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Saturday, November 10, 2012
Thursday, November 8, 2012
Setting national goals to bolster patient safety with electronic health records
ScienceDaily (Nov. 7, 2012) ? Electronic health records (EHRs) are expected to improve patient safety, but they themselves can present challenges for which health care providers must be prepared. Experts at The University of Texas Health Science Center at Houston and Baylor College of Medicine have proposed a framework to help develop new national patient safety goals unique to electronic health record-enabled clinical settings.
Their report appears in the current issue of the New England Journal of Medicine.
Proposed framework
"One of the reasons electronic health records were introduced was because we wanted to make health care safer, more efficient and of higher quality," said Dr. Hardeep Singh, assistant professor of medicine and health services research at the Veterans Affairs Health Services Research and Development Center of Excellence and BCM. "However, electronic health records present new hazards that were brought in with the use of technology and were not seen before. In this paper, we propose a framework that addresses three types of intersections between patient safety and electronic health records."
Those three intersections include making sure that the EHR technology is itself safe, the application and use of the EHR technology is safe and the EHR technology is used to monitor and improve patient safety.
Dr. Dean Sittig, professor at the UTHealth School of Biomedical Informatics and a member of the UTHealth-Memorial Hermann Center for Healthcare Quality and Safety, uses the analogy of driving a car. First, you want to be sure that the car is safe, i.e., that your brakes and headlights are working. Next, you want to be sure that you are driving the car safely. That means you are not texting and driving, you have both hands on the wheel and your seatbelt is buckled. Finally, with newer cars, technology makes driving safer, as in when backup cameras serve as "eyes" in the back of your head. In essence, the car is making your driving experience safer.
"That's what we want from electronic health records," said Sittig.
Hazards unique to technology
To account for variation in stages of EHR implementation across clinical practice settings, Sittig and Singh propose that goals should first address safety hazards unique to technology (i.e. safer EHRs in phase 1). Phase 2 goals should mitigate safety hazards from failure to use technology appropriately (i.e. safer application and use of EHRs); and phase 3 goals should stimulate the use of technology in order to monitor and improve patient safety (i.e. leveraging EHRs to detect all types of hazards and facilitating oversight).
Health care groups using electronic health records should start with phase 1, ensuring that the technology is safe to use, said Singh and Sittig. That includes making sure the technology is fast enough to ensure acceptable system response time and there is a data backup in the case of a loss or corruption of the main data store. In phase 2, the groups should make sure that electronic health records are being used appropriately. Some organizations mix paper records and electronic records, which can result in not only extra work but also confusion and risky scenarios when doctors and nurses have to refer to two different records.
"We suggest that organizations should use electronic health records 'completely' rather than partially. It should be the only way to practice medicine in hospitals," said Sittig.
Consistent use of technology
In some cases, hospitals allow physicians on some units to use paper for orders while other units require that orders be entered through electronic health records, a potential hazard. He suggests the technology should be used consistently for the same purpose rather than haphazardly, which creates a lack of clarity.
Finally, organizations should address phase 3 to improve patient safety by better measurements.
For example, they said, the computer could monitor risky situations within a system and identify potential problems. In some cases, the computer could alert someone that there were abnormal lab results from last month that have not been reviewed yet.
"You cannot reach high levels of patient safety without using the computer and without paying attention to the requirements of these three phases," they said.
"Electronic health records are changing the way we practice medicine and deliver health care," said Singh. "Some of our recommendations are provided to ensure that you get the maximum benefits of EHRs. We want the EHR-enabled health system to be safer and far more effective than the paper-enabled health system."
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Story Source:
The above story is reprinted from materials provided by Baylor College of Medicine.
Note: Materials may be edited for content and length. For further information, please contact the source cited above.
Journal Reference:
- Dean F. Sittig, Hardeep Singh. Electronic Health Records and National Patient-Safety Goals. New England Journal of Medicine, 2012; 367 (19): 1854 DOI: 10.1056/NEJMsb1205420
Note: If no author is given, the source is cited instead.
Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.
Source: http://feeds.sciencedaily.com/~r/sciencedaily/top_news/~3/ZtzamewjYeQ/121107200022.htm
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Apple iPad mini (Wi-Fi)
How much are apps worth to you? How about $120? If you want those iPad-exclusive apps and price is no object, then no other small-screen tablet will do. Beautifully made, slim, and light, the iPad mini ($329/16GB, $429/32GB, $529/64GB direct) packs precisely the power of an iPad 2 ?into a tablet you'll actually want to carry around.
Aside from the apps, though, the iPad mini isn't the best small tablet. Compared with the current $200 tablet crop that includes the Google Nexus 7 , the Amazon Kindle Fire HD, and the Barnes & Noble Nook HD, it's a little too wide, its screen isn't the best you'll find, and it's quite a bit too expensive. Nowadays, Android apps are good enough to keep the excellent Nexus 7 our Editors' Choice for small tablets.?
Design and Physical Features
At 7.87 by 5.30 by .28 inches (HWD), the mini is the slimmest tablet I've ever tested, and at 10.9 ounces, it's an ounce lighter than the Nexus 7. The front is a glass screen surrounded by a very narrow black or white bezel, with Apple's signature Home button below it. As always, Apple's Volume controls, Home button, and Mute/Screen Lock Rotation switch are perfectly placed and easy to find. The headphone jack lives in the left corner of the top panel, with Apple's new, compact Lightning port on the center of the bottom edge.
