Background: Understanding and extracting valuable information from electronic health records (EHRs) is important for improving healthcare delivery and health outcomes. Large language models (LLMs) have demonstrated significant proficiency in natural language understanding and processing, offering promises for automating the typically labor-intensive and time-consuming analytical tasks with EHRs. Despite the active application of LLMs in the healthcare setting, many foundation models lack real-world healthcare relevance. Applying LLMs to EHRs is still in its early stage. To advance this field, in this study, we pioneer a generation-augmented prompting paradigm “GAPrompt” to empower generic LLMs for automated clinical assessment, in particular, quantitative stroke severity assessment, using data extracted from EHRs. Methods: The GAPrompt paradigm comprises five components: (i) prompt-driven selection of LLMs, (ii) generation-augmented construction of a knowledge base, (iii) summary-based generation-augmented retrieval (SGAR); (iv) inferencing with a hierarchical chain-of-thought (HCoT), and (v) ensembling of multiple generations. Results: GAPrompt addresses the limitations of generic LLMs in clinical applications in a progressive manner. It efficiently evaluates the applicability of LLMs in specific tasks through LLM selection prompting, enhances their understanding of task-specific knowledge from the constructed knowledge base, improves the accuracy of knowledge and demonstration retrieval via SGAR, elevates LLM inference precision through HCoT, enhances generation robustness, and reduces hallucinations of LLM via ensembling. Experiment results demonstrate the capability of our method to empower LLMs to automatically assess EHRs and generate quantitative clinical assessment results. Conclusion: Our study highlights the applicability of enhancing the capabilities of foundation LLMs in medical domain-specific tasks, i.e., automated quantitative analysis of EHRs, addressing the challenges of labor-intensive and often manually conducted quantitative assessment of stroke in clinical practice and research. This approach offers a practical and accessible GAPrompt paradigm for researchers and industry practitioners seeking to leverage the power of LLMs in domain-specific applications. Its utility extends beyond the medical domain, applicable to a wide range of fields.

Background: Unhealthy alcohol use (UAU) is one of the major causes of preventable morbidity, mortality, and associated behavioral risks worldwide. Although mobile health (mHealth) interventions can provide consumers with an effective means for self-control of UAU in a timely, ubiquitous, and cost-effective manner, to date, there is a lack of understanding about different health outcomes brought by such interventions. The core components of these interventions are also unclear. Objective: This study aimed to systematically review and synthesize the research evidence about the efficacy of mHealth interventions on various health outcomes for consumer self-control of UAU and to identify the core components to achieve these outcomes. Methods: We systematically searched 7 electronic interdisciplinary databases: Scopus, PubMed, PubMed Central, CINAHL Plus with full text, MEDLINE with full text, PsycINFO, and PsycARTICLES. Search terms and Medical Subject Headings “mHealth,” “text message,” “SMS,” “App,” “IVR,” “self-control,” “self-regulation,” “alcohol*,” and “intervention” were used individually or in combination to identify peer-reviewed publications in English from 2008 to 2017. We screened titles and abstracts and assessed full-text papers as per inclusion and exclusion criteria. Data were extracted from the included papers according to the Consolidated Standards of Reporting Trials-EHEALTH checklist (V 1.6.1) by 2 authors independently. Data quality was assessed by the Mixed Methods Appraisal Tool. Data synthesis and analyses were conducted following the procedures for qualitative content analysis. Statistical testing was also conducted to test differences among groups of studies. Results: In total, 19 studies were included in the review. Of these 19 studies, 12 (63%) mHealth interventions brought significant positive outcomes in improving participants’ health as measured by behavioral (n=11), physiological (n=1), and cognitive indicators (n=1). No significant health outcome was reported in 6 studies (6/19, 32%). Surprisingly, a significant negative outcome was reported for the male participants in the intervention arm in 1 study (1/19, 5%), but no change was found for the female participants. In total, 5 core components reported in the mHealth interventions for consumer self-control of UAU were context, theoretical base, delivery mode, content, and implementation procedure. However, sound evidence is yet to be generated about the role of each component for mHealth success. The health outcomes were similar regardless of types of UAU, deployment setting, with or without nonmobile cointervention, and with or without theory. Conclusions: Most studies reported mHealth interventions for self-control of UAU appeared to be improving behavior, especially the ones delivered by short message service and interactive voice response systems. Further studies are needed to gather sound evidence about the effects of mHealth interventions on improving physiological and cognitive outcomes as well as the optimal design of these interventions, their implementation, and effects in supporting self-control of UAU.

