Lack of recording of systemic lupus erythematosus in the death certificates of lupus patients.

PubMed

Calvo-Alén, J; Alarcón, G S; Campbell, R; Fernández, M; Reveille, J D; Cooper, G S

2005-09-01

To determine to what extent the diagnosis of systemic lupus erythematosus (SLE) in deceased lupus patients is under-reported in death certificates, and the patient characteristics associated with such an occurrence. The death certificates of 76 of the 81 deceased SLE patients from two US lupus cohorts (LUMINA for Lupus in Minorities: Nature vs Nurture and CLU for Carolina Lupus Study), including 570 and 265 patients, respectively, were obtained from the Offices of Vital Statistics of the states where the patients died (Alabama, Georgia, North Carolina, South Carolina, Tennessee and Texas). Both cohorts included patients with SLE as per the American College of Rheumatology criteria, aged > or =16 yr, and disease duration at enrolment of < or =5 yr. The median duration of follow-up in each cohort at the time of these analyses ranged from 38.1 to 53.0 months. Standard univariable analyses were performed comparing patients with SLE recorded anywhere in the death certificate and those without it. A multivariable logistic regression model was performed to identify the variables independently associated with not recording SLE in death certificates. In 30 (40%) death certificates, SLE was not recorded anywhere in the death certificate. In univariable analyses, older age was associated with lack of recording of SLE in death certificates [mean age (standard deviation) 50.9 (15.6) years and 39.1 (18.6) yr among those for whom SLE was omitted and included on the death certificates, respectively, P = 0.005]. Patients without health insurance, those dying of a cardiovascular event and those of Caucasian ethnicity were also more likely to be in the non-recorded group. In the multivariable analysis, variables independently associated with not recording SLE as cause of death were older age [odds ratio = (95% confidence interval) 1.043 (1.005-1.083 per yr increase); P = 0.023] and lack of health insurance [4.649 (1.152-18.768); P = 0.031]. A high proportion of SLE diagnoses are not

A Patient Record-Filing System for Family Practice

PubMed Central

Levitt, Cheryl

1988-01-01

The efficient storage and easy retrieval of quality records are a central concern of good family practice. Many physicians starting out in practice have difficulty choosing a practical and lasting system for storing their records. Some who have established practices are installing computers in their offices and finding that their filing systems are worn, outdated, and incompatible with computerized systems. This article describes a new filing system installed simultaneously with a new computer system in a family-practice teaching centre. The approach adopted solved all identifiable problems and is applicable in family practices of all sizes.

Protecting Patient Records from Unwarranted Access

NASA Astrophysics Data System (ADS)

Gardner, Ryan; Garera, Sujata; Rubin, Aviel D.; Rajan, Anand; Rozas, Carlos V.; Sastry, Manoj

Securing access to medical information is vital to protecting patient privacy. However, Electronic Patient Record (EPR) systems are vulnerable to a number of inside and outside threats. Adversaries can compromise EPR client machines to obtain a variety of highly sensitive information including valid EPR login credentials, without detection. Furthermore, medical staff can covertly view records of their choosing for personal interest or more malicious purposes. In particular, we observe that the lack of integrity measurement and auditability in these systems creates a potential threat to the privacy of patient information. We explore the use of virtualization and trusted computing hardware to address these problems. We identify open problems and encourage further research in the area.

[Evaluation of a context sensitive system for intra-operative usage of the electronic patient record].

PubMed

Dressler, C R; Fischer, M; Burgert, O; Strauß, G

2012-06-01

This article analyzes the usage of an electronic patient record (EPR), which may be accessed intra-operatively by the surgeon. The focus lies on the automatic prioritization of documents to dramatically reduce the surgeon's interaction with the EPR system. An EPR system has been developed, which displays documents in accordance to the current procedure. The system is controlled by a foot switch and the documents are displayed on a large-scale screen in the operating room. The usage of the system by 2 surgeons has been recorded in clinical routine. 55 surgical procedures have been recorded. The EPR system has been used 2 times per procedure in average for surgeries at the middle ear, for surgeries of the paranasal sinuses, it has been used 1.3 times per procedure. The EPR-system has been used pre-operatively in 58% of cases. The surgeons did not have to interact with the EPR system for more than the half of the procedures to view the desired document. The existence of digitized documents in a clinic does not automatically lead to improved workflows. The evaluated EPR system presented the patient data in a simple and comfortable way. The extensive pre-operative usage had not been expected. Because of the low barrier to view patient data, higher patient safety may be assumed. On the other hand, the surgeon could be encouraged to skip the important preparation before the procedure. Due to the low pervasiveness of medical communication standards at this time, the integrated connection between clinic IT and an EPR system would nowadays only be possible by great efforts. © Georg Thieme Verlag KG Stuttgart · New York.

Medical record search engines, using pseudonymised patient identity: an alternative to centralised medical records.

PubMed

Quantin, Catherine; Jaquet-Chiffelle, David-Olivier; Coatrieux, Gouenou; Benzenine, Eric; Allaert, François-André

2011-02-01

The purpose of our multidisciplinary study was to define a pragmatic and secure alternative to the creation of a national centralised medical record which could gather together the different parts of the medical record of a patient scattered in the different hospitals where he was hospitalised without any risk of breaching confidentiality. We first analyse the reasons for the failure and the dangers of centralisation (i.e. difficulty to define a European patients' identifier, to reach a common standard for the contents of the medical record, for data protection) and then propose an alternative that uses the existing available data on the basis that setting up a safe though imperfect system could be better than continuing a quest for a mythical perfect information system that we have still not found after a search that has lasted two decades. We describe the functioning of Medical Record Search Engines (MRSEs), using pseudonymisation of patients' identity. The MRSE will be able to retrieve and to provide upon an MD's request all the available information concerning a patient who has been hospitalised in different hospitals without ever having access to the patient's identity. The drawback of this system is that the medical practitioner then has to read all of the information and to create his own synthesis and eventually to reject extra data. Faced with the difficulties and the risks of setting up a centralised medical record system, a system that gathers all of the available information concerning a patient could be of great interest. This low-cost pragmatic alternative which could be developed quickly should be taken into consideration by health authorities. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Providing a complete online multimedia patient record.

PubMed Central

Dayhoff, R. E.; Kuzmak, P. M.; Kirin, G.; Frank, S.

1999-01-01

Seamless integration of all types of patient data is a critical feature for clinical workstation software. The Dept. of Veterans Affairs has developed a multimedia online patient record that includes traditional medical chart information as well as a wide variety of medical images from specialties such as cardiology, pulmonary and gastrointestinal medicine, pathology, radiology, hematology, and nuclear medicine. This online patient record can present data in ways not possible with a paper chart or other physical media. Obtaining a critical mass of information online is essential to achieve the maximum benefits from an integrated patient record system. Images Figure 1 Figure 2 PMID:10566357

Utilization of multimedia-based prototype system for patient electronic medical record.

