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Sample records for electronic record system

  1. Electronic Dental Records System Adoption.

    PubMed

    Abramovicz-Finkelsztain, Renata; Barsottini, Claudia G N; Marin, Heimar Fatima

    2015-01-01

    The use of Electronic Dental Records (EDRs) and management software has become more frequent, following the increase in prevelance of new technologies and computers in dental offices. The purpose of this study is to identify and evaluate the use of EDRs by the dental community in the São Paulo city area. A quantitative case study was performed using a survey on the phone. A total of 54 offices were contacted and only one declinedparticipation in this study. Only one office did not have a computer. EDRs were used in 28 offices and only four were paperless. The lack of studies in this area suggests the need for more usability and implementation studies on EDRs so that we can improve EDR adoption by the dental community. PMID:26262001

  2. Recent perspectives of electronic medical record systems

    PubMed Central

    ZHANG, XIAO-YING; ZHANG, PEIYING

    2016-01-01

    Implementation of electronic medical record (EMR) systems within developing contexts as part of efforts to monitor and facilitate the attainment of health-related aims has been on the increase. However, these efforts have been concentrated on urban hospitals. Recent findings showed that development processes of EMR systems are associated with various discrepancies between protocols and work practices. These discrepancies were mainly caused by factors including high workload, lack of medical resources, misunderstanding of the protocols by health workers, and client/patient practices. The present review focused on the effects of EMRs on patient care work, and on appropriate EMR designs principles and strategies to ameliorate these systems. PMID:27284289

  3. National electronic medical records integration on cloud computing system.

    PubMed

    Mirza, Hebah; El-Masri, Samir

    2013-01-01

    Few Healthcare providers have an advanced level of Electronic Medical Record (EMR) adoption. Others have a low level and most have no EMR at all. Cloud computing technology is a new emerging technology that has been used in other industry and showed a great success. Despite the great features of Cloud computing, they haven't been utilized fairly yet in healthcare industry. This study presents an innovative Healthcare Cloud Computing system for Integrating Electronic Health Record (EHR). The proposed Cloud system applies the Cloud Computing technology on EHR system, to present a comprehensive EHR integrated environment. PMID:23920993

  4. Perfusion Electronic Record Documentation Using Epic Systems Software

    PubMed Central

    Steffens, Thomas G.; Gunser, John M.; Saviello, George M.

    2015-01-01

    Abstract: This paper describes the design and use of Epic Systems software for documentation of perfusion activities as part of the patient electronic medical record. The University of Wisconsin Hospital and Clinics adapted the Anesthesia software module and developed an integrated perfusion/anesthesia record for the documentation of cardiac and non-cardiac surgical procedures. This project involved multiple committees, approvals, and training to successfully implement. This article will describe our documentation options, concepts, design, challenges, training, and implementation during our initial experience. PMID:26834288

  5. Implementing electronic medical record systems in developing countries.

    PubMed

    Fraser, Hamish S F; Biondich, Paul; Moodley, Deshen; Choi, Sharon; Mamlin, Burke W; Szolovits, Peter

    2005-01-01

    The developing world faces a series of health crises including HIV/AIDS and tuberculosis that threaten the lives of millions of people. Lack of infrastructure and trained, experienced staff are considered important barriers to scaling up treatment for these diseases. In this paper we explain why information systems are important in many healthcare projects in the developing world. We discuss pilot projects demonstrating that such systems are possible and can expand to manage hundreds of thousands of patients. We also pass on the most important practical lessons in design and implementation from our experience in doing this work. Finally, we discuss the importance of collaboration between projects in the development of electronic medical record systems rather than reinventing systems in isolation, and the use of open standards and open source software. PMID:15992493

  6. Disrupting Electronic Health Records Systems: The Next Generation

    PubMed Central

    Marshall, Jeffrey David; Lai, Yuan

    2015-01-01

    The health care system suffers from both inefficient and ineffective use of data. Data are suboptimally displayed to users, undernetworked, underutilized, and wasted. Errors, inefficiencies, and increased costs occur on the basis of unavailable data in a system that does not coordinate the exchange of information, or adequately support its use. Clinicians’ schedules are stretched to the limit and yet the system in which they work exerts little effort to streamline and support carefully engineered care processes. Information for decision-making is difficult to access in the context of hurried real-time workflows. This paper explores and addresses these issues to formulate an improved design for clinical workflow, information exchange, and decision making based on the use of electronic health records. PMID:26500106

  7. Diffusion of Electronic Medical Record Based Public Hospital Information Systems

    PubMed Central

    Cho, Kyoung Won; Kim, Seong Min; An, Chang-Ho

    2015-01-01

    Objectives This study was conducted to evaluate the adoption behavior of a newly developed Electronic Medical Record (EMR)-based information system (IS) at three public hospitals in Korea with a focus on doctors and nurses. Methods User satisfaction scores from four performance layers were analyzed before and two times after the newly develop system was introduced to evaluate the adoption process of the IS with Rogers' diffusion theory. Results The 'intention to use' scores, the most important indicator for determining whether or not to adopt the IS in Rogers' confirmation stage for doctors, were very high in the third survey (4.21). In addition, the scores for 'reduced medication errors', which is the key indicator for evaluating the success of the IS, increased in the third survey for both doctors and nurses. The factors influencing 'intention to use' with a high odds ratio (>1.5) were the 'frequency of attendance of user training sessions', 'mandatory use of system', 'reduced medication errors', and 'reduced medical record documentation time' for both doctors and nurses. Conclusions These findings show that the new EMR-based IS was well accepted by doctors. Both doctors and nurses also positively considered the effects of the new IS on their clinical environments. PMID:26279954

  8. Role prediction using Electronic Medical Record system audits.

    PubMed

    Zhang, Wen; Gunter, Carl A; Liebovitz, David; Tian, Jian; Malin, Bradley

    2011-01-01

    Electronic Medical Records (EMRs) provide convenient access to patient data for parties who should have it, but, unless managed properly, may also provide it to those who should not. Distinguishing the two is a core security challenge for EMRs. Strategies proposed to address these problems include Role Based Access Control (RBAC), which assigns collections of privileges called roles to users, and Experience Based Access Management (EBAM), which analyzes audit logs to determine access rights. In this paper, we integrate RBAC and EBAM through an algorithm, called Roll-Up, to manage roles effectively. In doing so, we introduce the concept of "role prediction" to identify roles from audit data. We apply the algorithm to three months of logs from Northwestern Memorial Hospital's Cerner system with approximately 8000 users and 140 roles. We demonstrate that existing roles can be predicted with 50% accuracy and intelligent grouping of roles through Roll-Up can facilitate 65% accuracy. PMID:22195144

  9. CADe system integrated within the electronic health record.

    PubMed

    Vállez, Noelia; Bueno, Gloria; Déniz, Óscar; Fernández, María del Milagro; Pastor, Carlos; Rienda, Miguel Ángel; Esteve, Pablo; Arias, María

    2013-01-01

    The latest technological advances and information support systems for clinics and hospitals produce a wide range of possibilities in the storage and retrieval of an ever-growing amount of clinical information as well as in detection and diagnosis. In this work, an Electronic Health Record (EHR) combined with a Computer Aided Detection (CADe) system for breast cancer diagnosis has been implemented. Our objective is to provide to radiologists a comprehensive working environment that facilitates the integration, the image visualization, and the use of aided tools within the EHR. For this reason, a development methodology based on hardware and software system features in addition to system requirements must be present during the whole development process. This will lead to a complete environment for displaying, editing, and reporting results not only for the patient information but also for their medical images in standardised formats such as DICOM and DICOM-SR. As a result, we obtain a CADe system which helps in detecting breast cancer using mammograms and is completely integrated into an EHR. PMID:24151586

  10. CADe System Integrated within the Electronic Health Record

    PubMed Central

    Vállez, Noelia; Déniz, Óscar; Fernández, María del Milagro; Pastor, Carlos; Rienda, Miguel Ángel; Esteve, Pablo; Arias, María

    2013-01-01

    The latest technological advances and information support systems for clinics and hospitals produce a wide range of possibilities in the storage and retrieval of an ever-growing amount of clinical information as well as in detection and diagnosis. In this work, an Electronic Health Record (EHR) combined with a Computer Aided Detection (CADe) system for breast cancer diagnosis has been implemented. Our objective is to provide to radiologists a comprehensive working environment that facilitates the integration, the image visualization, and the use of aided tools within the EHR. For this reason, a development methodology based on hardware and software system features in addition to system requirements must be present during the whole development process. This will lead to a complete environment for displaying, editing, and reporting results not only for the patient information but also for their medical images in standardised formats such as DICOM and DICOM-SR. As a result, we obtain a CADe system which helps in detecting breast cancer using mammograms and is completely integrated into an EHR. PMID:24151586

  11. Using Electronic Health Record Systems in Diabetes Care: Emerging Practices.

    PubMed

    Veinot, Tiffany C; Zheng, Kai; Lowery, Julie C; Souden, Maria; Keith, Rosalind

    2010-01-01

    While there has been considerable attention devoted to the deployment of electronic health record (EHR) systems, there has been far less attention given to their appropriation for use in clinical encounters - particularly in the context of complex, chronic illness. The Department of Veterans' Affairs (VA) has been at the forefront of EHR adoption and, as such, provides a unique opportunity to examine a mature EHR system in widespread use. Moreover, with a high prevalence of diabetes in its patient population, the VA provides a useful platform for examining EHR use in the context of chronic disease care. We conducted a sequential, exploratory qualitative study at two VA Medical Centers in the Midwest. First, we conducted observations of 64 clinical consultations with diabetes patients. These observations involved 31 different health care providers. Second, using insights from these observations, we conducted in-depth, semi-structured interviews with 39 health care providers focusing on their use of information in diabetes patient care. Field notes and interview transcripts were analyzed using a grounded theory approach. Our analysis generated several categories of EHR use in clinical encounters: priming, structuring, assessing, informing, and continuing. We also outline some mismatches between EHR system design and VA diabetes care practices. We conclude by discussing implications of these emergent system uses for improving the software design of EHRs to better support chronic disease care, as well as for our understanding of the integration of technologies in health care. PMID:25264545

  12. Benefits and drawbacks of electronic health record systems

    PubMed Central

    Menachemi, Nir; Collum, Taleah H

    2011-01-01

    The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 that was signed into law as part of the “stimulus package” represents the largest US initiative to date that is designed to encourage widespread use of electronic health records (EHRs). In light of the changes anticipated from this policy initiative, the purpose of this paper is to review and summarize the literature on the benefits and drawbacks of EHR systems. Much of the literature has focused on key EHR functionalities, including clinical decision support systems, computerized order entry systems, and health information exchange. Our paper describes the potential benefits of EHRs that include clinical outcomes (eg, improved quality, reduced medical errors), organizational outcomes (eg, financial and operational benefits), and societal outcomes (eg, improved ability to conduct research, improved population health, reduced costs). Despite these benefits, studies in the literature highlight drawbacks associated with EHRs, which include the high upfront acquisition costs, ongoing maintenance costs, and disruptions to workflows that contribute to temporary losses in productivity that are the result of learning a new system. Moreover, EHRs are associated with potential perceived privacy concerns among patients, which are further addressed legislatively in the HITECH Act. Overall, experts and policymakers believe that significant benefits to patients and society can be realized when EHRs are widely adopted and used in a “meaningful” way. PMID:22312227

  13. Record Storage Systems: From Paper Based Files to Electronic Image Systems.

    ERIC Educational Resources Information Center

    Gregory, Bob; Lonabocker, Louise

    1986-01-01

    Alternative methods of storing and handling the registrar's records are described, and their relative advantages and disadvantages are noted. The methods include paper files, micrographics (computer output microfilm and source document microfilm), and electronic image systems. (MSE)

  14. Authorisation and access control for electronic health record systems.

    PubMed

    Blobel, Bernd

    2004-03-31

    Enabling the shared care paradigm, centralised or even decentralised electronic health record (EHR) systems increasingly become core applications in hospital information systems and health networks. For realising multipurpose use and reuse as well as inter-operability at knowledge level, EHR have to meet special architectural requirements. The component-oriented and model-based architecture should meet international standards. Especially in extended health networks realising inter-organisational communication and co-operation, authorisation cannot be organised at user level anymore. Therefore, models, methods and tools must be established to allow formal and structured policy definition, policy agreements, role definition, authorisation and access control. Based on the author's international engagement in EHR architecture and security standards referring to the revision of CEN ENV 13606, the GEHR/open EHR approach, HL7 and CORBA, models for health-specific and EHR-related roles, for authorisation management and access control have been developed. The basic concept is the separation of structural roles defining organisational entity-to-entity relationships and enabling specific acts on the one hand, and functional roles bound to specific activities and realising rights and duties on the other hand. Aggregation of organisational, functional, informational and technological components follows specific rules. Using UML and XML, the principles as well as some examples for analysis, design, implementation and maintenance of policy and authorisation management as well as access control have been practically implemented. PMID:15066555

  15. Electronic Record Systems and Individual Privacy. Federal Government Information Technology.

    ERIC Educational Resources Information Center

    Congress of the U.S., Washington, DC. Office of Technology Assessment.

    This report considers the privacy issues raised by the growth of the new technology being applied to the personal information collected, maintained, and disseminated by the Federal Government. Four major areas are addressed: (1) technological developments relevant to government record systems; (2) current and prospective Federal agency use of…

  16. Landsat electron beam recorder

    NASA Astrophysics Data System (ADS)

    Grosso, P. F.; Whitley, J. P.

    A minicomputer-controlled electron beam recorder (EBR) presently in use at the Brazilian Government's Institute De Pesquisas Espaclais (INPE) satellite ground station is described. This 5-in.-film-size EBR is used to record both Landsat and SPOT satellite imagery in South America. A brief electron beam recorder technology review is presented. The EBR is capable of recording both vector and text data from computer-aided design, publishing, and line art systems and raster data from image scanners, raster image processors (RIPS), halftone/screen generators, and remote image sensors. A variety of image formats may be recorded on numerous film sizes (16 mm, 35 mm, 70 mm, 105 mm, 5-in, 5.5-in., and 9.5-in.). These recordings are used directly or optically enlarged depending on the final product.

  17. Radiology Reporting System Data Exchange With the Electronic Health Record System: A Case Study in Iran

    PubMed Central

    Ahmadi, Maryam; Ghazisaeidi, Marjan; Bashiri, Azadeh

    2015-01-01

    Introduction: In order to better designing of electronic health record system in Iran, integration of health information systems based on a common language must be done to interpret and exchange this information with this system is required. Background: This study provides a conceptual model of radiology reporting system using unified modeling language. The proposed model can solve the problem of integration this information system with the electronic health record system. By using this model and design its service based, easily connect to electronic health record in Iran and facilitate transfer radiology report data. Methods: This is a cross-sectional study that was conducted in 2013. The study population was 22 experts that working at the Imaging Center in Imam Khomeini Hospital in Tehran and the sample was accorded with the community. Research tool was a questionnaire that prepared by the researcher to determine the information requirements. Content validity and test-retest method was used to measure validity and reliability of questioner respectively. Data analyzed with average index, using SPSS. Also Visual Paradigm software was used to design a conceptual model. Result: Based on the requirements assessment of experts and related texts, administrative, demographic and clinical data and radiological examination results and if the anesthesia procedure performed, anesthesia data suggested as minimum data set for radiology report and based it class diagram designed. Also by identifying radiology reporting system process, use case was drawn. Conclusion: According to the application of radiology reports in electronic health record system for diagnosing and managing of clinical problem of the patient, with providing the conceptual Model for radiology reporting system; in order to systematically design it, the problem of data sharing between these systems and electronic health records system would eliminate. PMID:26156904

  18. Perfusion Electronic Record Documentation Using Epic Systems Software.

    PubMed

    Riley, Jeffrey B; Justison, George A

    2015-12-01

    The authors comment on Steffens and Gunser's article describing the University of Wisconsin adoption of the Epic anesthesia record to include perfusion information from the cardiopulmonary bypass patient experience. We highlight the current-day lessons and the valuable quality and safety principles the Wisconsin-Epic model anesthesia-perfusion record provides. PMID:26834289

  19. Electronic surgical record management.

    PubMed

    Rockman, Justin

    2010-01-01

    This paper explores the challenges surgical practices face in coordinating surgeries and how the electronic surgical record management (ESRM) approach to surgical coordination can solve these problems and improve efficiency. Surgical practices continue to experience costly inefficiencies when managing surgical coordination. Application software like practice management and electronic health record systems have enabled practices to "go digital" for their administrative, financial, and clinical data. However, surgical coordination is still a manual and labor-intensive process. Surgical practices need to create a central and secure record of their surgeries. When surgical data are inputted once only and stored in a central repository, the data are transformed into active information that can be outputted to any form, letter, calendar, or report. ESRM is a new approach to surgical coordination. It enables surgical practices to automate and streamline their processes, reduce costs, and ensure that patients receive the best possible care. PMID:20480775

  20. Fine-Grained Access Control for Electronic Health Record Systems

    NASA Astrophysics Data System (ADS)

    Hue, Pham Thi Bach; Wohlgemuth, Sven; Echizen, Isao; Thuy, Dong Thi Bich; Thuc, Nguyen Dinh

    There needs to be a strategy for securing the privacy of patients when exchanging health records between various entities over the Internet. Despite the fact that health care providers such as Google Health and Microsoft Corp.'s Health Vault comply with the U.S Health Insurance Portability and Accountability Act (HIPAA), the privacy of patients is still at risk. Several encryption schemes and access control mechanisms have been suggested to protect the disclosure of a patient's health record especially from unauthorized entities. However, by implementing these approaches, data owners are not capable of controlling and protecting the disclosure of the individual sensitive attributes of their health records. This raises the need to adopt a secure mechanism to protect personal information against unauthorized disclosure. Therefore, we propose a new Fine-grained Access Control (FGAC) mechanism that is based on subkeys, which would allow a data owner to further control the access to his data at the column-level. We also propose a new mechanism to efficiently reduce the number of keys maintained by a data owner in cases when the users have different access privileges to different columns of the data being shared.

  1. Assessing electronic health record systems in emergency departments: Using a decision analytic Bayesian model.

    PubMed

    Ben-Assuli, Ofir; Leshno, Moshe

    2016-09-01

    In the last decade, health providers have implemented information systems to improve accuracy in medical diagnosis and decision-making. This article evaluates the impact of an electronic health record on emergency department physicians' diagnosis and admission decisions. A decision analytic approach using a decision tree was constructed to model the admission decision process to assess the added value of medical information retrieved from the electronic health record. Using a Bayesian statistical model, this method was evaluated on two coronary artery disease scenarios. The results show that the cases of coronary artery disease were better diagnosed when the electronic health record was consulted and led to more informed admission decisions. Furthermore, the value of medical information required for a specific admission decision in emergency departments could be quantified. The findings support the notion that physicians and patient healthcare can benefit from implementing electronic health record systems in emergency departments. PMID:26033468

  2. 5 CFR 850.301 - Electronic records; other acceptable records.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false Electronic records; other acceptable... SERVICE REGULATIONS (CONTINUED) RETIREMENT SYSTEMS MODERNIZATION Records § 850.301 Electronic records; other acceptable records. (a) Acceptable electronic records for processing by the electronic...

  3. 5 CFR 850.301 - Electronic records; other acceptable records.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 5 Administrative Personnel 2 2013-01-01 2013-01-01 false Electronic records; other acceptable... SERVICE REGULATIONS (CONTINUED) RETIREMENT SYSTEMS MODERNIZATION Records § 850.301 Electronic records; other acceptable records. (a) Acceptable electronic records for processing by the electronic...

  4. 5 CFR 850.301 - Electronic records; other acceptable records.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Electronic records; other acceptable... SERVICE REGULATIONS (CONTINUED) RETIREMENT SYSTEMS MODERNIZATION Records § 850.301 Electronic records; other acceptable records. (a) Acceptable electronic records for processing by the electronic...

  5. 5 CFR 850.301 - Electronic records; other acceptable records.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Electronic records; other acceptable... SERVICE REGULATIONS (CONTINUED) RETIREMENT SYSTEMS MODERNIZATION Records § 850.301 Electronic records; other acceptable records. (a) Acceptable electronic records for processing by the electronic...

  6. [Electronic patient records and teleophthalmology : part 1: introduction to the various systems and standards].

    PubMed

    Schargus, M; Michelson, G; Grehn, F

    2011-05-01

    Electronic storage of patient-related data will replace paper-based patient records in the near future. Some steps in medical practice can even now not be achieved without electronic data processing. Both systems, conventional paper-based and electronic-based records, have advantages and disadvantages which have to be taken into consideration. The advantages of electronic-based records are e.g. good availability of data, structured storage of data, scientific analysis of long-term data and possible data exchange with colleagues in the context of teleconsultation systems. Problems have to be solved in the field of data security, initial high investment costs and time consumption in learning to use the system as well as in incompatibility of existing IT systems. PMID:21590353

  7. What is Clinical Safety in Electronic Health Care Record Systems?

    NASA Astrophysics Data System (ADS)

    Davies, George

    There is mounting public awareness of an increasing number of adverse clinical incidents within the National Health Service (NHS), but at the same time, large health care projects like the National Programme for IT (NPFIT) are claiming that safer care is one of the benefits of the project and that health software systems in particular have the potential to reduce the likelihood of accidental or unintentional harm to patients. This paper outlines the approach to clinical safety management taken by CSC, a major supplier to NPFIT; discusses acceptable levels of risk and clinical safety as an end-to-end concept; and touches on the future for clinical safety in health systems software.

  8. Implementation of an Electronic Health Records System in a Small Clinic: The Viewpoint of Clinic Staff

    ERIC Educational Resources Information Center

    Carayon, Pascale; Smith, Paul; Hundt, Ann Schoofs; Kuruchittham, Vipat; Li, Qian

    2009-01-01

    In this study, we examined the implementation of an electronic health records (EHR) system in a small family practice clinic. We used three data collection instruments to evaluate user experience, work pattern changes, and organisational changes related to the implementation and use of the EHR system: (1) an EHR user survey, (2) interviews with…

  9. Acceptance and Usage of Electronic Health Record Systems in Small Medical Practices

    ERIC Educational Resources Information Center

    Tannan, Ritu

    2012-01-01

    One of the objectives of the U.S. government has been the development of a nationwide health information infrastructure, including adoption and use of an electronic health records (EHR) system. However, a 2008 survey conducted by the National Center for Health Statistics indicated a 41.5% usage of the EHR system by physicians in office-based…

  10. An Evaluation of Authentic Learning in an Electronic Medical Records System

    ERIC Educational Resources Information Center

    Stuart, Sandra L.

    2013-01-01

    This study examined participants' perceptions of the effectiveness of a new job-training program designed to enhance the authentic learning in adult learners using an electronic medical records system at a naval health clinic. This job-training program lacked data about participants' perceptions of this learning process by which to gauge its…

  11. Evolution of Medication Administration Workflow in Implementing Electronic Health Record System

    ERIC Educational Resources Information Center

    Huang, Yuan-Han

    2013-01-01

    This study focused on the clinical workflow evolutions when implementing the health information technology (HIT). The study especially emphasized on administrating medication when the electronic health record (EHR) systems were adopted at rural healthcare facilities. Mixed-mode research methods, such as survey, observation, and focus group, were…

  12. Develop security architecture for both in-house healthcare information systems and electronic patient record

    NASA Astrophysics Data System (ADS)

    Zhang, Jianguo; Chen, Xiaomeng; Zhuang, Jun; Jiang, Jianrong; Zhang, Xiaoyan; Wu, Dongqing; Huang, H. K.

    2003-05-01

    In this paper, we presented a new security approach to provide security measures and features in both healthcare information systems (PACS, RIS/HIS), and electronic patient record (EPR). We introduced two security components, certificate authoring (CA) system and patient record digital signature management (DSPR) system, as well as electronic envelope technology, into the current hospital healthcare information infrastructure to provide security measures and functions such as confidential or privacy, authenticity, integrity, reliability, non-repudiation, and authentication for in-house healthcare information systems daily operating, and EPR exchanging among the hospitals or healthcare administration levels, and the DSPR component manages the all the digital signatures of patient medical records signed through using an-symmetry key encryption technologies. The electronic envelopes used for EPR exchanging are created based on the information of signers, digital signatures, and identifications of patient records stored in CAS and DSMS, as well as the destinations and the remote users. The CAS and DSMS were developed and integrated into a RIS-integrated PACS, and the integration of these new security components is seamless and painless. The electronic envelopes designed for EPR were used successfully in multimedia data transmission.

  13. Automated Methods to Extract Patient New Information from Clinical Notes in Electronic Health Record Systems

    ERIC Educational Resources Information Center

    Zhang, Rui

    2013-01-01

    The widespread adoption of Electronic Health Record (EHR) has resulted in rapid text proliferation within clinical care. Clinicians' use of copying and pasting functions in EHR systems further compounds this by creating a large amount of redundant clinical information in clinical documents. A mixture of redundant information (especially outdated…

  14. A study of general practitioners’ perspectives on electronic medical records systems in NHSScotland

    PubMed Central

    2013-01-01

    Background Primary care doctors in NHSScotland have been using electronic medical records within their practices routinely for many years. The Scottish Health Executive eHealth strategy (2008-2011) has recently brought radical changes to the primary care computing landscape in Scotland: an information system (GPASS) which was provided free-of-charge by NHSScotland to a majority of GP practices has now been replaced by systems provided by two approved commercial providers. The transition to new electronic medical records had to be completed nationally across all health-boards by March 2012. Methods We carried out 25 in-depth semi-structured interviews with primary care doctors to elucidate GPs’ perspectives on their practice information systems and collect more general information on management processes in the patient surgical pathway in NHSScotland. We undertook a thematic analysis of interviewees’ responses, using Normalisation Process Theory as the underpinning conceptual framework. Results The majority of GPs’ interviewed considered that electronic medical records are an integral and essential element of their work during the consultation, playing a key role in facilitating integrated and continuity of care for patients and making clinical information more accessible. However, GPs expressed a number of reservations about various system functionalities – for example: in relation to usability, system navigation and information visualisation. Conclusion Our study highlights that while electronic information systems are perceived as having important benefits, there remains substantial scope to improve GPs’ interaction and overall satisfaction with these systems. Iterative user-centred improvements combined with additional training in the use of technology would promote an increased understanding, familiarity and command of the range of functionalities of electronic medical records among primary care doctors. PMID:23688255

  15. Integration of Evidence into a Detailed Clinical Model-based Electronic Nursing Record System

    PubMed Central

    Park, Hyeoun-Ae; Jeon, Eunjoo; Chung, Eunja

    2012-01-01

    Objectives The purpose of this study was to test the feasibility of an electronic nursing record system for perinatal care that is based on detailed clinical models and clinical practice guidelines in perinatal care. Methods This study was carried out in five phases: 1) generating nursing statements using detailed clinical models; 2) identifying the relevant evidence; 3) linking nursing statements with the evidence; 4) developing a prototype electronic nursing record system based on detailed clinical models and clinical practice guidelines; and 5) evaluating the prototype system. Results We first generated 799 nursing statements describing nursing assessments, diagnoses, interventions, and outcomes using entities, attributes, and value sets of detailed clinical models for perinatal care which we developed in a previous study. We then extracted 506 recommendations from nine clinical practice guidelines and created sets of nursing statements to be used for nursing documentation by grouping nursing statements according to these recommendations. Finally, we developed and evaluated a prototype electronic nursing record system that can provide nurses with recommendations for nursing practice and sets of nursing statements based on the recommendations for guiding nursing documentation. Conclusions The prototype system was found to be sufficiently complete, relevant, useful, and applicable in terms of content, and easy to use and useful in terms of system user interface. This study has revealed the feasibility of developing such an ENR system. PMID:22844649

  16. Building a national electronic medical record exchange system - experiences in Taiwan.

    PubMed

    Li, Yu-Chuan Jack; Yen, Ju-Chuan; Chiu, Wen-Ta; Jian, Wen-Shan; Syed-Abdul, Shabbir; Hsu, Min-Huei

    2015-08-01

    There are currently 501 hospitals and about 20,000 clinics in Taiwan. The National Health Insurance (NHI) system, which is operated by the NHI Administration, uses a single-payer system and covers 99.9% of the nation's total population of 23,000,000. Taiwan's NHI provides people with a high degree of freedom in choosing their medical care options. However, there is the potential concern that the available medical resources will be overused. The number of doctor consultations per person per year is about 15. Duplication of laboratory tests and prescriptions are not rare either. Building an electronic medical record exchange system is a good method of solving these problems and of improving continuity in health care. In November 2009, Taiwan's Executive Yuan passed the 'Plan for accelerating the implementation of electronic medical record systems in medical institutions' (2010-2012; a 3-year plan). According to this plan, a patient can, at any hospital in Taiwan, by using his/her health insurance IC card and physician's medical professional IC card, upon signing a written agreement, retrieve all important medical records for the past 6 months from other participating hospitals. The focus of this plan is to establish the National Electronic Medical Record Exchange Centre (EEC). A hospital's information system will be connected to the EEC through an electronic medical record (EMR) gateway. The hospital will convert the medical records for the past 6 months in its EMR system into standardized files and save them on the EMR gateway. The most important functions of the EEC are to generate an index of all the XML files on the EMR gateways of all hospitals, and to provide search and retrieval services for hospitals and clinics. The EEC provides four standard inter-institution EMR retrieval services covering medical imaging reports, laboratory test reports, discharge summaries, and outpatient records. In this system, we adopted the Health Level 7 (HL7) Clinical Document

  17. Interoperability of a mobile health care solution with electronic healthcare record systems.

    PubMed

    De Toledo, P; Lalinde, W; Del Pozo, F; Thurber, D; Jimenez-Fernandez, S

    2006-01-01

    Mobile health care solutions involving patient monitoring are an increasingly accepted element in chronic disease management strategies. When used in healthcare systems with different providers, it is essential that the information gathered from the patient is available at each of these providers information repositories. This paper describes the design of a connectivity interface based on the HL7 standard that allows the MOTOHEALTH mobile health care solution to communicate with external electronic healthcare record systems supporting HL7. PMID:17946289

  18. Development of an Electronic Claim System Based on an Integrated Electronic Health Record Platform to Guarantee Interoperability

    PubMed Central

    Kim, Hwa Sun; Cho, Hune

    2011-01-01

    Objectives We design and develop an electronic claim system based on an integrated electronic health record (EHR) platform. This system is designed to be used for ambulatory care by office-based physicians in the United States. This is achieved by integrating various medical standard technologies for interoperability between heterogeneous information systems. Methods The developed system serves as a simple clinical data repository, it automatically fills out the Centers for Medicare and Medicaid Services (CMS)-1500 form based on information regarding the patients and physicians' clinical activities. It supports electronic insurance claims by creating reimbursement charges. It also contains an HL7 interface engine to exchange clinical messages between heterogeneous devices. Results The system partially prevents physician malpractice by suggesting proper treatments according to patient diagnoses and supports physicians by easily preparing documents for reimbursement and submitting claim documents to insurance organizations electronically, without additional effort by the user. To show the usability of the developed system, we performed an experiment that compares the time spent filling out the CMS-1500 form directly and time required create electronic claim data using the developed system. From the experimental results, we conclude that the system could save considerable time for physicians in making claim documents. Conclusions The developed system might be particularly useful for those who need a reimbursement-specialized EHR system, even though the proposed system does not completely satisfy all criteria requested by the CMS and Office of the National Coordinator for Health Information Technology (ONC). This is because the criteria are not sufficient but necessary condition for the implementation of EHR systems. The system will be upgraded continuously to implement the criteria and to offer more stable and transparent transmission of electronic claim data. PMID

  19. [Design and Implementation of a Mobile Operating Room Information Management System Based on Electronic Medical Record].