This chapter considers Australia’s second attempt to create a national EHR—the Personally Controlled Electronic Health Record and documents how the focus on ‘personal control’ by citizens added a new dimension to the digital disruption of the division of medical labour. Events from the late 2000s to the present day are chronicled. These are shown to contribute to a story of Australia’s attempt to build a national EHR system that bears many of the hallmarks of experiences in other jurisdictions. In particular it bears the hallmarks of the ‘dangerous enthusiasms’ of policy-makers and the failure to deliver working and useable systems in practice. Rather than transform the healthcare system through disruptive innovation, attempts to digitalize healthcare information in Australia have instead resulted in a disruption of moral orders, the most recent manifestation of which has been a struggle over the meaning of ‘personal control’ of health records.

In this chapter the core thesis of the book is outlined. This proposes that healthcare can be fruitfully viewed as a cluster of negotiated and interrelated moral orders, a deeper understanding of which is required to explain the difficulties associated with implementing EHRs, especially at a national level. Moral orders can be seen as an integral aspect of the division of labour in healthcare and the reciprocal relationships that develop over time among healthcare providers, administrators, citizens, and the state. They embody core values and serve to legitimate and provide justification for the distribution of key rights and responsibilities that enable healthcare systems to function and develop. It is argued that it is the challenge to moral orders which is at the heart of the problems plaguing the implementations of shareable electronic records.

This chapter further illustrates the explanatory power of the moral orders framework by examining a second case of ‘disruption’ provided by the introduction of the ‘summary care record’ as part of the ill-fated National Programme for IT in the English National Health Service. The significant difficulties and delay experience by the project as a whole and to the attempt to introduce a national EHR are chronicled and various attempts to evaluate and explain the reasons for the difficulties are discussed. The analysis of EHRs as disruptors of moral orders is continued through an examination of the tensions and contests that arose when interested groups applied ‘tests of worth’ to the proposed arrangements that invoked different ‘goods’. As a result, as in other countries, it is suggested that stakeholders expended much energy but struggled to reach consensus regarding a moral reordering around the electronic record.

In order to clarify the influence of temperature, humidity and air pressure on the verification environment for the wind speed sensor, According to "JJG431-2014 Portable 3-cup anemometers" verification the speed sensors, through the formula for computing the standard wind speed analysis of air temperature, humidity and air pressure changes before and after verification on the result of test, the calculated by weighted calculation method verification of temperature, humidity and air pressure in the process of their weight, through experiment, the experimental results show that through the analysis and research on the influence of temperature, humidity and air pressure values on the wind speed standard , the wind speed sensor calibration accuracy is increased significantly, reduce the uncertainty of measurement.

Governments around the world are investing in large scale information andcommunication technology projects that are intended to modernize andstreamline healthcare through the provision of nationally accessibleelectronic health records. In this way, they hope to `tame' the complex`wicked' problems facing healthcare, such as rising costs and fragmenteddelivery. However, these projects often encounter difficulties. Using a casestudy of Australia's 20-year journey towards a national electronic healthrecord system, we show how these projects can ironically take on thecharacteristics of the `wicked problems' they are intended to solve, and howa failure to recognize and cope with these `wicked' characteristics can leadto waste, conflict and frustration among potential users. We suggest somealternative approaches to the management of large-scale ICT projects inhealthcare and other public service sectors that deal with complex,sensitive data.

The attempts to train nurses to effectively use information systems have had mixed results. One problem is that training materials are not adequately designed to guide trainees to gradually learn to use a system without experiencing a heavy cognitive load. This is because training design often does not take into consideration a learner's cognitive ability to absorb new information in a short training period. Given the high cost and difficulty of organising training in healthcare organisations, there is an urgent need for information system trainers to be aware of how cognitive overload or information overload affect a trainee's capability to acquire new knowledge and skills, and what instructional techniques can be used to facilitate effective learning.This paper introduces the concept of cognitive load and how it affects nurses when learning to use a new health information system. This is followed by the relevant strategies for instructional design, underpinned by the principles of cognitive load theory, which may be helpful for the development of effective instructional materials and activities for training nurses to use information systems.

