the formats hospitals stated that they could use to release information (69 [83%] vs 40 [48%] for pick up in person, 20 [24%] vs 14 [17%] for fax, 39 [47%] vs 27 [33%] for email, 55 [66%] vs 35 [42%] for CD, and 21 [25%] vs 33 [40%] for online patient portals), additionally demonstrating noncompliance with federal regulations in refusing to provide records in the format requested by the patient. There were 48 hospitals that had costs of release (as much as $541.50 for a 200-page record) above the federal recommendation of $6.50 for electronically maintained records. At least 6 of the hospitals (7%) were noncompliant with state requirements for processing times. Conclusions and Relevance: The study revealed that there are discrepancies in the information provided to patients regarding the medical records release processes and noncompliance with federal and state regulations and recommendations. Policies focused on improving patient access may require stricter enforcement to ensure more transparent and less burdensome medical records request processes for patients.

Integridad de la información del subsistema estadístico de urgencias en el Hospital Provincial Manuel Ascunce Domenech, de Camagüey / Information integrity in the emergency statistics subsystem of Manuel Ascunce Domenech Provincial Hospital in Camagüey

Objetivo: se realizó un estudio de evaluación en el Departamento de Registros Médicos y Estadísticas del Hospital Provincial Manuel Ascunce Domenech, de Camagüey, durante el año 2012, con el objetivo de evaluar la integridad de la información del subsistema de urgencias. Métodos: para determinar el nivel de eficacia se aplicó una encuesta a los médicos que atienden el Cuerpo de Guardia. Se utilizó la matriz BAFI como instrumento gerencial. Resultados: los resultados obtenidos permiten calificar la integridad de la información estadística del Servicio de Urgencias como deficiente. La elevada pérdida económica ocasionada por la omisión del diagnóstico manifiesta la ineficiencia estadística del subsistema. Se evidencia un predominio de las debilidades sobre las fortalezas, la vulnerabilidad ante las amenazas y el poco aprovechamiento de las oportunidades. Recomendaciones: se recomienda la aplicación de la propuesta de acciones elaborada, con el propósito de revertir dicha situación

Objective: an evaluation study was conducted in the Department of Medical Records and Statistics of Manuel Ascunce Domenech Provincial Hospital in Camagüey during the year 2012, with the purpose of evaluating the integrity of the information stored in the emergency subsystem. Methods: determination of the level of efficacy was based on a survey given to doctors from the emergency service. The Innovative Power Balance Matrix was used as a management instrument. Results: integrity of the statistical information in the Emergency Service was evaluated as deficient, based on the results of the study. The considerable economic loss caused by the omission of diagnoses is evidence of the statistical inefficiency of the subsystem. It was found that weaknesses predominate over strengths, there is vulnerability to threats, and opportunities are hardly taken advantage of. Recommendations: it is recommended that the actions proposed are implemented, with a view to overcoming the present deficiencies

Integridad de la información del subsistema estadístico de urgencias en el Hospital Provincial Manuel Ascunce Domenech, de Camagüey / Information integrity in the emergency statistics subsystem of Manuel Ascunce Domenech Provincial Hospital in Camagüey

Objetivo: se realizó un estudio de evaluación en el Departamento de Registros Médicos y Estadísticas del Hospital Provincial Manuel Ascunce Domenech, de Camagüey, durante el año 2012, con el objetivo de evaluar la integridad de la información del subsistema de urgencias. Métodos: para determinar el nivel de eficacia se aplicó una encuesta a los médicos que atienden el Cuerpo de Guardia. Se utilizó la matriz BAFI como instrumento gerencial. Resultados: los resultados obtenidos permiten calificar la integridad de la información estadística del Servicio de Urgencias como deficiente. La elevada pérdida económica ocasionada por la omisión del diagnóstico manifiesta la ineficiencia estadística del subsistema. Se evidencia un predominio de las debilidades sobre las fortalezas, la vulnerabilidad ante las amenazas y el poco aprovechamiento de las oportunidades. Recomendaciones: se recomienda la aplicación de la propuesta de acciones elaborada, con el propósito de revertir dicha situación(AU)