    PubMed

    Liu, Baozhen; Liu, Zhiguo; Wang, Xianwen

    2015-06-01

    A mobile operating room information management system with electronic medical record (EMR) is designed to improve work efficiency and to enhance the patient information sharing. In the operating room, this system acquires the information from various medical devices through the Client/Server (C/S) pattern, and automatically generates XML-based EMR. Outside the operating room, this system provides information access service by using the Browser/Server (B/S) pattern. Software test shows that this system can correctly collect medical information from equipment and clearly display the real-time waveform. By achieving surgery records with higher quality and sharing the information among mobile medical units, this system can effectively reduce doctors' workload and promote the information construction of the field hospital. PMID:26485982

  20. Architecture of portable electronic medical records system integrated with streaming media.

    PubMed

    Chen, Wei; Shih, Chien-Chou

    2012-02-01

    Due to increasing occurrence of accidents and illness during business trips, travel, or overseas studies, the requirement for portable EMR (Electronic Medical Records) has increased. This study proposes integrating streaming media technology into the EMR system to facilitate referrals, contracted laboratories, and disease notification among hospitals. The current study encoded static and dynamic medical images of patients into a streaming video format and stored them in a Flash Media Server (FMS). Based on the Taiwan Electronic Medical Record Template (TMT) standard, EMR records can be converted into XML documents and used to integrate description fields with embedded streaming videos. This investigation implemented a web-based portable EMR interchanging system using streaming media techniques to expedite exchanging medical image information among hospitals. The proposed architecture of the portable EMR retrieval system not only provides local hospital users the ability to acquire EMR text files from a previous hospital, but also helps access static and dynamic medical images as reference for clinical diagnosis and treatment. The proposed method protects property rights of medical images through information security mechanisms of the Medical Record Interchange Service Center and Health Certificate Authorization to facilitate proper, efficient, and continuous treatment of patients. PMID:20703752

  1. Exploring the Relationships between the Electronic Health Record System Components and Patient Outcomes in an Acute Hospital Setting

    ERIC Educational Resources Information Center

    Wiggley, Shirley L.

    2011-01-01

    Purpose: The purpose of this study was to examine the relationship between the electronic health record system components and patient outcomes in an acute hospital setting, given that the current presidential administration has earmarked nearly $50 billion to the implementation of the electronic health record. The relationship between the…

  2. Public trust in health information sharing: implications for biobanking and electronic health record systems.

    PubMed

    Platt, Jodyn; Kardia, Sharon

    2015-01-01

    Biobanks are made all the more valuable when the biological samples they hold can be linked to health information collected in research, electronic health records, or public health practice. Public trust in such systems that share health information for research and health care practice is understudied. Our research examines characteristics of the general public that predict trust in a health system that includes researchers, health care providers, insurance companies and public health departments. We created a 119-item survey of predictors and attributes of system trust and fielded it using Amazon's MTurk system (n = 447). We found that seeing one's primary care provider, having a favorable view of data sharing and believing that data sharing will improve the quality of health care, as well as psychosocial factors (altruism and generalized trust) were positively and significantly associated with system trust. As expected, privacy concern, but counterintuitively, knowledge about health information sharing were negatively associated with system trust. We conclude that, in order to assure the public's trust, policy makers charged with setting best practices for governance of biobanks and access to electronic health records should leverage critical access points to engage a diverse public in joint decision making. PMID:25654300

  3. Public Trust in Health Information Sharing: Implications for Biobanking and Electronic Health Record Systems

    PubMed Central

    Platt, Jodyn; Kardia, Sharon

    2015-01-01

    Biobanks are made all the more valuable when the biological samples they hold can be linked to health information collected in research, electronic health records, or public health practice. Public trust in such systems that share health information for research and health care practice is understudied. Our research examines characteristics of the general public that predict trust in a health system that includes researchers, health care providers, insurance companies and public health departments. We created a 119-item survey of predictors and attributes of system trust and fielded it using Amazon’s MTurk system (n = 447). We found that seeing one’s primary care provider, having a favorable view of data sharing and believing that data sharing will improve the quality of health care, as well as psychosocial factors (altruism and generalized trust) were positively and significantly associated with system trust. As expected, privacy concern, but counterintuitively, knowledge about health information sharing were negatively associated with system trust. We conclude that, in order to assure the public’s trust, policy makers charged with setting best practices for governance of biobanks and access to electronic health records should leverage critical access points to engage a diverse public in joint decision making. PMID:25654300

  4. Development and Preliminary Evaluation of a Prototype of a Learning Electronic Medical Record System

    PubMed Central

    King, Andrew J.; Cooper, Gregory F.; Hochheiser, Harry; Clermont, Gilles; Visweswaran, Shyam

    2015-01-01

    Electronic medical records (EMRs) are capturing increasing amounts of data per patient. For clinicians to efficiently and accurately understand a patient’s clinical state, better ways are needed to determine when and how to display EMR data. We built a prototype system that records how physicians view EMR data, which we used to train models that predict which EMR data will be relevant in a given patient. We call this approach a Learning EMR (LEMR). A physician used the prototype to review 59 intensive care unit (ICU) patient cases. We used the data-access patterns from these cases to train logistic regression models that, when evaluated, had AUROC values as high as 0.92 and that averaged 0.73, supporting that the approach is promising. A preliminary usability study identified advantages of the system and a few concerns about implementation. Overall, 3 of 4 ICU physicians were enthusiastic about features of the prototype. PMID:26958296

  5. Nurses' perceptions of and attitudes toward an electronic medical record system at Seoul National University Hospital.

    PubMed

    Ahn, Tae-Sa; Park, Ihn Sook; You, Ock-Su; Shin, Hyeon-Ju; Woo, Kyung-Shun; Jo, Eun-Mee

    2006-01-01

    In an effort to investigate nurses' perceptions of and attitudes toward the use of electronic medical record (EMR) systems, 904 nurses in a university hospital were surveyed for demographic data and their perceptions of and attitudes toward an EMR system 6 months after its implementation. The questionnaire consisted of demographic information, perception statements relating to the effect of an EMR system, and attitude statements toward an EMR system (assessed on 4-point Likert scales, Cronbach's alpha = 0.979). Nurses' perceptions and attitudes were generally positive and correlated with the type of nursing unit, and their age, years of nursing experience, and job title. This result reinforces that nurses are generally accepting of the implementation of a new EMR system. However, strategies are needed for improving the satisfaction of nurses who have a negative perception of and attitude toward EMR systems. It is recommended that the findings of our study be implemented in other hospitals with ongoing EMR projects. PMID:17102423

  6. Predicting length of stay from an electronic patient record system: a primary total knee replacement example

    PubMed Central

    2014-01-01

    Background To investigate whether factors can be identified that significantly affect hospital length of stay from those available in an electronic patient record system, using primary total knee replacements as an example. To investigate whether a model can be produced to predict the length of stay based on these factors to help resource planning and patient expectations on their length of stay. Methods Data were extracted from the electronic patient record system for discharges from primary total knee operations from January 2007 to December 2011 (n = 2,130) at one UK hospital and analysed for their effect on length of stay using Mann-Whitney and Kruskal-Wallis tests for discrete data and Spearman’s correlation coefficient for continuous data. Models for predicting length of stay for primary total knee replacements were tested using the Poisson regression and the negative binomial modelling techniques. Results Factors found to have a significant effect on length of stay were age, gender, consultant, discharge destination, deprivation and ethnicity. Applying a negative binomial model to these variables was successful. The model predicted the length of stay of those patients who stayed 4–6 days (~50% of admissions) with 75% accuracy within 2 days (model data). Overall, the model predicted the total days stayed over 5 years to be only 88 days more than actual, a 6.9% uplift (test data). Conclusions Valuable information can be found about length of stay from the analysis of variables easily extracted from an electronic patient record system. Models can be successfully created to help improve resource planning and from which a simple decision support system can be produced to help patient expectation on their length of stay. PMID:24708853

  7. The Evaluation of SEPAS National Project Based on Electronic Health Record System (EHRS) Coordinates in Iran

    PubMed Central

    Asadi, Farkhondeh; Moghaddasi, Hamid; Rabiei, Reza; Rahimi, Forough; Mirshekarlou, Soheila Jahangiri

    2015-01-01

    Background: Electronic Health Records (EHRs) are secure private lifetime records that can be shared by using interoperability standards between different organizations and units. These records are created by the productive system that is called EHR system. Implementing EHR systems has a number of advantages such as facilitating access to medical records, supporting patient care, and improving the quality of care and health care decisions. The project of electronic health record system in Iran, which is the goal of this study, is called SEPAS. With respect to the importance of EHR and EHR systems the researchers investigated the project from two perspectives: determining the coordinates of the project and how it evolved, and incorporating the coordinates of EHR system in this project. Methods: In this study two evaluation tools, a checklist and a questionnaire, were developed based on texts and reliable documentation. The questionnaire and the checklist were validated using content validity by receiving the experts’ comments and the questionnaire’s reliability was estimated through Test-retest(r =87%). Data were collected through study, observation, and interviews with experts and specialists of SEPAS project. Results: This research showed that SEPAS project, like any other project, could be evaluated. It has some aims; steps, operational phases and certain start and end time, but all the resources and required facilities for the project have not been considered. Therefore it could not satisfy its specified objective and the useful and unique changes which are the other characteristics of any project have not been achieved. In addition, the findings of EHR system coordinates can be determined in 4 categories as Standards and rules, Telecommunication-Communication facilities, Computer equipment and facilities and Stakeholders. Conclusions: The findings indicated that SEPAS has the ability to use all standards of medical terminology and health classification

  8. Interconnection of electronic medical record with clinical data management system by CDISC ODM.

    PubMed

    Matsumura, Yasushi; Hattori, Atsushi; Manabe, Shiro; Takeda, Toshihiro; Takahashi, Daiyo; Yamamoto, Yuichiro; Murata, Taizo; Mihara, Naoki

    2014-01-01

    EDC system has been used in the field of clinical research. The current EDC system does not connect with electronic medical record system (EMR), thus a medical staff has to transcribe the data in EMR to EDC system manually. This redundant process causes not only inefficiency but also human error. We developed an EDC system cooperating with EMR, in which the data required for a clinical research form (CRF) is transcribed automatically from EMR to electronic CRF (eCRF) and is sent via network. We call this system as "eCRF reporter". The interface module of eCRF reporter can retrieves the data in EMR database including patient biography data, laboratory test data, prescription data and data entered by template in progress notes. The eCRF reporter also enables users to enter data directly to eCRF. The eCRF reporter generates CDISC ODM file and PDF which is a translated form of Clinical data in ODM. After storing eCRF in EMR, it is transferred via VPN to a clinical data management system (CDMS) which can receive the eCRF files and parse ODM. We started some clinical research by using this system. This system is expected to promote clinical research efficiency and strictness. PMID:25160311

  9. The politics of healthcare informatics: knowledge management using an electronic medical record system.

    PubMed

    Bar-Lev, Shirly

    2015-03-01

    The design and implementation of an electronic medical record system pose significant epistemological and practical complexities. Despite optimistic assessments of their potential contribution to the quality of care, their implementation has been problematic, and their actual employment in various clinical settings remains controversial. Little is known about how their use actually mediates knowing. Employing a variety of qualitative research methods, this article attempts an answer by illustrating how omitting, editing and excessive reporting were employed as part of nurses' and physicians' political efforts to shape knowledge production and knowledge sharing in a technologically mediated healthcare setting. PMID:25581280

  10. Stepwise approach to establishing multiple outreach laboratory information system-electronic medical record interfaces

    PubMed Central

    Pantanowitz, Liron; LaBranche, Wayne; Lareau, William

    2010-01-01

    Clinical laboratory outreach business is changing as more physician practices adopt an electronic medical record (EMR). Physician connectivity with the laboratory information system (LIS) is consequently becoming more important. However, there are no reports available to assist the informatician with establishing and maintaining outreach LIS–EMR connectivity. A four-stage scheme is presented that was successfully employed to establish unidirectional and bidirectional interfaces with multiple physician EMRs. This approach involves planning (step 1), followed by interface building (step 2) with subsequent testing (step 3), and finally ongoing maintenance (step 4). The role of organized project management, software as a service (SAAS), and alternate solutions for outreach connectivity are discussed. PMID:20805958

  11. Stepwise approach to establishing multiple outreach laboratory information system-electronic medical record interfaces.

    PubMed

    Pantanowitz, Liron; Labranche, Wayne; Lareau, William

    2010-01-01

    Clinical laboratory outreach business is changing as more physician practices adopt an electronic medical record (EMR). Physician connectivity with the laboratory information system (LIS) is consequently becoming more important. However, there are no reports available to assist the informatician with establishing and maintaining outreach LIS-EMR connectivity. A four-stage scheme is presented that was successfully employed to establish unidirectional and bidirectional interfaces with multiple physician EMRs. This approach involves planning (step 1), followed by interface building (step 2) with subsequent testing (step 3), and finally ongoing maintenance (step 4). The role of organized project management, software as a service (SAAS), and alternate solutions for outreach connectivity are discussed. PMID:20805958

  12. Risk mitigation of shared electronic records system in campus institutions: medical social work practice in singapore.

    PubMed

    Ow Yong, Lai Meng; Tan, Amanda Wei Li; Loo, Cecilia Lay Keng; Lim, Esther Li Ping

    2014-10-01

    In 2013, the Singapore General Hospital (SGH) Campus initiated a shared electronic system where patient records and documentations were standardized and shared across institutions within the Campus. The project was initiated to enhance quality of health care, improve accessibility, and ensure integrated (as opposed to fragmented) care for best outcomes in our patients. In mitigating the risks of ICT, it was found that familiarity with guiding ethical principles, and ensuring adherence to regulatory and technical competencies in medical social work were important. The need to negotiate and maneuver in a large environment within the Campus to ensure proactive integrative process helped. PMID:25321932

  13. Impact of Electronic Health Record Systems on Information Integrity: Quality and Safety Implications

    PubMed Central

    Bowman, Sue

    2013-01-01

    While the adoption of electronic health record (EHR) systems promises a number of substantial benefits, including better care and decreased healthcare costs, serious unintended consequences from the implementation of these systems have emerged. Poor EHR system design and improper use can cause EHR-related errors that jeopardize the integrity of the information in the EHR, leading to errors that endanger patient safety or decrease the quality of care. These unintended consequences also may increase fraud and abuse and can have serious legal implications. This literature review examines the impact of unintended consequences of the use of EHR systems on the quality of care and proposed solutions to address EHR-related errors. This analysis of the literature on EHR risks is intended to serve as an impetus for further research on the prevalence of these risks, their impact on quality and safety of patient care, and strategies for reducing them. PMID:24159271

  14. Electronic Health Record Systems and Intent to Apply for Meaningful Use Incentives among Office-based Physician ...

    MedlinePlus

    ... in Wisconsin. The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act authorized incentive payments through Medicare and Medicaid to increase physician adoption of electronic health record (EHR) systems ( 1 , 2 ). Eligible Medicare and Medicaid physicians may ...

  15. An Electronic Medical Record system to support HIV treatment in rural Haiti.

    PubMed

    Jazayeri, Darius; Farmer, Paul; Nevil, Patrice; Mukherjee, Joia S; Leandre, Fernet; Fraser, Hamish S F

    2003-01-01

    HIV-AIDS has become the world's leading infectious cause of adult deaths. Approximately 5% of Haiti's adult population is infected with HIV, making it the most affected nation in the western hemisphere[1]. The non-governmental organization Zanmi Lasante (ZL) launched an innovative program 5 years ago to treat HIV patients in the very impoverished central plateau with highly active anti-retroviral therapy (HAART)[1]. ZL currently follows more than 4000 HIV-positive patients, over 10% of whom are already on HAART, and was recently awarded funds from the Haitian grant from the Global Fund to fight AIDS, Tuberculosis and Malaria. Expanding treatment in a region with few doctors and virtually no roads, electricity, or electronic communication is a major challenge requiring careful coordination of clinical care, investigations and drug supplies. We describe a prototype Electronic Medical Record system to support treatment of HIV and tuberculosis in remote and impoverished areas. PMID:14728383

  16. Transforming XML-based electronic patient records for use in medical case based reasoning systems.

    PubMed

    Abidi, S S; Manickam, S

    2000-01-01

    Electronic patient records (EPR) can be regarded as an implicit source of clinical behaviour and problem-solving knowledge, systematically compiled by clinicians. We present an approach, together with its computational implementation, to pro-actively transform XML-based EPR into specialised Clinical Cases (CC) in the realm of Medical Case Base Systems. The 'correct' transformation of EPR to CC involves structural, terminological and conceptual standardisation, which is achieved by a confluence of techniques and resources, such as XML, UMLS (meta-thesaurus) and medical knowledge ontologies. We present below the functional architecture of a Medical Case-Base Reasoning Info-Structure (MCRIS) that features two distinct, yet related, functionalities: (1) a generic medical case-based reasoning system for decision-support activities; and (2) an EPR-CC transformation system to transform typical EPR's to CC. PMID:11187645

  17. A SWOT Analysis of the Various Backup Scenarios Used in Electronic Medical Record Systems

    PubMed Central

    Seo, Hwa Jeong; Kim, Hye Hyeon

    2011-01-01

    Objectives Electronic medical records (EMRs) are increasingly being used by health care services. Currently, if an EMR shutdown occurs, even for a moment, patient safety and care can be seriously impacted. Our goal was to determine the methodology needed to develop an effective and reliable EMR backup system. Methods Our "independent backup system by medical organizations" paradigm implies that individual medical organizations develop their own EMR backup systems within their organizations. A "personal independent backup system" is defined as an individual privately managing his/her own medical records, whereas in a "central backup system by the government" the government controls all the data. A "central backup system by private enterprises" implies that individual companies retain control over their own data. A "cooperative backup system among medical organizations" refers to a networked system established through mutual agreement. The "backup system based on mutual trust between an individual and an organization" means that the medical information backup system at the organizational level is established through mutual trust. Results Through the use of SWOT analysis it can be shown that cooperative backup among medical organizations is possible to be established through a network composed of various medical agencies and that it can be managed systematically. An owner of medical information only grants data access to the specific person who gave the authorization for backup based on the mutual trust between an individual and an organization. Conclusions By employing SWOT analysis, we concluded that a linkage among medical organizations or between an individual and an organization can provide an efficient backup system. PMID:22084811

  18. A knowledge-based taxonomy of critical factors for adopting electronic health record systems by physicians: a systematic literature review

    PubMed Central

    2010-01-01

    Background The health care sector is an area of social and economic interest in several countries; therefore, there have been lots of efforts in the use of electronic health records. Nevertheless, there is evidence suggesting that these systems have not been adopted as it was expected, and although there are some proposals to support their adoption, the proposed support is not by means of information and communication technology which can provide automatic tools of support. The aim of this study is to identify the critical adoption factors for electronic health records by physicians and to use them as a guide to support their adoption process automatically. Methods This paper presents, based on the PRISMA statement, a systematic literature review in electronic databases with adoption studies of electronic health records published in English. Software applications that manage and process the data in the electronic health record have been considered, i.e.: computerized physician prescription, electronic medical records, and electronic capture of clinical data. Our review was conducted with the purpose of obtaining a taxonomy of the physicians main barriers for adopting electronic health records, that can be addressed by means of information and communication technology; in particular with the information technology roles of the knowledge management processes. Which take us to the question that we want to address in this work: "What are the critical adoption factors of electronic health records that can be supported by information and communication technology?". Reports from eight databases covering electronic health records adoption studies in the medical domain, in particular those focused on physicians, were analyzed. Results The review identifies two main issues: 1) a knowledge-based classification of critical factors for adopting electronic health records by physicians; and 2) the definition of a base for the design of a conceptual framework for supporting the

  19. Principal Challenges Facing Electronic Records Management in Federal Agencies Today.

    ERIC Educational Resources Information Center

    Patterson, Giovanna; Sprehe, J. Timothy

    2002-01-01

    Discusses electronic records management in the federal government. Highlights include managing electronic mail; information technology planning, systems design, and architecture; updating conventional records management; integrating electronic records management with other information technology systems; challenges of end-user training; business…

  20. Building national electronic medical record systems via the World Wide Web.

    PubMed Central

    Kohane, I S; Greenspun, P; Fackler, J; Cimino, C; Szolovits, P

    1996-01-01

    Electronic medical record systems (EMRSs) currently do not lend themselves easily to cross-institutional clinical care and research. Unique system designs coupled with a lack of standards have led to this difficulty. The authors have designed a preliminary EMRS architecture (W3-EMRS) that exploits the multiplatform, multiprotocol, client-server technology of the World Wide Web. The architecture abstracts the clinical information model and the visual presentation away from the underlying EMRS. As a result, computation upon data elements of the EMRS and their presentation are no longer tied to the underlying EMRS structures. The architecture is intended to enable implementation of programs that provide uniform access to multiple, heterogeneous legacy EMRSs. The authors have implemented an initial prototype of W3-EMRS that accesses the database of the Boston Children's Hospital Clinician's Workstation. PMID:8723610

  1. Stand-alone laboratory information systems versus laboratory modules incorporated in the electronic health record.

    PubMed

    Sinard, John H; Castellani, William J; Wilkerson, Myra L; Henricks, Walter H

    2015-03-01

    The increasing availability of laboratory information management modules within enterprise electronic health record solutions has resulted in some institutional administrators deciding which laboratory information system will be used to manage workflow within the laboratory, often with minimal input from the pathologists. This article aims to educate pathologists on many of the issues and implications this change may have on laboratory operations, positioning them to better evaluate and represent the needs of the laboratory during this decision-making process. The experiences of the authors, many of their colleagues, and published observations relevant to this debate are summarized. There are multiple dimensions of the interdependency between the pathology laboratory and its information system that must be factored into the decision. Functionality is important, but management authority and gap-ownership are also significant elements to consider. Thus, the pathologist must maintain an active role in the decision-making process to ensure the success of the laboratory. PMID:25724027

  2. Disseminating Context-Specific Access to Online Knowledge Resources within Electronic Health Record Systems

    PubMed Central

    Fiol, Guilherme Del; Curtis, Clayton; Cimino, James J.; Iskander, Andrew; Kalluri, Aditya S.D.; Jing, Xia; Hulse, Nathan C.; Long, Jie; Overby, Casey L.; Schardt, Connie; Douglas, David M.

    2013-01-01

    Clinicians’ patient care information needs are frequent and largely unmet. Online knowledge resources are available that can help clinicians meet these information needs. Yet, significant barriers limit the use of these resources within the clinical workflow. Infobuttons are clinical decision support tools that use the clinical context (e.g., institution, user, patient) within electronic health record (EHR) systems to anticipate clinicians’ questions and provide automated links to relevant information in knowledge resources. This paper describes OpenInfobutton (www.openinfobutton.org): a standards-based, open source Web service that was designed to disseminate infobutton capabilities in multiple EHR systems and healthcare organizations. OpenInfobutton has been successfully integrated with 38 knowledge resources at 5 large healthcare organizations in the United States. We describe the OpenInfobutton architecture, knowledge resource integration, and experiences at five large healthcare organizations. PMID:23920641

  3. A pragmatic method for electronic medical record-based observational studies: developing an electronic medical records retrieval system for clinical research

    PubMed Central

    Yamamoto, Keiichi; Sumi, Eriko; Yamazaki, Toru; Asai, Keita; Yamori, Masashi; Teramukai, Satoshi; Bessho, Kazuhisa; Yokode, Masayuki; Fukushima, Masanori

    2012-01-01

    Objective The use of electronic medical record (EMR) data is necessary to improve clinical research efficiency. However, it is not easy to identify patients who meet research eligibility criteria and collect the necessary information from EMRs because the data collection process must integrate various techniques, including the development of a data warehouse and translation of eligibility criteria into computable criteria. This research aimed to demonstrate an electronic medical records retrieval system (ERS) and an example of a hospital-based cohort study that identified both patients and exposure with an ERS. We also evaluated the feasibility and usefulness of the method. Design The system was developed and evaluated. Participants In total, 800 000 cases of clinical information stored in EMRs at our hospital were used. Primary and secondary outcome measures The feasibility and usefulness of the ERS, the method to convert text from eligible criteria to computable criteria, and a confirmation method to increase research data accuracy. Results To comprehensively and efficiently collect information from patients participating in clinical research, we developed an ERS. To create the ERS database, we designed a multidimensional data model optimised for patient identification. We also devised practical methods to translate narrative eligibility criteria into computable parameters. We applied the system to an actual hospital-based cohort study performed at our hospital and converted the test results into computable criteria. Based on this information, we identified eligible patients and extracted data necessary for confirmation by our investigators and for statistical analyses with our ERS. Conclusions We propose a pragmatic methodology to identify patients from EMRs who meet clinical research eligibility criteria. Our ERS allowed for the efficient collection of information on the eligibility of a given patient, reduced the labour required from the investigators and

  4. The Usability of Electronic Personal Health Record Systems for an Underserved Adult Population

    PubMed Central

    Czaja, Sara J.; Zarcadoolas, Christina; Vaughon, Wendy L.; Lee, Chin Chin; Rockoff, Maxine L.; Levy, Joslyn

    2015-01-01

    Objective The goals of this study were to identify the demands associated with using electronic personal health records (PHRs) and to evaluate the ability of adults of lower socioeconomic status and low health literacy to use PHRs to perform health management activities. Background PHRs are proliferating in clinical practices and health care organizations. These systems offer the potential of increasing the active involvement of patients in health self-management. However, little is known about the actual usability of these tools for health consumers. Method We used task analysis and health literacy load analysis to identify the cognitive and literacy demands inherent in the use of PHRs and evaluated the usability of three currently available PHR systems with a sample of 54 adults. Participants used the systems to perform tasks related to medication management, interpretation of lab/test results, and health maintenance. Data were also gathered on the participants’ perception of the potential value of using a PHR. Results The results indicated that a majority of the participants had difficulty completing the tasks and needed assistance. There was some variability according to task and PHR system. However, most participants perceived the use of PHRs as valuable. Conclusions Although considered a valuable tool by consumers, the use of PHR systems may be challenging for many people. Strategies are needed to enhance the usability of these systems, especially for people with low literacy, low health literacy, or limited technology skills. Application The data from this study have implications for the design of PHRs. PMID:25875437

  5. An innovative electronic health records system for rare and complex diseases

    PubMed Central

    2015-01-01

    Background There exists a large number of rare and complex diseases that are neglected due to the difficulty in diagnosis and treatment. Being rare, they normally do not justify the costs of developing an especialized Electronic Health Record (EHR) system to assist doctors and patients of these diseases. In this work we propose the use of Computer applications known as Laboratory Information Management Systems (LIMS) to address this issue. Results In this work we describe a fully customizable EHR system that uses a workflow based LIMS with an easy to adapt interface for data collection and retrieval. This system can easily be customized to manage different types of medical data. The customization for a new disease can be done in a few hours with the help of a specialist. Conclusion We have used the proposed system to manage data from patients of three complex diseases: neuromyelitis optica, paracoccidioidomycosis and adrenoleukodistrofy. These diseases have very different symptoms, exams, diagnostics and treatments, but the FluxMED system is able to manage these data in a highly specialized manner without any modifications to its code. PMID:26695733

  6. Meaningful Use of an Electronic Health Record in the New York City Jail System

    PubMed Central

    Martelle, Michelle; Farber, Benjamin; Stazesky, Richard; Dickey, Nathaniel; Parsons, Amanda

    2015-01-01

    Use of electronic health records (EHRs) is an important innovation for patients in jails and prisons. Efforts to incentivize health information technology, including the Medicaid EHR Incentive Program, are generally aimed at community providers; however, recent regulation changes allow participation of jail health providers. In the New York City jail system, the Department of Health and Mental Hygiene oversees care delivery and was able to participate in and earn incentives through the Medicaid EHR Incentive Program. Despite the challenges of this program and other health information innovations, participation by correctional health services can generate financial assistance and useful frameworks to guide these efforts. Policymakers will need to consider the specific challenges of implementing these programs in correctional settings. PMID:26180977

  7. Meaningful Use of an Electronic Health Record in the New York City Jail System.

    PubMed

    Martelle, Michelle; Farber, Benjamin; Stazesky, Richard; Dickey, Nathaniel; Parsons, Amanda; Venters, Homer

    2015-09-01

    Use of electronic health records (EHRs) is an important innovation for patients in jails and prisons. Efforts to incentivize health information technology, including the Medicaid EHR Incentive Program, are generally aimed at community providers; however, recent regulation changes allow participation of jail health providers. In the New York City jail system, the Department of Health and Mental Hygiene oversees care delivery and was able to participate in and earn incentives through the Medicaid EHR Incentive Program. Despite the challenges of this program and other health information innovations, participation by correctional health services can generate financial assistance and useful frameworks to guide these efforts. Policymakers will need to consider the specific challenges of implementing these programs in correctional settings. PMID:26180977

  8. Lessons Learned from Implementation of Voice Recognition for Documentation in the Military Electronic Health Record System

    PubMed Central

    Hoyt, Robert; Yoshihashi, Ann

    2010-01-01

    This study evaluated the implementation of voice recognition (VR) for documenting outpatient encounters in the electronic health record (EHR) system at a military hospital and its 12 outlying clinics. Seventy-five clinicians volunteered to use VR, and 64 (85 percent) responded to an online questionnaire post implementation to identify variables related to VR continuance or discontinuance. The variables investigated were user characteristics, training experience, logistics, and VR utility. Forty-four respondents (69 percent) continued to use VR and overall felt that the software was accurate, was faster than typing, improved note quality, and permitted closing a patient encounter the same day. The discontinuation rate of 31 percent was related to location at an outlying clinic and perceptions of inadequacy of training, decreased productivity due to VR inaccuracies, and no improvement in note quality. Lessons learned can impact future deployment of VR in other military and civilian healthcare facilities. PMID:20697464

  9. Effects of Shared Electronic Health Record Systems on Drug-Drug Interaction and Duplication Warning Detection

    PubMed Central

    Rinner, Christoph; Grossmann, Wilfried; Sauter, Simone Katja; Wolzt, Michael; Gall, Walter

    2015-01-01

    Shared electronic health records (EHRs) systems can offer a complete medication overview of the prescriptions of different health care providers. We use health claims data of more than 1 million Austrians in 2006 and 2007 with 27 million prescriptions to estimate the effect of shared EHR systems on drug-drug interaction (DDI) and duplication warnings detection and prevention. The Austria Codex and the ATC/DDD information were used as a knowledge base to detect possible DDIs. DDIs are categorized as severe, moderate, and minor interactions. In comparison to the current situation where only DDIs between drugs issued by a single health care provider can be checked, the number of warnings increases significantly if all drugs of a patient are checked: severe DDI warnings would be detected for 20% more persons, and the number of severe DDI warnings and duplication warnings would increase by 17%. We show that not only do shared EHR systems help to detect more patients with warnings but DDIs are also detected more frequently. Patient safety can be increased using shared EHR systems. PMID:26682218

  10. An Information Systems Model of the Determinants of Electronic Health Record Use

    PubMed Central

    Messeri, P.; Khan, S.; Millery, M.; Campbell, A.; Merrill, J.; Shih, S.; Kukafka, R.