Telehealth has the potential to improve the management of chronic health conditions but there are still limited data on its effectiveness and cost-effectiveness in routine practice. A questionnaire study nested within a pragmatic randomized controlled trial estimated costs and outcomes for management of patients in England who had heart failure, chronic obstructive pulmonary disease, or diabetes. Patients received telehealth support and usual care or usual care only. The study perspective was that of the health system. Incremental cost per quality-adjusted life year of telehealth when added to usual care was £79,000. In this setting, telehealth had a low probability of being a cost-effective addition to standard care for patients with the chronic conditions.

AIM:To develop an Australian nursing documentation in aged care (Quality of Australian Nursing Documentation in Aged Care (QANDAC)) instrument to measure the quality of paper-based and electronic resident records.METHODS:The instrument was based on the nursing process model and on three attributes of documentation quality identified in a systematic review. The development process involved five phases following approaches to designing criterion-referenced measures. The face and content validities and the inter-rater reliability of the instrument were estimated using a focus group approach and consensus model.RESULTS:The instrument contains 34 questions in three sections: completion of nursing history and assessment, description of care process and meeting the requirements of data entry. Estimates of the validity and inter-rater reliability of the instrument gave satisfactory results.CONCLUSION:The QANDAC instrument may be a useful audit tool for quality improvement and research in aged care documentation.

A national AIDS program evaluation system has been applied to the ranking of the performance of involved public health organizations in China since 2007. The system provides quantitative performance comparison information based on automatic mining of the data stored in a unified web-based national information system, China AIDS Comprehensive Response Information Management System (the CRIMS). Hence, the quality of the AIDS program evaluation system is directly related to the data quality in the CRIMS. This study aims to evaluate the performance of the AIDS program evaluation system. The research method is qualitative interview of public health practitioners in Jiangxi Province. The public health practitioners believed that the introduction and ongoing usage of the CRIMS has significantly transformed the practice of AIDS prevention and control. They believed that the AIDS program evaluation system has brought in increased accountability of public health. They suggested that the accuracy and completeness of AIDS program evaluation needs to go beyond the data from the CRIMS. Further research will continue to identify the unknown factors that undermine the performance of AIDS programs in China.

PURPOSE:The aim of this study was to investigate the unintended adverse consequences of introducing electronic health records (EHR) in residential aged care homes (RACHs) and to examine the causes of these unintended adverse consequences. METHOD:A qualitative interview study was conducted in nine RACHs belonging to three organisations in the Australian Capital Territory (ACT), New South Wales (NSW) and Queensland, Australia. A longitudinal investigation after the implementation of the aged care EHR systems was conducted at two data points: January 2009 to December 2009 and December 2010 to February 2011. Semi-structured interviews were conducted with 110 care staff members identified through convenience sampling, representing all levels of care staff who worked in these facilities. Data analysis was guided by DeLone and McLean Information Systems Success Model, in reference with the previous studies of unintended consequences for the introduction of computerised provider order entry systems in hospitals. RESULTS:Eight categories of unintended adverse consequences emerged from 266 data items mentioned by the interviewees. In descending order of the number and percentage of staff mentioning them, they are: inability/difficulty in data entry and information retrieval, end user resistance to using the system, increased complexity of information management, end user concerns about access, increased documentation burden, the reduction of communication, lack of space to place enough computers in the work place and increasing difficulties in delivering care services. The unintended consequences were caused by the initial conditions, the nature of the EHR system and the way the system was implemented and used by nursing staff members. CONCLUSIONS:Although the benefits of the EHR systems were obvious, as found by our previous study, introducing EHR systems in RACH can also cause adverse consequences of EHR avoidance, difficulty in access, increased complexity in information management, increased documentation burden, reduction of communication and the risks of lacking care follow-up, which may cause negative effects on aged care services. Further research can focus on investigating how the unintended adverse consequences can be mitigated or eliminated by understanding more about nursing staff's work as well as the information flow in RACH. This will help to improve the design, introduction and management of EHR systems in this setting.