Objective: an evaluation study was conducted in the Department of Medical Records and Statistics of Manuel Ascunce Domenech Provincial Hospital in Camagüey during the year 2012, with the purpose of evaluating the integrity of the information stored in the emergency subsystem. Methods: determination of the level of efficacy was based on a survey given to doctors from the emergency service. The Innovative Power Balance Matrix was used as a management instrument. Results: integrity of the statistical information in the Emergency Service was evaluated as deficient, based on the results of the study. The considerable economic loss caused by the omission of diagnoses is evidence of the statistical inefficiency of the subsystem. It was found that weaknesses predominate over strengths, there is vulnerability to threats, and opportunities are hardly taken advantage of. Recommendations: it is recommended that the actions proposed are implemented, with a view to overcoming the present deficiencies(AU)

Aportaciones de la Armada española en la introducción de la anestesia en España. La ciencia médica en el último tercio del siglo xix / Contributions of the Spanish Navy to the introduction of anaesthesia in Spain. Medical science in the last third of the xix century

Las últimas décadas del siglo xix son años de resurgimiento y progreso en el ámbito de la Sanidad Naval, encontrándose a la vanguardia de las estructuras sanitarias europeas del momento. En esta época, los médicos de la armada desarrollaron unos documentos conocidos como «Memorias Clínicas», establecidas previamente como obligatorias en sus reglamentos y ordenanzas. Preciosos documentos de la ciencia médica y arte de curar que se encuentran depositados en el Archivo General de la Marina (Viso del Marqués, Ciudad Real). Si bien la información recogida en estas Memorias es muy variada, hemos centrado el interés en aquellas que versan sobre el descubrimiento y desarrollo de la anestesia. La implantación de la misma en España estuvo rodeada de una inmensa polémica, con defensores y detractores. La exclusividad de los documentos que aquí se presentan es testimonio original del saber médico-quirúrgico de la época y sitúan la Sanidad Naval española a la vanguardia de las estructuras sanitarias europeas del momento(AU)

The last decades of the xix century were years of resurgence and progress in the field of Naval Health, which was in the vanguard of European health structures at that time. In this era, the navy physicians produced some documents known as “Memorias Clínicas” (Clinical Reports), previously established as obligatory in their rules and regulations. Valuable documents on medical science and the art of healing are deposited in the Archivo General de la Marina (Viso del Marqués, Ciudad Real). Although the information recorded in these Reports varies considerably, we have centred our interest on those that focus on the discovery and development of anaesthesia. The introduction of these discoveries was surrounded by immense controversy, with its defenders and critics. The exclusiveness of the documents presented here is an original testimony to the medical-surgical knowledge of the era and places Naval Health in the vanguard of European health structures at that time(AU)

Validating self-reported strokes in a longitudinal UK cohort study (Whitehall II): Extracting information from hospital medical records versus the Hospital Episode Statistics database.

BACKGROUND: Valuable information on the determinants of non-fatal stroke can be obtained from longitudinal observational cohort studies. Such studies often rely on self-reported stroke events, which are best validated with external medical evidence. The aim of this paper is to compare the information on incident non-fatal stroke events arising from different sources. METHODS: We carried out a validation of self-reported stoke events among participants in the Whitehall II Study, a large UK based cohort study (baseline sample size 10,308 men and women). RESULTS: 106 stroke events were self-reported in three self-administered questionnaires between 2002 and 2009. Eight (7.5%) of these events were discarded as false positives after medical review, 66 were validated by information from the NHS Hospital Episode Statistics (HES) database in England, 16 by manual searches of hospital records alone, and 12 by letters from general practitioners alone. HES provided information on an additional (i.e. not self-reported) 47 events coded as stroke during the period 2002 to 2009 in hospitals in England among the original baseline participants. Of these, 43 participants were no longer active in the study and 4 had completed questionnaires but not reported a stroke event. CONCLUSIONS: Validating self-reported strokes in cohort studies with information from the NHS HES database was efficient and provided information on probable non-fatal stroke events among cohort members no longer in active follow-up. Manual extraction from hospital notes can provide supplementary information beyond that available in the HES discharge summary and was used to sub-type some strokes. However, the process was labour intensive. Multiple sources are needed to capture maximum information on stroke events but increasingly with hospitalisation in the acute phase of stroke, HES has an important role. Further development of HES is required to assure validity and coverage.