    2013-01-01

    Objectives The prominence given to universal implementation of electronic health record (EHR) systems in U.S. health care reform, underscores the importance of devising reliable measures of factors that predict medical care providers’ use of EHRs. This paper presents an easily administered provider survey instrument that includes measures corresponding to core dimensions of DeLone and McClean’s (D & M) model of information system success. Methods Study data came from self-administered surveys completed by 460 primary care providers, who had recently begun using an EHR. Results Based upon assessment of psychometric properties of survey items, a revised D&M causal model was formulated that included four measures of the determinants of EHR use (system quality, IT support, ease of use, user satisfaction) and five indicators of provider beliefs about the impact on an individual’s clinical practice. A structural equation model was estimated that demonstrated a high level of inter-correlation between the four scales measuring determinants of EHR use. All four variables had positive association with each of the five individual impact measures. Consistent with our revised D&M model, the association of system quality and IT support with the individual impact measures was entirely mediated by ease of use and user satisfaction. Conclusions Survey research provides important insights into provider experiences with EHR. Additional studies are in progress to investigate how the variables constructed for this study are related to direct measures of EHR use. PMID:23874357

  11. Analysis of the Security and Privacy Requirements of Cloud-Based Electronic Health Records Systems

    PubMed Central

    Fernández, Gonzalo; López-Coronado, Miguel

    2013-01-01

    Background The Cloud Computing paradigm offers eHealth systems the opportunity to enhance the features and functionality that they offer. However, moving patients’ medical information to the Cloud implies several risks in terms of the security and privacy of sensitive health records. In this paper, the risks of hosting Electronic Health Records (EHRs) on the servers of third-party Cloud service providers are reviewed. To protect the confidentiality of patient information and facilitate the process, some suggestions for health care providers are made. Moreover, security issues that Cloud service providers should address in their platforms are considered. Objective To show that, before moving patient health records to the Cloud, security and privacy concerns must be considered by both health care providers and Cloud service providers. Security requirements of a generic Cloud service provider are analyzed. Methods To study the latest in Cloud-based computing solutions, bibliographic material was obtained mainly from Medline sources. Furthermore, direct contact was made with several Cloud service providers. Results Some of the security issues that should be considered by both Cloud service providers and their health care customers are role-based access, network security mechanisms, data encryption, digital signatures, and access monitoring. Furthermore, to guarantee the safety of the information and comply with privacy policies, the Cloud service provider must be compliant with various certifications and third-party requirements, such as SAS70 Type II, PCI DSS Level 1, ISO 27001, and the US Federal Information Security Management Act (FISMA). Conclusions Storing sensitive information such as EHRs in the Cloud means that precautions must be taken to ensure the safety and confidentiality of the data. A relationship built on trust with the Cloud service provider is essential to ensure a transparent process. Cloud service providers must make certain that all security

  12. Exploring the business case for ambulatory electronic health record system adoption.

    PubMed

    Song, Paula H; McAlearney, Ann Scheck; Robbins, Julie; McCullough, Jeffrey S

    2011-01-01

    Widespread implementation and use of electronic health record (EHR) systems has been recognized by healthcare leaders as a cornerstone strategy for systematically reducing medical errors and improving clinical quality. However, EHR adoption requires a significant capital investment for healthcare providers, and cost is often cited as a barrier. Despite the capital requirements, a true business case for EHR system adoption and implementation has not been made. This is of concern, as the lack of a business case can influence decision making about EHR investments. The purpose of this study was to examine the role of business case analysis in healthcare organizations' decisions to invest in ambulatory EHR systems, and to identify what factors organizations considered when justifying an ambulatory EHR. Using a qualitative case study approach, we explored how five organizations that are considered to have best practices in ambulatory EHR system implementation had evaluated the business case for EHR adoption. We found that although the rigor of formal business case analysis was highly variable, informants across these organizations consistently reported perceiving that a positive business case for EHR system adoption existed, especially when they considered both financial and non-financial benefits. While many consider EHR system adoption inevitable in healthcare, this viewpoint should not deter managers from conducting a business case analysis. Results of such an analysis can inform healthcare organizations' understanding about resource allocation needs, help clarify expectations about financial and clinical performance metrics to be monitored through EHR systems, and form the basis for ongoing organizational support to ensure successful system implementation. PMID:21714372

  13. A Strategy for Reusing the Data of Electronic Medical Record Systems for Clinical Research.

    PubMed

    Matsumura, Yasushi; Hattori, Atsushi; Manabe, Shiro; Tsuda, Tsutomu; Takeda, Toshihiro; Okada, Katsuki; Murata, Taizo; Mihara, Naoki

    2016-01-01

    There is a great need to reuse data stored in electronic medical records (EMR) databases for clinical research. We previously reported the development of a system in which progress notes and case report forms (CRFs) were simultaneously recorded using a template in the EMR in order to exclude redundant data entry. To make the data collection process more efficient, we are developing a system in which the data originally stored in the EMR database can be populated within a frame in a template. We developed interface plugin modules that retrieve data from the databases of other EMR applications. A universal keyword written in a template master is converted to a local code using a data conversion table, then the objective data is retrieved from the corresponding database. The template element data, which are entered by a template, are stored in the template element database. To retrieve the data entered by other templates, the objective data is designated by the template element code with the template code, or by the concept code if it is written for the element. When the application systems in the EMR generate documents, they also generate a PDF file and a corresponding document profile XML, which includes important data, and send them to the document archive server and the data sharing saver, respectively. In the data sharing server, the data are represented by an item with an item code with a document class code and its value. By linking a concept code to an item identifier, an objective data can be retrieved by designating a concept code. We employed a flexible strategy in which a unique identifier for a hospital is initially attached to all of the data that the hospital generates. The identifier is secondarily linked with concept codes. The data that are not linked with a concept code can also be retrieved using the unique identifier of the hospital. This strategy makes it possible to reuse any of a hospital's data. PMID:27577391

  14. An electronic medical record system with treatment recommendations based on patient similarity.

    PubMed

    Wang, Yu; Tian, Yu; Tian, Li-Li; Qian, Yang-Ming; Li, Jing-Song

    2015-05-01

    As the core of health information technology (HIT), electronic medical record (EMR) systems have been changing to meet health care demands. To construct a new-generation EMR system framework with the capability of self-learning and real-time feedback, thus adding intelligence to the EMR system itself, this paper proposed a novel EMR system framework by constructing a direct pathway between the EMR workflow and EMR data. A prototype of this framework was implemented based on patient similarity learning. Patient diagnoses, demographic data, vital signs and structured lab test results were considered for similarity calculations. Real hospitalization data from 12,818 patients were substituted, and Precision @ Position measurements were used to validate self-learning performance. Our EMR system changed the way in which orders are placed by establishing recommendation order menu and shortcut applications. Two learning modes (EASY MODE and COMPLEX MODE) were provided, and the precision values @ position 5 of both modes were 0.7458 and 0.8792, respectively. The precision performance of COMPLEX MODE was better than that of EASY MODE (tested using a paired Wilcoxon-Mann-Whitney test, p < 0.001). Applying the proposed framework, the EMR data value was directly demonstrated in the clinical workflow, and intelligence was added to the EMR system, which could improve system usability, reliability and the physician's work efficiency. This self-learning mechanism is based on dynamic learning models and is not limited to a specific disease or clinical scenario, thus decreasing maintenance costs in real world applications and increasing its adaptability. PMID:25762458

  15. Use of an Electronic Patient Record system to evaluate restorative treatment following root canal therapy.

    PubMed

    Shelley, Peter Q; Johnson, Bradford R; BeGole, Ellen A

    2007-10-01

    Electronic Patient Record (EPR) systems are rapidly gaining acceptance as an important tool for managing patient information. The purpose of this project was to evaluate the use of an EPR system for assessment of quality of care in an academic dental institution. The primary outcome of interest was the timeliness and completeness of restorative care following completion of nonsurgical root canal therapy. An initial query of the EPR database was performed using the following inclusion criteria: root canal treatment performed in the postgraduate endodontics clinic between September 2002 and June 2004, patient age > or =18 years old, and posterior tooth (premolars and molars). A total of 925 patients with 1,014 endodontically treated teeth met the inclusion criteria. A random sample of 30 percent of the treated teeth (302 teeth on 281 patients) was selected for detailed review. This sample of 302 teeth was then screened to determine if any restorative treatment had been performed between September 2002 and November 2005. Forty-eight percent (n=146) of the 302 teeth did not receive any form of permanent restoration over the time period studied. Twenty-five percent (n=75) of the teeth received a buildup only, and 27 percent (n=82) received the recommended treatment, a full occlusal coverage restoration. This study documents the use of an EPR system to objectively and efficiently assess one aspect of quality of care in a dental school environment. PMID:17923711

  16. Graphical display of diagnostic test results in electronic health records: a comparison of 8 systems.

    PubMed

    Sittig, Dean F; Murphy, Daniel R; Smith, Michael W; Russo, Elise; Wright, Adam; Singh, Hardeep

    2015-07-01

    Accurate display and interpretation of clinical laboratory test results is essential for safe and effective diagnosis and treatment. In an attempt to ascertain how well current electronic health records (EHRs) facilitated these processes, we evaluated the graphical displays of laboratory test results in eight EHRs using objective criteria for optimal graphs based on literature and expert opinion. None of the EHRs met all 11 criteria; the magnitude of deficiency ranged from one EHR meeting 10 of 11 criteria to three EHRs meeting only 5 of 11 criteria. One criterion (i.e., the EHR has a graph with y-axis labels that display both the name of the measured variable and the units of measure) was absent from all EHRs. One EHR system graphed results in reverse chronological order. One EHR system plotted data collected at unequally-spaced points in time using equally-spaced data points, which had the effect of erroneously depicting the visual slope perception between data points. This deficiency could have a significant, negative impact on patient safety. Only two EHR systems allowed users to see, hover-over, or click on a data point to see the precise values of the x-y coordinates. Our study suggests that many current EHR-generated graphs do not meet evidence-based criteria aimed at improving laboratory data comprehension. PMID:25792704

  17. Validation of a nurses' views on electronic medical record systems (EMR) questionnaire in Turkish health system.

    PubMed

    Top, Mehmet; Yilmaz, Ali; Karabulut, Erdem; Otieno, Ochieng George; Saylam, Melahat; Bakır, Sevgi; Top, Sümbül

    2015-06-01

    Using of EMR in health services and organizations is steadily increasing for quality improvement, cost effectiveness and performance development. However, no validated national and international instruments (scale, questionnaire, index, and inventory) have assessed the effectiveness, satisfaction, health care savings, patient safety and cost minimization of electronic medical and health systems from the viewpoint and perceptions of nurses in Turkish health services. The perceptions of health care professionals especially physicians and nurses can contribute important information that may predict their acceptance of EMR and desired mode of use for EMR, evaluation performance of EMR thus guiding EMR implementation in hospitals. This article is a report of validation of the instrument to measure nurses' views on the use, quality and user satisfaction with EMR in Turkish health system. Items in the questionnaire were designed and obtained following O.G. Otieno, H. Toyama, M. Asonuma, M. Kanai-Pak, K. Naitoh's questionnaire about Use, Quality and User Satisfaction with EMR systems. Reliability and validity were examined and investigated in terms of responses from 487 nurses from one education hospital in Ankara, Turkey. This study was planned and conducted at a university hospital. The validation process was based on construct validity in this study. The response rate was 74.92%. Cronbach's alphas of three factors (use, quality and satisfaction of EMR) ranged from 0.78 to 0.94. Goodness-of-fit indices from the confirmatory factor analysis showed a reasonable model fit. Results of confirmatory factor analysis showed that χ2 statistic indicated significant result (p < 0.001) and model fit was acceptable according to relative χ2 statistic (χ2/df = 2.8 < 5). Further validation of the instrument could yield positive results in health systems in the different countries. Also further validation and reliability studies could be planned on physicians and other

  18. Security Requirements for a Lifelong Electronic Health Record System: An Opinion

    PubMed Central

    Wainer, J; Campos, C.J.R; Salinas, M.D.U; Sigulem, D

    2008-01-01

    This article discusses the authors' views on the security requirements of a central, unique electronic health record. The requirements are based on the well-known principles of confidentiality and integrity and the less discussed principles of control and legal value. The article does not discuss any technical or legal solutions to the requirements proposed herein. PMID:19415143

  19. Developing a Systematic Architecture Approach for Designing an Enhanced Electronic Medical Record (EEMR) System

    ERIC Educational Resources Information Center

    Aldukheil, Maher A.

    2013-01-01

    The Healthcare industry is characterized by its complexity in delivering care to the patients. Accordingly, healthcare organizations adopt and implement Information Technology (IT) solutions to manage complexity, improve quality of care, and transform to a fully integrated and digitized environment. Electronic Medical Records (EMR), which is…

  20. Understanding Clinician Information Demands and Synthesis of Clinical Documents in Electronic Health Record Systems

    ERIC Educational Resources Information Center

    Farri, Oladimeji Feyisetan

    2012-01-01

    Large quantities of redundant clinical data are usually transferred from one clinical document to another, making the review of such documents cognitively burdensome and potentially error-prone. Inadequate designs of electronic health record (EHR) clinical document user interfaces probably contribute to the difficulties clinicians experience while…

  1. Electronic Document Imaging and Optical Storage Systems for Local Governments: An Introduction. Local Government Records Technical Information Series. Number 21.

    ERIC Educational Resources Information Center

    Schwartz, Stanley F.

    This publication introduces electronic document imaging systems and provides guidance for local governments in New York in deciding whether such systems should be adopted for their own records and information management purposes. It advises local governments on how to develop plans for using such technology by discussing its advantages and…

  2. Primary Care Physicians’ Use of an Electronic Medical Record System: A Cognitive Task Analysis

    PubMed Central

    Hadas-Dayagi, Michal; Ziv, Amitai; Reis, Shmuel

    2009-01-01

    OBJECTIVE To describe physicians’ patterns of using an Electronic Medical Record (EMR) system; to reveal the underlying cognitive elements involved in EMR use, possible resulting errors, and influences on patient–doctor communication; to gain insight into the role of expertise in incorporating EMRs into clinical practice in general and communicative behavior in particular. DESIGN Cognitive task analysis using semi-structured interviews and field observations. PARTICIPANTS Twenty-five primary care physicians from the northern district of the largest health maintenance organization (HMO) in Israel. RESULTS The comprehensiveness, organization, and readability of data in the EMR system reduced physicians’ need to recall information from memory and the difficulty of reading handwriting. Physicians perceived EMR use as reducing the cognitive load associated with clinical tasks. Automaticity of EMR use contributed to efficiency, but sometimes resulted in errors, such as the selection of incorrect medication or the input of data into the wrong patient’s chart. EMR use interfered with patient–doctor communication. The main strategy for overcoming this problem involved separating EMR use from time spent communicating with patients. Computer mastery and enhanced physicians’ communication skills also helped. CONCLUSIONS There is a fine balance between the benefits and risks of EMR use. Automaticity, especially in combination with interruptions, emerged as the main cognitive factor contributing to errors. EMR use had a negative influence on communication, a problem that can be partially addressed by improving the spatial organization of physicians’ offices and by enhancing physicians’ computer and communication skills. PMID:19130148

  3. Adoption and utilization of electronic health record systems by long-term care facilities in Texas.

    PubMed

    Wang, Tiankai; Biedermann, Sue

    2012-01-01

    Long-term care (LTC) is an important sector in the healthcare industry; however, the adoption of electronic health record (EHR) systems in LTC facilities lags behind that in other sectors of healthcare. This study examines the adoption and utilization of EHRs in LTC facilities in Texas and identifies the barriers preventing implementation of EHRs. A survey instrument was mailed to all Texas LTC facilities between October 2010 and March 2011. The survey found that in Texas, 39.5 percent of LTC facilities have fully or partially implemented EHR systems and 15 percent of LTC facilities have no plans to adopt EHRs yet. There is significant variation in the use of EHR functionalities across the LTC facilities in Texas. In the LTC facilities, the administrative functions of EHRs have been more widely adopted and are more widely utilized than the clinical functions of EHRs. Among the clinical functions adopted, the resident assessment, physician orders, care management plan, and census management are the leading functions used by the LTC facilities in Texas. Lack of capital resources is still the greatest barrier to EHR adoption and implementation. Policy makers, vendors, LTC administrators, educators, and researchers should make more effort to improve EHR adoption in LTC facilities. PMID:22737099

  4. Cost-Benefit Analysis of Electronic Medical Record System at a Tertiary Care Hospital

    PubMed Central

    Choi, Jong Soo; Lee, Woo Baik

    2013-01-01

    Objectives Although Electronic Medical Record (EMR) systems provide various benefits, there are both advantages and disadvantages regarding its cost-effectiveness. This study analyzed the economic effects of EMR systems using a cost-benefit analysis based on the differential costs of managerial accounting. Methods Samsung Medical Center (SMC) is a general hospital in Korea that developed an EMR system for outpatients from 2006 to 2008. This study measured the total costs and benefits during an 8-year period after EMR adoption. The costs include the system costs of building the EMR and the costs incurred in smoothing its adoption. The benefits included cost reductions after its adoption and additional revenues from both remodeling of paper-chart storage areas and medical transcriptionists' contribution. The measured amounts were discounted by SMC's expected interest rate to calculate the net present value (NPV), benefit-cost ratio (BCR), and discounted payback period (DPP). Results During the analysis period, the cumulative NPV and the BCR were US$3,617 thousand and 1.23, respectively. The DPP was about 6.18 years. Conclusions Although the adoption of an EMR resulted in overall growth in administrative costs, it is cost-effective since the cumulative NPV was positive. The positive NPV was attributed to both cost reductions and additional revenues. EMR adoption is not so attractive to management in that the DPP is longer than 5 years at 6.18 and the BCR is near 1 at 1.23. However, an EMR is a worthwhile investment, seeing that this study did not include any qualitative benefits and that the paper-chart system was cost-centric. PMID:24175119

  5. Electronic Health Records

    MedlinePlus

    ... Does your doc scribble notes onto sheets of paper and then slide them into an ever-expanding ... for errors. Security. There's always the chance that paper records can get lost or misfiled or somehow ...

  6. Implementing electronic identification for performance recording in sheep: I. Manual versus semiautomatic and automatic recording systems in dairy and meat farms.

    PubMed

    Ait-Saidi, A; Caja, G; Salama, A A K; Carné, S

    2014-12-01

    With the aim of assessing the secondary benefits of using electronic identification (e-ID) in sheep farms, we compared the use of manual (M), semiautomatic (SA), and automatic (AU) data-collection systems for performance recording (i.e., milk, lambing, and weight) in 3 experiments. Ewes were identified with visual ear tags and electronic rumen boluses. The M system consisted of visual ear tags, on-paper data recording, and manual data uploading to a computer; the use of a personal digital assistant (PDA) for data recording and data uploading was also done in M. The SA system used a handheld reader (HHR) for e-ID, data recording, and uploading. Both PDA and HHR used Bluetooth for uploading. The AU system was only used for body weight recording and consisted of e-ID, data recording in an electronic scale, and data uploading. In experiment 1, M and SA milk-recording systems were compared in a flock of 48 dairy ewes. Ewes were milked once- (×1, n=24) or twice- (×2, n=24) daily in a 2 × 12 milking parlor and processed in groups of 24. Milk yield (1.21 ± 0.04 L/d, on average) was 36% lower in ×1 than ×2 ewes and milk recording time correlated positively with milk yield (R(2)=0.71). Data transfer was markedly faster for PDA and HHR than for M. As a result, overall milk recording time was faster in SA (×1=12.1 ± 0.6 min/24 ewes; ×2=22.1 ± 0.9 min/24 ewes) than M (×1=14.9 ± 0.6 min/24 ewes; ×2=27.9 ± 1.0 min/24 ewes). No differences between PDA and HHR were detected. Time savings, with regard to M, were greater for ×2 than for ×1 (5.6 ± 0.2 vs. 2.8 ± 0.1 min per 24 ewes, respectively), but similar for PDA and HHR. Data transfer errors averaged 3.6% in M, whereas no errors were found in either SA system. In experiment 2, 73 dairy and 80 meat ewes were monitored at lambing using M and SA. Overall time for lambing recording was greater in M than SA in dairy (1.67 ± 0.06 vs. 0.87 ± 0.04 min/ewe) and meat (1.30 ± 0.03 vs. 0.73 ± 0.03 min/ewe) ewes

  7. Applying representational state transfer (REST) architecture to archetype-based electronic health record systems

    PubMed Central

    2013-01-01

    Background The openEHR project and the closely related ISO 13606 standard have defined structures supporting the content of Electronic Health Records (EHRs). However, there is not yet any finalized openEHR specification of a service interface to aid application developers in creating, accessing, and storing the EHR content. The aim of this paper is to explore how the Representational State Transfer (REST) architectural style can be used as a basis for a platform-independent, HTTP-based openEHR service interface. Associated benefits and tradeoffs of such a design are also explored. Results The main contribution is the formalization of the openEHR storage, retrieval, and version-handling semantics and related services into an implementable HTTP-based service interface. The modular design makes it possible to prototype, test, replicate, distribute, cache, and load-balance the system using ordinary web technology. Other contributions are approaches to query and retrieval of the EHR content that takes caching, logging, and distribution into account. Triggering on EHR change events is also explored. A final contribution is an open source openEHR implementation using the above-mentioned approaches to create LiU EEE, an educational EHR environment intended to help newcomers and developers experiment with and learn about the archetype-based EHR approach and enable rapid prototyping. Conclusions Using REST addressed many architectural concerns in a successful way, but an additional messaging component was needed to address some architectural aspects. Many of our approaches are likely of value to other archetype-based EHR implementations and may contribute to associated service model specifications. PMID:23656624

  8. Physicians' perception about electronic medical record system in Makkah Region, Saudi Arabia

    PubMed Central

    Shaker, Hani Abdulsattar; Farooq, Mian Usman; Dhafar, Khalid Obeid

    2015-01-01

    Objectives: The study was done to determine the physicians' perception about electronic medical record system (EMRS) in the context of its productivity in order to improve its functionality and advantages. Materials and Methods: This cross-sectional survey was performed from July to August 2009 with structured questionnaire of 15 closed-ended questions with five points Likert scaling starting from strongly disagree to strongly agree as 1–5, reflecting the perception of physicians about EMRS. The physicians of the Makkah region working in six different hospitals were selected. “Positive” response means if percent of responses were rated 4 or 5 (agree/strongly agree), “neutral” if rated 3, and negative if rated 1 or 2 (strongly disagree/disagree). Descriptive data analysis techniques were used. Results: We selected 317 completed questionnaires. Majority of subjects were from King Fahd Hospital, Jeddah (83, 26.3%), residents (147, 46.4%), male (200,63.1%), expatriates (207, 65%), and age group 36–45 years (133, 42%) were dominant. The stem regarding importance of computers for practicing medicine and EMRS to improve quality of practice was appreciated by majority, that is, 77.7 and 71.2%, respectively. However, “It does not disrupt the workflow” (35.1%) and “EMRS is comfortable while entering the data instead of writing” (34.8%) were appreciated negatively. Consultants (53.9%), male (53.4%), expatriates (56.7%), physicians of King Abdul Aziz Hospital, Ta'if (56.9%), and age group of 46–55 years (53.8%) appreciated EMRS positively. Overall perception of EMRS was found positive by 52.8%. Conclusion: Majority appreciated the EMRS, but specific concerns about its usage easiness and workflow disturbance were opposed by them also. PMID:25625082

  9. 36 CFR 1236.20 - What are appropriate recordkeeping systems for electronic records?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... systems, depending on their business needs, for managing their records. Transitory e-mail may be managed... repository, such as a DoD-5015.2 STD-certified product. The following functionalities are necessary for... retrievable and usable for as long as needed to conduct agency business and to meet NARA-approved...

  10. 36 CFR 1236.20 - What are appropriate recordkeeping systems for electronic records?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... systems, depending on their business needs, for managing their records. Transitory e-mail may be managed... repository, such as a DoD-5015.2 STD-certified product. The following functionalities are necessary for... retrievable and usable for as long as needed to conduct agency business and to meet NARA-approved...

  11. 36 CFR 1236.20 - What are appropriate recordkeeping systems for electronic records?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... systems, depending on their business needs, for managing their records. Transitory e-mail may be managed... repository, such as a DoD-5015.2 STD-certified product. The following functionalities are necessary for... retrievable and usable for as long as needed to conduct agency business and to meet NARA-approved...

  12. 36 CFR 1236.20 - What are appropriate recordkeeping systems for electronic records?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... systems, depending on their business needs, for managing their records. Transitory e-mail may be managed... repository, such as a DoD-5015.2 STD-certified product. The following functionalities are necessary for... retrievable and usable for as long as needed to conduct agency business and to meet NARA-approved...

  13. 36 CFR 1236.20 - What are appropriate recordkeeping systems for electronic records?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... systems, depending on their business needs, for managing their records. Transitory e-mail may be managed... repository, such as a DoD-5015.2 STD-certified product. The following functionalities are necessary for... retrievable and usable for as long as needed to conduct agency business and to meet NARA-approved...

  14. Getting the data in: three year experience with a pediatric electronic medical record system.

    PubMed Central

    Kohane, I. S.

    1994-01-01

    The Clinician's Workstation (CWS) has provided the full-functionality of an on-line electronic patient record for outpatient pediatric clinics over the past 3 years. The implementation of the CWS built upon a substantial effort in integration of data from various sources. This paper addresses the subsequent design issues which had to be resolved in order to enable both physician and transcriptionist-driven data entry and retrieval, notably selecting a feasible mixture of controlled vocabulary and free text. Some of the consequences of these design decisions on clinical care, clinical education, clinical and basic research are reviewed with examples from the last three years. PMID:7949969

  15. Integration of data from remote monitoring systems and programmers into the hospital electronic health record system based on international standards.

    PubMed

    van der Velde, E T; Foeken, H; Witteman, T A; van Erven, L; Schalij, M J

    2012-02-01

    Remote follow-up of implanted ICDs may offer a solution to the problem of overcrowded outpatient clinics. All major device companies have developed a remote follow-up solution. Data obtained from the remote follow-up systems are stored in a central database system, operated and owned by the device company and accessible for the physician or technician. However, the problem now arises that part of the patient's clinical information is stored in the local electronic health record (EHR) system in the hospital, while another part is only available in the remote monitoring database. This may potentially result in patient safety issues. Ideally all information should become available in the EHR system. IHE (Integrating the Healthcare Enterprise) is an initiative to improve the way computer systems in healthcare share information. To address the requirement of integrating remote monitoring data in the local EHR, the IHE Implantable Device Cardiac Observation (IDCO) profile has been developed. In our hospital, we have implemented the IHE IDCO profile to import data from the remote databases from two device vendors into the departmental Cardiology Information System. Data are exchanged via an HL7/XML communication protocol, as defined in the IHE IDCO profile. PMID:22231151

  16. Electronic health records lifecycle cost.

    PubMed

    Eastaugh, Steven R

    2013-01-01

    We have overestimated the ability of electronic health records (EHR) systems to enhance efficiency by eliminating transcription and the need to physically pull charts. Hospital managers typically underestimate the costs of upgrade fees and support. To avoid this problem, hospitals must develop a full total cost of ownership (TCO) analysis to independently forecast total lifecycle costs for EHR information technology. Vendor information must be checked for validity and a milestone payment schedule must be devised to pay for results (outcomes) not promises. Vendors vary widely in their capacity to set up a fully functional inpatient-outpatient EHR system. Documentation programming will help to control hospital costs while enhancing service quality and staff morale. This study presents cost analysis from 62 hospitals in 16 cities during the period 2012-2013. PMID:24003760

  17. Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA.