PubMed

Chu, Yuan-Chia; Jian, Wen-Shan; Yen, Li-Po; Chang, Polun

2006-01-01

Taiwanese Department of Health (DOH) proposed the basic format template of electronic medical records (EMR), for the reference of healthcare institutions nationwide. It facilitates the establishment of EMR in healthcare institutions and the foundation of the sharing and exchange center of EMR. We use this basic content format template as the data exchange carrier, and build a Multimedia EMR prototype system by using web-based XML structured documents, which can thoroughly show the information needed by patients and healthcare institutions, offer Macromedia inverted exclamation markV Flash style viewer, provide people and institutions with the operation interface for downloading relevant medical record formats, and realize the dream that people can actually own their Multimedia EMR.

Attitudes of pregnant women towards personally controlled electronic, hospital-held, and patient-held medical record systems: a survey study.

PubMed

Quinlivan, Julie A; Lyons, Sarah; Petersen, Rodney W

2014-09-01

On July 1, 2012 the Australian Government launched the personally controlled electronic health record (PCEHR). This article surveys obstetric patients about their medical record preferences and identifies barriers to adoption of the PCEHR. A survey study was conducted of antenatal patients attending a large Australian metropolitan hospital. Consecutive patients completed questionnaires during the launch phase of the PCEHR system. Quantitative and qualitative data were collected on demographics, computer access and familiarity, preference for medical record system, and perceived benefits and concerns. Of 528 women eligible to participate, 474 completed the survey (89.8%). Respondents had high levels of home access to a computer (90.5%) and the Internet (87.1%) and were familiar with using computers in daily life (median Likert scale of 9 out of 10). Despite this, respondents preferred hospital-held paper records, and only one-third preferred a PCEHR; the remainder preferred patient-held records. Compared with hospital-held paper records, respondents felt a PCEHR would reduce the risk of lost records (p<0.0001) and improve staff communication (p<0.0001). However, there were significant concerns about confidentiality and privacy of the PCEHR (p<0.0001) and lack of control (p<0.0001). Consumers see advantages and disadvantages with the PCEHR, although the majority still prefer existing record systems. To increase uptake, confidentiality, privacy, and control concerns need to be addressed.

System requirements for a computerised patient record information system at a busy primary health care clinic.

PubMed

Blignaut, P J; McDonald, T; Tolmie, C J

2001-05-01

A prototyping approach was used to determine the essential system requirements of a computerised patient record information system for a typical township primary health care clinic. A pilot clinic was identified and the existing manual system and business processes in this clinic was studied intensively before the first prototype was implemented. Interviews with users, incidental observations and analysis of actual data entered were used as primary techniques to refine the prototype system iteratively until a system with an acceptable data set and adequate functionalities were in place. Several non-functional and user-related requirements were also discovered during the prototyping period.

Developing a point-of-care electronic medical record system for TB/HIV co-infected patients: experiences from Lighthouse Trust, Lilongwe, Malawi.

PubMed

Tweya, Hannock; Feldacker, Caryl; Gadabu, Oliver Jintha; Ng'ambi, Wingston; Mumba, Soyapi L; Phiri, Dave; Kamvazina, Luke; Mwakilama, Shawo; Kanyerere, Henry; Keiser, Olivia; Mwafilaso, Johnbosco; Kamba, Chancy; Egger, Matthias; Jahn, Andreas; Simwaka, Bertha; Phiri, Sam

2016-03-05

Implementation of user-friendly, real-time, electronic medical records for patient management may lead to improved adherence to clinical guidelines and improved quality of patient care. We detail the systematic, iterative process that implementation partners, Lighthouse clinic and Baobab Health Trust, employed to develop and implement a point-of-care electronic medical records system in an integrated, public clinic in Malawi that serves HIV-infected and tuberculosis (TB) patients. Baobab Health Trust, the system developers, conducted a series of technical and clinical meetings with Lighthouse and Ministry of Health to determine specifications. Multiple pre-testing sessions assessed patient flow, question clarity, information sequencing, and verified compliance to national guidelines. Final components of the TB/HIV electronic medical records system include: patient demographics; anthropometric measurements; laboratory samples and results; HIV testing; WHO clinical staging; TB diagnosis; family planning; clinical review; and drug dispensing. Our experience suggests that an electronic medical records system can improve patient management, enhance integration of TB/HIV services, and improve provider decision-making. However, despite sufficient funding and motivation, several challenges delayed system launch including: expansion of system components to include of HIV testing and counseling services; changes in the national antiretroviral treatment guidelines that required system revision; and low confidence to use the system among new healthcare workers. To ensure a more robust and agile system that met all stakeholder and user needs, our electronic medical records launch was delayed more than a year. Open communication with stakeholders, careful consideration of ongoing provider input, and a well-functioning, backup, paper-based TB registry helped ensure successful implementation and sustainability of the system. Additional, on-site, technical support provided

Patients' experiences when accessing their on-line electronic patient records in primary care.

PubMed Central

Pyper, Cecilia; Amery, Justin; Watson, Marion; Crook, Claire

2004-01-01

BACKGROUND: Patient access to on-line primary care electronic patient records is being developed nationally. Knowledge of what happens when patients access their electronic records is poor. AIM: To enable 100 patients to access their electronic records for the first time to elicit patients' views and to understand their requirements. DESIGN OF STUDY: In-depth interviews using semi-structured questionnaires as patients accessed their electronic records, plus a series of focus groups. SETTING: Secure facilities for patients to view their primary care records privately. METHOD: One hundred patients from a randomised group viewed their on-line electronic records for the first time. The questionnaire and focus groups addressed patients' views on the following topics: ease of use; confidentiality and security; consent to access; accuracy; printing records; expectations regarding content; exploitation of electronic records; receiving new information and bad news. RESULTS: Most patients found the computer technology used acceptable. The majority found viewing their record useful and understood most of the content, although medical terms and abbreviations required explanation. Patients were concerned about security and confidentiality, including potential exploitation of records. They wanted the facility to give informed consent regarding access and use of data. Many found errors, although most were not medically significant. Many expected more detail and more information. Patients wanted to add personal information. CONCLUSION: Patients have strong views on what they find acceptable regarding access to electronic records. Working in partnership with patients to develop systems is essential to their success. Further work is required to address legal and ethical issues of electronic records and to evaluate their impact on patients, health professionals and service provision. PMID:14965405

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

PubMed

Carter, Evelene M; Potts, Henry W W

2014-04-04

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. 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. 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). 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.