Performance evaluation of medical records departments by analytical hierarchy process (AHP) approach in the selected hospitals in Isfahan : medical records dep. & AHP.

Medical Records Department (MRD) is an important unit for evaluating and planning of care services. The goal of this study is evaluating the performance of the Medical Records Departments (MRDs) of the selected hospitals in Isfahan, Iran by using Analytical Hierarchy Process (AHP). This was an analytic of cross-sectional study that was done in spring 2008 in Isfahan, Iran. The statistical population consisted of MRDs of Alzahra, Kashani and Khorshid Hospitals in Isfahan. Data were collected by forms and through brainstorm technique. To analyze and perform AHP, Expert Choice software was used by researchers. Results were showed archiving unit has received the largest importance weight with respect to information management. However, on customer aspect admission unit has received the largest weight. Ordering weights of Medical Records Departments' Alzahra, Kashani and Khorshid Hospitals in Isfahan were with 0.394, 0.342 and 0.264 respectively. It is useful for managers to allocate and prioritize resources according to AHP technique for ranking at the Medical Records Departments.

Accuracy of external cause-of-injury coding in VA polytrauma patient discharge records.

Valid and efficient methods of identifying the etiology of treated injuries are critical for characterizing patient populations and developing prevention and rehabilitation strategies. We examined the accuracy of external cause-of-injury codes (E-codes) in Veterans Health Administration (VHA) administrative data for a population of injured patients. Chart notes and E-codes were extracted for 566 patients treated at any one of four VHA Polytrauma Rehabilitation Center sites between 2001 and 2006. Two expert coders, blinded to VHA E-codes, used chart notes to assign "gold standard" E-codes to injured patients. The accuracy of VHA E-coding was examined based on these gold standard E-codes. Only 382 of 517 (74%) injured patients were assigned E-codes in VHA records. Sensitivity of VHA E-codes varied significantly by site (range: 59%-91%, p < 0.001). Sensitivity was highest for combat-related injuries (81%) and lowest for fall-related injuries (60%). Overall specificity of E-codes was high (92%). E-coding accuracy was markedly higher when we restricted analyses to records that had been assigned VHA E-codes. E-codes may not be valid for ascertaining source-of-injury data for all injuries among VHA rehabilitation inpatients at this time. Enhanced training and policies may ensure more widespread, standardized use and accuracy of E-codes for injured veterans treated in the VHA.

Quality control methods at a hospital.

PURPOSE: Healthcare providers need the information contained in patient records to provide high-quality services. To be effective, patient record assembly must be completed in a timely manner. This study aims to analyse the medical records assembly process for a hospital in Southeastern United States having difficulty meeting standard completion times established by the Joint Commission on the Accreditation of Healthcare Organization. DESIGN/METHODOLOGY/APPROACH: Several quality improvement tools were used to evaluate and improve the assembly process. FINDINGS: As a result of the study, a new procedure was implemented. Consequently, the hospital reduced the time required to assemble medical records, thereby improving efficiency and effectiveness. There are hopes to further improve the process. RESEARCH LIMITATIONS/IMPLICATIONS: The study provides guidance on how statistical process control techniques can be applied to improve hospital services. The techniques employed can be used to analyze and improve any process. However, results are limited to improving medical record assembly processes at one particular hospital. ORIGINALITY/VALUE: Past studies considered the application of various statistical process control techniques for improving healthcare quality. The study extends research by employing process improvement efforts to understand and develop medical record assembly in a regional hospital via process flow diagramming and control charts.

How accurate is ICD coding for epilepsy?