    PubMed

    Middleton, Blackford; Bloomrosen, Meryl; Dente, Mark A; Hashmat, Bill; Koppel, Ross; Overhage, J Marc; Payne, Thomas H; Rosenbloom, S Trent; Weaver, Charlotte; Zhang, Jiajie

    2013-06-01

    In response to mounting evidence that use of electronic medical record systems may cause unintended consequences, and even patient harm, the AMIA Board of Directors convened a Task Force on Usability to examine evidence from the literature and make recommendations. This task force was composed of representatives from both academic settings and vendors of electronic health record (EHR) systems. After a careful review of the literature and of vendor experiences with EHR design and implementation, the task force developed 10 recommendations in four areas: (1) human factors health information technology (IT) research, (2) health IT policy, (3) industry recommendations, and (4) recommendations for the clinician end-user of EHR software. These AMIA recommendations are intended to stimulate informed debate, provide a plan to increase understanding of the impact of usability on the effective use of health IT, and lead to safer and higher quality care with the adoption of useful and usable EHR systems. PMID:23355463

  18. Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA

    PubMed Central

    Middleton, Blackford; Bloomrosen, Meryl; Dente, Mark A; Hashmat, Bill; Koppel, Ross; Overhage, J Marc; Payne, Thomas H; Rosenbloom, S Trent; Weaver, Charlotte; Zhang, Jiajie

    2013-01-01

    In response to mounting evidence that use of electronic medical record systems may cause unintended consequences, and even patient harm, the AMIA Board of Directors convened a Task Force on Usability to examine evidence from the literature and make recommendations. This task force was composed of representatives from both academic settings and vendors of electronic health record (EHR) systems. After a careful review of the literature and of vendor experiences with EHR design and implementation, the task force developed 10 recommendations in four areas: (1) human factors health information technology (IT) research, (2) health IT policy, (3) industry recommendations, and (4) recommendations for the clinician end-user of EHR software. These AMIA recommendations are intended to stimulate informed debate, provide a plan to increase understanding of the impact of usability on the effective use of health IT, and lead to safer and higher quality care with the adoption of useful and usable EHR systems. PMID:23355463

  19. Wireless connection of continuous glucose monitoring system to the electronic patient record

    NASA Astrophysics Data System (ADS)

    Murakami, Alexandre; Gutierrez, Marco A.; Lage, Silvia G.; Rebelo, Marina S.; Granja, Luiz A. R.; Ramires, Jose A. F.

    2005-04-01

    The control of blood sugar level (BSL) at near-normal levels has been documented to reduce both acute and chronic complications of diabetes mellitus. Recent studies suggested, the reduction of mortality in a surgical intensive care unit (ICU), when the BSL are maintained at normal levels. Despite of the benefits appointed by these and others clinical studies, the strict BSL control in critically ill patients suffers from some difficulties: a) medical staff need to measure and control the patient"s BSL using blood sample at least every hour. This is a complex and time consuming task; b) the inaccuracy of standard capillary glucose monitoring (fingerstick) in hypotensive patients and, if frequently used to sample arterial or venous blood, may lead to excess phlebotomy; c) there is no validated procedure for continuously monitoring of BSL levels. This study used the MiniMed CGMS in ill patients at ICU to send, in real-time, BSL values to a Web-Based Electronic Patient Record. The BSL values are parsed and delivered through a wireless network as an HL7 message. The HL7 messages with BSL values are collected, stored into the Electronic Patient Record and presented into a bed-side monitor at the ICU together with other relevant patient information.

  20. Problems in the Preservation of Electronic Records.

    ERIC Educational Resources Information Center

    Lin, Lim Siew; Ramaiah, Chennupati K.; Wal, Pitt Kuan

    2003-01-01

    Discusses issues related to the preservation of electronic records. Highlights include differences between physical and electronic records; volume of electronic records; physical media; authenticity; migration of electronic records; metadata; legal issues; improved storage media; and projects for preservation of electronic records. (LRW)

  1. Program: A Record of the First 40 Years of Electronic Library and Information Systems

    ERIC Educational Resources Information Center

    Tedd, Lucy A.

    2006-01-01

    Purpose: To provide a broad overview of the history of the journal Program: electronic library and information systems and its contents over its first 40 years. Design/methodology/approach: Analysis of content from the original published material, as well as from abstracting and indexing publications and from minutes of Editorial Board meetings.…

  2. Validation of Autism Spectrum Disorder Diagnoses in Large Healthcare Systems with Electronic Medical Records

    ERIC Educational Resources Information Center

    Coleman, Karen J.; Lutsky, Marta A.; Yau, Vincent; Qian, Yinge; Pomichowski, Magdalena E.; Crawford, Phillip M.; Lynch, Frances L.; Madden, Jeanne M.; Owen-Smith, Ashli; Pearson, John A.; Pearson, Kathryn A.; Rusinak, Donna; Quinn, Virginia P.; Croen, Lisa A.

    2015-01-01

    To identify factors associated with valid Autism Spectrum Disorder (ASD) diagnoses from electronic sources in large healthcare systems. We examined 1,272 charts from ASD diagnosed youth <18 years old. Expert reviewers classified diagnoses as confirmed, probable, possible, ruled out, or not enough information. A total of 845 were classified with…

  3. The Electronic Medical Record: Promises and Problems.

    ERIC Educational Resources Information Center

    Hersh, William R.

    1995-01-01

    Describes the state of electronic medical records, their advantage over existing paper records, the problems impeding their implementation, and concerns over their security and confidentiality. Topics include challenges for the new health care era, including managed care systems, cost benefits, lack of standards, and future possibilities.…

  4. Using electronic health record systems to optimize admission decisions: the Creatinine case study.

    PubMed

    Ben-Assuli, Ofir; Shabtai, Itamar; Leshno, Moshe

    2015-03-01

    Many medical organizations have implemented electronic health record (EHR) and health information exchange (HIE) networks to improve medical decision-making. This study evaluated the contribution of EHR and HIE networks to physicians by investigating whether health information technology can lead to more efficient admission decisions by reducing redundant admissions in the stressful environment of emergency. Log-files were retrieved from an integrative and interoperable EHR that serves seven main Israeli hospitals. The analysis was restricted to a group of patients seen in the emergency departments who were administered a Creatinine test. The assessment of the contribution of EHR to admission decisions used various statistical analyses and track log-file analysis. We showed that using the EHR contributes to more efficient admission decisions and reduces the number of avoidable admissions. In particular, there was a reduction in readmissions when patient history was viewed. Using EHR can help respond to the international problem of avoidable hospital readmissions. PMID:24692078

  5. The Impact of Electronic Health Records on Risk Management of Information Systems in Australian Residential Aged Care Homes.

    PubMed

    Jiang, Tao; Yu, Ping; Hailey, David; Ma, Jun; Yang, Jie

    2016-09-01

    To obtain indications of the influence of electronic health records (EHR) in managing risks and meeting information system accreditation standard in Australian residential aged care (RAC) homes. The hypothesis to be tested is that the RAC homes using EHR have better performance in meeting information system standards in aged care accreditation than their counterparts only using paper records for information management. Content analysis of aged care accreditation reports from the Aged Care Standards and Accreditation Agency produced between April 2011 and December 2013. Items identified included types of information systems, compliance with accreditation standards, and indicators of failure to meet an expected outcome for information systems. The Chi-square test was used to identify difference between the RAC homes that used EHR systems and those that used paper records in not meeting aged care accreditation standards. 1,031 (37.4%) of 2,754 RAC homes had adopted EHR systems. Although the proportion of homes that met all accreditation standards was significantly higher for those with EHR than for homes with paper records, only 13 RAC homes did not meet one or more expected outcomes. 12 used paper records and nine of these failed the expected outcome for information systems. The overall contribution of EHR to meeting aged care accreditation standard in Australia was very small. Risk indicators for not meeting information system standard were no access to accurate and appropriate information, failure in monitoring mechanisms, not reporting clinical incidents, insufficient recording of residents' clinical changes, not providing accurate care plans, and communication processes failure. The study has provided indications that use of EHR provides small, yet significant advantages for RAC homes in Australia in managing risks for information management and in meeting accreditation requirements. The implication of the study for introducing technology innovation in RAC in

  6. Data-driven discovery of seasonally linked diseases from an Electronic Health Records system

    PubMed Central

    2014-01-01

    Background Patterns of disease incidence can identify new risk factors for the disease or provide insight into the etiology. For example, allergies and infectious diseases have been shown to follow periodic temporal patterns due to seasonal changes in environmental or infectious agents. Previous work searching for seasonal or other temporal patterns in disease diagnosis rates has been limited both in the scope of the diseases examined and in the ability to distinguish unexpected seasonal patterns. Electronic Health Records (EHR) compile extensive longitudinal clinical information, constituting a unique source for discovery of trends in occurrence of disease. However, the data suffer from inherent biases that preclude a identification of temporal trends. Methods Motivated by observation of the biases in this data source, we developed a method (Lomb-Scargle periodograms in detrended data, LSP-detrend) to find periodic patterns by adjusting the temporal information for broad trends in incidence, as well as seasonal changes in total hospitalizations. LSP-detrend can sensitively uncover periodic temporal patterns in the corrected data and identify the significance of the trend. We apply LSP-detrend to a compilation of records from 1.5 million patients encoded by ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification), including 2,805 disorders with more than 500 occurrences across a 12 year period, recorded from 1.5 million patients. Results and conclusions Although EHR data, and ICD-9 coded records in particular, were not created with the intention of aggregated use for research, these data can in fact be mined for periodic patterns in incidence of disease, if confounders are properly removed. Of all diagnoses, around 10% are identified as seasonal by LSP-detrend, including many known phenomena. We robustly reproduce previous findings, even for relatively rare diseases. For instance, Kawasaki disease, a rare childhood disease that has

  7. PACS and electronic health records

    NASA Astrophysics Data System (ADS)

    Cohen, Simona; Gilboa, Flora; Shani, Uri

    2002-05-01

    Electronic Health Record (EHR) is a major component of the health informatics domain. An important part of the EHR is the medical images obtained over a patient's lifetime and stored in diverse PACS. The vision presented in this paper is that future medical information systems will convert data from various medical sources -- including diverse modalities, PACS, HIS, CIS, RIS, and proprietary systems -- to HL7 standard XML documents. Then, the various documents are indexed and compiled to EHRs, upon which complex queries can be posed. We describe the conversion of data retrieved from PACS systems through DICOM to HL7 standard XML documents. This enables the EHR system to answer queries such as 'Get all chest images of patients at the age of 20-30, that have blood type 'A' and are allergic to pine trees', which a single PACS cannot answer. The integration of data from multiple sources makes our approach capable of delivering such answers. It enables the correlation of medical, demographic, clinical, and even genetic information. In addition, by fully indexing all the tagged data in DICOM objects, it becomes possible to offer access to huge amounts of valuable data, which can be better exploited in the specific radiology domain.

  8. Using SNOMED CT Expression Constraints to Bridge the Gap Between Clinical Decision-Support Systems and Electronic Health Records.

    PubMed

    Martínez-Salvador, Begoña; Marcos, Mar; Mañas, Alejandro; Maldonado, José Alberto; Robles, Monserrat

    2016-01-01

    Clinical decision-support systems (CDSSs) should be able to interact with the electronic health record (EHR) to obtain the patient data they require. A recent solution for the interoperability of CDSSs and EHR systems consists in the use of a mediated schema which provides a unified view of their two schemas. The use of such a mediated schema requires the definition of a mapping between this schema and the EHR one. In this paper we investigate the use of the SNOMED CT Expression Constraint Language to characterize these mappings. PMID:27577434

  9. Systems Medicine 2.0: Potential Benefits of Combining Electronic Health Care Records With Systems Science Models

    PubMed Central

    Gibson, Alexander R; Scott, Gregory; Harrison, Oliver; Dominiczak, Anna; Hanlon, Phil

    2015-01-01

    Background The global burden of disease is increasingly dominated by non-communicable diseases.These diseases are less amenable to curative and preventative interventions than communicable disease. This presents a challenge to medical practice and medical research, both of which are experiencing diminishing returns from increasing investment. Objective Our aim was to (1) review how medical knowledge is generated, and its limitations, (2) assess the potential for emerging technologies and ideas to improve medical research, and (3) suggest solutions and recommendations to increase medical research efficiency on non-communicable diseases. Methods We undertook an unsystematic review of peer-reviewed literature and technology websites. Results Our review generated the following conclusions and recommendations. (1) Medical knowledge continues to be generated in a reductionist paradigm. This oversimplifies our models of disease, rendering them ineffective to sufficiently understand the complex nature of non-communicable diseases. (2) Some of these failings may be overcome by adopting a “Systems Medicine” paradigm, where the human body is modeled as a complex adaptive system. That is, a system with multiple components and levels interacting in complex ways, wherein disease emerges from slow changes to the system set-up. Pursuing systems medicine research will require larger datasets. (3) Increased data sharing between researchers, patients, and clinicians could provide this unmet need for data. The recent emergence of electronic health care records (EHR) could potentially facilitate this in real-time and at a global level. (4) Efforts should continue to aggregate anonymous EHR data into large interoperable data silos and release this to researchers. However, international collaboration, data linkage, and obtaining additional information from patients will remain challenging. (5) Efforts should also continue towards “Medicine 2.0”. Patients should be given access to

  10. Leading change: introducing an electronic medical record system to a paramedic service.

    PubMed

    Baird, Shawn; Boak, George

    2016-05-01

    Purpose Leaders in health-care organizations introducing electronic medical records (EMRs) face implementation challenges. The adoption of EMR by the emergency medical and ambulance setting is expected to provide wide-ranging benefits, but there is little research into the processes of adoption in this sector. The purpose of this study is to examine the introduction of EMR in a small emergency care organization and identify factors that aided adoption. Design/methodology/approach Semi-structured interviews with selected paramedics were followed up with a survey issued to all paramedics in the company. Findings The user interfaces with the EMR, and perceived ease of use, were important factors affecting adoption. Individual paramedics were found to have strong and varied preferences about how and when they integrated the EMR into their practice. As company leadership introduced flexibility of use, this enhanced both individual and collective ability to make sense of the change and removed barriers to acceptance. Research limitations/implications This is a case study of one small organization. However, there may be useful lessons for other emergency care organizations adopting EMR. Practical implications Leaders introducing EMR in similar situations may benefit from considering a sense-making perspective and responding promptly to feedback. Originality/value The study contributes to a wider understanding of issues faced by leaders who seek to implement EMRs in emergency medical services, a sector in which there has been to date very little research on this issue. PMID:27198703

  11. Design and evaluation of a wireless electronic health records system for field care in mass casualty settings

    PubMed Central

    Kirsh, D; Griswold, W G; Buono, C; Lyon, J; Rao, R; Chan, T C

    2011-01-01

    Background There is growing interest in the use of technology to enhance the tracking and quality of clinical information available for patients in disaster settings. This paper describes the design and evaluation of the Wireless Internet Information System for Medical Response in Disasters (WIISARD). Materials and methods WIISARD combined advanced networking technology with electronic triage tags that reported victims' position and recorded medical information, with wireless pulse-oximeters that monitored patient vital signs, and a wireless electronic medical record (EMR) for disaster care. The EMR system included WiFi handheld devices with barcode scanners (used by front-line responders) and computer tablets with role-tailored software (used by managers of the triage, treatment, transport and medical communications teams). An additional software system provided situational awareness for the incident commander. The WIISARD system was evaluated in a large-scale simulation exercise designed for training first responders. A randomized trial was overlaid on this exercise with 100 simulated victims, 50 in a control pathway (paper-based), and 50 in completely electronic WIISARD pathway. All patients in the electronic pathway were cared for within the WIISARD system without paper-based workarounds. Results WIISARD reduced the rate of the missing and/or duplicated patient identifiers (0% vs 47%, p<0.001). The total time of the field was nearly identical (38:20 vs 38:23, IQR 26:53–1:05:32 vs 18:55–57:22). Conclusion Overall, the results of WIISARD show that wireless EMR systems for care of the victims of disasters would be complex to develop but potentially feasible to build and deploy, and likely to improve the quality of information available for the delivery of care during disasters. PMID:21709162

  12. Automating occupational protection records systems

    SciTech Connect

    Lyon, M.; Martin, J.B.

    1991-10-01

    Occupational protection records have traditionally been generated by field and laboratory personnel, assembled into files in the safety office, and eventually stored in a warehouse or other facility. Until recently, these records have been primarily paper copies, often handwritten. Sometimes, the paper is microfilmed for storage. However, electronic records are beginning to replace these traditional methods. The purpose of this paper is to provide guidance for making the transition to automated record keeping and retrieval using modern computer equipment. This paper describes the types of records most readily converted to electronic record keeping and a methodology for implementing an automated record system. The process of conversion is based on a requirements analysis to assess program needs and a high level of user involvement during the development. The importance of indexing the hard copy records for easy retrieval is also discussed. The concept of linkage between related records and its importance relative to reporting, research, and litigation will be addressed. 2 figs.

  13. Identifying patients with asthma in primary care electronic medical record systems

    PubMed Central

    Xi, Nancy; Wallace, Rebecca; Agarwal, Gina; Chan, David; Gershon, Andrea; Gupta, Samir

    2015-01-01

    Objective To develop and test a variety of electronic medical record (EMR) search algorithms to allow clinicians to accurately identify their patients with asthma in order to enable improved care. Design A retrospective chart analysis identified 5 relevant unique EMR information fields (electronic disease registry, cumulative patient profile, billing diagnostic code, medications, and chart notes); asthma-related search terms were designated for each field. The accuracy of each term was tested for its ability to identify the asthma patients among all patients whose charts were reviewed. Increasingly sophisticated search algorithms were then designed and evaluated by serially combining individual searches with Boolean operators. Setting Two large academic primary care clinics in Hamilton, Ont. Participants Charts for 600 randomly selected patients aged 16 years and older identified in an initial EMR search as likely having asthma (n = 150), chronic obstructive pulmonary disease (n = 150), other respiratory conditions (n = 150), or nonrespiratory conditions (n = 150) were reviewed until 100 patients per category were identified (or until all available names were exhausted). A total of 398 charts were reviewed in full and included. Main outcome measures Sensitivity and specificity of each search for asthma diagnosis (against the reference standard of a physician chart review–based diagnosis). Results Two physicians reviewed the charts identified in the initial EMR search using a standardized data collection form and ascribed the following diagnoses in 398 patients: 112 (28.1%) had asthma, 81 (20.4%) had chronic obstructive pulmonary disease, 104 (26.1%) had other respiratory conditions, and 101 (25.4%) had nonrespiratory conditions. Concordance between reviewers in chart abstraction diagnosis was high (κ = 0.89, 95% CI 0.80 to 0.97). Overall, the algorithm searching for patients who had asthma in their cumulative patient profiles or for whom an asthma billing code

  14. Performance evaluation of a web-based system to exchange Electronic Health Records using Queueing model (M/M/1).

    PubMed

    de la Torre, Isabel; Díaz, Francisco Javier; Antón, Míriam; Martínez, Mario; Díez, José Fernando; Boto, Daniel; López, Miguel; Hornero, Roberto; López, María Isabel

    2012-04-01

    Response time measurement of a web-based system is essential to evaluate its performance. This paper shows a comparison of the response times of a Web-based system for Ophthalmologic Electronic Health Records (EHRs), TeleOftalWeb. It makes use of different database models like Oracle 10 g, dbXML 2.0, Xindice 1.2, and eXist 1.1.1. The system's modelling, which uses Tandem Queue networks, will allow us to estimate the service times of the different components of the system (CPU, network and databases). In order to calculate those times, associated to the different databases, benchmarking techniques are used. The final objective of the comparison is to choose the database system resulting in the lowest response time to TeleOftalWeb and to compare the obtained results using a new benchmarking. PMID:20703642

  15. Implementation of electronic medical records

    PubMed Central

    Greiver, Michelle; Barnsley, Jan; Glazier, Richard H.; Moineddin, Rahim; Harvey, Bart J.

    2011-01-01

    Abstract Objective To apply the diffusion-of-innovations theory to the examination of factors that are perceived by family physicians as influencing the implementation of electronic medical records (EMRs). Design Qualitative study with 2 focus groups 18 months after EMR implementation; participants also took part in a concurrent quantitative study examining EMR implementation and preventive services. Setting Toronto, Ont. Participants Twelve community-based family physicians. Methods We employed a semistructured interview guide. The interviews were audiotaped and transcribed verbatim; 2 researchers independently categorized and coded the transcripts and then met to compare and contrast their findings, category mapping, and interpretations. Findings were then mapped to an existing theoretical framework. Main findings Multiple barriers to EMR implementation were described. These included lack of relative advantage for many processes, high complexity of the system, low compatibility with physician needs and past experiences, difficulty with adaptation of the EMR to the organization and adaptation of the organization to the EMR, and lack of organizational slack. Positive factors were the presence of a champion and relative advantages for some processes. Conclusion Early EMR implementation experience is consistent with theoretical concepts associated with implementation of innovations. A problematic implementation process helps to explain, at least in part, the lack of improvement in preventive services in our quantitative results. PMID:21998247

  16. Biometrics for electronic health records.

    PubMed

    Flores Zuniga, Alejandro Enrique; Win, Khin Than; Susilo, Willy

    2010-10-01

    Securing electronic health records, in scenarios in which the provision of care services is share among multiple actors, could become a complex and costly activity. Correct identification of patients and physician, protection of privacy and confidentiality, assignment of access permissions for healthcare providers and resolutions of conflicts rise as main points of concern in the development of interconnected health information networks. Biometric technologies have been proposed as a possible technological solution for these issues due to its ability to provide a mechanism for unique verification of an individual identity. This paper presents an analysis of the benefit as well as disadvantages offered by biometric technology. A comparison between this technology and more traditional identification methods is used to determine the key benefits and flaws of the use biometric in health information systems. The comparison as been made considering the viability of the technologies for medical environments, global security needs, the contemplation of a share care environment and the costs involved in the implementation and maintenance of such technologies. This paper also discusses alternative uses for biometrics technologies in health care environments. The outcome of this analysis lays in the fact that even when biometric technologies offer several advantages over traditional method of identification, they are still in the early stages of providing a suitable solution for a health care environment. PMID:20703610

  17. Adverse inpatient outcomes during the transition to a new electronic health record system: observational study

    PubMed Central

    Barnett, Michael L; Mehrotra, Ateev

    2016-01-01

    Objective To assess the short term association of inpatient implementation of electronic health records (EHRs) with patient outcomes of mortality, readmissions, and adverse safety events. Design Observational study with difference-in-differences analysis. Setting Medicare, 2011-12. Participants Patients admitted to 17 study hospitals with a verifiable “go live” date for implementation of inpatient EHRs during 2011-12, and 399 control hospitals in the same hospital referral region. Main outcome measures All cause readmission within 30 days of discharge, all cause mortality within 30 days of admission, and adverse safety events as defined by the patient safety for selected indicators (PSI)-90 composite measure among Medicare beneficiaries admitted to one of these hospitals 90 days before and 90 days after implementation of the EHRs (n=28 235 and 26 453 admissions), compared with the control group of all contemporaneous admissions to hospitals in the same hospital referral region (n=284 632 and 276 513 admissions). Analyses were adjusted for beneficiaries’ sociodemographic and clinical characteristics. Results Before and after implementation, characteristics of admissions were similar in both study and control hospitals. Among study hospitals, unadjusted 30 day mortality (6.74% to 7.15%, P=0.06) and adverse safety event rates (10.5 to 11.4 events per 1000 admissions, P=0.34) did not significantly change after implementation of EHRs. There was an unadjusted decrease in 30 day readmission rates, from 19.9% to 19.0% post-implementation (P=0.02). In difference-in-differences analysis, however, there was no significant change in any outcome between pre-implementation and post-implementation periods (all P≥0.13). Conclusions Despite concerns that implementation of EHRs might adversely impact patient care during the acute transition period, we found no overall negative association of such implementation on short term inpatient mortality, adverse safety

  18. Towards plug-and-play integration of archetypes into legacy electronic health record systems: the ArchiMed experience

    PubMed Central

    2013-01-01

    Background The dual model approach represents a promising solution for achieving semantically interoperable standardized electronic health record (EHR) exchange. Its acceptance, however, will depend on the effort required for integrating archetypes into legacy EHR systems. Methods We propose a corresponding approach that: (a) automatically generates entry forms in legacy EHR systems from archetypes; and (b) allows the immediate export of EHR documents that are recorded via the generated forms and stored in the EHR systems’ internal format as standardized and archetype-compliant EHR extracts. As a prerequisite for applying our approach, we define a set of basic requirements for the EHR systems. Results We tested our approach with an EHR system called ArchiMed and were able to successfully integrate 15 archetypes from a test set of 27. For 12 archetypes, the form generation failed owing to a particular type of complex structure (multiple repeating subnodes), which was prescribed by the archetypes but not supported by ArchiMed’s data model. Conclusions Our experiences show that archetypes should be customized based on the planned application scenario before their integration. This would allow problematic structures to be dissolved and irrelevant optional archetype nodes to be removed. For customization of archetypes, openEHR templates or specialized archetypes may be employed. Gaps in the data types or terminological features supported by an EHR system will often not preclude integration of the relevant archetypes. More work needs to be done on the usability of the generated forms. PMID:23339403

  19. Electronic medical records and quality improvement.

    PubMed

    Carter, Jonathan T

    2015-04-01

    Widespread adoption of electronic medical records (EMRs) in the United States is transforming the practice of medicine from a paper-based cottage industry into an integrated health care delivery system. Most physicians and institutions view the widespread use of EMRs to be inevitable. But the transformation has not been painless. Many have questioned whether the substantial investment in electronic health records has really been justified by improved patient outcomes or quality of care. This article describes historical and recent efforts to use EMRs to improve the quality of patient care, and provides a roadmap of EMR uses for the foreseeable future. PMID:25771280

  20. Use and Characteristics of Electronic Health Record Systems among Office-Based Physician Practices: United States, ...

    MedlinePlus

    ... NCHS Publications and Electronic Media Errata List Listservs Data and Statistics Data Visualization Gallery FastStats MMWR QuickStats ... Stage 2 meaningful use objectives for which 2010 data are available increased significantly. Increased adoption occurred for ...

  1. Electronic Health Records Access During a Disaster

    PubMed Central

    Morchel, Herman; Raheem, Murad; Stevens, Lee

    2014-01-01

    As has been demonstrated previously, medical care providers that employ an electronic health records (EHR) system provide more appropriate, cost effective care. Those providers are also better positioned than those who rely on paper records to recover if their facility is damaged as a result of severe storms, fires, or other events. The events surrounding Superstorm Sandy in 2012 made it apparent that, with relatively little additional effort and investment, health care providers with EHR systems may be able to use those systems for patient care purposes even during disasters that result in damage to buildings and facilities, widespread power outages, or both. PMID:24683443

  2. DRUG-DRUG INTERACTION PROFILES OF MEDICATION REGIMENS EXTRACTED FROM A DE-IDENTIFIED ELECTRONIC MEDICAL RECORDS SYSTEM.

    PubMed

    Butkiewicz, Mariusz; Restrepo, Nicole A; Haines, Jonathan L; Crawford, Dana C

    2016-01-01

    With age, the number of prescribed medications increases and subsequently raises the risk for adverse drug-drug interactions. These adverse effects lower quality of life and increase health care costs. Quantifying the potential burden of adverse effects before prescribing medications can be a valuable contribution to health care. This study evaluated medication lists extracted from a subset of the Vanderbilt de-identified electronic medical record system. Reported drugs were cross-referenced with the Kyoto Encyclopedia of Genes and Genomes DRUG database to identify known drug-drug interactions. On average, a medication regimen contained 6.58 medications and 2.68 drug-drug interactions. Here, we quantify the burden of potential adverse events from drug-drug interactions through drug-drug interaction profiles and include a number of alternative medications as provided by the Anatomical Therapeutic Chemical Classification System. PMID:27570646

  3. Assessing the efficacy of the electronic patient record system EDeR: implementation study—study protocol

    PubMed Central

    Job, Oliver; Bachmann, Lucas M; Schmid, Martin K; Thiel, Michael A; Ivic, Sandra

    2013-01-01

    Introduction Despite many innovations in information technology, many clinics still rely on paper-based medical records. Critics, however, claim that they are hard to read, because of illegible handwriting, and uncomfortable to use. Moreover, a chronological overview is not always easily possible, content can be destroyed or get lost. There is an overall opinion that electronic medical records (EMRs) should solve these problems and improve physicians’ efficiency, patients’ safety and reduce the overall costs in practice. However, to date, the evidence supporting this view is sparse. Methods and analysis In this protocol, we describe a study exploring differences in speed and accuracy when searching clinical information using the paper-based patient record or the Elektronische DateneRfassung (EDeR). Designed as a randomised vignette study, we hypothesise that the EDeR increases efficiency, that is, reduces time on reading the patient history and looking for relevant examination results, helps finding mistakes and missing information quicker and more reliably. In exploratory analyses, we aim at exploring factors associated with a higher performance. Ethics and dissemination The ethics committee of the Canton Lucerne, Switzerland, approved this study. We presume that the implementation of the EMR software EDeR will have a positive impact on the efficiency of the doctors, which will result in an increase of consultations per day. We believe that the results of our study will provide a valid basis to quantify the added value of an EMR system in an ophthalmological environment. PMID:23578684

  4. Using a Scripted Data Entry Process to Transfer Legacy Immunization Data While Transitioning Between Electronic Medical Record Systems

    PubMed Central

    Michel, J.; Hsiao, A.; Fenick, A.