Using electronic patient records to discover disease correlations and stratify patient cohorts.

PubMed

Roque, Francisco S; Jensen, Peter B; Schmock, Henriette; Dalgaard, Marlene; Andreatta, Massimo; Hansen, Thomas; Søeby, Karen; Bredkjær, Søren; Juul, Anders; Werge, Thomas; Jensen, Lars J; Brunak, Søren

2011-08-01

Electronic patient records remain a rather unexplored, but potentially rich data source for discovering correlations between diseases. We describe a general approach for gathering phenotypic descriptions of patients from medical records in a systematic and non-cohort dependent manner. By extracting phenotype information from the free-text in such records we demonstrate that we can extend the information contained in the structured record data, and use it for producing fine-grained patient stratification and disease co-occurrence statistics. The approach uses a dictionary based on the International Classification of Disease ontology and is therefore in principle language independent. As a use case we show how records from a Danish psychiatric hospital lead to the identification of disease correlations, which subsequently can be mapped to systems biology frameworks.

[Introduction of computerized anesthesia-recording systems and construction of comprehensive medical information network for patients undergoing surgery in the University of Tokyo Hospital].

PubMed

Kitamura, Takayuki; Hoshimoto, Hiroyuki; Yamada, Yoshitsugu

2009-10-01

The computerized anesthesia-recording systems are expensive and the introduction of the systems takes time and requires huge effort. Generally speaking, the efficacy of the computerized anesthesia-recording systems on the anesthetic managements is focused on the ability to automatically input data from the monitors to the anesthetic records, and tends to be underestimated. However, once the computerized anesthesia-recording systems are integrated into the medical information network, several features, which definitely contribute to improve the quality of the anesthetic management, can be developed; for example, to prevent misidentification of patients, to prevent mistakes related to blood transfusion, and to protect patients' personal information. Here we describe our experiences of the introduction of the computerized anesthesia-recording systems and the construction of the comprehensive medical information network for patients undergoing surgery in The University of Tokyo Hospital. We also discuss possible efficacy of the comprehensive medical information network for patients during surgery under anesthetic managements.

[Development of electronic medical recording system for clinics using the internet based on patient participation in pursuit of NBM].

PubMed

Omatsu, Masahiko; Tachibana, Hidenobu; Umeda, Tokuo

2004-06-01

The current medical system does not allow sufficient time for medical interviews, a situation that can create problems in patient-doctor relationships and result in a variety of problems. The importance of narrative based medicine (NBM) has been raised as a result of the overemphasis on evidence based medicine (EBM) in recent years. From this point of view, we have developed an electronic medical recording (EMR) system for clinics that uses the Internet and is based on patient participation, in pursuit of NBM. This system enables the patient to report information prior to the face-to-face interview with his or her doctor. In this way, the patient has more time to summarize and explain physical conditions and concerns. These reports from patients are automatically saved to the EMR database, without any additional workload. Therefore, this system will provide more effective communication between patient and doctor. In addition, the doctor is able to receive the results of medical treatment directly, in addition to the patient's other records. These sets of records will contribute to more efficient operation of the clinic. At this time, we have improved this system on the assumption that outsourcing the server will avoid the burden of maintenance. This prototype system uses a personal identification number (PIN) and an encode/decode algorithm for security. The secure PIN enables us to use conventional e-mail. Through experimental clinical testing, the effects on mutual understanding in medical examinations were studied. We are confident that this system based on patient narratives will contribute greatly to the spread of EMR systems for clinics operated by family physicians.

Patients prefer electronic medical records - fact or fiction?

PubMed

Masiza, Melissa; Mostert-Phipps, Nicky; Pottasa, Dalenca

2013-01-01

Incomplete patient medical history compromises the quality of care provided to a patient while well-kept, adequate patient medical records are central to the provision of good quality of care. According to research, patients have the right to contribute to decision-making affecting their health. Hence, the researchers investigated their views regarding a paper-based system and an electronic medical record (EMR). An explorative approach was used in conducting a survey within selected general practices in the Nelson Mandela Metropole. The majority of participants thought that the use of a paper-based system had no negative impact on their health. Participants expressed concerns relating to the confidentiality of their medical records with both storage mediums. The majority of participants indicated they prefer their GP to computerise their consultation details. The main objective of the research on which this poster is based was to investigate the storage medium of preference for patients and the reasons for their preference. Overall, 48% of the 85 participants selected EMRs as their preferred storage medium and the reasons for their preference were also uncovered.

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

Patient-Reported Use of Personalized Video Recordings to Improve Neurosurgical Patient-Provider Communication

PubMed Central

Porter, Randall

2015-01-01

Background: Providing patients with a video recording of their visit with a medical professional is a common-sense method for improving patient-provider communication. Objective: To describe the patient and provider experiences to video recording clinical medical encounters and providing the patient with a copy of the video for informational purposes. Methods: Since 2009, over 2,800 patients of eight different neurosurgeons chose to be video recorded during their encounter with the doctor and were provided access to the recording to watch over again as a way to recall what the doctor had said. The video system was set up as a handheld video camera, and video files were downloaded and made accessible to patients via a secure Internet patient portal. Between 2012 and 2014, patients who participated were surveyed regarding their use of the video and what was recorded on the video. The experience of the providers from a clinical and medico-legal standpoint was also reviewed. Results: Three hundred and thirty-three responses to the survey were received (39.2% response rate). More than half of patients (N=333; 56.2%) watched their video more than once, and over two-thirds (N=333; 68.6%) shared their video with a family member, friend, or another physician. Patients self-reported improved memory after watching their videos (N=299; 73.6% could remember more) and 50.2% responded that having the video made them feel more “at ease” with their medical problem (N=299). Overall, 88.0% of respondents indicated that their video had been helpful to them, and 98.5% would recommend having future visits video recorded. No patient made a comment that the video was intrusive or had prevented them from being open with their doctor. Finally, in the high-risk specialty of neurosurgery, none of the 2,807 patients who have been recorded since 2009 have used a video in a medico-legal action. Conclusions: Patient responses to the recording system and having a copy of their video

A study on agent-based secure scheme for electronic medical record system.