BACKGROUND:The aim of the study is to describe the work pattern of personal care workers (PCWs) in nursing homes. This knowledge is important for staff performance appraisal, task allocation and scheduling. It will also support funding allocation based on activities.METHODS:A time-motion study was conducted in 2010 at two Australian nursing homes. The observation at Site 1 was between the hours of 7:00 and 14:00 or 15:00 for 14 days. One PCW was observed on each day. The observation at Site 2 was from 10:00 to 17:00 for 16 days. One PCW working on a morning shift and another one working on an afternoon shift were observed on each day. Fifty-eight work activities done by PCWs were grouped into eight categories. Activity time, frequency, duration and the switch between two consecutive activities were used as measurements to describe the work pattern.RESULTS:Personal care workers spent about 70.0% of their time on four types of activities consistently at both sites: direct care (30.7%), indirect care (17.6%), infection control (6.4%) and staff break (15.2%). Oral communication was the most frequently observed activity. It could occur independently or concurrently with other activities. At Site 2, PCWs spent significantly more time than their counterparts at Site 1 on oral communication (Site 1: 47.3% vs. Site 2: 63.5%, P = 0.003), transit (Site 1: 3.4% vs. Site 2: 5.5%, P < 0.001) and others (Site 1: 0.5% vs. Site 2: 1.8%, P < 0.001). They spent less time on documentation (Site 1: 4.1% vs. Site 2: 2.3%, P < 0.001). More than two-thirds of the observed activities had a very short duration (1 minute or less). Personal care workers frequently switched within or between oral communication, direct and indirect care activities.CONCLUSIONS:At both nursing homes, direct care, indirect care, infection control and staff break occupied the major part of a PCW's work, however oral communication was the most time consuming activity. Personal care workers frequently switched between activities, suggesting that looking after the elderly in nursing homes is a busy and demanding job.

PURPOSE:Information and communications technology solutions have been introduced into the residential aged care system in order to improve the effectiveness and efficiency of aged care, however to date, the actual benefits have not been systematically analysed. The aim of this study was to identify the benefits of electronic health records (EHR) in residential aged care services and to examine how the benefits have been achieved. METHOD:A qualitative interview study was conducted in nine residential aged care facilities (RACFs) belonging to three organisations in the Australian Capital Territory (ACT), New South Wales (NSW) and Queensland, Australia. A longitudinal investigation after the implementation of the aged care EHR systems was conducted at two data points: January 2009 to December 2009 and December 2010 to February 2011. Semi-structured interviews were conducted with 110 care staff members selected through theoretical sampling, representing all levels of care staff who worked in those facilities. RESULTS:Three categories of benefits were perceived by the care staff members according to who gain the benefits: the benefits to individual care staff members, to residents and to the RACFs. The benefits to individual care staff members include an improvement of documentation efficiency, information and knowledge growth as well as empowering the staff; the benefits to residents are an improvement in the quality of individual residents' health records, the higher quality of care and smoother communication between the residents and aged care staff; the RACFs gain an increased ability to manage information and acquire funding, an increase in their ability to control the care quality and improvements in the working environment and educational benefits. Three factors leading to these benefits were examined: the nature of the aged care EHR systems in comparison with paper-based records; the way the systems were used by the staff and one benefit that could lead to another. CONCLUSIONS:In this study, EHR systems were perceived to have substantial benefits for care staff, residents and the aged care organisations introducing the systems. The benefits were derived from the nature of the aged care EHR systems, staff members' continuous use of the systems, and one benefit led to the other.

AIMS AND OBJECTIVESTo examine the effect of the introduction of an electronic nursing documentation system on the efficiency of documentation in a residential aged care facility.BACKGROUNDModern technology has the potential to free caregivers in residential aged care facilities from their burden of paper documentation and allow them more time to care for residents. To date, there is inadequate evidence to verify this assumption.DESIGNLongitudinal cohort study with work sampling method for data collection.METHODSThis study was conducted between 2009-2011; two months before and 3, 6, 12 and 23 months after implementation of an electronic documentation system. A work classification tool was used by an observer to record documentation activities being performed on paper or on a computer by the caregivers.RESULTSWhen compared with the proportion of time caregivers spent on documentation in the preimplementation period, personal carers' proportion reduced at three months after implementation. The proportion increased from six months and then dropped at 23 months. Recreational activity officers' proportion increased at three months after implementation. It stabilised at six months and increased again at 12 months. At 23 months, the proportion returned to the preimplementation level. Less than half of the caregivers' time on documentation after implementation was associated with computer-related tasks.CONCLUSIONSIntroduction of an electronic documentation system may not necessarily lead to efficiency in documentation for the caregivers. Charting some information items on paper and others on a computer may hinder realization of documentation efficiency.RELEVANCE TO CLINICAL PRACTICETo optimise the efficiency benefit of electronic documentation in a residential aged care facility, it is not only necessary to automate all nursing forms but also to ensure that the system is aligned with caregivers' documentation practice. Continuous education and mentor support is essential to ensure caregivers' effective usage of the electronic system.