    2014-01-01

    Summary Background Transitioning between Electronic Medical Records (EMR) can result in patient data being stranded in legacy systems with subsequent failure to provide appropriate patient care. Manual chart abstraction is labor intensive, error-prone, and difficult to institute for immunizations on a systems level in a timely fashion. Objectives We sought to transfer immunization data from two of our health system’s soon to be replaced EMRs to the future EMR using a single process instead of separate interfaces for each facility. Methods We used scripted data entry, a process where a computer automates manual data entry, to insert data into the future EMR. Using the Center for Disease Control’s CVX immunization codes we developed a bridge between immunization identifiers within our system’s EMRs. We performed a two-step process evaluation of the data transfer using automated data comparison and manual chart review. Results We completed the data migration from two facilities in 16.8 hours with no data loss or corruption. We successfully populated the future EMR with 99.16% of our legacy immunization data – 500,906 records – just prior to our EMR transition date. A subset of immunizations, first recognized during clinical care, had not originally been extracted from the legacy systems. Once identified, this data – 1,695 records – was migrated using the same process with minimal additional effort. Conclusions Scripted data entry for immunizations is more accurate than published estimates for manual data entry and we completed our data transfer in 1.2% of the total time we predicted for manual data entry. Performing this process before EMR conversion helped identify obstacles to data migration. Drawing upon this work, we will reuse this process for other healthcare facilities in our health system as they transition to the future EMR. PMID:24734139

  5. Use of electronic personal health record systems to encourage HIV screening: an exploratory study of patient and provider perspectives

    PubMed Central

    2011-01-01

    Background When detected, HIV can be effectively treated with antiretroviral therapy. Nevertheless in the U.S. approximately 25% of those who are HIV-infected do not know it. Much remains unknown about how to increase HIV testing rates. New Internet outreach methods have the potential to increase disease awareness and screening among patients, especially as electronic personal health records (PHRs) become more widely available. In the US Department of Veterans' Affairs medical care system, 900,000 veterans have indicated an interest in receiving electronic health-related communications through the PHR. Therefore we sought to evaluate the optimal circumstances and conditions for outreach about HIV screening. In an exploratory, qualitative research study we examined patient and provider perceptions of Internet-based outreach to increase HIV screening among veterans who use the Veterans Health Administration (VHA) health care system. Findings We conducted two rounds of focus groups with veterans and healthcare providers at VHA medical centers. The study's first phase elicited general perceptions of an electronic outreach program to increase screening for HIV, diabetes, and high cholesterol. Using phase 1 results, outreach message texts were drafted and then presented to participants in the second phase. Analysis followed modified grounded theory. Patients and providers indicated that electronic outreach through a PHR would provide useful information and would motivate patients to be screened for HIV. Patients believed that electronic information would be more convenient and understandable than information provided verbally. Patients saw little difference between messages about HIV versus about diabetes and cholesterol. Providers, however, felt patients would disapprove of HIV-related messages due to stigma. Providers expected increased workload from the electronic outreach, and thus suggested adding primary care resources and devising methods to smooth the flow of

  6. Physician user satisfaction with an electronic medical records system in primary healthcare centres in Al Ain: a qualitative study

    PubMed Central

    Al Alawi, Shamma; Al Dhaheri, Aysha; Al Baloushi, Durra; Al Dhaheri, Mouza; Prinsloo, Engela A M

    2014-01-01

    Objectives To explore physician satisfaction with an electronic medical records (EMR) system, to identify and explore the main limitations of the system and finally to submit recommendations to address these limitations. Design A descriptive qualitative study that entailed three focus group interviews was performed among physicians using open-ended questions. The interviews were audiotaped, documented and transcribed verbatim. The themes were explored and analysed in different categories. Setting The study was conducted in primary healthcare centres (PHC) in Al Ain, United Arab Emirates (UAE). Participants A total of 23 physicians, all using the same EMR system, attended one of three focus groups held in PHC in Al Ain Medical District. Each focus group consisted of 7–9 physicians working in PHC as family medicine specialists, residents or general practitioners. Primary outcome measure Physician satisfaction with the EMR system. Results Key themes emerged and were categorised as physician-dependent, patient-related and system-related factors. In general, physicians were satisfied with the EMR system in spite of initial difficulties with implementation. Most participants identified that the long time required to do the documentation affected their practice and patient communication. Many physicians expressed satisfaction with the orders and results of laboratory and radiology functions and they emphasised that this was the strongest point in the EMR. They were also satisfied with the electronic prescription function, stating that it reduced errors and saved time. Conclusions Physicians are satisfied with the EMR and have a positive perception regarding the application of the system. Several themes emerged during this study that need to be considered to enhance the EMR system. Further studies need to be conducted among other healthcare practitioners and patients to explore their attitude and perception about the EMR. PMID:25377010

  7. Sleep-monitoring, experiment M133. [electronic recording system for automatic analysis of human sleep patterns

    NASA Technical Reports Server (NTRS)

    Frost, J. D., Jr.; Salamy, J. G.

    1973-01-01

    The Skylab sleep-monitoring experiment simulated the timelines and environment expected during a 56-day Skylab mission. Two crewmembers utilized the data acquisition and analysis hardware, and their sleep characteristics were studied in an online fashion during a number of all night recording sessions. Comparison of the results of online automatic analysis with those of postmission visual data analysis was favorable, confirming the feasibility of obtaining reliable objective information concerning sleep characteristics during the Skylab missions. One crewmember exhibited definite changes in certain sleep characteristics (e.g., increased sleep latency, increased time Awake during first third of night, and decreased total sleep time) during the mission.

  8. Converting to electronic dental records.

    PubMed

    Hudis, Stephen I

    2010-01-01

    The gradual conversion of a prosthetic specialty office to digital format is described. Electronic format and equipment does not create effective office systems; it reflects the existing systems and makes improvement possible. An incremental approach is favored because it is possible to ensure the success and integration of each step and because it does not overwhelm the dentist's and staff's understanding of the practice. In addition to efficiency, office technology has great potential for improving communication, both with patients and with other practitioners. The electronic practice is an opportunity for continuous improvement. PMID:20481066

  9. Electronic health records: Context matters!

    PubMed

    Ventres, William B; Frankel, Richard M

    2016-06-01

    Comments on the article by Kotay, Huang, Jordan, and Korin (see record 2016-22430-001). They tackle how to document patients' social histories in a way that is useful in real-time clinical practice-and explore the implementation of a new electronic health record (EHR) template specifically built to support their residency practice's commitment to addressing the social dimensions of patients' lives. For all of us convinced that the simultaneous integration of the biological, social, psychological, and existential dimensions of care is key to the practice of primary care, there are many questions to explore in relation to using EHRs. How are we going to do this in an environment that preferentially supports particularized data over an engaged awareness of context? How are we going to convince those with the technological expertise and administrative power that the transmission of information alone is not a substitute for insight, meaning, and relationships (Ventres & Frankel, 2010)? And ultimately, how are we going to make sure the EHR works for us instead of against us? Kotay and her colleagues have not answered all these questions in their study-such a task is beyond the abilities of one person or group of researchers- but along with others they have begun to illuminate a way forward (Cifuentes et al., 2015; Glowa-Kollisch et al., 2014). May we all now strive to continue the work that these authors have started. (PsycINFO Database Record PMID:27270249

  10. 32 CFR 701.21 - Electronic record.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 5 2013-07-01 2013-07-01 false Electronic record. 701.21 Section 701.21... THE NAVY DOCUMENTS AFFECTING THE PUBLIC FOIA Definitions and Terms § 701.21 Electronic record. Records (including e-mail) which are created, stored, and retrieved by electronic means....

  11. 32 CFR 701.21 - Electronic record.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 5 2012-07-01 2012-07-01 false Electronic record. 701.21 Section 701.21... THE NAVY DOCUMENTS AFFECTING THE PUBLIC FOIA Definitions and Terms § 701.21 Electronic record. Records (including e-mail) which are created, stored, and retrieved by electronic means....

  12. 32 CFR 701.21 - Electronic record.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 5 2014-07-01 2014-07-01 false Electronic record. 701.21 Section 701.21... THE NAVY DOCUMENTS AFFECTING THE PUBLIC FOIA Definitions and Terms § 701.21 Electronic record. Records (including e-mail) which are created, stored, and retrieved by electronic means....

  13. 32 CFR 701.21 - Electronic record.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 5 2010-07-01 2010-07-01 false Electronic record. 701.21 Section 701.21... THE NAVY DOCUMENTS AFFECTING THE PUBLIC FOIA Definitions and Terms § 701.21 Electronic record. Records (including e-mail) which are created, stored, and retrieved by electronic means....

  14. 32 CFR 701.21 - Electronic record.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 5 2011-07-01 2011-07-01 false Electronic record. 701.21 Section 701.21... THE NAVY DOCUMENTS AFFECTING THE PUBLIC FOIA Definitions and Terms § 701.21 Electronic record. Records (including e-mail) which are created, stored, and retrieved by electronic means....

  15. Implementation of Indigenous Electronic Medical Record System to Facilitate Care of Sickle Cell Disease Patients in Chhattisgarh

    PubMed Central

    Choubey, Mona; Mishra, Hrishikesh; Soni, Khushboo

    2016-01-01

    Introduction Sickle cell disease (SCD) is prevalent in central India including Chhattisgarh. Screening for SCD is being carried out by Government of Chhattisgarh. Electronic Medical Record (EMR) system was developed and implemented in two phases. Aim Aim was to use informatics techniques and indigenously develop EMR system to improve the care of SCD patients in Chhattisgarh. EMR systems had to be developed to store and manage: i) huge data generated through state wide screening for SCD; ii) clinical data for SCD patients attending the outpatient department (OPD) of institute. Materials and Methods ‘State Wide Screening Data Interface’ (SWSDI) was designed and implemented for storing and managing data generated through screening program. Further, ‘Sickle Cell Patients Temporal Data Management System’ (SCPTDMS) was developed and implemented for storing, managing and analysing sickle cell disease patients’ data at OPD. Both systems were developed using VB.Net and MS SQL Server 2012. Results Till April 2015, SWSDI has data of 1294558 persons, out of which 121819 and 4087 persons are carriers and patients of sickle cell disease respectively. Similarly till June 2015, SCPTDMS has data of 3760 persons, of which 923 are sickle cell disease patients (SS) and 1355 are sickle cell carriers (AS). Conclusion Both systems are proving to be useful in efficient storage, management and analysis of data for clinical and research purposes. The systems are an example of beneficial usage of medical informatics solutions for managing large data at community level. PMID:27042486

  16. Monitoring reasons for encounter via an electronic patient record system: the case of a rural practice initiative.

    PubMed

    Klinis, Spyridon; Markaki, Adelais; Kounalakis, Dimitrios; Symvoulakis, Emmanouil K

    2012-01-01

    The objective of this brief communication was to tabulate common reasons for encounter in a Greek rural general practice, as result of a recently adopted electronic patient record (EPR) application. Twenty encounter reasons accounted for 3,797 visits (61% of all patient encounters), whereas 565 other reasons accounted for the remaining 2,429 visits (39%). Number one reason for encounter was health maintenance or disease prevention seeking services, including screening examinations for malignancies, immunization and provision of medical opinion reports. Hypertension, lipid disorder and ischemic heart disease without angina were among the most common reasons for seeking care. A strengths/weaknesses/opportunities/threats (SWOT) analysis on the key role of an EPR system in collecting data from rural and remote primary health care settings is also presented. PMID:23091407

  17. Evaluating the impact and costs of deploying an electronic medical record system to support TB treatment in Peru.

    PubMed

    Fraser, Hamish S F; Blaya, Joaquin; Choi, Sharon S; Bonilla, Cesar; Jazayeri, Darius

    2006-01-01

    The PIH-EMR is a Web based electronic medical record that has been in operation for over four years in Peru supporting the treatment of drug resistant TB. We describe here the types of evaluations that have been performed on the EMR to assess its impact on patient care, reporting, logistics and observational research. Formal studies have been performed on components for drug order entry, drug requirements prediction tools and the use of PDAs to collect bacteriology data. In addition less formal data on the use of the EMR for reporting and research are reviewed. Experience and insights from porting the PIH-EMR to the Philippines, and modifying it to support HIV treatment in Haiti and Rwanda are discussed. We propose that additional data of this sort is valuable in assessing medical information systems especially in resource poor areas. PMID:17238344

  18. Using OpenEHR in SICTI an electronic health record system for critical medicine

    NASA Astrophysics Data System (ADS)

    Filgueira, R.; Odriazola, A.; Simini, F.

    2007-11-01

    SICTI is a software tool for registering health records in critical medicine environments. Version 1.0 has been in use since 2003. The Biomedical Engineering Group (Núcleo de Ingeniería Biomédica), with support from the Technological Development Programme (Programa de Desarrollo Tecnológico), decided to develop a new version, to provide an aid for more critical medicine processes, based on a framework which would make the application domain change oriented. The team analyzed three alternatives: to develop an original product based on new research, to base the development on OpenEHR framework, or to use HL7 RIM as the reference model for SICTI. The team opted for OpenEHR. This work describes the use of OpenEHR, its strong and weak points, and states future work perspectives.

  19. The Automated Bicron Tester: Automated electronic instrument diagnostic, testing, and alignment system with records generation

    SciTech Connect

    Rao, G.S.; Maddox, S.R.; Turner, G.W.; Vandermolen, R.I.

    1995-11-01

    The Bicron Surveyor MX is a portable radiation monitoring instrument used by the Office of Radiation Protection at Oak Ridge National Laboratory. This instrument must be calibrated in order to assure reliable operation. A manual calibration procedure was developed, but it was time consuming and repetitive. Therefore, an automated tester station that would allow the technicians to calibrate the instruments faster and more reliably was developed. With the automated tester station, calibration records and accountability could be generated and maintained automatically. This allows the technicians to concentrate on repairing defective units. The Automated Bicron Tester consists of an operator interface, an analog board, and a digital controller board. The panel is the user interface that allows the technician to communicate with the tester. The analog board has an analog-to-digital converter (ADC) that converts the signals from the instrument into digital data that the tester can manipulate. The digital controller board contains the circuitry to perform the test and to communicate the results to the host personal computer (PC). The tester station is connected to the unit under test through a special test harness that attaches to a header on the Bicron. The tester sends pulse trains to the Bicron and measures the resulting meter output. This is done to determine if the unit is functioning properly. The testers are connected to the host PC through an RS-485 serial line. The host PC polls all the tester stations that are connected to it and collects data from those that have completed a calibration. It logs these data and stores the record in a format ready for export to the Maintenance, Accountability, Jobs, and Inventory Control (MAJIC) database. It also prints a report. The programs for the Automated Bicron Tester and the host are written in the C language.

  20. Association of Medical Directors of Information Systems Consensus on Inpatient Electronic Health Record Documentation

    PubMed Central

    Shoolin, J.; Ozeran, L.; Hamann, C.; Bria II, W.

    2013-01-01

    In 2013, electronic documentation of clinical care stands at a crossroads. The benefits of creating digital notes are at risk of being overwhelmed by the inclusion of easily importable detail. Providers are the primary authors of encounters with patients. We must document clearly our understanding of patients and our communication with them and our colleagues. We want to document efficiently to meet without exceeding documentation guidelines. We copy and paste documentation, because it not only simplifies the documentation process generally, but also supports meeting coding and regulatory requirements specifically. Since the primary goal of our profession is to spend as much time as possible listening to, understanding and helping patients, clinicians need information technology to make electronic documentation easier, not harder. At the same time, there should be reasonable restrictions on the use of copy and paste to limit the growing challenge of ‘note bloat’. We must find the right balance between ease of use and thoughtless documentation. The guiding principles in this document may be used to launch an interdisciplinary dialogue that promotes useful and necessary documentation that best facilitates efficient information capture and effective display. PMID:23874365

  1. Association of Medical Directors of Information Systems consensus on inpatient electronic health record documentation.

    PubMed

    Shoolin, J; Ozeran, L; Hamann, C; Bria, W

    2013-01-01

    In 2013, electronic documentation of clinical care stands at a crossroads. The benefits of creating digital notes are at risk of being overwhelmed by the inclusion of easily importable detail. Providers are the primary authors of encounters with patients. We must document clearly our understanding of patients and our communication with them and our colleagues. We want to document efficiently to meet without exceeding documentation guidelines. We copy and paste documentation, because it not only simplifies the documentation process generally, but also supports meeting coding and regulatory requirements specifically. Since the primary goal of our profession is to spend as much time as possible listening to, understanding and helping patients, clinicians need information technology to make electronic documentation easier, not harder. At the same time, there should be reasonable restrictions on the use of copy and paste to limit the growing challenge of 'note bloat'. We must find the right balance between ease of use and thoughtless documentation. The guiding principles in this document may be used to launch an interdisciplinary dialogue that promotes useful and necessary documentation that best facilitates efficient information capture and effective display. PMID:23874365

  2. 77 FR 8217 - Evaluating the Usability of Electronic Health Record (EHR) Systems

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-14

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF COMMERCE...) Systems AGENCY: National Institute of Standards and Technology, Commerce. ACTION: Notice. SUMMARY: NIST is... Letters of Understanding. Comparative information (e.g., testing results from unidentified EHR systems...

  3. Ontology-Based Data Integration of Open Source Electronic Medical Record and Data Capture Systems

    ERIC Educational Resources Information Center

    Guidry, Alicia F.

    2013-01-01

    In low-resource settings, the prioritization of clinical care funding is often determined by immediate health priorities. As a result, investment directed towards the development of standards for clinical data representation and exchange are rare and accordingly, data management systems are often redundant. Open-source systems such as OpenMRS and…

  4. Determination of Minimum Data Set (MSD) in Echocardiography Reporting System to Exchange with Iran’s Electronic Health Record (EHR) System

    PubMed Central

    Mahmoudvand, Zahra; Kamkar, Mehran; Shahmoradi, Leila; Nejad, Ahmadreza Farzaneh

    2016-01-01

    Background: Determination of minimum data set (MDS) in echocardiography reports is necessary for documentation and putting information in a standard way, and leads to the enhancement of electrocardiographic studies through having access to precise and perfect reports and also to the development of a standard database for electrocardiographic reports. Aim: to determine the minimum data set of echocardiography reporting system to exchange with Iran’s electronic health record (EHR) system. Methods: First, a list of minimum data set was prepared after reviewing texts and studying cardiac patients’ records. Then, to determine the content validity of the prepared MDS, the expert views of 10 cardiologists and 10 health information management (HIM) specialists were obtained; to estimate the reliability of the set, test-retest method was employed. Finally, the data were analyzed using SPSS software. Results: The highest degree of consensus was found for the following MDSs: patient’s name and family name (5), accepting doctor’s name and family name, familial death records due to cardiac disorders, the image identification code, mitral valve, aortic valve, tricuspid valve, pulmonary valve, left ventricle, hole, atrium valve, Doppler examination of ventricular and atrial movement models and diagnoses with an average of. Conclusions: To prepare a model of echocardiography reporting system to exchange with EHR system, creation a standard data set is the vital point. Therefore, based on the research findings, the minimum reporting system data to exchange with Iran’s electronic health record system include information on entity, management, medical record, carried-out acts, and the main content of the echocardiography report, which the planners of reporting system should consider. PMID:27147803

  5. Annotation methods to develop and evaluate an expert system based on natural language processing in electronic medical records.

    PubMed

    Gicquel, Quentin; Tvardik, Nastassia; Bouvry, Côme; Kergourlay, Ivan; Bittar, André; Segond, Frédérique; Darmoni, Stefan; Metzger, Marie-Hélène

    2015-01-01

    The objective of the SYNODOS collaborative project was to develop a generic IT solution, combining a medical terminology server, a semantic analyser and a knowledge base. The goal of the project was to generate meaningful epidemiological data for various medical domains from the textual content of French medical records. In the context of this project, we built a care pathway oriented conceptual model and corresponding annotation method to develop and evaluate an expert system's knowledge base. The annotation method is based on a semi-automatic process, using a software application (MedIndex). This application exchanges with a cross-lingual multi-termino-ontology portal. The annotator selects the most appropriate medical code proposed for the medical concept in question by the multi-termino-ontology portal and temporally labels the medical concept according to the course of the medical event. This choice of conceptual model and annotation method aims to create a generic database of facts for the secondary use of electronic health records data. PMID:26262366

  6. Electronic system

    DOEpatents

    Robison, G H; Dickson, J F

    1960-11-15

    An electronic system is designed for indicating the occurrence of a plurality of electrically detectable events within predetermined time intervals. The system comprises separate input means electrically associated with the events under observation an electronic channel associated with each input means, including control means and indicating means; timing means adapted to apply a signal from the input means after a predetermined time to the control means to deactivate each of the channels; and means for resetting the system to its initial condition after the observation of each group of events. (D.L.C.)

  7. CKD screening and management in the Veterans Health Administration: the impact of system organization and an innovative electronic record.

    PubMed

    Patel, Thakor G; Pogach, Leonard M; Barth, Robert H

    2009-03-01

    At the beginning of this decade, Healthy People 2010 issued a series of objectives to "reduce the incidence, morbidity, mortality and health care costs of chronic kidney disease." A necessary feature of any program to reduce the burden of kidney disease in the US population must include mechanisms to screen populations at risk and institute early the aspects of management, such as control of blood pressure, management of diabetes, and, in patients with advanced chronic kidney disease (CKD), preparation for dialysis therapy and proper vascular access management, that can retard CKD progression and improve long-term outcome. The Department of Veterans Affairs and the Veterans Health Administration is a broad-based national health care system that is almost uniquely situated to address these issues and has developed a number of effective approaches using evidence-based clinical practice guidelines, performance measures, innovative use of a robust electronic medical record system, and system oversight during the past decade. In this report, we describe the application of this systems approach to the prevention of CKD in veterans through the treatment of risk factors, identification of CKD in veterans, and oversight of predialysis and dialysis care. The lessons learned and applicability to the private sector are discussed. PMID:19231765

  8. Software engineering risk factors in the implementation of a small electronic medical record system: the problem of scalability.

    PubMed

    Chiang, Michael F; Starren, Justin B

    2002-01-01

    The successful implementation of clinical information systems is difficult. In examining the reasons and potential solutions for this problem, the medical informatics community may benefit from the lessons of a rich body of software engineering and management literature about the failure of software projects. Based on previous studies, we present a conceptual framework for understanding the risk factors associated with large-scale projects. However, the vast majority of existing literature is based on large, enterprise-wide systems, and it unclear whether those results may be scaled down and applied to smaller projects such as departmental medical information systems. To examine this issue, we discuss the case study of a delayed electronic medical record implementation project in a small specialty practice at Columbia-Presbyterian Medical Center. While the factors contributing to the delay of this small project share some attributes with those found in larger organizations, there are important differences. The significance of these differences for groups implementing small medical information systems is discussed. PMID:12463804

  9. 5 CFR 850.301 - Electronic records; other acceptable records.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... OPM include— (1) Electronic employee data, including an eIRR or an ERR, submitted by an agency, agency... Repository, the eIRR records storage database, or other OPM database. (2) Electronic Official...

  10. 36 CFR 1236.10 - What records management controls must agencies establish for records in electronic information...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... controls must agencies establish for records in electronic information systems? 1236.10 Section 1236.10... Implementing Electronic Information Systems § 1236.10 What records management controls must agencies establish for records in electronic information systems? The following types of records management controls...

  11. Photonic Data Recording Systems

    NASA Astrophysics Data System (ADS)

    Fanning, J.; Chang, J.; Davis, P.; Holmgren, D.; Bruns, D.; Watson, D.; Lechner, M.; Graham, R.; Kemme, S.

    1989-02-01

    Steady advancement has been made in bringing photonic recorder technologies from a pure research and development stage to the practical laboratory and fielding environment. Streak camera-based systems have been incorporated into large data recording systems and have shown significant improvement in channel density and single-shot bandwidth. In particular, remote photonic sensing using fiber optic cables to transmit the information to the recorder has shown advantages over conventional coax cable methods. One streak camera-based recorder system has been designed into the underground test (UGT) data acquisition system. The design allowed for video rate readout, redundant digitized image storage, UGT system compatibility, and full real time system diagnostics. Another stand-alone streak camera-based recorder has been designed that incorporates an IEEE-488 interface and a unique software package. Operation of this photonic recorder system (PRS-1000), as either a streak imaging recorder or as a high-speed multi-channel data recorder (HSMCDR), has been greatly simplified through use of the icon-driven, window-based custom software. An overview of photonic recording methods will be presented along with the details of the PRS-1000 and the associated system software.

  12. Design of an image-enabled electronic healthcare record system for regional collaborative healthcare applications

    NASA Astrophysics Data System (ADS)

    Zhang, Kai; Yang, Yuanyuan; He, Zhenyu; Sun, Jianyong; Ling, Tonghui; Zhang, Jianguo

    2009-02-01

    Shanghai is piloting to develop an EHR system to solve the problems of medical document sharing for collaborative healthcare, the solution of which is considering to following IHE XDS (cross-enterprise document sharing) and XCA (cross-community access) technical profiles as well as combined with grid storage for images. The first phase of the project targets text and image documents sharing cross four local domains or communities, each of which consists of multiple hospitals. The prototype system was designed and developed with service-oriented architecture (SOA) and Event-Driven Architecture (EDA), basing on IHE XDS.b and XCA profiles, and consists of four level components: one central city registry; the multiple domain registries, each of which is for one local domain or community; the multiple repositories corresponding to multiple local domain registries; and multiple document source agents, each of which is located in each hospital to provide the patient healthcare information. The system was developed and tested for performance evaluation including data publication, user query and image retrieval. The results are extremely positive and demonstrate that the designed EHR solution based on SOA with grid concept can scale effectively to serve medical document sharing cross-domain or community in a large city.

  13. Using a generalised identity reference model with archetypes to support interoperability of demographics information in electronic health record systems.

    PubMed

    Xu Chen; Berry, Damon; Stephens, Gaye

    2015-01-01

    Computerised identity management is in general encountered as a low-level mechanism that enables users in a particular system or region to securely access resources. In the Electronic Health Record (EHR), the identifying information of both the healthcare professionals who access the EHR and the patients whose EHR is accessed, are subject to change. Demographics services have been developed to manage federated patient and healthcare professional identities and to support challenging healthcare-specific use cases in the presence of diverse and sometimes conflicting demographic identities. Demographics services are not the only use for identities in healthcare. Nevertheless, contemporary EHR specifications limit the types of entities that can be the actor or subject of a record to health professionals and patients, thus limiting the use of two level models in other healthcare information systems. Demographics are ubiquitous in healthcare, so for a general identity model to be usable, it should be capable of managing demographic information. In this paper, we introduce a generalised identity reference model (GIRM) based on key characteristics of five surveyed demographic models. We evaluate the GIRM by using it to express the EN13606 demographics model in an extensible way at the metadata level and show how two-level modelling can support the exchange of instances of demographic identities. This use of the GIRM to express demographics information shows its application for standards-compliant two-level modelling alongside heterogeneous demographics models. We advocate this approach to facilitate the interoperability of identities between two-level model-based EHR systems and show the validity and the extensibility of using GIRM for the expression of other health-related identities. PMID:26737863

  14. Electron beam recording of optical disc

    NASA Astrophysics Data System (ADS)

    Cartwright, Giles; Reynolds, Gerald; Baylis, Chris; Pearce, Adrian; Dix, Colin; Ogilvie, Nick

    2002-09-01

    The Nimbus Technology & Engineering e -Beam Mastering System was developed to gain a large improvement in optical disc and structured hard disc recording capacity, significantly more than is possible from deep UV and SIL mastering. The current electron beam recorder is essentially a production machine capable of making full-length exposures at capacities of up to 50 GB with a simple low-cost upgrade path to disc capacities of several hundred gigabytes and beyond and hard disk drives (HDD) with capacities of up to 1 tera bit per square inch.

  15. Permanent record. Electronic records aid in the aftermath of Joplin tornado.

    PubMed

    Russell, Matthew

    2011-09-01

    When a tornado struck St. John's Regional Medical Center in May 2011, its patient records were stored in a newly launched electronic health record system, helping prevent a bad situation from being worse. PMID:21980902

  16. ELECTRONIC SYSTEM

    DOEpatents

    Robison, G.H. et al.

    1960-11-15

    An electronic system is described for indicating the occurrence of a plurality of electrically detectable events within predetermined time intervals. It is comprised of separate input means electrically associated with the events under observation: an electronic channel associated with each input means including control means and indicating means; timing means associated with each of the input means and the control means and adapted to derive a signal from the input means and apply it after a predetermined time to the control means to effect deactivation of each of the channels; and means for resetting the system to its initial condition after observation of each group of events.

  17. [Automated anesthesia record system].

    PubMed

    Zhu, Tao; Liu, Jin

    2005-12-01

    Based on Client/Server architecture, a software of automated anesthesia record system running under Windows operation system and networks has been developed and programmed with Microsoft Visual C++ 6.0, Visual Basic 6.0 and SQL Server. The system can deal with patient's information throughout the anesthesia. It can collect and integrate the data from several kinds of medical equipment such as monitor, infusion pump and anesthesia machine automatically and real-time. After that, the system presents the anesthesia sheets automatically. The record system makes the anesthesia record more accurate and integral and can raise the anesthesiologist's working efficiency. PMID:16422117

  18. Building a house on shifting sand: methodological considerations when evaluating the implementation and adoption of national electronic health record systems

    PubMed Central

    2012-01-01

    Background A commitment to Electronic Health Record (EHR) systems now constitutes a core part of many governments’ healthcare reform strategies. The resulting politically-initiated large-scale or national EHR endeavors are challenging because of their ambitious agendas of change, the scale of resources needed to make them work, the (relatively) short timescales set, and the large number of stakeholders involved, all of whom pursue somewhat different interests. These initiatives need to be evaluated to establish if they improve care and represent value for money. Methods Critical reflections on these complexities in the light of experience of undertaking the first national, longitudinal, and sociotechnical evaluation of the implementation and adoption of England’s National Health Service’s Care Records Service (NHS CRS). Results/discussion We advance two key arguments. First, national programs for EHR implementations are likely to take place in the shifting sands of evolving sociopolitical and sociotechnical and contexts, which are likely to shape them in significant ways. This poses challenges to conventional evaluation approaches which draw on a model of baseline operations → intervention → changed operations (outcome). Second, evaluation of such programs must account for this changing context by adapting to it. This requires careful and creative choice of ontological, epistemological and methodological assumptions. Summary New and significant challenges are faced in evaluating national EHR implementation endeavors. Based on experiences from this national evaluation of the implementation and adoption of the NHS CRS in England, we argue for an approach to these evaluations which moves away from seeing EHR systems as Information and Communication Technologies (ICT) projects requiring an essentially outcome-centred assessment towards a more interpretive approach that reflects the situated and evolving nature of EHR seen within multiple specific settings and

  19. Biomedical recording system

    NASA Technical Reports Server (NTRS)

    Vick, H. A.

