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Dive into the research topics where Damian Borbolla is active.

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Featured researches published by Damian Borbolla.


Methods of Information in Medicine | 2012

Attitude of physicians towards automatic alerting in computerized physician order entry systems. A comparative international survey

Minoa Jung; Alexander Hoerbst; Werner O. Hackl; Kirrane F; Damian Borbolla; Monique W. M. Jaspers; Oertle M; Vassilis Koutkias; L. Ferret; Massari P; Lawton K; Daniel Riedmann; Darmoni S; Nicos Maglaveras; Christian Lovis; Elske Ammenwerth

OBJECTIVES To analyze the attitude of physicians towards alerting in CPOE systems in different hospitals in different countries, addressing various organizational and technical settings and the view of physicians not currently using a CPOE. METHODS A cross-sectional quantitative and qualitative questionnaire survey. We invited 2,600 physicians in eleven hospitals from nine countries to participate. Eight of the hospitals had different CPOE systems in use, and three of the participating hospitals were not using a CPOE system. RESULTS 1,018 physicians participated. The general attitude of the physicians towards CPOE alerting is positive and is found to be mostly independent of the country, the specific organizational settings in the hospitals and their personal experience with CPOE systems. Both quantitative and qualitative results show that the majority of the physicians, both CPOE-users and non-users, appreciate the benefits of alerting in CPOE systems on medication safety. However, alerting should be better adapted to the clinical context and make use of more sophisticated ways to present alert information. The vast majority of physicians agree that additional information regarding interactions is useful on demand. Around half of the respondents see possible alert overload as a major problem; in this regard, physicians in hospitals with sophisticated alerting strategies show partly better attitude scores. CONCLUSIONS Our results indicate that the way alerting information is presented to the physicians may play a role in their general attitude towards alerting, and that hospitals with a sophisticated alerting strategy with less interruptive alerts tend towards more positive attitudes. This aspect needs to be further investigated in future studies.


International Journal of Medical Informatics | 2015

Problem list completeness in electronic health records: A multi-site study and assessment of success factors.

Adam Wright; Allison B. McCoy; Thu Trang T. Hickman; Daniel St Hilaire; Damian Borbolla; Watson A. Bowes; William G. Dixon; David A. Dorr; Michael Krall; Sameer Malholtra; David W. Bates; Dean F. Sittig

OBJECTIVE To assess problem list completeness using an objective measure across a range of sites, and to identify success factors for problem list completeness. METHODS We conducted a retrospective analysis of electronic health record data and interviews at ten healthcare organizations within the United States, United Kingdom, and Argentina who use a variety of electronic health record systems: four self-developed and six commercial. At each site, we assessed the proportion of patients who have diabetes recorded on their problem list out of all patients with a hemoglobin A1c elevation>=7.0%, which is diagnostic of diabetes. We then conducted interviews with informatics leaders at the four highest performing sites to determine factors associated with success. Finally, we surveyed all the sites about common practices implemented at the top performing sites to determine whether there was an association between problem list management practices and problem list completeness. RESULTS Problem list completeness across the ten sites ranged from 60.2% to 99.4%, with a mean of 78.2%. Financial incentives, problem-oriented charting, gap reporting, shared responsibility, links to billing codes, and organizational culture were identified as success factors at the four hospitals with problem list completeness at or near 90.0%. DISCUSSION Incomplete problem lists represent a global data integrity problem that could compromise quality of care and put patients at risk. There was a wide range of problem list completeness across the healthcare facilities. Nevertheless, some facilities have achieved high levels of problem list completeness, and it is important to better understand the factors that contribute to success to improve patient safety. CONCLUSION Problem list completeness varies substantially across healthcare facilities. In our review of EHR systems at ten healthcare facilities, we identified six success factors which may be useful for healthcare organizations seeking to improve the quality of their problem list documentation: financial incentives, problem oriented charting, gap reporting, shared responsibility, links to billing codes, and organizational culture.


world congress on medical and health informatics, medinfo | 2010

Implementation of a clinical decision support system using a service model: results of a feasibility study.