PubMed

Chen, Tzer-Long; Chung, Yu-Fang; Lin, Frank Y S

2012-06-01

Patient records, including doctors' diagnoses of diseases, trace of treatments and patients' conditions, nursing actions, and examination results from allied health profession departments, are the most important medical records of patients in medical systems. With patient records, medical staff can instantly understand the entire medical information of a patient so that, according to the patient's conditions, more accurate diagnoses and more appropriate in-depth treatments can be provided. Nevertheless, in such a modern society with booming information technologies, traditional paper-based patient records have faced a lot of problems, such as lack of uniform formats, low data mobility, slow data transfer, illegible handwritings, enormous and insufficient storage space, difficulty of conservation, being easily damaged, and low transferability. To improve such drawbacks, reduce medical costs, and advance medical quality, paper-based patient records are modified into electronic medical records and reformed into electronic patient records. However, since electronic patient records used in various hospitals are diverse and different, in consideration of cost, it is rather difficult to establish a compatible and complete integrated electronic patient records system to unify patient records from heterogeneous systems in hospitals. Moreover, as the booming of the Internet, it is no longer necessary to build an integrated system. Instead, doctors can instantly look up patients' complete information through the Internet access to electronic patient records as well as avoid the above difficulties. Nonetheless, the major problem of accessing to electronic patient records cross-hospital systems exists in the security of transmitting and accessing to the records in case of unauthorized medical personnels intercepting or stealing the information. This study applies the Mobile Agent scheme to cope with the problem. Since a Mobile Agent is a program, which can move among hosts and

75 FR 72873 - Privacy Act Of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-26

...) is amending two existing systems of records 121VA19, ``National Patient Databases--VA'', and 136VA19E... being amended for additional databases. DATES: Comments on the amendment of these systems of records... system identified as 121VA19, ``National Patient Databases--VA,'' as set forth in the Federal Register...

The risks and benefits of disclosing psychotherapy records to the legal system: What psychologists and patients need to know for informed consent.

PubMed

Borkosky, Bruce; Smith, Deirdre M

2015-01-01

When psychologists release patient records to the legal system, the typical practice is to obtain the patient's signature on a consent form, but rarely is a formal informed-consent obtained from the patient. Although psychologists are legally and ethically required to obtain informed consent for all services (including disclosure of records), there are a number of barriers to obtaining truly informed consent. Furthermore, compared to disclosures to nonlegal third parties, there are significantly greater risks when records are disclosed to the legal system. For these reasons, true informed consent should be obtained from the patient when records are disclosed to the legal system. A model for informed consent is proposed. This procedure should include a description of risks and benefits of disclosing or refusing to disclose by the psychotherapist, an opportunity to ask questions, and indication by the patient of a freely made choice. Both psychotherapist and patient share decision making responsibilities in our suggested model. The patient should be informed about potential harm to the therapeutic relationship, if applicable. Several recommendations for practice are described, including appropriate communications with attorneys and the legal system. A sample form, for use by psychotherapists, is included. Copyright © 2015 Elsevier Ltd. All rights reserved.

Internet Patient Records: new techniques

PubMed Central

Moehrs, Sascha; Anedda, Paolo; Tuveri, Massimiliano; Zanetti, Gianluigi

2001-01-01

Background The ease by which the Internet is able to distribute information to geographically-distant users on a wide variety of computers makes it an obvious candidate for a technological solution for electronic patient record systems. Indeed, second-generation Internet technologies such as the ones described in this article - XML (eXtensible Markup Language), XSL (eXtensible Style Language), DOM (Document Object Model), CSS (Cascading Style Sheet), JavaScript, and JavaBeans - may significantly reduce the complexity of the development of distributed healthcare systems. Objective The demonstration of an experimental Electronic Patient Record (EPR) system built from those technologies that can support viewing of medical imaging exams and graphically-rich clinical reporting tools, while conforming to the newly emerging XML standard for digital documents. In particular, we aim to promote rapid prototyping of new reports by clinical specialists. Methods We have built a prototype EPR client, InfoDOM, that runs in both the popular web browsers. In this second version it receives each EPR as an XML record served via the secure SSL (Secure Socket Layer) protocol. JavaBean software components manipulate the XML to store it and then to transform it into a variety of useful clinical views. First a web page summary for the patient is produced. From that web page other JavaBeans can be launched. In particular, we have developed a medical imaging exam Viewer and a clinical Reporter bean parameterized appropriately for the particular patient and exam in question. Both present particular views of the XML data. The Viewer reads image sequences from a patient-specified network URL on a PACS (Picture Archiving and Communications System) server and presents them in a user-controllable animated sequence, while the Reporter provides a configurable anatomical map of the site of the pathology, from which individual "reportlets" can be launched. The specification of these reportlets is

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…

[Development of Diagrammatic Recording System for Choledochoscope and Its Clinical Application].

PubMed

Xue, Zhao; Hu, Liangshuo; Tang, Bo; Zhang, Xiaogang; Lyu, Yi

2017-11-30

To develop a diagrammatic recording system for choledochoscopy and evaluate the system with clinical application. To match the real-time image and procedure illustration during choledochoscopy examination, we combined video-image capture and speech recognition technology to quickly generate personalized choledochoscopy images and texts records. The new system could be used in sharing territorial electronic medical records, telecommuting, scientific research and education, et al. In the clinical application of 32 patients, the choledochoscopy diagrammatic recording system could significantly improve the surgeons' working efficiency and patients' satisfaction. It could also meet the design requirement of remote information interaction. The choledochoscopy diagrammatic recording system which is recommended could elevate the quality of medical service and promote academic exchange and training.

Patient Health Record Systems Scope and Functionalities: Literature Review and Future Directions.

PubMed

Bouayad, Lina; Ialynytchev, Anna; Padmanabhan, Balaji

2017-11-15

A new generation of user-centric information systems is emerging in health care as patient health record (PHR) systems. These systems create a platform supporting the new vision of health services that empowers patients and enables patient-provider communication, with the goal of improving health outcomes and reducing costs. This evolution has generated new sets of data and capabilities, providing opportunities and challenges at the user, system, and industry levels. The objective of our study was to assess PHR data types and functionalities through a review of the literature to inform the health care informatics community, and to provide recommendations for PHR design, research, and practice. We conducted a review of the literature to assess PHR data types and functionalities. We searched PubMed, Embase, and MEDLINE databases from 1966 to 2015 for studies of PHRs, resulting in 1822 articles, from which we selected a total of 106 articles for a detailed review of PHR data content. We present several key findings related to the scope and functionalities in PHR systems. We also present a functional taxonomy and chronological analysis of PHR data types and functionalities, to improve understanding and provide insights for future directions. Functional taxonomy analysis of the extracted data revealed the presence of new PHR data sources such as tracking devices and data types such as time-series data. Chronological data analysis showed an evolution of PHR system functionalities over time, from simple data access to data modification and, more recently, automated assessment, prediction, and recommendation. Efforts are needed to improve (1) PHR data quality through patient-centered user interface design and standardized patient-generated data guidelines, (2) data integrity through consolidation of various types and sources, (3) PHR functionality through application of new data analytics methods, and (4) metrics to evaluate clinical outcomes associated with automated PHR