    1970-01-01

    System collects medical data directly from patients and permanently records and displays several parameters - electrocardiograph, electroencephalograph, heart rate, respiration rate, auscultatory blood pressure, leg circumference changes, body temperature, and time. Components and operation of the system are described.

  20. Interoperability of clinical decision-support systems and electronic health records using archetypes: a case study in clinical trial eligibility.

    PubMed

    Marcos, Mar; Maldonado, Jose A; Martínez-Salvador, Begoña; Boscá, Diego; Robles, Montserrat

    2013-08-01

    Clinical decision-support systems (CDSSs) comprise systems as diverse as sophisticated platforms to store and manage clinical data, tools to alert clinicians of problematic situations, or decision-making tools to assist clinicians. Irrespective of the kind of decision-support task CDSSs should be smoothly integrated within the clinical information system, interacting with other components, in particular with the electronic health record (EHR). However, despite decades of developments, most CDSSs lack interoperability features. We deal with the interoperability problem of CDSSs and EHRs by exploiting the dual-model methodology. This methodology distinguishes a reference model and archetypes. A reference model is represented by a stable and small object-oriented model that describes the generic properties of health record information. For their part, archetypes are reusable and domain-specific definitions of clinical concepts in the form of structured and constrained combinations of the entities of the reference model. We rely on archetypes to make the CDSS compatible with EHRs from different institutions. Concretely, we use archetypes for modelling the clinical concepts that the CDSS requires, in conjunction with a series of knowledge-intensive mappings relating the archetypes to the data sources (EHR and/or other archetypes) they depend on. We introduce a comprehensive approach, including a set of tools as well as methodological guidelines, to deal with the interoperability of CDSSs and EHRs based on archetypes. Archetypes are used to build a conceptual layer of the kind of a virtual health record (VHR) over the EHR whose contents need to be integrated and used in the CDSS, associating them with structural and terminology-based semantics. Subsequently, the archetypes are mapped to the EHR by means of an expressive mapping language and specific-purpose tools. We also describe a case study where the tools and methodology have been employed in a CDSS to support

  1. Electronic Health Record Meets Digital Library

    PubMed Central

    Humphreys, Betsy L.

    2000-01-01

    Linking the electronic health record to the digital library is a Web-era reformulation of the long-standing informatics goal of seamless integration of automated clinical data and relevant knowledge-based information to support informed decisions. The spread of the Internet, the development of the World Wide Web, and converging format standards for electronic health data and digital publications make effective linking increasingly feasible. Some existing systems link electronic health data and knowledge-based information in limited settings or limited ways. Yet many challenging informatics research problems remain to be solved before flexible and seamless linking becomes a reality and before systems become capable of delivering the specific piece of information needed at the time and place a decision must be made. Connecting the electronic health record to the digital library also requires positive resolution of important policy issues, including health data privacy, government envouragement of high-speed communications, electronic intellectual property rights, and standards for health data and for digital libraries. Both the research problems and the policy issues should be important priorities for the field of medical informatics. PMID:10984463

  2. Effectiveness of Computerized Decision Support Systems Linked to Electronic Health Records: A Systematic Review and Meta-Analysis

    PubMed Central

    Kwag, Koren H.; Lytras, Theodore; Bertizzolo, Lorenzo; Brandt, Linn; Pecoraro, Valentina; Rigon, Giulio; Vaona, Alberto; Ruggiero, Francesca; Mangia, Massimo; Iorio, Alfonso; Kunnamo, Ilkka; Bonovas, Stefanos

    2014-01-01

    We systematically reviewed randomized controlled trials (RCTs) assessing the effectiveness of computerized decision support systems (CDSSs) featuring rule- or algorithm-based software integrated with electronic health records (EHRs) and evidence-based knowledge. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Abstracts of Reviews of Effects. Information on system design, capabilities, acquisition, implementation context, and effects on mortality, morbidity, and economic outcomes were extracted. Twenty-eight RCTs were included. CDSS use did not affect mortality (16 trials, 37395 patients; 2282 deaths; risk ratio [RR] = 0.96; 95% confidence interval [CI] = 0.85, 1.08; I2 = 41%). A statistically significant effect was evident in the prevention of morbidity, any disease (9 RCTs; 13868 patients; RR = 0.82; 95% CI = 0.68, 0.99; I2 = 64%), but selective outcome reporting or publication bias cannot be excluded. We observed differences for costs and health service utilization, although these were often small in magnitude. Across clinical settings, new generation CDSSs integrated with EHRs do not affect mortality and might moderately improve morbidity outcomes. PMID:25322302

  3. 22 CFR 503.9 - Electronic records.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 2 2012-04-01 2009-04-01 true Electronic records. 503.9 Section 503.9 Foreign Relations BROADCASTING BOARD OF GOVERNORS FREEDOM OF INFORMATION ACT REGULATION § 503.9 Electronic records... electronic format. Documentation not previously subject to the FOIA when maintained in a...

  4. 22 CFR 503.9 - Electronic records.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 2 2013-04-01 2009-04-01 true Electronic records. 503.9 Section 503.9 Foreign Relations BROADCASTING BOARD OF GOVERNORS FREEDOM OF INFORMATION ACT REGULATION § 503.9 Electronic records... electronic format. Documentation not previously subject to the FOIA when maintained in a...

  5. 22 CFR 503.9 - Electronic records.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 2 2014-04-01 2014-04-01 false Electronic records. 503.9 Section 503.9 Foreign Relations BROADCASTING BOARD OF GOVERNORS FREEDOM OF INFORMATION ACT REGULATION § 503.9 Electronic records... electronic format. Documentation not previously subject to the FOIA when maintained in a...

  6. 22 CFR 503.9 - Electronic records.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Electronic records. 503.9 Section 503.9 Foreign Relations BROADCASTING BOARD OF GOVERNORS FREEDOM OF INFORMATION ACT REGULATION § 503.9 Electronic records... electronic format. Documentation not previously subject to the FOIA when maintained in a...

  7. Implementation of Clinical Pharmacogenomics within a Large Health System: From Electronic Health Record Decision Support to Consultation Services.

    PubMed

    Hicks, J Kevin; Stowe, David; Willner, Marc A; Wai, Maya; Daly, Thomas; Gordon, Steven M; Lashner, Bret A; Parikh, Sumit; White, Robert; Teng, Kathryn; Moss, Timothy; Erwin, Angelika; Chalmers, Jeffrey; Eng, Charis; Knoer, Scott

    2016-08-01

    The number of clinically relevant gene-based guidelines and recommendations pertaining to drug prescribing continues to grow. Incorporating gene-drug interaction information into the drug-prescribing process can help optimize pharmacotherapy outcomes and improve patient safety. However, pharmacogenomic implementation barriers exist such as integration of pharmacogenomic results into electronic health records (EHRs), development and deployment of pharmacogenomic decision support tools to EHRs, and feasible models for establishing ambulatory pharmacogenomic clinics. We describe the development of pharmacist-managed pharmacogenomic services within a large health system. The Clinical Pharmacogenetics Implementation Consortium guidelines for HLA-B*57:01-abacavir, HLA-B*15:02-carbamazepine, and TPMT-thiopurines (i.e., azathioprine, mercaptopurine, and thioguanine) were systematically integrated into patient care. Sixty-three custom rules and alerts (20 for TPMT-thiopurines, 8 for HLA-B*57:01-abacavir, and 35 for HLA-B*15:02-anticonvulsants) were developed and deployed to the EHR for the purpose of providing point-of-care pharmacogenomic decision support. In addition, a pharmacist and physician-geneticist collaboration established a pharmacogenomics ambulatory clinic. This clinic provides genetic testing when warranted, result interpretation along with pharmacotherapy recommendations, and patient education. Our processes for developing these pharmacogenomic services and solutions for addressing implementation barriers are presented. PMID:27312955

  8. Does use of an electronic health record with dental diagnostic system terminology promote dental students' critical thinking?

    PubMed

    Reed, Susan G; Adibi, Shawn S; Coover, Mullen; Gellin, Robert G; Wahlquist, Amy E; AbdulRahiman, Anitha; Hamil, Lindsey H; Walji, Muhammad F; O'Neill, Paula; Kalenderian, Elsbeth

    2015-06-01

    The Consortium for Oral Health Research and Informatics (COHRI) is leading the way in use of the Dental Diagnostic System (DDS) terminology in the axiUm electronic health record (EHR). This collaborative pilot study had two aims: 1) to investigate whether use of the DDS terms positively impacted predoctoral dental students' critical thinking skills measured by the Health Sciences Reasoning Test (HSRT), and 2) to refine study protocols. The study design was a natural experiment with cross-sectional data collection using the HSRT for 15 classes (2013-17) of students at three dental schools. Characteristics of students who had been exposed to the DDS terms were compared with students who had not, and the differences were tested by t-tests or chi-square tests. Generalized linear models were used to evaluate the relationship between exposure and outcome on the overall critical thinking score. The results showed that exposure was significantly related to overall score (p=0.01), with not-exposed students having lower mean overall scores. This study thus demonstrated a positive impact of using the DDS terminology in an EHR on the critical thinking skills of predoctoral dental students in three COHRI schools as measured by their overall score on the HSRT. These preliminary findings support future research to further evaluate a proposed model of critical thinking in clinical dentistry. PMID:26034034

  9. Comprehensive Evaluation of Electronic Medical Record System Use and User Satisfaction at Five Low-Resource Setting Hospitals in Ethiopia

    PubMed Central

    Fritz, Fleur

    2015-01-01

    Background Electronic medical record (EMR) systems are increasingly being implemented in hospitals of developing countries to improve patient care and clinical service. However, only limited evaluation studies are available concerning the level of adoption and determinant factors of success in those settings. Objective The objective of this study was to assess the usage pattern, user satisfaction level, and determinants of health professional’s satisfaction towards a comprehensive EMR system implemented in Ethiopia where parallel documentation using the EMR and the paper-based medical records is in practice. Methods A quantitative, cross-sectional study design was used to assess the usage pattern, user satisfaction level, and determinant factors of an EMR system implemented in Ethiopia based on the DeLone and McLean model of information system success. Descriptive statistical methods were applied to analyze the data and a binary logistic regression model was used to identify determinant factors. Results Health professionals (N=422) from five hospitals were approached and 406 responded to the survey (96.2% response rate). Out of the respondents, 76.1% (309/406) started to use the system immediately after implementation and user training, but only 31.7% (98/309) of the professionals reported using the EMR during the study (after 3 years of implementation). Of the 12 core EMR functions, 3 were never used by most respondents, and they were also unaware of 4 of the core EMR functions. It was found that 61.4% (190/309) of the health professionals reported over all dissatisfaction with the EMR (median=4, interquartile range (IQR)=1) on a 5-level Likert scale. Physicians were more dissatisfied (median=5, IQR=1) when compared to nurses (median=4, IQR=1) and the health management information system (HMIS) staff (median=2, IQR=1). Of all the participants, 64.4% (199/309) believed that the EMR had no positive impact on the quality of care. The participants indicated an

  10. A multimedia Electronic Patient Record (ePR) system for Image-Assisted Minimally Invasive Spinal Surgery

    PubMed Central

    Documet, Jorge; Le, Anh; Liu, Brent; Chiu, John; Huang, HK

    2009-01-01

    Purpose This paper presents the concept of bridging the gap between diagnostic images and image-assisted surgical treatment through the development of a one-stop multimedia electronic patient record (ePR) system that manages and distributes the real-time multimodality imaging and informatics data that assists the surgeon during all clinical phases of the operation from planning Intra-Op to post-care follow-up. We present the concept of this multimedia ePR for surgery by first focusing on Image-Assisted Minimally Invasive Spinal Surgery as a clinical application. Methods Three clinical Phases of Minimally Invasive Spinal Surgery workflow in Pre-Op, Intra-Op, and Post Op are discussed. The ePR architecture was developed based on the three-phased workflow, which includes the Pre-Op, Intra-Op, and Post-Op modules and four components comprising of the input integration unit, fault-tolerant gateway server, fault-tolerant ePR server, and the visualization and display. A prototype was built and deployed to a Minimally Invasive Spinal Surgery clinical site with user training and support for daily use. Summary A step-by step approach was introduced to develop a multi-media ePR system for Imaging-Assisted Minimally Invasive Spinal Surgery that includes images, clinical forms, waveforms, and textual data for planning the surgery, two real-time imaging techniques (digital fluoroscopic, DF) and endoscope video images (Endo), and more than half a dozen live vital signs of the patient during surgery. Clinical implementation experiences and challenges were also discussed. PMID:20033507

  11. Medical narratives in electronic medical records.

    PubMed

    Tange, H J; Hasman, A; de Vries Robbé, P F; Schouten, H C

    1997-08-01

    In this article, we describe the state of the art and directions of current development and research with respect to the inclusion of medical narratives in electronic medical-record systems. We used information about 20 electronic medical-record systems as presented in the literature. We divided these systems into 'classical' systems that matured before 1990 and are now used in a broad range of medical domains, and 'experimental' systems, more recently developed and, in general, more innovative. In the literature, three major challenges were addressed: facilitation of direct data entry, achieving unambiguous understandability of data, and improvement of data presentation. Promising approaches to tackle the first and second challenge are the use of dynamic data-entry forms that anticipate sensible input, and free-text data entry followed by natural-language interpretation. Both these approaches require a highly expressive medical terminology. How to facilitate the access to medical narratives has not been studied much. We found facilitating examples of presenting this information as fluent prose, of optimising the screen design with fixed position cues, and of imposing medical narratives with a structure of indexable paragraphs that can be used in flowsheets. We conclude that further study is needed to develop an optimal searching structure for medical narratives. PMID:9476152

  12. Confidentiality, electronic health records, and the clinician.

    PubMed

    Graves, Stuart

    2013-01-01

    The advent of electronic health records (EHRs) to improve access and enable research in the everyday clinical world has simultaneously made medical information much more vulnerable to illicit, non-beneficent uses. This wealth of identified, aggregated data has and will attract attacks by domestic governments for surveillance and protection, foreign governments for espionage and sabotage, organized crime for illegal profits, and large corporations for "legal" profits. Against these powers with almost unlimited resources no security scheme is likely to prevail, so the design of such systems should include appropriate security measures. Unlike paper records, where the person maintaining and controlling the existence of the records also controls access to them, these two functions can be separated for EHRs. By giving physical control over access to individual records to their individual owners, the aggregate is dismantled, thereby protecting the nation's identified health information from large-scale data mining or tampering. Control over the existence and integrity of all the records--yet without the ability to examine their contents--would be left with larger institutions. This article discusses the implications of all of the above for the role of the clinician in assuring confidentiality (a cornerstone of clinical practice), for research and everyday practice, and for current security designs. PMID:23748530

  13. Mandatory Use of Electronic Health Records: Overcoming Physician Resistance

    ERIC Educational Resources Information Center

    Brown, Viseeta K.

    2012-01-01

    Literature supports the idea that electronic health records hold tremendous value for the healthcare system in that it increases patient safety, improves the quality of care and provides greater efficiency. The move toward mandatory implementation of electronic health records is a growing concern in the United States health care industry. The…

  14. Security infrastructure services for electronic archives and electronic health records.

    PubMed

    Pharow, Peter; Blobel, Bernd

    2004-01-01

    Communication and co-operation in the domain of healthcare and welfare require a well-defined set of security services based on a Public Key Infrastructure and provided by a Trusted Third Party (TTP). These services describe both status and relation of communicating principals, corresponding keys and attributes, and the access rights to applications and data. Additional services are needed to provide trustworthy information about dynamic issues of communication and co-operation such as time and location of processes, workflow relations, and system behaviour. Legal, social, behavioural and ethical requirements demand securely stored patient information and well-established access tools and tokens. Electronic (and more specifically digital) signatures--as important means for securing the integrity of a message or file--along with certified time stamps or time signatures are especially important for purposes of data storage in electronic archives and electronic health records (EHR). While just mentioning technical storage problems (e.g. lifetime of the storage devices, interoperability of retrieval and presentation software), this paper identifies mechanisms of securing data items, files, messages, sets of archived items or documents, electronic archive structures, and life-long electronic health records. Other workshop contributions will demonstrate related aspects of policies, patient privacy, and privilege management. PMID:15747952

  15. Use of Electronic Health Records and Geographic Information Systems in Public Health Surveillance of Type 2 Diabetes: A Feasibility Study

    PubMed Central

    Rodrigues, David; Pereira, Ana Marta; Ribeiro, Rogério T; Boavida, José Manuel

    2016-01-01

    Background Data routinely collected in electronic health records (EHRs) offer a unique opportunity to monitor chronic health conditions in real-time. Geographic information systems (GIS) may be an important complement in the analysis of those data. Objective The aim of this study was to explore the feasibility of using primary care EHRs and GIS for population care management and public health surveillance of chronic conditions, in Portugal. Specifically, type 2 diabetes was chosen as a case study, and we aimed to map its prevalence and the presence of comorbidities, as well as to identify possible populations at risk for cardiovascular complications. Methods Cross-sectional study using individual-level data from 514 primary care centers, collected from three different types of EHRs. Data were obtained on adult patients with type 2 diabetes (identified by the International Classification of Primary Care [ICPC-2] code, T90, in the problems list). GISs were used for mapping the prevalence of diabetes and comorbidities (hypertension, dyslipidemia, and obesity) by parish, in the region of Lisbon and Tagus Valley. Descriptive statistics and multivariate logistic regression were used for data analysis. Results We identified 205,068 individuals with the diagnosis of type 2 diabetes, corresponding to a prevalence of 5.6% (205,068/3,659,868) in the study population. The mean age of these patients was 67.5 years, and hypertension was present in 71% (144,938/205,068) of all individuals. There was considerable variation in diagnosed comorbidities across parishes. Diabetes patients with concomitant hypertension or dyslipidemia showed higher odds of having been diagnosed with cardiovascular complications, when adjusting for age and gender (hypertension odds ratio [OR] 2.16, confidence interval [CI] 2.10-2.22; dyslipidemia OR 1.57, CI 1.54-1.60). Conclusions Individual-level data from EHRs may play an important role in chronic disease surveillance, namely through the use of GIS

  16. Quality and Certification of Electronic Health Records

    PubMed Central

    Hoerbst, A.; Ammenwerth, E.

    2010-01-01

    Background Numerous projects, initiatives, and programs are dedicated to the development of Electronic Health Records (EHR) worldwide. Increasingly more of these plans have recently been brought from a scientific environment to real life applications. In this context, quality is a crucial factor with regard to the acceptance and utility of Electronic Health Records. However, the dissemination of the existing quality approaches is often rather limited. Objectives The present paper aims at the description and comparison of the current major quality certification approaches to EHRs. Methods A literature analysis was carried out in order to identify the relevant publications with regard to EHR quality certification. PubMed, ACM Digital Library, IEEExplore, CiteSeer, and Google (Scholar) were used to collect relevant sources. The documents that were obtained were analyzed using techniques of qualitative content analysis. Results The analysis discusses and compares the quality approaches of CCHIT, EuroRec, IHE, openEHR, and EN13606. These approaches differ with regard to their focus, support of service-oriented EHRs, process of (re-)certification and testing, number of systems certified and tested, supporting organizations, and regional relevance. Discussion The analyzed approaches show differences with regard to their structure and processes. System vendors can exploit these approaches in order to improve and certify their information systems. Health care organizations can use these approaches to support selection processes or to assess the quality of their own information systems. PMID:23616834

  17. Developing Clinical Decision Support within a Commercial Electronic Health Record System to Improve Antimicrobial Prescribing in the Neonatal ICU

    PubMed Central

    Cato, K.; Sheehan, B.; Patel, S.; Duchon, J.; DeLaMora, P.; Ferng, Y.H.; Graham, P.; Vawdrey, D.K.; Perlman, J.; Larson, E.; Saiman, L.

    2014-01-01

    Summary Objective To develop and implement a clinical decision support (CDS) tool to improve antibiotic prescribing in neonatal intensive care units (NICUs) and to evaluate user acceptance of the CDS tool. Methods Following sociotechnical analysis of NICU prescribing processes, a CDS tool for empiric and targeted antimicrobial therapy for healthcare-associated infections (HAIs) was developed and incorporated into a commercial electronic health record (EHR) in two NICUs. User logs were reviewed and NICU prescribers were surveyed for their perceptions of the CDS tool. Results The CDS tool aggregated selected laboratory results, including culture results, to make treatment recommendations for common clinical scenarios. From July 2010 to May 2012, 1,303 CDS activations for 452 patients occurred representing 22% of patients prescribed antibiotics during this period. While NICU clinicians viewed two culture results per tool activation, prescribing recommendations were viewed during only 15% of activations. Most (63%) survey respondents were aware of the CDS tool, but fewer (37%) used it during their most recent NICU rotation. Respondents considered the most useful features to be summarized culture results (43%) and antibiotic recommendations (48%). Discussion During the study period, the CDS tool functionality was hindered by EHR upgrades, implementation of a new laboratory information system, and changes to antimicrobial testing methodologies. Loss of functionality may have reduced viewing antibiotic recommendations. In contrast, viewing culture results was frequently performed, likely because this feature was perceived as useful and functionality was preserved. Conclusion To improve CDS tool visibility and usefulness, we recommend early user and information technology team involvement which would facilitate use and mitigate implementation challenges. PMID:25024755

  18. An investigation of the effect of nurses’ technology readiness on the acceptance of mobile electronic medical record systems

    PubMed Central

    2013-01-01

    Background Adopting mobile electronic medical record (MEMR) systems is expected to be one of the superior approaches for improving nurses’ bedside and point of care services. However, nurses may use the functions for far fewer tasks than the MEMR supports. This may depend on their technological personality associated to MEMR acceptance. The purpose of this study is to investigate nurses’ personality traits in regard to technology readiness toward MEMR acceptance. Methods The study used a self-administered questionnaire to collect 665 valid responses from a large hospital in Taiwan. Structural Equation modeling was utilized to analyze the collected data. Results Of the four personality traits of the technology readiness, the results posit that nurses are optimistic, innovative, secure but uncomfortable about technology. Furthermore, these four personality traits were all proven to have a significant impact on the perceived ease of use of MEMR while the perceived usefulness of MEMR was significantly influenced by the optimism trait only. The results also confirmed the relationships between the perceived components of ease of use, usefulness, and behavioral intention in the Technology Acceptance Model toward MEMR usage. Conclusions Continuous educational programs can be provided for nurses to enhance their information technology literacy, minimizing their stress and discomfort about information technology. Further, hospital should recruit, either internally or externally, more optimistic nurses as champions of MEMR by leveraging the instrument proposed in this study. Besides, nurses’ requirements must be fully understood during the development of MEMR to ensure that MEMR can meet the real needs of nurses. The friendliness of user interfaces of MEMR and the compatibility of nurses’ work practices as these will also greatly enhance nurses’ willingness to use MEMR. Finally, the effects of technology personality should not be ignored, indicating that hospitals

  19. Intelligent consumer-centric electronic medical record.

    PubMed

    Luo, Gang; Thomas, Selena B; Tang, Chunqiang

    2009-01-01

    Web-based, consumer-centric electronic medical records (CEMRs) are currently undergoing widespread deployment. Existing CEMRs, however, have limited intelligence and cannot satisfy users' many needs. This paper proposes the concept of intelligent CEMR. We introduce and extend expert system and web search technology into the CEMR domain. The resulting intelligent CEMRs can automatically provide users with personalized healthcare information to facilitate their daily activities. We use automatic home medical product recommendation as a concrete application to demonstrate the benefits offered by intelligent CEMRs. PMID:19745280

  20. Drug-Induced Acute Myocardial Infarction: Identifying ‘Prime Suspects’ from Electronic Healthcare Records-Based Surveillance System

    PubMed Central

    Coloma, Preciosa M.; Schuemie, Martijn J.; Trifirò, Gianluca; Furlong, Laura; van Mulligen, Erik; Bauer-Mehren, Anna; Avillach, Paul; Kors, Jan; Sanz, Ferran; Mestres, Jordi; Oliveira, José Luis; Boyer, Scott; Helgee, Ernst Ahlberg; Molokhia, Mariam; Matthews, Justin; Prieto-Merino, David; Gini, Rosa; Herings, Ron; Mazzaglia, Giampiero; Picelli, Gino; Scotti, Lorenza; Pedersen, Lars; van der Lei, Johan; Sturkenboom, Miriam

    2013-01-01

    Background Drug-related adverse events remain an important cause of morbidity and mortality and impose huge burden on healthcare costs. Routinely collected electronic healthcare data give a good snapshot of how drugs are being used in ‘real-world’ settings. Objective To describe a strategy that identifies potentially drug-induced acute myocardial infarction (AMI) from a large international healthcare data network. Methods Post-marketing safety surveillance was conducted in seven population-based healthcare databases in three countries (Denmark, Italy, and the Netherlands) using anonymised demographic, clinical, and prescription/dispensing data representing 21,171,291 individuals with 154,474,063 person-years of follow-up in the period 1996–2010. Primary care physicians’ medical records and administrative claims containing reimbursements for filled prescriptions, laboratory tests, and hospitalisations were evaluated using a three-tier triage system of detection, filtering, and substantiation that generated a list of drugs potentially associated with AMI. Outcome of interest was statistically significant increased risk of AMI during drug exposure that has not been previously described in current literature and is biologically plausible. Results Overall, 163 drugs were identified to be associated with increased risk of AMI during preliminary screening. Of these, 124 drugs were eliminated after adjustment for possible bias and confounding. With subsequent application of criteria for novelty and biological plausibility, association with AMI remained for nine drugs (‘prime suspects’): azithromycin; erythromycin; roxithromycin; metoclopramide; cisapride; domperidone; betamethasone; fluconazole; and megestrol acetate. Limitations Although global health status, co-morbidities, and time-invariant factors were adjusted for, residual confounding cannot be ruled out. Conclusion A strategy to identify potentially drug-induced AMI from electronic healthcare data has

  1. [Shared electronic health record in Catalonia, Spain].

    PubMed

    Marimon-Suñol, Santiago; Rovira-Barberà, María; Acedo-Anta, Mateo; Nozal-Baldajos, Montserrat A; Guanyabens-Calvet, Joan

    2010-02-01

    Under the law adopted by its Parliament, the Government of Catalonia has developed an electronic medical record system for its National Health System (NHS). The model is governed by the following principles: 1) The citizen as owner of the data: direct access to his data and right to exercise his opposition's privileges; 2) Generate confidence in the system: security and confidentiality strength; 3) Shared model of information management: publishing system and access to organized and structured information, keeping in mind that the NHS of Catalonia is formally an "Integrated system of healthcare public use" (catalan acronym: SISCAT) with a wide variety of legal structures within its healthcare institutions; 4) Use of communication standards and catalogs as a need for technological and functional integration. In summary: single system of medical records shared between different actors, using interoperability tools and whose development is according to the legislation applicable in Catalonia and within its healthcare system. The result has been the establishment of a set of components and relation rules among which we highlight the following: 1) Display of information that collects sociodemographic data of the citizen, documents or reports (radiology, laboratory, therapeutic procedures, hospital release, emergency room), diagnostic health, prescription and immunization plus a summary screen with the most recent and relevant references; 2) Set of tools helping the user and direct messaging between professionals to facilitate their cooperation; 3) Model designed for supranational connections which will allow adding later, with ad hoc rules, clinical data provided by the private health sector or the proper citizen. PMID:20211353

  2. Crossing the "digital divide:" implementing an electronic medical record system in a rural Kenyan health center to support clinical care and research.

    PubMed Central

    Tierney, William M.; Rotich, Joseph K.; Smith, Faye E.; Bii, John; Einterz, Robert M.; Hannan, Terry J.

    2002-01-01

    To improve care, one must measure it. In the US, electronic medical record systems have been installed in many institutions to support health care management, quality improvement, and research. Developing countries lack such systems and thus have difficulties managing scarce resources and investigating means of improving health care delivery and outcomes. We describe the implementation and use of the first documented electronic medical record system in ambulatory care in sub-Saharan Africa. After one year, it has captured data for more than 13,000 patients making more than 26,000 visits. We present lessons learned and modifications made to this system to improve its capture of data and ability to support a comprehensive clinical care and research agenda. PMID:12463933

  3. Conducting research using the electronic health record across multi-hospital systems: semantic harmonization implications for administrators.