Damian Borbolla; Carlos Otero; David F. Lobach; Kensaku Kawamoto; Gomez Saldaño Am; Staccia G; López G; Silvana Figar; Daniel R. Luna; Bernaldo de Quirós Fg

Numerous studies have shown that the quality of health care is inadequate, and healthcare organizations are increasingly turning to clinical decision support systems (CDSS) to address this problem. In implementing CDSS, a highly promising architectural approach is the use of decision support services. However, there are few reported examples of successful implementations of operational CDSS using this approach. Here, we describe how Hospital Italiano de Buenos Aires evaluated the feasibility of using the SEBASTIAN clinical decision support Web service to implement a CDSS integrated with its electronic medical record system. The feasibility study consisted of three stages: first, end-user acceptability testing of the proposed CDSS through focus groups; second, the design and implementation of the system through integration of SEBASTIAN and the authoring of new rules; and finally, validation of system performance and accuracy. Through this study, we found that it is feasible to implement CDSS using a service-based approach. The CDSS is now under evaluation in a randomized controlled trial. The processes and lessons learned from this initiative are discussed.


Journal of the American Medical Informatics Association | 2017

Information needs of physicians, care coordinators, and families to support care coordination of children and youth with special health care needs (CYSHCN)

Pallavi Ranade-Kharkar; Charlene R. Weir; Chuck Norlin; Sarah A. Collins; Lou Ann Scarton; Gina B. Baker; Damian Borbolla; Vanina Taliercio; Guilherme Del Fiol

Objectives Identify and describe information needs and associated goals of physicians, care coordinators, and families related to coordinating care for medically complex children and youth with special health care needs (CYSHCN). Materials and Methods We conducted 19 in-depth interviews with physicians, care coordinators, and parents of CYSHCN following the Critical Decision Method technique. We analyzed the interviews for information needs posed as questions using a systematic content analysis approach and categorized the questions into information need goal types and subtypes. Results The Critical Decision Method interviews resulted in an average of 80 information needs per interview. We categorized them into 6 information need goal types: (1) situation understanding, (2) care networking, (3) planning, (4) tracking/monitoring, (5) navigating the health care system, and (6) learning, and 32 subtypes. Discussion and Conclusion Caring for CYSHCN generates a large amount of information needs that require significant effort from physicians, care coordinators, parents, and various other individuals. CYSHCN are often chronically ill and face developmental challenges that translate into intense demands on time, effort, and resources. Care coordination for CYCHSN involves multiple information systems, specialized resources, and complex decision-making. Solutions currently offered by health information technology fall short in providing support to meet the information needs to perform the complex care coordination tasks. Our findings present significant opportunities to improve coordination of care through multifaceted and fully integrated informatics solutions.


Studies in health technology and informatics | 2013

Physicians Perceptions of an Educational Support System Integrated into an Electronic Health Record

Damian Borbolla; Paul N. Gorman; Guilherme Del Fiol; Vishnu Mohan; William R. Hersh; Carlos Otero; Daniel R. Luna; Fernán Gonzalez Bernaldo de Quirós

The purpose of this study is to determine the perceptions by physicians of an educational system integrated into an electronic health record (EHR). Traditional approaches to continuous medical education (CME) have not shown improvement in patient health care outcomes. Hospital Italiano de Buenos Aires (HIBA) has implemented a system that embeds information pearls into the EHR, providing learning opportunities that are integrated into the patient care process. This study explores the acceptability and general perceptions of the system by physicians when they are in the consulting room. We interviewed 12 physicians after one or two weeks of using this CME system and we performed a thematic analysis of these interviews. The themes that emerged were use and ease of use of the system; value physicians gave to the system; educational impact on physicians; respect for the individual learning styles; content available in the system; and barriers that were present or absent for using the CME system. We found that the integrated CME system developed at HIBA was well accepted and perceived as useful and easy to use. Future work will involve modifications to the system interface, expansion of the content offered and further evaluation.