Patient Health Record Systems Scope and Functionalities: Literature Review and Future Directions

PubMed Central

2017-01-01

Background A new generation of user-centric information systems is emerging in health care as patient health record (PHR) systems. These systems create a platform supporting the new vision of health services that empowers patients and enables patient-provider communication, with the goal of improving health outcomes and reducing costs. This evolution has generated new sets of data and capabilities, providing opportunities and challenges at the user, system, and industry levels. Objective The objective of our study was to assess PHR data types and functionalities through a review of the literature to inform the health care informatics community, and to provide recommendations for PHR design, research, and practice. Methods We conducted a review of the literature to assess PHR data types and functionalities. We searched PubMed, Embase, and MEDLINE databases from 1966 to 2015 for studies of PHRs, resulting in 1822 articles, from which we selected a total of 106 articles for a detailed review of PHR data content. Results We present several key findings related to the scope and functionalities in PHR systems. We also present a functional taxonomy and chronological analysis of PHR data types and functionalities, to improve understanding and provide insights for future directions. Functional taxonomy analysis of the extracted data revealed the presence of new PHR data sources such as tracking devices and data types such as time-series data. Chronological data analysis showed an evolution of PHR system functionalities over time, from simple data access to data modification and, more recently, automated assessment, prediction, and recommendation. Conclusions Efforts are needed to improve (1) PHR data quality through patient-centered user interface design and standardized patient-generated data guidelines, (2) data integrity through consolidation of various types and sources, (3) PHR functionality through application of new data analytics methods, and (4) metrics to evaluate

Open source electronic health record and patient data management system for intensive care.

PubMed

Massaut, Jacques; Reper, Pascal

2008-01-01

In Intensive Care Units, the amount of data to be processed for patients care, the turn over of the patients, the necessity for reliability and for review processes indicate the use of Patient Data Management Systems (PDMS) and electronic health records (EHR). To respond to the needs of an Intensive Care Unit and not to be locked with proprietary software, we developed a PDMS and EHR based on open source software and components. The software was designed as a client-server architecture running on the Linux operating system and powered by the PostgreSQL data base system. The client software was developed in C using GTK interface library. The application offers to the users the following functions: medical notes captures, observations and treatments, nursing charts with administration of medications, scoring systems for classification, and possibilities to encode medical activities for billing processes. Since his deployment in February 2004, the PDMS was used to care more than three thousands patients with the expected software reliability and facilitated data management and review processes. Communications with other medical software were not developed from the start, and are realized by the use of the Mirth HL7 communication engine. Further upgrade of the system will include multi-platform support, use of typed language with static analysis, and configurable interface. The developed system based on open source software components was able to respond to the medical needs of the local ICU environment. The use of OSS for development allowed us to customize the software to the preexisting organization and contributed to the acceptability of the whole system.

Designing a system for patients controlling providers' access to their electronic health records: organizational and technical challenges.

PubMed

Leventhal, Jeremy C; Cummins, Jonathan A; Schwartz, Peter H; Martin, Douglas K; Tierney, William M

2015-01-01

Electronic health records (EHRs) are proliferating, and financial incentives encourage their use. Applying Fair Information Practice principles to EHRs necessitates balancing patients' rights to control their personal information with providers' data needs to deliver safe, high-quality care. We describe the technical and organizational challenges faced in capturing patients' preferences for patient-controlled EHR access and applying those preferences to an existing EHR. We established an online system for capturing patients' preferences for who could view their EHRs (listing all participating clinic providers individually and categorically-physicians, nurses, other staff) and what data to redact (none, all, or by specific categories of sensitive data or patient age). We then modified existing data-viewing software serving a state-wide health information exchange and a large urban health system and its primary care clinics to allow patients' preferences to guide data displays to providers. Patients could allow or restrict data displays to all clinicians and staff in a demonstration primary care clinic, categories of providers (physicians, nurses, others), or individual providers. They could also restrict access to all EHR data or any or all of five categories of sensitive data (mental and reproductive health, sexually transmitted diseases, HIV/AIDS, and substance abuse) and for specific patient ages. The EHR viewer displayed data via reports, data flowsheets, and coded and free text data displayed by Google-like searches. Unless patients recorded restrictions, by default all requested data were displayed to all providers. Data patients wanted restricted were not displayed, with no indication they were redacted. Technical barriers prevented redacting restricted information in free textnotes. The program allowed providers to hit a "Break the Glass" button to override patients' restrictions, recording the date, time, and next screen viewed. Establishing patient

[Video recording system of endoscopic procedures for digital forensics].

PubMed

Endo, Chiaki; Sakurada, A; Kondo, T

2009-07-01

Recently, endoscopic procedures including surgery, intervention, and examination have been widely performed. Medical practitioners are required to record the procedures precisely in order to check the procedures retrospectively and to get the legally reliable record. Medical Forensic System made by KS Olympus Japan offers 2 kinds of movie and patient's data, such as heart rate, blood pressure, and Spo, which are simultaneously recorded. We installed this system into the bronchoscopy room and have experienced its benefit. Under this system, we can get bronchoscopic image, bronchoscopy room view, and patient's data simultaneously. We can check the quality of the bronchoscopic procedures retrospectively, which is useful for bronchoscopy staff training. Medical Forensic System should be installed in any kind of endoscopic procedures.

Information integrity and privacy for computerized medical patient records

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gallegos, J.; Hamilton, V.; Gaylor, T.

Sandia National Laboratories and Oceania, Inc. entered into a Cooperative Research and Development Agreement (CRADA) in November 1993 to provide ``Information Integrity and Privacy for Computerized Medical Patient Records`` (CRADA No. SC93/01183). The main objective of the project was to develop information protection methods that are appropriate for databases of patient records in health information systems. This document describes the findings and alternative solutions that resulted from this CRADA.