PURPOSE: Assess the validity of ICD-9-CM and ICD-10 epilepsy coding from an emergency visit (ER) and a hospital discharge abstract database (DAD). METHODS: Two separate sources of patient records were reviewed and validated. (1) Charts of patients admitted to our seizure monitoring unit over 2 years (n = 127, ICD-10 coded records) were reviewed. Sensitivity (Sn), specificity (Sp), and positive and negative predictive values (PPV and NPV) were calculated. (2) Random sample of charts for patients seen in the ER or admitted to hospital under any services, and whose charts were coded with epilepsy or an epilepsy-like condition, were reviewed. Two time-periods were selected to allow validation of both ICD-9-CM (n = 486) and ICD-10 coded (n = 454) records. Only PPV and NPV were calculated for these records. All charts were reviewed by two physicians to confirm the presence/absence of epilepsy and compare to administrative coding. RESULTS: Sample 1: Sn, Sp, PPV, and NPV of ICD-10 epilepsy coding from the seizure monitoring unit (SMU) chart review were 99%, 70%, 85%, and 97% respectively. Sample 2: The PPV and NPV for ICD-9-CM coding from the ER database were, respectively, 99% and 97% and from the DAD were 98% and 99%. The PPV and NPV for ICD-10 coding from the ER database were, respectively, 100% and 90% and from the DAD were 98% and 99%. The epilepsy subtypes grand mal status and partial epilepsy with complex partial seizures both had PPVs >75% (ICD-9-CM and ICD-10 data). DISCUSSION: Administrative emergency and hospital discharge data have high epilepsy coding validity overall in our health region.

Organisational factors affecting the quality of hospital clinical coding.

The influence of organisational factors on the quality of hospital coding using the International Statistical Classification of Diseases and Health Related Problems, 10th Revision, Australian Modification (ICD-10-AM) was investigated using a mixed quantitative-qualitative approach. The organisational variables studied were: hospital specialty; geographical locality; structural characteristics of the coding unit; education, training and resource supports for Clinical Coders; and quality control mechanisms. Baseline data on the hospitals' coding quality, measured by the Performance Indicators for Coding Quality tool, were used as an independent index measure. No differences were found in error rates between rural and metropolitan hospitals, or general and specialist hospitals. Clinical Coder allocation to "general" rather than "specialist" unit coding resulted in fewer errors. Coding Managers reported that coding quality can be improved by: Coders engaging in a variety of role behaviours; improved Coder career opportunities; higher staffing levels; reduced throughput; fewer time constraints on coding outputs and associated work; and increased Coder interactions with medical staff.

[Evaluation of the quality of hospital medical records in a hospital in Turin (Italy)]. / La valutazione qualitativa della cartella clinica: uno studio pilota.

The San Giovanni Battista Hospital in Turin validated a tool for evaluating the quality of hospital patient records. The tool defines the essential contents of patient records, indicators and weights as well as the standard score that must be reached. A pilot study was performed in 2007 to evaluate whether this tool adequately evaluates the quality of hospital patient records in both medical and surgical wards, and whether it can do so in a standardized and repeatable manner. A random sample of 206 medical charts of patients admitted to the San Giovanni Battista Hospital in 2007 was extracted and analysed. The instrument was found to adequately evaluate hospital patient records in a standardisd and repeatable manner.

Completeness of cause of injury coding in healthcare administrative databases in the United States, 2001.

OBJECTIVES: To determine the completeness of external cause of injury coding (E-coding) within healthcare administrative databases in the United States and to identify factors that contribute to variations in E-code reporting across states. DESIGN: Cross sectional analysis of the 2001 Healthcare Cost and Utilization Project (HCUP), including 33 State Inpatient Databases (SID), a Nationwide Inpatient Sample (NIS), and nine State Emergency Department Databases (SEDD). To assess state reporting practices, structured telephone interviews were conducted with the data organizations that participate in HCUP. RESULTS: The percent of injury records with an injury E-code was 86% in HCUP's nationally representative database, the NIS. For the 33 states represented in the SID, completeness averaged 87%, with more than half of the states reporting E-codes on at least 90% of injuries. In the nine states also represented in the SEDD, completeness averaged 93%. Twenty two states had mandates for E-code reporting, but only eight had provisions for enforcing the mandates. These eight states had the highest rates of E-code completeness. CONCLUSIONS: E-code reporting in administrative databases is relatively complete, but there is significant variation in completeness across the states. States with mandates for the collection of E-codes and with a mechanism to enforce those mandates had the highest rates of E-code reporting. Nine statewide ED data systems demonstrate consistently high E-coding completeness.