Journal of Medical Internet Research | 2018

Interactive Visual Displays for Interpreting the Results of Clinical Trials: Formative Evaluation With Case Vignettes

Jiantao Bian; Charlene R. Weir; Prasad Unni; Damian Borbolla; Thomas Reese; Yik-Ki Jacob Wan; Guilherme Del Fiol

Background At the point of care, evidence from randomized controlled trials (RCTs) is underutilized in helping clinicians meet their information needs. Objective To design interactive visual displays to help clinicians interpret and compare the results of relevant RCTs for the management of a specific patient, and to conduct a formative evaluation with physicians comparing interactive visual versus narrative displays. Methods We followed a user-centered and iterative design process succeeded by development of information display prototypes as a Web-based application. We then used a within-subjects design with 20 participants (8 attendings and 12 residents) to evaluate the usability and problem-solving impact of the information displays. We compared subjects’ perceptions of the interactive visual displays versus narrative abstracts. Results The resulting interactive visual displays present RCT results side-by-side according to the Population, Intervention, Comparison, and Outcome (PICO) framework. Study participants completed 19 usability tasks in 3 to 11 seconds with a success rate of 78% to 100%. Participants favored the interactive visual displays over narrative abstracts according to perceived efficiency, effectiveness, effort, user experience and preference (all P values <.001). Conclusions When interpreting and applying RCT findings to case vignettes, physicians preferred interactive graphical and PICO-framework-based information displays that enable direct comparison of the results from multiple RCTs compared to the traditional narrative and study-centered format. Future studies should investigate the use of interactive visual displays to support clinical decision making in care settings and their effect on clinician and patient outcomes.


ieee international conference on healthcare informatics | 2017

Trend Displays to Support Critical Care: A Systematic Review

Noa Segall; Damian Borbolla; Guilherme Del Fiol; Rosalie Waller; Thomas Reese; Paige Nesbitt; Melanie C. Wright

An important aspect of designing information displays to support monitoring and decision-making in critical care is the representation of change of patient data over time. We systematically reviewed articles to identify novel alternatives to tabular and single variable plots of values over time to convey information about change in multiple related variables. Following screening of 5,119 articles, 28 met our inclusion criteria. They described 26 unique displays evaluated in 31 experiments. Methods for representing change varied widely. We classified these methods as enhanced graphical displays (enhanced plots of quantitative data over time), other displays (novel object and metaphoric displays), small multiples displays (multiple co-presented small graphic displays), and simple change indicator displays. Overall, findings support the value of an explicit display of trend information using many different approaches. Few studies directly compared different methods for displaying trend information in ways that would support broader conclusions about which approaches may be preferred for specific applications. The studies suggest that, for displaying patient data trends, it is feasible to develop electronic displays that will outperform both historical paper-based flowcharts and current electronic health record (EHR)-based tabular approaches. There is evidence to suggest that even minor improvements to current approaches such as the automatic presentation of simple line plots of trends on EHRs or the addition of simple graphical indicators of trend direction on patient monitors could lead to clinically meaningful improvements in diagnostic accuracy and efficiency.


Studies in health technology and informatics | 2004

Evolution of medical informatics in bibliographic databases.

Otero P; Pedernera F; Montenegro S; Damian Borbolla; Garcia Marti S; Daniel R. Luna; de Quirós Fg


Studies in health technology and informatics | 2007

Effectiveness of a Chronic Disease Surveillance Systems for Blood Pressure Monitoring

Damian Borbolla; Diego Giunta; Silvana Figar; Mercedes Soriano; Adriana Dawidowski; Fernán Gonzalez Bernaldo de Quirós


medical informatics europe | 2014

Integrating personalized health information from MedlinePlus in a patient portal

Damian Borbolla; Guilherme Del Fiol; Vanina Taliercio; Carlos Otero; Fernando Campos; Marcela Martinez; Daniel R. Luna; Fernán Gonzalez Bernaldo de Quirós

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Daniel R. Luna

Hospital Italiano de Buenos Aires

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Carlos Otero

Hospital Italiano de Buenos Aires

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