Sharing Annotated Audio Recordings of Clinic Visits With Patients—Development of the Open Recording Automated Logging System (ORALS): Study Protocol

PubMed Central

Dannenberg, Michelle D; Ganoe, Craig H; Haslett, William; Faill, Rebecca; Hassanpour, Saeed; Das, Amar; Arend, Roger; Masel, Meredith C; Piper, Sheryl; Reicher, Haley; Ryan, James; Elwyn, Glyn

2017-01-01

Background Providing patients with recordings of their clinic visits enhances patient and family engagement, yet few organizations routinely offer recordings. Challenges exist for organizations and patients, including data safety and navigating lengthy recordings. A secure system that allows patients to easily navigate recordings may be a solution. Objective The aim of this project is to develop and test an interoperable system to facilitate routine recording, the Open Recording Automated Logging System (ORALS), with the aim of increasing patient and family engagement. ORALS will consist of (1) technically proficient software using automated machine learning technology to enable accurate and automatic tagging of in-clinic audio recordings (tagging involves identifying elements of the clinic visit most important to patients [eg, treatment plan] on the recording) and (2) a secure, easy-to-use Web interface enabling the upload and accurate linkage of recordings to patients, which can be accessed at home. Methods We will use a mixed methods approach to develop and formatively test ORALS in 4 iterative stages: case study of pioneer clinics where recordings are currently offered to patients, ORALS design and user experience testing, ORALS software and user interface development, and rapid cycle testing of ORALS in a primary care clinic, assessing impact on patient and family engagement. Dartmouth’s Informatics Collaboratory for Design, Development and Dissemination team, patients, patient partners, caregivers, and clinicians will assist in developing ORALS. Results We will implement a publication plan that includes a final project report and articles for peer-reviewed journals. In addition to this work, we will regularly report on our progress using popular relevant Tweet chats and online using our website, www.openrecordings.org. We will disseminate our work at relevant conferences (eg, Academy Health, Health Datapalooza, and the Institute for Healthcare Improvement

A shared computer-based problem-oriented patient record for the primary care team.

PubMed

Linnarsson, R; Nordgren, K

1995-01-01

1. INTRODUCTION. A computer-based patient record (CPR) system, Swedestar, has been developed for use in primary health care. The principal aim of the system is to support continuous quality improvement through improved information handling, improved decision-making, and improved procedures for quality assurance. The Swedestar system has evolved during a ten-year period beginning in 1984. 2. SYSTEM DESIGN. The design philosophy is based on the following key factors: a shared, problem-oriented patient record; structured data entry based on an extensive controlled vocabulary; advanced search and query functions, where the query language has the most important role; integrated decision support for drug prescribing and care protocols and guidelines; integrated procedures for quality assurance. 3. A SHARED PROBLEM-ORIENTED PATIENT RECORD. The core of the CPR system is the problem-oriented patient record. All problems of one patient, recorded by different members of the care team, are displayed on the problem list. Starting from this list, a problem follow-up can be made, one problem at a time or for several problems simultaneously. Thus, it is possible to get an integrated view, across provider categories, of those problems of one patient that belong together. This shared problem-oriented patient record provides an important basis for the primary care team work. 4. INTEGRATED DECISION SUPPORT. The decision support of the system includes a drug prescribing module and a care protocol module. The drug prescribing module is integrated with the patient records and includes an on-line check of the patient's medication list for potential interactions and data-driven reminders concerning major drug problems. Care protocols have been developed for the most common chronic diseases, such as asthma, diabetes, and hypertension. The patient records can be automatically checked according to the care protocols. 5. PRACTICAL EXPERIENCE. The Swedestar system has been implemented in a

Patients' acceptance towards a web-based personal health record system: an empirical study in Taiwan.

PubMed

Liu, Chung-Feng; Tsai, Yung-Chieh; Jang, Fong-Lin

2013-10-17

The health care sector has become increasingly interested in developing personal health record (PHR) systems as an Internet-based telehealthcare implementation to improve the quality and decrease the cost of care. However, the factors that influence patients' intention to use PHR systems remain unclear. Based on physicians' therapeutic expertise, we implemented a web-based infertile PHR system and proposed an extended Technology Acceptance Model (TAM) that integrates the physician-patient relationship (PPR) construct into TAM's original perceived ease of use (PEOU) and perceived usefulness (PU) constructs to explore which factors will influence the behavioral intentions (BI) of infertile patients to use the PHR. From ninety participants from a medical center, 50 valid responses to a self-rating questionnaire were collected, yielding a response rate of 55.56%. The partial least squares (PLS) technique was used to assess the causal relationships that were hypothesized in the extended model. The results indicate that infertile patients expressed a moderately high intention to use the PHR system. The PPR and PU of patients had significant effects on their BI to use PHR, whereas the PEOU indirectly affected the patients' BI through the PU. This investigation confirms that PPR can have a critical role in shaping patients' perceptions of the use of healthcare information technologies. Hence, we suggest that hospitals should promote the potential usefulness of PHR and improve the quality of the physician-patient relationship to increase patients' intention of using PHR.

[CompuRecord--A perioperative information management-system for anesthesia].

PubMed

Martin, J; Ederle, D; Milewski, P

2002-08-01

Since 1977 procedures for automatic documentation of anesthesias have repeatedly been described. Because of a limited arrangement of the desk top and because of its focussing on intraoperative documentation only a widespread introduction could not be established so far. Todays systems are offered with graphically orientated desktops which can be operated by intuition. The CompuRecord(R)-System (Philips Healthcare) is a perioperative management system for anaesthesia. It is constructed with modular components, recording the complete anaesthesiological care of a patient from preanaesthesiological assessment to the recovery room. Additional modules allow an economical check, provide for quality management and exportation of a core data base. Except for the original software all other components of the system including the net work components are IT standard products allowing reduced costs for supplementation, expansion and support. The advantage of an automatical documentation system of anaesthesia is frequent and detailed recording of anaesthesiological data as well as the possibility of a meticulous calculation of cost for each patient. The anaesthesiologist's time used for documentation is reduced remarkably with a limited and reasonable amount of data to be recorded. This leaves more time of attention for the patient himself. Time necessary for training is kept low with the touch screens of the CompuRecord(R) - System, which can be operated intuitively. Primary to purchase an exact analysis of process and of subsequent costs should be done. Standardized documentation allows to establish Standard Operating Procedures in a department of Anaesthesia. Using the given systems an implementation is possible already today despite restricted resources of man power.

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.

Patients want granular privacy control over health information in electronic medical records.

PubMed

Caine, Kelly; Hanania, Rima

2013-01-01

To assess patients' desire for granular level privacy control over which personal health information should be shared, with whom, and for what purpose; and whether these preferences vary based on sensitivity of health information. A card task for matching health information with providers, questionnaire, and interview with 30 patients whose health information is stored in an electronic medical record system. Most patients' records contained sensitive health information. No patients reported that they would prefer to share all information stored in an electronic medical record (EMR) with all potential recipients. Sharing preferences varied by type of information (EMR data element) and recipient (eg, primary care provider), and overall sharing preferences varied by participant. Patients with and without sensitive records preferred less sharing of sensitive versus less-sensitive information. Patients expressed sharing preferences consistent with a desire for granular privacy control over which health information should be shared with whom and expressed differences in sharing preferences for sensitive versus less-sensitive EMR data. The pattern of results may be used by designers to generate privacy-preserving EMR systems including interfaces for patients to express privacy and sharing preferences. To maintain the level of privacy afforded by medical records and to achieve alignment with patients' preferences, patients should have granular privacy control over information contained in their EMR.