    PubMed

    Bowles, Kathryn H; Potashnik, Sheryl; Ratcliffe, Sarah J; Rosenberg, Melissa; Shih, Nai-Wei; Topaz, Maxim; Holmes, John H; Naylor, Mary D

    2013-06-01

    Administrators play a major role in choosing and managing the use of the electronic health record (EHR). The documentation policies and EHR changes enacted or approved by administrators affect the ability to use clinical data for research. This article illustrates the challenges that can be avoided through awareness of the consequences of customization, variations in documentation policies and quality, and user interface features. Solutions are posed that assist administrators in avoiding these challenges and promoting data harmonization for research and quality improvement. PMID:23708504

  4. A Standards-Based Architecture Proposal for Integrating Patient mHealth Apps to Electronic Health Record Systems

    PubMed Central

    Fontelo, P.; Rossi, E.; Ackerman, MJ

    2015-01-01

    Summary Background Mobile health Applications (mHealth Apps) are opening the way to patients’ responsible and active involvement with their own healthcare management. However, apart from Apps allowing patient’s access to their electronic health records (EHRs), mHealth Apps are currently developed as dedicated “island systems”. Objective Although much work has been done on patient’s access to EHRs, transfer of information from mHealth Apps to EHR systems is still low. This study proposes a standards-based architecture that can be adopted by mHealth Apps to exchange information with EHRs to support better quality of care. Methods Following the definition of requirements for the EHR/mHealth App information exchange recently proposed, and after reviewing current standards, we designed the architecture for EHR/mHealth App integration. Then, as a case study, we modeled a system based on the proposed architecture aimed to support home monitoring for congestive heart failure patients. We simulated such process using, on the EHR side, OpenMRS, an open source longitudinal EHR and, on the mHealth App side, the iOS platform. Results The integration architecture was based on the bi-directional exchange of standard documents (clinical document architecture rel2 – CDA2). In the process, the clinician “prescribes” the home monitoring procedures by creating a CDA2 prescription in the EHR that is sent, encrypted and de-identified, to the mHealth App to create the monitoring calendar. At the scheduled time, the App alerts the patient to start the monitoring. After the measurements are done, the App generates a structured CDA2-compliant monitoring report and sends it to the EHR, thus avoiding local storage. Conclusions The proposed architecture, even if validated only in a simulation environment, represents a step forward in the integration of personal mHealth Apps into the larger health-IT ecosystem, allowing the bi-directional data exchange between patients and

  5. Linking Electronic Health Records to Better Understand Breast Cancer Patient Pathways Within and Between Two Health Systems

    PubMed Central

    Thompson, Caroline A.; Kurian, Allison W.; Luft, Harold S.

    2015-01-01

    Introduction: In a fragmented health care system, research can be challenging when one seeks to follow cancer patients as they seek care which can continue for months or years and may reflect many physician and patient decisions. Claims data track patients, but lack clinical detail. Linking routine electronic health record (EHR) data with clinical registry data allows one to gain a more complete picture of the patient journey through a cancer care episode. However, valid analytical approaches to examining care trajectories must be longitudinal and account for the dynamic nature of what is “seen” in the EHR. Methods: The Oncoshare database combines clinical detail from the California Cancer Registry and EHR data from two large health care organizations in the same catchment area—a multisite community practice and an academic medical center—for all women treated in either organization for breast cancer from 2000 to 2012. We classified EHR encounters data according to typical periods of the cancer care episode (screening, diagnosis, treatment) and posttreatment surveillance, as well as by facility used to better characterize patterns of care for patients seen at both organizations. Findings: We identified a “treated” cohort consisting of women receiving interventions for their initial cancer diagnosis, and classified their encounters over time across multiple dimensions (type of care, provider of care, and timing of care with respect to their cancer diagnosis). Forty-three percent of the patients were treated at the academic center only, 42 percent at the community center only, and 16 percent of the patients obtained care at both health care organizations. Compared to women seen at only one organization, the last group had similar-length initial care episodes, but more frequently had multiple episodes and longer observation periods. Discussion: Linking EHR data from neighboring systems can enhance our information on care trajectories, but careful

  6. Applications for detection of acute kidney injury using electronic medical records and clinical information systems: workgroup statements from the 15(th) ADQI Consensus Conference.

    PubMed

    James, Matthew T; Hobson, Charles E; Darmon, Michael; Mohan, Sumit; Hudson, Darren; Goldstein, Stuart L; Ronco, Claudio; Kellum, John A; Bagshaw, Sean M

    2016-01-01

    Electronic medical records and clinical information systems are increasingly used in hospitals and can be leveraged to improve recognition and care for acute kidney injury. This Acute Dialysis Quality Initiative (ADQI) workgroup was convened to develop consensus around principles for the design of automated AKI detection systems to produce real-time AKI alerts using electronic systems. AKI alerts were recognized by the workgroup as an opportunity to prompt earlier clinical evaluation, further testing and ultimately intervention, rather than as a diagnostic label. Workgroup members agreed with designing AKI alert systems to align with the existing KDIGO classification system, but recommended future work to further refine the appropriateness of AKI alerts and to link these alerts to actionable recommendations for AKI care. The consensus statements developed in this review can be used as a roadmap for development of future electronic applications for automated detection and reporting of AKI. PMID:26925245

  7. Privacy, confidentiality, and electronic medical records.

    PubMed Central

    Barrows, R C; Clayton, P D

    1996-01-01

    The enhanced availability of health information in an electronic format is strategic for industry-wide efforts to improve the quality and reduce the cost of health care, yet it brings a concomitant concern of greater risk for loss of privacy among health care participants. The authors review the conflicting goals of accessibility and security for electronic medical records and discuss nontechnical and technical aspects that constitute a reasonable security solution. It is argued that with guiding policy and current technology, an electronic medical record may offer better security than a traditional paper record. PMID:8653450

  8. Mining Electronic Health Records using Linked Data

    PubMed Central

    Odgers, David J.; Dumontier, Michel

    2015-01-01

    Meaningful Use guidelines have pushed the United States Healthcare System to adopt electronic health record systems (EHRs) at an unprecedented rate. Hospitals and medical centers are providing access to clinical data via clinical data warehouses such as i2b2, or Stanford’s STRIDE database. In order to realize the potential of using these data for translational research, clinical data warehouses must be interoperable with standardized health terminologies, biomedical ontologies, and growing networks of Linked Open Data such as Bio2RDF. Applying the principles of Linked Data, we transformed a de-identified version of the STRIDE into a semantic clinical data warehouse containing visits, labs, diagnoses, prescriptions, and annotated clinical notes. We demonstrate the utility of this system though basic cohort selection, phenotypic profiling, and identification of disease genes. This work is significant in that it demonstrates the feasibility of using semantic web technologies to directly exploit existing biomedical ontologies and Linked Open Data. PMID:26306276

  9. Mining Electronic Health Records using Linked Data.

    PubMed

    Odgers, David J; Dumontier, Michel

    2015-01-01

    Meaningful Use guidelines have pushed the United States Healthcare System to adopt electronic health record systems (EHRs) at an unprecedented rate. Hospitals and medical centers are providing access to clinical data via clinical data warehouses such as i2b2, or Stanford's STRIDE database. In order to realize the potential of using these data for translational research, clinical data warehouses must be interoperable with standardized health terminologies, biomedical ontologies, and growing networks of Linked Open Data such as Bio2RDF. Applying the principles of Linked Data, we transformed a de-identified version of the STRIDE into a semantic clinical data warehouse containing visits, labs, diagnoses, prescriptions, and annotated clinical notes. We demonstrate the utility of this system though basic cohort selection, phenotypic profiling, and identification of disease genes. This work is significant in that it demonstrates the feasibility of using semantic web technologies to directly exploit existing biomedical ontologies and Linked Open Data. PMID:26306276

  10. Electronic Health Record Application Support Service Enablers.

    PubMed

    Neofytou, M S; Neokleous, K; Aristodemou, A; Constantinou, I; Antoniou, Z; Schiza, E C; Pattichis, C S; Schizas, C N

    2015-08-01

    There is a huge need for open source software solutions in the healthcare domain, given the flexibility, interoperability and resource savings characteristics they offer. In this context, this paper presents the development of three open source libraries - Specific Enablers (SEs) for eHealth applications that were developed under the European project titled "Future Internet Social and Technological Alignment Research" (FI-STAR) funded under the "Future Internet Public Private Partnership" (FI-PPP) program. The three SEs developed under the Electronic Health Record Application Support Service Enablers (EHR-EN) correspond to: a) an Electronic Health Record enabler (EHR SE), b) a patient summary enabler based on the EU project "European patient Summary Open Source services" (epSOS SE) supporting patient mobility and the offering of interoperable services, and c) a Picture Archiving and Communications System (PACS) enabler (PACS SE) based on the dcm4che open source system for the support of medical imaging functionality. The EHR SE follows the HL7 Clinical Document Architecture (CDA) V2.0 and supports the Integrating the Healthcare Enterprise (IHE) profiles (recently awarded in Connectathon 2015). These three FI-STAR platform enablers are designed to facilitate the deployment of innovative applications and value added services in the health care sector. They can be downloaded from the FI-STAR cataloque website. Work in progress focuses in the validation and evaluation scenarios for the proving and demonstration of the usability, applicability and adaptability of the proposed enablers. PMID:26736531

  11. The Electronic Medical Record at the Medical University of South Carolina: Successful Integration of Multiple Commercial “Best of Breed” Systems

    PubMed Central

    Afrin, Lawrence B.; Northrup, David J.; Daniels, Mark R.; Irving, Michael G.

    1999-01-01

    Over a 15 year period, MUSC has implemented an evolving set of commercially available “best of breed” clinical information systems throughout the enterprise. Successful systems integration efforts allow users to enter and retrieve information across a wide array of systems. Careful assessments of human impact and aggressive efforts to involve stakeholding users beginning early in systems design and implementation processes have been instrumental in securing widespread acceptance and effective use of new systems. The MUSC Electronic Medical Record (EMR) will be demonstrated, focusing particularly on its applications on the clinical “front lines.”

  12. Platform links clinical data with electronic health records

    Cancer.gov

    To make data gathered from patients in clinical trials available for use in standard care, NCI has created a new computer tool to support interoperability between clinical research and electronic health record systems. This new software represents an inno

  13. The Future Is Coming: Electronic Health Records

    MedlinePlus

    ... Navigation Bar Home Current Issue Past Issues The Future Is Coming: Electronic Health Records Past Issues / Spring ... Act's $19.5 billion investment in health information technology can best save money, improve patient care, and ...

  14. Electronic medical records in colorectal surgery.

    PubMed

    Turina, Matthias; Kiran, Ravi P

    2013-03-01

    Electronic medical records (EMRs) are being widely implemented today, either as stand-alone applications in smaller practices or as systems-based integrated network solutions in larger health care organizations. Advantages include rapid accessibility, worldwide availability, ease of storage, and secure transfer of protected health information (PHI). Computerized physician order entry (CPOE) and decision-support capabilities such as the triggering of an alarm when multiple medications with known interactions are ordered, as well as the seemingly endless possibilities for electronic integration and extraction of PHI for clinical and research purposes, have created opportunities and pitfalls alike. Risks include breaches of confidentiality with a need to implement tighter measures for electronic security. These measures contrast efforts required for the realization of common data formats that have national and even international compatibility. EMRs provide a common platform that could potentially allow for the integration and administration of clinical care, research, and quality metrics, thus promoting optimal outcomes for patients. Technical and medicolegal difficulties need to be overcome in the years to come so that the safe use of PHI can be ensured while still maintaining the benefits and convenience of modern EMR systems. PMID:24436643

  15. Patient information: confidentiality and the electronic record.

    PubMed

    Griffith, Richard

    The rise of the electronic record now allows nurses to access a large archive of patient information that was more difficult to obtain when records consisted of manually held paper files. There have been several instances where curiosity and, occasionally, more malicious motivations have led nurses to access these records and read the notes of a celebrity or a person they know. In this article, Richard Griffith considers whether nurses' accessing and reading of the record of someone who is not in their care is in breach of their duty of confidentiality. PMID:26419719

  16. Macro influencers of electronic health records adoption.

    PubMed

    Raghavan, Vijay V; Chinta, Ravi; Zhirkin, Nikita

    2015-01-01

    While adoption rates for electronic health records (EHRs) have improved, the reasons for significant geographical differences in EHR adoption within the USA have remained unclear. To understand the reasons for these variations across states, we have compiled from secondary sources a profile of different states within the USA, based on macroeconomic and macro health-environment factors. Regression analyses were performed using these indicator factors on EHR adoption. The results showed that internet usage and literacy are significantly associated with certain measures of EHR adoption. Income level was not significantly associated with EHR adoption. Per capita patient days (a proxy for healthcare need intensity within a state) is negatively correlated with EHR adoption rate. Health insurance coverage is positively correlated with EHR adoption rate. Older physicians (>60 years) tend to adopt EHR systems less than their younger counterparts. These findings have policy implications on formulating regionally focused incentive programs. PMID:26559074

  17. RF-Medisys: a radio frequency identification-based electronic medical record system for improving medical information accessibility and services at point of care.

    PubMed

    Ting, Jacky S L; Tsang, Albert H C; Ip, Andrew W H; Ho, George T S

    2011-01-01

    This paper presents an innovative electronic medical records (EMR) system, RF-MediSys, which can perform medical information sharing and retrieval effectively and which is accessible via a 'smart' medical card. With such a system, medical diagnoses and treatment decisions can be significantly improved when compared with the conventional practice of using paper medical records systems. Furthermore, the entire healthcare delivery process, from registration to the dispensing or administration of medicines, can be visualised holistically to facilitate performance review. To examine the feasibility of implementing RF-MediSys and to determine its usefulness to users of the system, a survey was conducted within a multi-disciplinary medical service organisation that operates a network of medical clinics and paramedical service centres throughout Hong Kong Island, the Kowloon Peninsula and the New Territories. Questionnaires were distributed to 300 system users, including nurses, physicians and patients, to collect feedback on the operation and performance of RF-MediSys in comparison with conventional paper-based medical record systems. The response rate to the survey was 67%. Results showed a medium to high level of user satisfaction with the radiofrequency identification (RFID)-based EMR system. In particular, respondents provided high ratings on both 'user-friendliness' and 'system performance'. Findings of the survey highlight the potential of RF-MediSys as a tool to enhance quality of medical services and patient safety. PMID:21430306

  18. Preserving electronic records: Not the easiest task

    NASA Technical Reports Server (NTRS)

    Eaton, Fynnette

    1993-01-01

    The National Archives and Records Administration has had a program for accessioning, describing, preserving and providing reference service to the electronic records (machine-readable records) created by Federal agencies for more than twenty years. Although there have been many changes in the name of the office, its basic mission has remained the same: to preserve and make available those records created by Federal agencies that the National Archives has determined to have value beyond the short-term need of the originating agency. A phrase that was once coined for a preservation conference still applies: the National Archives, when it decides to accept the transfer of records into its custody, is committing itself to preserving these records for perpetuity.

  19. Operating Room Delays: Meaningful Use in Electronic Health Record.

    PubMed

    Van Winkle, Rachelle A; Champagne, Mary T; Gilman-Mays, Meri; Aucoin, Julia

    2016-06-01

    Perioperative areas are the most costly to operate and account for more than 40% of expenses. The high costs prompted one organization to analyze surgical delays through a retrospective review of their new electronic health record. Electronic health records have made it easier to access and aggregate clinical data; 2123 operating room cases were analyzed. Implementing a new electronic health record system is complex; inaccurate data and poor implementation can introduce new problems. Validating the electronic health record development processes determines the ease of use and the user interface, specifically related to user compliance with the intent of the electronic health record development. The revalidation process after implementation determines if the intent of the design was fulfilled and data can be meaningfully used. In this organization, the data fields completed through automation provided quantifiable, meaningful data. However, data fields completed by staff that required subjective decision making resulted in incomplete data nearly 24% of the time. The ease of use was further complicated by 490 permutations (combinations of delay types and reasons) that were built into the electronic health record. Operating room delay themes emerged notwithstanding the significant complexity of the electronic health record build; however, improved accuracy could improve meaningful data collection and a more accurate root cause analysis of operating room delays. Accurate and meaningful use of data affords a more reliable approach in quality, safety, and cost-effective initiatives. PMID:27046388

  20. Collaborative Electronic Notebooks as Electronic Records: Design Issues for the Secure Electronic Laboratory Notebook (ELN)

    SciTech Connect

    Myers, James D.

    2003-01-24

    Current electronic notebooks (EN) can be grouped roughly into two general classes - personal/group productivity tools and enterprise records/knowledge management systems. Personal/group productivity-oriented ENs extend the notebook metaphor in terms of supporting multimedia annotations, automating workflow and data processing, supporting simultaneous use by distributed researchers, providing displays on personal digital assistants

  1. Towards lifetime electronic health record implementation.

    PubMed

    Gand, Kai; Richter, Peggy; Esswein, Werner

    2015-01-01

    Integrated care concepts can help to diminish demographic challenges. Hereof, the use of eHealth, esp. overarching electronic health records, is recognized as an efficient approach. The article aims at rigorously defining the concept of lifetime electronic health records (LEHRs) and the identification of core factors that need to be fulfilled in order to implement such. A literature review was conducted. Existing definitions were identified and relevant factors were categorized. The derived assessment categories are demonstrated by a case study on Germany. Seven dimensions to differentiate types of electronic health records were found. The analysis revealed, that culture, regulation, informational self-determination, incentives, compliance, ICT infrastructure and standards are important preconditions to successfully implement LEHRs. The article paves the way for LEHR implementation and therewith for integrated care. Besides the expected benefits of LEHRs, there are a number of ethical, legal and social concerns, which need to be balanced. PMID:26063281

  2. Voice-Recognition System Records Inspection Data

    NASA Technical Reports Server (NTRS)

    Rochester, Larry L.

    1993-01-01

    Main Injector Voice Activated Record (MIVAR) system acts on vocal commands and processes spoken inspection data into electronic and printed inspection reports. Devised to improve acquisition and recording of data from borescope inspections of interiors of liquid-oxygen-injecting tubes on main engine of Space Shuttle. With modifications, system used in other situations to relieve inspectors of manual recording of data. Enhances flow of work and quality of data acquired by enabling inspector to remain visually focused on workpiece.

  3. Teaching Electronic Health Record Communication Skills.

    PubMed

    Palumbo, Mary Val; Sandoval, Marie; Hart, Vicki; Drill, Clarissa

    2016-06-01

    This pilot study investigated nurse practitioner students' communication skills when utilizing the electronic health record during history taking. The nurse practitioner students (n = 16) were videotaped utilizing the electronic health record while taking health histories with standardized patients. The students were videotaped during two separate sessions during one semester. Two observers recorded the time spent (1) typing and talking, (2) typing only, and (3) looking at the computer without talking. Total history taking time, computer placement, and communication skills were also recorded. During the formative session, mean history taking time was 11.4 minutes, with 3.5 minutes engaged with the computer (30.6% of visit). During the evaluative session, mean history taking time was 12.4 minutes, with 2.95 minutes engaged with the computer (24% of visit). The percentage of time individuals spent changed over the two visits: typing and talking, -3.1% (P = .3); typing only, +12.8% (P = .038); and looking at the computer, -9.6% (P = .039). This study demonstrated that time spent engaged with the computer during a patient encounter does decrease with student practice and education. Therefore, students benefit from instruction on electronic health record-specific communication skills, and use of a simple mnemonic to reinforce this is suggested. PMID:27058674

  4. Nurses' Perceptions of the Electronic Health Record

    ERIC Educational Resources Information Center

    Crawley, Rocquel Devonne

    2013-01-01

    The implementation of electronic health records (EHR) by health care organizations has been limited. Despite the broad consensus on the potential benefits of EHRs, health care organizations have been slow to adopt the technology. The purpose of this qualitative phenomenological study was to explore licensed practical and registered nurses'…

  5. Patient Perceptions of Electronic Health Records

    ERIC Educational Resources Information Center

    Lulejian, Armine

    2011-01-01

    Research objective. Electronic Health Records (EHR) are expected to transform the way medicine is delivered with patients/consumers being the intended beneficiaries. However, little is known regarding patient knowledge and attitudes about EHRs. This study examined patient perceptions about EHR. Study design. Surveys were administered following…

  6. [Electronic health records and biomedical research].

    PubMed

    Daniel, Christel; Jais, Jean-Philippe; El Fadly, Naji; Landais, Paul

    2009-10-01

    The rapid progress in Web technology has led to the multiplication of health and research records for any given patient. Initiatives such as the personal medical record or the communicating cancer communicable records have recently been introduced. However, their primary aim is not for biomedical research. Several international groups of researchers are analyzing the appropriate role of the electronic health record as a support to biomedical research. The need to complete several distinct records for a given patient is a limiting factor, in view of the lack of medical and paramedical resources and the rising quality demands for both medical care and biomedical research. The impediments to "secondary reuse" of clinical data stored in electronic health records for biomedical research purposes are statutory, organizational, and technical. The international Integrating the Healthcare Enterprise (IHE) initiative has proposed a promising approach that uses an integration profile known as a Retrieve Form for Data Capture (RFD). A joint project by the North American Association of Cancer Registries and the Centers for Disease Control has made possible the automated transmission of pathology reports to the registries and thus limited the need for registry technicians to come copy these forms at the hospital. PMID:19766440

  7. A Detailed Description of the Implementation of Inpatient Insulin Orders With a Commercial Electronic Health Record System

    PubMed Central

    MacMaster, Heidemarie Windham; Sullivan, Mary M.; Rushakoff, Robert

    2014-01-01

    Background: In the setting of Meaningful Use laws and professional society guidelines, hospitals are rapidly implementing electronic glycemic management order sets. There are a number of best practices established in the literature for glycemic management protocols and programs. We believe that this is the first published account of the detailed steps to be taken to design, implement, and optimize glycemic management protocols in a commercial computerized provider order entry (CPOE) system. Process: Prior to CPOE implementation, our hospital already had a mature glycemic management program. To transition to CPOE, we underwent the following 4 steps: (1) preparation and requirements gathering, (2) design and build, (3) implementation and dissemination, and (4) optimization. These steps required more than 2 years of coordinated work between physicians, nurses, pharmacists, and programmers. With the move to CPOE, our complex glycemic management order sets were successfully implemented without any significant interruptions in care. With feedback from users, we have continued to refine the order sets, and this remains an ongoing process. Conclusions: Successful implementation of glycemic management protocols in CPOE is dependent on broad stakeholder input and buy-in. When using a commercial CPOE system, there may be limitations of the system, necessitating workarounds. There should be an upfront plan to apply resources for continuous process improvement and optimization after implementation. PMID:24876450

  8. A detailed description of the implementation of inpatient insulin orders with a commercial electronic health record system.

    PubMed

    Neinstein, Aaron; MacMaster, Heidemarie Windham; Sullivan, Mary M; Rushakoff, Robert

    2014-07-01

    In the setting of Meaningful Use laws and professional society guidelines, hospitals are rapidly implementing electronic glycemic management order sets. There are a number of best practices established in the literature for glycemic management protocols and programs. We believe that this is the first published account of the detailed steps to be taken to design, implement, and optimize glycemic management protocols in a commercial computerized provider order entry (CPOE) system. Prior to CPOE implementation, our hospital already had a mature glycemic management program. To transition to CPOE, we underwent the following 4 steps: (1) preparation and requirements gathering, (2) design and build, (3) implementation and dissemination, and (4) optimization. These steps required more than 2 years of coordinated work between physicians, nurses, pharmacists, and programmers. With the move to CPOE, our complex glycemic management order sets were successfully implemented without any significant interruptions in care. With feedback from users, we have continued to refine the order sets, and this remains an ongoing process. Successful implementation of glycemic management protocols in CPOE is dependent on broad stakeholder input and buy-in. When using a commercial CPOE system, there may be limitations of the system, necessitating workarounds. There should be an upfront plan to apply resources for continuous process improvement and optimization after implementation. PMID:24876450

  9. The impact on patient safety of free-text entry of nursing orders into an electronic medical record in an integrated delivery system.

    PubMed

    Reynolds, Katherine; Peres, Alan; Tatham, Judith M

    2005-01-01

    The introduction of Computerized Provider Order Entry (CPOE) has been shown to reduce the incidence of medication-related errors in hospitals. Successful implementation of CPOE and electronic health records requires redesigning workflows and analysis of information collected and training of staff to use these new systems. However, well intentioned processes that seem to solve a unique problem can sometimes go in an unanticipated direction for several reasons. This can have unintentional consequences, especially when the built-in safeguards are not engaged. This poster describes one organization's efforts to identify the causes of one such breakdown, and how the obvious solutions were inappropriate. PMID:16779382

  10. Electronic Health Records and Quality of Care

    PubMed Central

    Yanamadala, Swati; Morrison, Doug; Curtin, Catherine; McDonald, Kathryn; Hernandez-Boussard, Tina

    2016-01-01

    Abstract Electronic health records (EHRs) were implemented to improve quality of care and patient outcomes. This study assessed the relationship between EHR-adoption and patient outcomes. We performed an observational study using State Inpatient Databases linked to American Hospital Association survey, 2011. Surgical and medical patients from 6 large, diverse states were included. We performed univariate analyses and developed hierarchical regression models relating level of EHR utilization and mortality, readmission rates, and complications. We evaluated the effect of EHR adoption on outcomes in a difference-in-differences analysis, 2008 to 2011. Medical and surgical patients sought care at hospitals reporting no EHR (3.5%), partial EHR (55.2%), and full EHR systems (41.3%). In univariate analyses, patients at hospitals with full EHR had the lowest rates of inpatient mortality, readmissions, and Patient Safety Indicators followed by patients at hospitals with partial EHR and then patients at hospitals with no EHR (P < 0.05). However, these associations were not robust when accounting for other patient and hospital factors, and adoption of an EHR system was not associated with improved patient outcomes (P > 0.05). These results indicate that patients receiving medical and surgical care at hospitals with no EHR system have similar outcomes compared to patients seeking care at hospitals with a full EHR system, after controlling for important confounders. To date, we have not yet seen the promised benefits of EHR systems on patient outcomes in the inpatient setting. EHRs may play a smaller role than expected in patient outcomes and overall quality of care. PMID:27175631

  11. Enabling cross-platform clinical decision support through Web-based decision support in commercial electronic health record systems: proposal and evaluation of initial prototype implementations.

    PubMed

    Zhang, Mingyuan; Velasco, Ferdinand T; Musser, R Clayton; Kawamoto, Kensaku

    2013-01-01

    Enabling clinical decision support (CDS) across multiple electronic health record (EHR) systems has been a desired but largely unattained aim of clinical informatics, especially in commercial EHR systems. A potential opportunity for enabling such scalable CDS is to leverage vendor-supported, Web-based CDS development platforms along with vendor-supported application programming interfaces (APIs). Here, we propose a potential staged approach for enabling such scalable CDS, starting with the use of custom EHR APIs and moving towards standardized EHR APIs to facilitate interoperability. We analyzed three commercial EHR systems for their capabilities to support the proposed approach, and we implemented prototypes in all three systems. Based on these analyses and prototype implementations, we conclude that the approach proposed is feasible, already supported by several major commercial EHR vendors, and potentially capable of enabling cross-platform CDS at scale. PMID:24551426

  12. Enabling Cross-Platform Clinical Decision Support through Web-Based Decision Support in Commercial Electronic Health Record Systems: Proposal and Evaluation of Initial Prototype Implementations

    PubMed Central

    Zhang, Mingyuan; Velasco, Ferdinand T.; Musser, R. Clayton; Kawamoto, Kensaku

    2013-01-01

    Enabling clinical decision support (CDS) across multiple electronic health record (EHR) systems has been a desired but largely unattained aim of clinical informatics, especially in commercial EHR systems. A potential opportunity for enabling such scalable CDS is to leverage vendor-supported, Web-based CDS development platforms along with vendor-supported application programming interfaces (APIs). Here, we propose a potential staged approach for enabling such scalable CDS, starting with the use of custom EHR APIs and moving towards standardized EHR APIs to facilitate interoperability. We analyzed three commercial EHR systems for their capabilities to support the proposed approach, and we implemented prototypes in all three systems. Based on these analyses and prototype implementations, we conclude that the approach proposed is feasible, already supported by several major commercial EHR vendors, and potentially capable of enabling cross-platform CDS at scale. PMID:24551426

  13. 76 FR 13991 - Privacy Act of 1974; System of Records

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-15

    ... Lists (May 26, 2009, 74 FR 24831). Changes: * * * * * System location: Delete entry and replace with... guarded cabinets. The electronic records systems employ user identification and password or smart...

  14. Spaceborne electronic imaging systems

    NASA Technical Reports Server (NTRS)

    1971-01-01

    Criteria and recommended practices for the design of the spaceborne elements of electronic imaging systems are presented. A spaceborne electronic imaging system is defined as a device that collects energy in some portion of the electromagnetic spectrum with detector(s) whose direct output is an electrical signal that can be processed (using direct transmission or delayed transmission after recording) to form a pictorial image. This definition encompasses both image tube systems and scanning point-detector systems. The intent was to collect the design experience and recommended practice of the several systems possessing the common denominator of acquiring images from space electronically and to maintain the system viewpoint rather than pursuing specialization in devices. The devices may be markedly different physically, but each was designed to provide a particular type of image within particular limitations. Performance parameters which determine the type of system selected for a given mission and which influence the design include: Sensitivity, Resolution, Dynamic range, Spectral response, Frame rate/bandwidth, Optics compatibility, Image motion, Radiation resistance, Size, Weight, Power, and Reliability.

  15. Assessing the process of designing and implementing electronic health records in a statewide public health system: the case of Colima, Mexico

    PubMed Central

    Hernández-Ávila, Juan Eugenio; Palacio-Mejía, Lina Sofia; Lara-Esqueda, Agustín; Silvestre, Eva; Agudelo-Botero, Marcela; Diana, Mark L; Hotchkiss, David R; Plaza, Beatriz; Sanchez Parbul, Alicia

    2013-01-01

    The findings of a case study assessing the design and implementation of an electronic health record (EHR) in the public health system of Colima, Mexico, its perceived benefits and limitations, and recommendations for improving the implementation process are presented. In-depth interviews and focus group discussions were used to examine the experience of the actors and stakeholders participating in the design and implementation of EHRs. Results indicate that the main driving force behind the use of EHRs was to improve reporting to the two of the main government health and social development programs. Significant challenges to the success of the EHR include resistance by physicians to use the ICD-10 to code diagnoses, insufficient attention to recurrent resources needed to maintain the system, and pressure from federal programs to establish parallel information systems. Operating funds and more importantly political commitment are required to ensure sustainability of the EHRs in Colimaima. PMID:23019239

  16. 78 FR 73890 - Amendment to System of Records

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-09

    ... electronic system. These files may include panelist contracts, copies of which are forwarded to IMLS' Office...: STORAGE: Electronic records in this system are maintained off-site by the Department of Interior, Interior... number, or date of birth. SAFEGUARDS: Access to the electronic records in this system is controlled...