The back is wraparound black (or silver for the white model) aluminum, with the 5-megapixel camera up in the corner. The fit and finish make every other tablet look amateurish, and the body is beautifully rigid and flex-free. The metal back sure is beautiful, but it's an ergonomic mistake: It's too slippery. With a tablet you're supposed to be using with a single hand, you want a slightly grippy material on the back panel so you have something to grab. While the iPad mini is comfortable to hold because it's so light, its width puts its center of gravity further from your palm than with narrower tablets, and I kept feeling like it was almost about to slip out of my hand.
For me, the problem was made worse by the grip I had to hold it in, because the mini is just too wide for me to wrap my hand around. Everyone's hands are different, but I found the mini's 5.3-inch width is a real thumb-stretcher. It compared poorly with the Nexus 7, whose 4.7-inch width is easily grippable, especially when combined with the smaller tablet's textured back. Unlike the Nexus, I couldn't fit the mini into my back pocket, and it's a snug fit in a jacket pocket. I know others have called this a one-handed tablet, but I'm not finding it so.
Apple dodged another potential ergonomic bullet, though. The narrow bezel made me worry about accidental touches, but I didn't run into that problem; Apple has "thumb-detection" technology which, in my tests, successfully ignored my thumb on the edge of the screen.
The Screen
The iPad mini's 7.9-inch, 1,024-by-768 IPS LCD screen doesn't look low-res on its own, although you can definitely see the difference next to a 4th-generation iPad with Retina Display, a Kindle Fire HD, or a Nook HD. But the display here is sharper than the iPad 2's screen since it's smaller. Colors are richer and the screen is brighter than on the Nexus 7, although neither the color depth nor brightness measures up to the Kindle Fire HD and Nook HD displays. Another thing to consider: If you've gotten used to reading text on a Retina Display, text will look horribly low-res here.
The display is also quite reflective, and I found that very noticeable. Dr. Raymond Soneira of DisplayMate Technologies found it noticeable, too, noting in his Display Technology Shoot-Out?that the mini "reflects 53 percent more ambient light than the Nexus 7 and 41 percent more than the Kindle Fire HD."
Since the screen is larger than competing 7-inch tablets, keys on the on-screen keyboard are a little larger, too. But Apple's claim of having greater real estate than competitors is belied by the tablet's lower resolution. You see a little bit less of a Web page at a time on the mini than on the Nexus 7, and noticeably less than on the Kindle Fire. On the PCMag.com home page, for instance, the Nexus 7 displays about 75 percent of the total height, while the iPad mini's display ends about three lines of text above; the Kindle, with its even sharper screen, shows two more lines of text below the Nexus 7's range. The Nexus 7 fits more icons on a home screen: 42 versus 24 on the mini. Small type looks sharper on the other two tablets, as well.
The larger screen also doesn't confer much advantage when watching wide-screen movies; you just get huge black bars above and below them. I rented "The Hunger Games" in HD from Apple, Amazon, and Google Play. Apple's encoding was the sharpest. But the video looked about the same size on the Nexus 7 and Kindle Fire; much of Apple's increased screen area was wasted by larger letterboxing bars, thanks to the boxy 4:3 screen aspect ratio. The Nexus 7's 16:10 screen displayed the movie better.
Performance and Battery Life
The iPad mini shares the iPad 2's 1GHz dual-core Apple A5 processor and screen resolution, and delivers roughly the same performance. (We test iOS devices with the Browsermark, Sunspider, Guimark, GLBenchmark, and Geekbench benchmarks.) The iPad 2, the third-generation iPad, and iPad mini all offer similar performance, a little faster than the iPhone 4S ?and the new iPod touch, but noticeably slower than the new fourth-generation iPad and the iPhone 5 .
Since iOS is a hugely popular platform, though, apps are generally written to work well on the A5 and you don't see a lot of slowdowns. Need for Speed: Most Wanted, for instance, played just fine on the mini. The only hiccup I could see was in zooming the Barefoot World Atlas app, which was a bit jerky on the mini but smoother on the fourth-gen iPad. Accelerometer-based games work especially well here because the mini is such a small, light tablet. It's much easier to tilt and control the mini than with a larger iPad.
Web browsing performance beats competing seven-inch tablets. Part of that is thanks to the mini's faster 5GHz 802.11n Wi-Fi with channel bonding, which will probably max out your home connection. On a fast corporate link using the Ookla Speedtest.net app, I got an average of 36Mbps down, as compared with about 7Mbps on a Kindle Fire HD, and 7.6Mbps on a Nexus 7. (The low result from the KFHD really surprised me, as it's supposed to have the same faster Wi-Fi as the iPad mini.) That translates into much faster app downloads, updates, and less buffering for streaming video. The mini was also the fastest Web browser, although not by much. My basket of Web sites loaded in an average of 5 seconds each on the mini, as compared with 7.1 seconds on the Nexus 7, and 10.3 on the Kindle Fire HD.
While the model we tested was Wi-Fi-only, the mini is also available in cellular versions for AT&T's, Sprint's, and Verizon's LTE networks at a $130 premium, working on those carriers' existing iPad service plans. The LTE models integrate GPS, making the mini an excellent in-car navigation system with a third-party app like Navigon. None of the new models will run on T-Mobile's HSPA+ network.
Battery life was quite good at 7 hours, 37 minutes of video playback time with the screen at full brightness. That's better than the Kindle Fire HD's 7 hours, but doesn't measure up to the 10.5 hours we got with the Nexus 7.
(Next Page: Multimedia and Conclusions)
Source: http://feedproxy.google.com/~r/ziffdavis/pcmag/~3/OrCKFb8fJPY/0,2817,2411807,00.asp
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