Patient data system for monitoring shunts.

PubMed

Frank, E; Su, E; Smith, K

1988-01-01

Rapidly locating accurate data on a patient's shunt system is often extremely difficult. We have developed a simple system to fill a perceived need for recording current data on a patients shunt. This system employs an easily updated record in the patient's hospital or clinic chart as well as a wallet-sized data card for the patient or his family to carry. The data in the chart include the configuration of the patient's current shunt system and a graphic record of previous shunt problems. The small patient data card describes the age of the shunt system and its current configuration. We have found that this system provides assistance in the routine follow-up of patients with shunts and plays an extremely necessary role in the emergency evaluation of these patients, particularly when an emergency evaluation is undertaken in facilities distant from the location of regular treatment.

[Problem list in computer-based patient records].

PubMed

Ludwig, C A

1997-01-14

Computer-based clinical information systems are capable of effectively processing even large amounts of patient-related data. However, physicians depend on rapid access to summarized, clearly laid out data on the computer screen to inform themselves about a patient's current clinical situation. In introducing a clinical workplace system, we therefore transformed the problem list-which for decades has been successfully used in clinical information management-into an electronic equivalent and integrated it into the medical record. The table contains a concise overview of diagnoses and problems as well as related findings. Graphical information can also be integrated into the table, and an additional space is provided for a summary of planned examinations or interventions. The digital form of the problem list makes it possible to use the entire list or selected text elements for generating medical documents. Diagnostic terms for medical reports are transferred automatically to corresponding documents. Computer technology has an immense potential for the further development of problem list concepts. With multimedia applications sound and images will be included in the problem list. For hyperlink purpose the problem list could become a central information board and table of contents of the medical record, thus serving as the starting point for database searches and supporting the user in navigating through the medical record.

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.

Semantic extraction and processing of medical records for patient-oriented visual index

NASA Astrophysics Data System (ADS)

Zheng, Weilin; Dong, Wenjie; Chen, Xiangjiao; Zhang, Jianguo

2012-02-01

To have comprehensive and completed understanding healthcare status of a patient, doctors need to search patient medical records from different healthcare information systems, such as PACS, RIS, HIS, USIS, as a reference of diagnosis and treatment decisions for the patient. However, it is time-consuming and tedious to do these procedures. In order to solve this kind of problems, we developed a patient-oriented visual index system (VIS) to use the visual technology to show health status and to retrieve the patients' examination information stored in each system with a 3D human model. In this presentation, we present a new approach about how to extract the semantic and characteristic information from the medical record systems such as RIS/USIS to create the 3D Visual Index. This approach includes following steps: (1) Building a medical characteristic semantic knowledge base; (2) Developing natural language processing (NLP) engine to perform semantic analysis and logical judgment on text-based medical records; (3) Applying the knowledge base and NLP engine on medical records to extract medical characteristics (e.g., the positive focus information), and then mapping extracted information to related organ/parts of 3D human model to create the visual index. We performed the testing procedures on 559 samples of radiological reports which include 853 focuses, and achieved 828 focuses' information. The successful rate of focus extraction is about 97.1%.

Patient-initiated electronic health record amendment requests

PubMed Central

Hanauer, David A; Preib, Rebecca; Zheng, Kai; Choi, Sung W

2014-01-01

Background and objective Providing patients access to their medical records offers many potential benefits including identification and correction of errors. The process by which patients ask for changes to be made to their records is called an ‘amendment request’. Little is known about the nature of such amendment requests and whether they result in modifications to the chart. Methods We conducted a qualitative content analysis of all patient-initiated amendment requests that our institution received over a 7-year period. Recurring themes were identified along three analytic dimensions: (1) clinical/documentation area, (2) patient motivation for making the request, and (3) outcome of the request. Results The dataset consisted of 818 distinct requests submitted by 181 patients. The majority of these requests (n=636, 77.8%) were made to rectify incorrect information and 49.7% of all requests were ultimately approved. In 6.6% of the requests, patients wanted valid information removed from their record, 27.8% of which were approved. Among all of the patients requesting a copy of their chart, only a very small percentage (approximately 0.2%) submitted an amendment request. Conclusions The low number of amendment requests may be due to inadequate awareness by patients about how to make changes to their records. To make this approach effective, it will be important to inform patients of their right to view and amend records and about the process for doing so. Increasing patient access to medical records could encourage patient participation in improving the accuracy of medical records; however, caution should be used. PMID:24863430

Context-based electronic health record: toward patient specific healthcare.

PubMed

Hsu, William; Taira, Ricky K; El-Saden, Suzie; Kangarloo, Hooshang; Bui, Alex A T

2012-03-01

Due to the increasingly data-intensive clinical environment, physicians now have unprecedented access to detailed clinical information from a multitude of sources. However, applying this information to guide medical decisions for a specific patient case remains challenging. One issue is related to presenting information to the practitioner: displaying a large (irrelevant) amount of information often leads to information overload. Next-generation interfaces for the electronic health record (EHR) should not only make patient data easily searchable and accessible, but also synthesize fragments of evidence documented in the entire record to understand the etiology of a disease and its clinical manifestation in individual patients. In this paper, we describe our efforts toward creating a context-based EHR, which employs biomedical ontologies and (graphical) disease models as sources of domain knowledge to identify relevant parts of the record to display. We hypothesize that knowledge (e.g., variables, relationships) from these sources can be used to standardize, annotate, and contextualize information from the patient record, improving access to relevant parts of the record and informing medical decision making. To achieve this goal, we describe a framework that aggregates and extracts findings and attributes from free-text clinical reports, maps findings to concepts in available knowledge sources, and generates a tailored presentation of the record based on the information needs of the user. We have implemented this framework in a system called Adaptive EHR, demonstrating its capabilities to present and synthesize information from neurooncology patients. This paper highlights the challenges and potential applications of leveraging disease models to improve the access, integration, and interpretation of clinical patient data. © 2012 IEEE

CLAIM (CLinical Accounting InforMation)--an XML-based data exchange standard for connecting electronic medical record systems to patient accounting systems.