  17. Legal Considerations for Electronic Health Records.

    PubMed

    Mostofi, Sherry; Hoffman, Andrew L

    2015-05-01

    Electronic health record (EHR) solutions provide many potential benefits for dental practices, whether those programs run internally on a dental practice's computers or are cloud-based solutions. However, these programs also create new risks for a dental practice, which may be mitigated through due diligence and adequate contractual provisions to ensure protection for dentists. This article addresses the legal considerations associated with a dentist entering into a service contract with an EHR vendor. PMID:26798899

  18. Legal issues of the electronic dental record: security and confidentiality.

    PubMed

    Szekely, D G; Milam, S; Khademi, J A

    1996-01-01

    Computer-based, electronic dental record keeping involves complex issues of patient privacy and the dental practitioner's ethical duty of confidentiality. Federal and state law is responding to the new legal issues presented by computer technology. Authenticating the electronic record in terms of ensuring its reliability and accuracy is essential in order to protect its admissibility as evidence in legal actions. Security systems must be carefully planned to limit access and provide for back-up and storage of dental records. Carefully planned security systems protect the patient from disclosure without the patient's consent and also protect the practitioner from the liability that would arise from such disclosure. Human errors account for the majority of data security problems. Personnel security is assured through pre-employment screening, employment contracts, policies, and staff education. Contracts for health information systems should include provisions for indemnification and ensure the confidentiality of the system by the vendor. PMID:8594098

  19. Ethical issues and the electronic health record.

    PubMed

    Layman, Elizabeth J

    2008-01-01

    Ethical issues related to electronic health records (EHRs) confront health personnel. Electronic health records create conflict among several ethical principals. Electronic health records may represent beneficence because they are alleged to increase access to health care, improve the quality of care and health, and decrease costs. Research, however, has not consistently demonstrated access for disadvantaged persons, the accuracy of EHRs, their positive effects on productivity, nor decreased costs. Should beneficence be universally acknowledged, conflicts exist with other ethical principles. Autonomy is jeopardized when patients' health data are shared or linked without the patients' knowledge. Fidelity is breached by the exposure of thousands of patients' health data through mistakes or theft. Lack of confidence in the security of health data may induce patients to conceal sensitive information. As a consequence, their treatment may be compromised. Justice is breached when persons, because of their socioeconomic class or age, do not have equal access to health information resources and public health services. Health personnel, leaders, and policy makers should discuss the ethical implications of EHRs before the occurrence of conflicts among the ethical principles. Recommendations to guide health personnel, leaders, and policy makers are provided. PMID:18475119

  20. 76 FR 63287 - Privacy Act of 1974; System of Records

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-12

    ... Maintaining Records About Individuals,'' dated February 8, 1996 (February 20, 1996, 61 FR 6427). Dated...: Electronic media, data and/or electronic records are maintained in a controlled area. The computer system is... of the Secretary Privacy Act of 1974; System of Records AGENCY: Office of the Secretary of...

  1. Effect of an electronic health record on the culture of an outpatient medical oncology practice in a four-hospital integrated health care system: 5-year experience.

    PubMed

    Brockstein, Bruce; Hensing, Thomas; Carro, George W; Obel, Jennifer; Khandekar, Janardan; Kaminer, Lynne; Van De Wege, Christine; de Wilton Marsh, Robert

    2011-07-01

    The electronic health record (EHR) was adopted into the NorthShore University HealthSystem, a four-hospital integrated health system located in suburban Chicago, in 2003. By 2005, all chemotherapy and medicine order entry was conducted through the EHR, completing the incorporation of a fully paperless EHR in our hospital-based oncology practice in both the inpatient and outpatient settings. The use of the EHR has dramatically changed our practice environment by improving efficiency, patient safety, research productivity, and operations, while allowing evaluation of adherence to established quality measures and incorporation of new quality improvement initiatives. The reach of the EHR has been substantial and has influenced every aspect of care at our institution over the short period since its implementation. In this article, we describe subjective and objective measures, outcomes, and achievements of our 5-year EHR experience. PMID:22043197

  2. Development of the electronic health record in Japan.

    PubMed

    Yoshihara, H

    1998-03-01

    In Japan, the order entry system has been employed in almost all university hospitals and popularisation of this system has also started in medium-sized hospitals. However, there has been a tendency in general hospitals in Japan to consider the electronic chart system where there has been no order entry system. Moreover, in small-scale clinics, there is no benefit in using the order entry system. Young doctors in Japan are beginning to employ the electronic chart system directly for the first time, without experience with the order entry system. In this paper, the development of the hospital information system in Japan and that of the electronic health record system are described. PMID:9723801

  3. Problems with the electronic health record.

    PubMed

    de Ruiter, Hans-Peter; Liaschenko, Joan; Angus, Jan

    2016-01-01

    One of the most significant changes in modern healthcare delivery has been the evolution of the paper record to the electronic health record (EHR). In this paper we argue that the primary change has been a shift in the focus of documentation from monitoring individual patient progress to recording data pertinent to Institutional Priorities (IPs). The specific IPs to which we refer include: finance/reimbursement; risk management/legal considerations; quality improvement/safety initiatives; meeting regulatory and accreditation standards; and patient care delivery/evidence based practice. Following a brief history of the transition from the paper record to the EHR, the authors discuss unintended or contested consequences resulting from this change. These changes primarily reflect changes in the organization and amount of clinician work and clinician-patient relationships. The paper is not a research report but was informed by an institutional ethnography the aim of which was to understand how the EHR impacted clinicians and administrators in a large, urban hospital in the United States. The paper was also informed by other sources, including the philosophies of Jacques Ellul, Don Idhe, and Langdon Winner. PMID:26603947

  4. Electron beam focusing system

    SciTech Connect

    Dikansky, N.; Nagaitsev, S.; Parkhomchuk, V.

    1997-09-01

    The high energy electron cooling requires a very cold electron beam. Thus, the electron beam focusing system is very important for the performance of electron cooling. A system with and without longitudinal magnetic field is presented for discussion. Interaction of electron beam with the vacuum chamber as well as with the background ions and stored antiprotons can cause the coherent electron beam instabilities. Focusing system requirements needed to suppress these instabilities are presented.

  5. Data extraction from a semi-structured electronic medical record system for outpatients: a model to facilitate the access and use of data for quality control and research.

    PubMed

    Kristianson, Krister J; Ljunggren, Henrik; Gustafsson, Lars L

    2009-12-01

    The use of clinical data from electronic medical records (EMRs) for clinical research and for evaluation of quality of care requires an extraction process. Many efforts have failed because the extracted data seemed to be unstructured, incomplete and ridden by errors. We have developed and tested a concept of extracting semi-structured EMRs (Journal III, Profdoc) data from 776 diabetes patients in a general practice clinic over a 5 year period. We used standard database management techniques commonly applied in clinical research in the pharmaceutical industry to clean up the data and make the data available for statistical analysis. The key problem was difficulties locating the data, as no standard way to enter the data in the EMR system was reinforced. Furthermore, no built-in edit checks to facilitate data entry were available. Laboratory, drug information and diagnostic data could be used directly while other data such as vital signs required much work to locate and become useful. PMID:20007655

  6. The Electronic Health Record for Translational Research

    PubMed Central

    Rasmussen, Luke V.

    2014-01-01

    With growing adoption and use, the electronic health record (EHR) represents a rich source of clinical data that also offers many benefits for secondary use in biomedical research. Such benefits include access to a more comprehensive medical history, cost reductions and increased efficiency in conducting research, as well as opportunities to evaluate new and expanded populations for sufficient statistical power. Existing work utilizing EHR data has uncovered some complexities and considerations for their use, but more importantly has also generated practical lessons and solutions. Given an understanding of EHR data use in cardiovascular research, expanded adoption of this data source offers great potential to further transform the research landscape. PMID:25070682

  7. Big data and the electronic health record.

    PubMed

    Peters, Steve G; Buntrock, James D

    2014-01-01

    The electronic medical record has evolved from a digital representation of individual patient results and documents to information of large scale and complexity. Big Data refers to new technologies providing management and processing capabilities, targeting massive and disparate data sets. For an individual patient, techniques such as Natural Language Processing allow the integration and analysis of textual reports with structured results. For groups of patients, Big Data offers the promise of large-scale analysis of outcomes, patterns, temporal trends, and correlations. The evolution of Big Data analytics moves us from description and reporting to forecasting, predictive modeling, and decision optimization. PMID:24887521

  8. Electronic Health Records and Patient Safety

    PubMed Central

    Gans, D.; White, J.; Nath, R.; Pohl, J.

    2015-01-01

    Summary Background The role of electronic health records (EHR) in enhancing patient safety, while substantiated in many studies, is still debated. Objective This paper examines early EHR adopters in primary care to understand the extent to which EHR implementation is associated with the workflows, policies and practices that promote patient safety, as compared to practices with paper records. Early adoption is defined as those who were using EHR prior to implementation of the Meaningful Use program. Methods We utilized the Physician Practice Patient Safety Assessment (PPPSA) to compare primary care practices with fully implemented EHR to those utilizing paper records. The PPPSA measures the extent of adoption of patient safety practices in the domains: medication management, handoffs and transition, personnel qualifications and competencies, practice management and culture, and patient communication. Results Data from 209 primary care practices responding between 2006–2010 were included in the analysis: 117 practices used paper medical records and 92 used an EHR. Results showed that, within all domains, EHR settings showed significantly higher rates of having workflows, policies and practices that promote patient safety than paper record settings. While these results were expected in the area of medication management, EHR use was also associated with adoption of patient safety practices in areas in which the researchers had no a priori expectations of association. Conclusions Sociotechnical models of EHR use point to complex interactions between technology and other aspects of the environment related to human resources, workflow, policy, culture, among others. This study identifies that among primary care practices in the national PPPSA database, having an EHR was strongly empirically associated with the workflow, policy, communication and cultural practices recommended for safe patient care in ambulatory settings. PMID:25848419

  9. Electronic Health Records Place 1st at Indy 500

    MedlinePlus

    ... Navigation Bar Home Current Issue Past Issues EHR Electronic Health Records Place 1st at Indy 500 Past ... last May's Indy 500 had thousands of personal Electronic Health Records on hand for those attending—and ...

  10. Development of Quality Control Parameters and Electronic Data Recording for an Ambient Air Particle Inhalation Exposure System

    EPA Science Inventory

    Ambient air particle concentrating systems were installed by the US EPA in RTP, NC. These systems, designed by Harvard School of Public Health’s Department of Environmental Sciences and Engineering (Boston, MA), concentrated ambient fine and ultra-fine mode particulate matter (P...

  11. Chief Information Officer's Role in Adopting an Interoperable Electronic Health Record System for Medical Data Exchange

    ERIC Educational Resources Information Center

    Akpabio, Akpabio Enebong Ema

    2013-01-01

    Despite huge growth in hospital technology systems, there remains a dearth of literature examining health care administrator's perceptions of the efficacy of interoperable EHR systems. A qualitative research methodology was used in this multiple-case study to investigate the application of diffusion of innovations theory and the technology…

  12. Electronic health records: the European scene.

    PubMed

    Kalra, D

    1994-11-19

    Caring for patients' health problems relies increasingly on sharing information between clinical departments and disciplines and with managers. The medical record of the future will need to provide a flexible and shareable framework for recording and analysing the consultation process. The advanced informatics in medicine (AIM) programme seeks to encourage research and development in telemedicine in areas that are beyond the scope of any one country. It includes many European projects attempting to define the best storage and transmission formats for such diverse data types as laboratory results, biosignals, x ray images, and photographs, and in clinical specialties varying from intensive care to medicine for elderly people. One example, the good European health record project, is developing a model architecture for computerised health records across Europe that is capable of operating on a wide variety of computer hardwares and will also be able to communicate with many different information systems. The ultimate European health record will be comprehensive and medicolegally acceptable across clinical domains, hold all data types, and be automatically translated between languages. PMID:7866088

  13. Designing an Electronic Personal Health Record for Professional Iranian Athletes

    PubMed Central

    Abdolkhani, Robab; Halabchi, Farzin; Safdari, Reza; Dargahi, Hossein; Shadanfar, Kamran

    2014-01-01

    Background: By providing sports organizations with electronic records and instruments that can be accessed at any time or place, specialized care can be offered to athletes regardless of injury location, and this makes the follow-up from first aid through to full recovery more efficient. Objectives: The aim of this study was to develop an electronic personal health record for professional Iranian athletes. Patients and Methods: First, a comparative study was carried out on the types of professional athletes’existing handheld and electronic health information management systems currently being used in Iran and leading countries in the field of sports medicine including; Australia, Canada and the United States. Then a checklist was developed containing a minimum dataset of professional athletes’ personal health records and distributed to the people involved, who consisted of 50 specialists in sports medicine and health information management, using the Delphi method. Through the use of data obtained from this survey, a basic paper model of professional athletes' personal health record was constructed and then an electronic model was created accordingly. Results: Access to information in the electronic record was through a web-based, portal system. The capabilities of this system included: access to information at any time and location, increased interaction between the medical team, comprehensive reporting and effective management of injuries, flexibility and interaction with financial, radiology and laboratory information systems. Conclusions: It is suggested that a framework should be created to promote athletes’ medical knowledge and provide the education necessary to manage their information. This would lead to improved data quality and ultimately promote the health of community athletes. PMID:25741410

  14. Digital optical recorder-reproducer system

    NASA Technical Reports Server (NTRS)

    Reddersen, Brad R. (Inventor); Zech, Richard G. (Inventor); Roberts, Howard N. (Inventor)

    1980-01-01

    A mass archival optical recording and reproduction system includes a recording light source such as a laser beam focussed and directed upon an acousto-optic linear modulator array (or page composer) that receives parallel blocks of data converted from a serial stream of digital data to be stored. The page composer imparts to the laser beam modulation representative of a plurality of parallel channels of data and through focussing optics downstream of the page composer parallel arrays of optical spots are recorded upon a suitable recording medium such as a photographic film floppy disc. The recording medium may be substantially frictionlessly and stably positioned for recording at a record/read station by an air-bearing platen arrangement which is preferably thermodynamically non-throttling so that the recording film may be positioned in the path of the information-carrying light beam in a static or dynamic mode. During readout, the page composer is bypassed and a readout light beam is focussed directly upon the recording medium containing an array of previously recorded digital spots, a sync bit, data positioning bits, and a tracking band. The readout beam which has been directed through the recording medium is then imaged upon a photodetector array, the output of which may be coupled to suitable electronic processing circuitry, such as a digital multiplexer, whereby the parallel spot array is converted back into the original serial data stream.

  15. Development and implementation of a secure, integrated management system for medical images and electronic clinical records for small hospitals.

    PubMed

    Pereira, Javier; Castro, Antonio F; Perez, Juan L; Novoa, Francisco J; Vázquez, Jose M; Teijeiro, Jorge; Pazos, Alejandro; Ezquerra, Norberto

    2007-06-01

    The field of Medical Informatics is currently experiencing increasing demands for new models of the Picture Archiving and Communication Systems (PACS) and Digital Imaging and Communications in Medicine (DICOM) protocols. Despite of the considerable advantages of current systems, implementation in hospitals is remarkably slow, due primarily to difficulties in integration and relatively high costs. Even though the success of DICOM standards has greatly contributed to the development of PACS, many hospitals remain unable to support it or to make full use of its potential because various imaging modalities in use at these sites generate images that cannot be stored in the PACS and cannot be managed in a centralized manner without DICOM standardization modules. Furthermore, the imaging modalities being used in such smaller centers are expensive and unlikely to be replaced, making DICOM compliance untenable. With this in mind, this paper describes the design, development, and implementation of a management system for medical diagnostic imaging, based on the DICOM standard and adapted to the needs of a small hospital. The system is currently being implemented in the San Rafael Hospital at A Coruna in Spain, and integrated with the existing hospital information system (HIS). We have studied the networking infrastructure of the hospital and its available image generation devices, and have subsequently carried out a series of measurements including transmission times, image file size, compression ratios, and many others that allow us to analyze the behavior of the system. Results obtained from these investigations demonstrate both the flexibility of using such a "small-hospital" DICOM-based framework as well as the relative cost-effectiveness of the system. In this regard, the approach, described herein, might serve as a model for other small, and possibly mid-sized, medical centers. PMID:17603833

  16. Real and imagined barriers to an electronic medical record.

    PubMed

    Rind, D M; Safran, C

    1993-01-01

    We developed an electronic medical record for ambulatory patients as part of the integrated clinical information system at Beth Israel Hospital. During the four years since it was installed, clinicians have entered 76,060 patient problems, 137,713 medications, and 33,938 notes. Residents, who had to type notes in themselves, entered 49.5% of their notes into OMR. Several factors that we had predicted would be barriers to an electronic medical record, such as clinician reluctance to type or perform data entry, have not proved to be significant problems. Other anticipated barriers, such as difficulties with dual charting on paper during transition to an electronic medical record, have been realized. The major unexpected barrier that has been encountered is increased clinician concern about the privacy and security of full text notes relative to other data elements in the clinical information system. We have attempted to modify the electronic medical record so as to overcome some of these barriers. PMID:8130574

  17. EASCON '82; Annual Electronics and Aerospace Systems Conference, 15th, Washington, DC, September 20-22, 1982, Conference Record

    NASA Astrophysics Data System (ADS)

    Among the topics discussed are diverse file management concepts, DOD trusted computer system evaluation criteria, computer security, the defense data network (DDN) and its interfacing strategy, the DDN personal authentication system, DDN survivability and management, military requirements for packet-switched networks, the DDN protocols, a critical analysis of military computer hardware, software and personnel resources, the impact of Ada on software engineering, and the survivability through proliferation of defense switched networks. Also discussed are the national Airspace Data Interchange Network, artificial intelligence, self-contained munitions, range estimation with a linear array, adaptive data processing for sonar systems, submarine laser communications, the very high speed integrated circuit program, intelligent surveillance and target acquisition, and potential military applications of space platforms. For individual items see A84-13327 to A84-13336

  18. Introduction of an electronic medical record system into physician practice offices: why is it so #%!&-ing hard for everybody?-Part II.

    PubMed

    Lyons, Joseph P; Klasko, Stephen

    2011-01-01

    Medical practice offices are experiencing a revolutionary change in the microprocesses that have been the norm for documenting and communicating patient care for decades. While this revolution is welcome for dozens of good reasons, migration of data storage from the paper-based record to electronic form often causes considerable stress for all involved. This three-part series looks at electronic medical record implementations from organizational and sociological perspectives, and draws attention to the often unappreciated aspects of medical work that give rise to the stress. In addition, IT professionals' perspectives are also addressed to highlight how medical /IT professional differences affect the experience of implementation. PMID:21815548

  19. Enabling Better Interoperability for HealthCare: Lessons in Developing a Standards Based Application Programing Interface for Electronic Medical Record Systems.

    PubMed

    Kasthurirathne, Suranga N; Mamlin, Burke; Kumara, Harsha; Grieve, Grahame; Biondich, Paul

    2015-11-01

    We sought to enable better interoperability and easy adoption of healthcare applications by developing a standardized domain independent Application Programming Interface (API) for an Electronic Medical Record (EMR) system. We leveraged the modular architecture of the Open Medical Record System (OpenMRS) to build a Fast Healthcare Interoperability Resources (FHIR) based add-on module that could consume FHIR resources and requests made on OpenMRS. The OpenMRS FHIR module supports a subset of FHIR resources that could be used to interact with clinical data persisted in OpenMRS. We demonstrate the ease of connecting healthcare applications using the FHIR API by integrating a third party Substitutable Medical Apps & Reusable Technology (SMART) application with OpenMRS via FHIR. The OpenMRS FHIR module is an optional component of the OpenMRS platform. The FHIR API significantly reduces the effort required to implement OpenMRS by preventing developers from having to learn or work with a domain specific OpenMRS API. We propose an integration pathway where the domain specific legacy OpenMRS API is gradually retired in favor of the new FHIR API, which would be integrated into the core OpenMRS platform. Our efforts indicate that a domain independent API is a reality for any EMR system. These efforts demonstrate the adoption of an emerging FHIR standard that is seen as a replacement for both Health Level 7 (HL7) Version 2 and Version 3. We propose a gradual integration approach where our FHIR API becomes the preferred method for communicating with the OpenMRS platform. PMID:26446013

  20. Access Control Model for Sharing Composite Electronic Health Records

    NASA Astrophysics Data System (ADS)

    Jin, Jing; Ahn, Gail-Joon; Covington, Michael J.; Zhang, Xinwen

    The adoption of electronically formatted medical records, so called Electronic Health Records (EHRs), has become extremely important in healthcare systems to enable the exchange of medical information among stakeholders. An EHR generally consists of data with different types and sensitivity degrees which must be selectively shared based on the need-to-know principle. Security mechanisms are required to guarantee that only authorized users have access to specific portions of such critical record for legitimate purposes. In this paper, we propose a novel approach for modelling access control scheme for composite EHRs. Our model formulates the semantics and structural composition of an EHR document, from which we introduce a notion of authorized zones of the composite EHR at different granularity levels, taking into consideration of several important criteria such as data types, intended purposes and information sensitivities.

  1. Cost-effectiveness of a shared computerized decision support system for diabetes linked to electronic medical records

    PubMed Central

    Holbrook, Anne; Blackhouse, Gordon; Troyan, Sue; Goeree, Ron

    2011-01-01

    Background Computerized decision support systems (CDSSs) are believed to enhance patient care and reduce healthcare costs; however the current evidence is limited and the cost-effectiveness remains unknown. Objective To estimate the long-term cost-effectiveness of a CDSS linked to evidence-based treatment recommendations for type 2 diabetes. Methods Using the Ontario Diabetes Economic Model, changes in factors (eg, HbA1c) from a randomized controlled trial were used to estimate cost-effectiveness. The cost of implementation, development, and maintenance of the core dataset, and projected diabetes-related complications were included. The base case assumed a 1-year treatment effect, 5% discount rate, and 40-year time horizon. Univariate, one-way sensitivity analyses were carried out by altering different parameter values. The perspective was the Ontario Ministry of Health and costs were in 2010 Canadian dollars. Results The cost of implementing the intervention was $483 699. The one-year intervention reduced HbA1c by 0.2 and systolic blood pressure by 3.95 mm Hg, but increased body mass index by 0.02 kg/m2, resulting in a relative risk reduction of 14% in the occurrence of amputation. The model estimated that the intervention resulted in an additional 0.0117 quality-adjusted life year; the incremental cost-effectiveness ratio was $160 845 per quality-adjusted life-year. Conclusion The web-based prototype decision support system slightly improved short-term risk factors. The model predicted moderate improvements in long-term health outcomes. This disease management program will need to develop considerable efficiencies in terms of costs and processes or improved effectiveness to be considered a cost-effective intervention for treating patients with type 2 diabetes. PMID:22052900

  2. The electronic patient record: a strategic planning framework.

    PubMed

    Gordon, D B; Marafioti, S; Carter, M; Kunov, H; Dolan, A

    1995-01-01

    Sunnybrook Health Science Center (Sunnybrook) is a multifacility academic teaching center. In May 1994, Sunnybrook struck an electronic patient record taskforce to develop a strategic plan for the implementation of a comprehensive, facility wide electronic patient record (EPR). The taskforce sought to create a conceptual framework which provides context and integrates decision-making related to the comprehensive electronic patient record. The EPR is very much broader in scope than the traditional paper-based record. It is not restricted to simply reporting individual patient data. By the Institute of Medicine's definition, the electronic patient record resides in a system specifically designed to support users through availability of complete and accurate data, practitioner reminders and alerts, clinical decision support systems, links to bodies of medical knowledge, and other aids [1]. It is a comprehensive resource for patient care. The taskforce proposed a three domain model for determining how the EPR affects Sunnybrook. The EPR enables Sunnybrook to have a high performance team structure (domain 1), to function as an integrated organization (domain 2), and to reach out and develop new relationships with external organizations to become an extended enterprise (domain 3) [2]. Domain 1: Sunnybrook's high performance teams or patient service units' (PSUs) are decentralized, autonomous operating units that provide care to patients grouped by 'like' diagnosis and resource needs. The EPR must provide functions and applications which promote patient focused care, such as cross functional charting and care maps, group scheduling, clinical email, and a range of enabling technologies for multiskilled workers. Domain 2: In the integrated organization domain, the EPR should facilitate closer linkages between the arrangement of PSUs into clinical teams and with other facilities within the center in order to provide a longitudinal record that covers a continuum of care

  3. Electronic health records for cardiovascular medicine.

    PubMed

    Ouhbi, Sofia; Idri, Ali; Fernández-Alemán, Jose Luis; Toval, Ambrosio; Benjelloun, Halima

    2014-01-01

    Nowadays, many cardiology health care centers and hospitals adopt new technologies to improve interaction with their patients. The Electronic Health Records (EHR) offer health care centers and institutions the possibility to improve the management of their patients' health data. Currently, many physicians are using EHRs to improve health care quality and efficiency. A large number of companies have emerged to provide hospitals with the opportunity to adopt EHRs within a health care platform proposing different functionalities and services which achieve certain certification criteria. This paper identifies the current list of certified EHRs for cardiovascular medicine and assesses the specifications of the EHRs selected. The result of this paper may assist EHR seekers for cardiovascular medicine in their tasks. PMID:25570218

  4. Project Records Information System (PRIS)

    SciTech Connect

    Smith, P.S.; Schwarz, R.K.

    1990-11-01

    The Project Records Information System (PRIS) is an interactive system developed for the Information Services Division (ISD) of Martin Marietta Energy Systems, Inc., to perform indexing, maintenance, and retrieval of information about Engineering project record documents for which they are responsible. This PRIS User's Manual provides instruction on the use of this system. This manual presents an overview of PRIS, describing the system's purpose; the data that it handles; functions it performs; hardware, software, and access; and help and error functions. This manual describes the interactive menu-driven operation of PRIS. Appendixes A, B, C, and D contain the data dictionary, help screens, report descriptions, and a primary menu structure diagram, respectively.

  5. Benefits and Risks of Electronic Medical Record (EMR): An Interpretive Analysis of Healthcare Consumers' Perceptions of an Evolving Health Information Systems Technology

    ERIC Educational Resources Information Center

    Thompson, Chester D.

    2013-01-01

    The purpose of this study is to explore healthcare consumers' perceptions of their Electronic Medical Records (EMRs). Although there have been numerous studies regarding EMRs, there have been minimal, if any, research that explores healthcare consumers' awareness of this technology and the social implications that result. As consumers' health…

  6. The effect of the electronic medical record on nurses' work.

    PubMed

    Robles, Jane

    2009-01-01

    The electronic medical record (EMR) is a workplace reality for most nurses. Its advantages include a single consolidated record for each person; capacity for data interfaces and alerts; improved interdisciplinary communication; and evidence-based decision support. EMRs can add to work complexity, by forcing better documentation of previously unrecorded data and/or because of poor design. Well-designed and well-implemented computerized provider order entry (CPOE) systems can streamline nurses' work. Generational differences in acceptance of and facility with EMRs can be addressed through open, healthy communication. PMID:19343848

  7. Physicians’ Attitudes regarding Patient Access to Electronic Medical Records

    PubMed Central

    Dorr, David A.; Rowan, Belle; Weed, Matt; James, Brent; Clayton, Paul

    2003-01-01

    Prior to the implementation of Electronic Medical Record (EMR) web access for patients at a large integrated delivery systems, we surveyed physicians’ attitudes. Our web based questionnaire revealed largely positive attitudes about access. The exceptions included abnormal reports, progress notes, and e-care. A factor analysis identified the group of physicians who didn’t view patients as partners felt most negative about the process. PMID:14728337

  8. 75 FR 2114 - Privacy Act of 1974; Systems of Records

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-14

    ... Responsibilities for Maintaining Records About Individuals,'' dated February 8, 1996 (February 20, 2996, 61 FR 6427... of Defense. T7320 System Name: Electronic Funds Transfer (EFT) Records (October 15, 2004, 69 FR 61225... of the Secretary Privacy Act of 1974; Systems of Records AGENCY: Defense Finance and...

  9. Linking medical records to an expert system

    NASA Technical Reports Server (NTRS)

    Naeymi-Rad, Frank; Trace, David; Desouzaalmeida, Fabio

    1991-01-01

    This presentation will be done using the IMR-Entry (Intelligent Medical Record Entry) system. IMR-Entry is a software program developed as a front-end to our diagnostic consultant software MEDAS (Medical Emergency Decision Assistance System). MEDAS (the Medical Emergency Diagnostic Assistance System) is a diagnostic consultant system using a multimembership Bayesian design for its inference engine and relational database technology for its knowledge base maintenance. Research on MEDAS began at the University of Southern California and the Institute of Critical Care in the mid 1970's with support from NASA and NSF. The MEDAS project moved to Chicago in 1982; its current progress is due to collaboration between Illinois Institute of Technology, The Chicago Medical School, Lake Forest College and NASA at KSC. Since the purpose of an expert system is to derive a hypothesis, its communication vocabulary is limited to features used by its knowledge base. The development of a comprehensive problem based medical record entry system which could handshake with an expert system while creating an electronic medical record at the same time was studied. IMR-E is a computer based patient record that serves as a front end to the expert system MEDAS. IMR-E is a graphically oriented comprehensive medical record. The programs major components are demonstrated.

  10. The challenges in making electronic health records accessible to patients

    PubMed Central

    Beard, Leslie; Schein, Rebecca; Morra, Dante; Wilson, Kumanan

    2011-01-01

    It is becoming increasingly apparent that there is a tension between growing consumer demands for access to information and a healthcare system that may not be prepared to meet these demands. Designing an effective solution for this problem will require a thorough understanding of the barriers that now stand in the way of giving patients electronic access to their health data. This paper reviews the following challenges related to the sharing of electronic health records: cost and security concerns, problems in assigning responsibilities and rights among the various players, liability issues and tensions between flexible access to data and flexible access to physicians. PMID:22120207