PubMed

Guo, Jinqiu; Takada, Akira; Tanaka, Koji; Sato, Junzo; Suzuki, Muneou; Takahashi, Kiwamu; Daimon, Hiroyuki; Suzuki, Toshiaki; Nakashima, Yusei; Araki, Kenji; Yoshihara, Hiroyuki

2005-08-01

With the evolving and diverse electronic medical record (EMR) systems, there appears to be an ever greater need to link EMR systems and patient accounting systems with a standardized data exchange format. To this end, the CLinical Accounting InforMation (CLAIM) data exchange standard was developed. CLAIM is subordinate to the Medical Markup Language (MML) standard, which allows the exchange of medical data among different medical institutions. CLAIM uses eXtensible Markup Language (XML) as a meta-language. The current version, 2.1, inherited the basic structure of MML 2.x and contains two modules including information related to registration, appointment, procedure and charging. CLAIM 2.1 was implemented successfully in Japan in 2001. Consequently, it was confirmed that CLAIM could be used as an effective data exchange format between EMR systems and patient accounting systems.

75 FR 50983 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-18

... and delete two systems of records maintained by the Agricultural Research Service (ARS). DATES: Submit... [email protected]ars.usda.gov . SUPPLEMENTARY INFORMATION: Pursuant to the PA, 5 U.S.C. 552a, USDA hereby.../ARS-2, Research Medical Records System on Patients and Human Volunteers Participating in Research at...

Patient health record on a smart card.

PubMed

Naszlady, A; Naszlady, J

1998-02-01

A validated health questionnaire has been used for the documentation of a patient's history (826 items) and of the findings from physical examination (591 items) in our clinical ward for 25 years. This computerized patient record has been completed in EUCLIDES code (CEN TC/251) for laboratory tests and an ATC and EAN code listing for the names of the drugs permanently required by the patient. In addition, emergency data were also included on an EEPROM chipcard with a 24 kb capacity. The program is written in FOX-PRO language. A group of 5000 chronically ill in-patients received these cards which contain their health data. For security reasons the contents of the smart card is only accessible by a doctor's PIN coded key card. The personalization of each card was carried out in our health center and the depersonalized alphanumeric data were collected for further statistical evaluation. This information served as a basis for a real need assessment of health care and for the calculation of its cost. Code-combined with an optical card, a completely paperless electronic patient record system has been developed containing all three information carriers in medicine: Texts, Curves and Pictures.

Problem-oriented patient record model as a conceptual foundation for a multi-professional electronic patient record.

PubMed

De Clercq, Etienne

2008-09-01

It is widely accepted that the development of electronic patient records, or even of a common electronic patient record, is one possible way to improve cooperation and data communication between nurses and physicians. Yet, little has been done so far to develop a common conceptual model for both medical and nursing patient records, which is a first challenge that should be met to set up a common electronic patient record. In this paper, we describe a problem-oriented conceptual model and we show how it may suit both nursing and medical perspectives in a hospital setting. We started from existing nursing theory and from an initial model previously set up for primary care. In a hospital pilot site, a multi-disciplinary team refined this model using one large and complex clinical case (retrospective study) and nine ongoing cases (prospective study). An internal validation was performed through hospital-wide multi-professional interviews and through discussions around a graphical user interface prototype. To assess the consistency of the model, a computer engineer specified it. Finally, a Belgian expert working group performed an external assessment of the model. As a basis for a common patient record we propose a simple problem-oriented conceptual model with two levels of meta-information. The model is mapped with current nursing theories and it includes the following concepts: "health care element", "health approach", "health agent", "contact", "subcontact" and "service". These concepts, their interrelationships and some practical rules for using the model are illustrated in this paper. Our results are compatible with ongoing standardization work at the Belgian and European levels. Our conceptual model is potentially a foundation for a multi-professional electronic patient record that is problem-oriented and therefore patient-centred.

Beyond the computer-based patient record: re-engineering with a vision.

PubMed

Genn, B; Geukers, L

1995-01-01

In order to achieve real benefit from the potential offered by a Computer-Based Patient Record, the capabilities of the technology must be applied along with true re-engineering of healthcare delivery processes. University Hospital recognizes this and is using systems implementation projects, such as the catalyst, for transforming the way we care for our patients. Integration is fundamental to the success of these initiatives and this must be explicitly planned against an organized systems architecture whose standards are market-driven. University Hospital also recognizes that Community Health Information Networks will offer improved quality of patient care at a reduced overall cost to the system. All of these implementation factors are considered up front as the hospital makes its initial decisions on to how to computerize its patient records. This improves our chances for success and will provide a consistent vision to guide the hospital's development of new and better patient care.

The case against showing patients their records.

PubMed

Ross, A P

1986-03-01

The author, a British consultant surgeon, expresses his reservations about patients' having access to their medical records. The nature of communication between doctors may change if it is known that patients will see the material; potentially helpful yet tentative diagnoses may be excluded while other information is watered down. Physicians will have additional, perhaps burdensome, demands placed on them to explain the records--including parts written by deceased or otherwise unavailable doctors, medical students, or nonphysicians. Persons other than patients may see the records, further complicating the issue. Ross asserts that, while patients do have the right to see records, full access could be more harmful than beneficial to patients and could be fraught with problems for physicians.

The development and evaluation of a new coding system for medical records.

PubMed

Papazissis, Elias

2014-01-01

The present study aims to develop a simple, reliable and easy tool enabling clinicians to codify the major part of individualized medical details (patient history and findings of physical examination) quickly and easily in routine medical practice, by entering data to a purpose-built software application, using structure data elements and detailed medical illustrations. We studied medical records of 9,320 patients and we extracted individualized medical details. We recorded the majority of symptoms and the majority of findings of physical examination into the system, which was named IMPACT® (Intelligent Medical Patient Record and Coding Tool). Subsequently the system was evaluated by clinicians, based on the examination of 1206 patients. The evaluation results showed that IMPACT® is an efficient tool, easy to use even under time-pressing conditions. IMPACT® seems to be a promising tool for illustration-guided, structured data entry of medical narrative, in electronic patient records.

The VA Computerized Patient Record — A First Look

PubMed Central

Anderson, Curtis L.; Meldrum, Kevin C.

1994-01-01

In support of its in-house DHCP Physician Order Entry/Results Reporting application, the VA is developing the first edition of a Computerized Patient Record. The system will feature a physician-oriented interface with real time, expert system-based order checking, a controlled vocabulary, a longitudinal repository of patient data, HL7 messaging support, a clinical reminder and warning system, and full integration with existing VA applications including lab, pharmacy, A/D/T, radiology, dietetics, surgery, vitals, allergy tracking, discharge summary, problem list, progress notes, consults, and online physician order entry. PMID:7949886

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

PubMed

Choubey, Mona; Mishra, Hrishikesh; Soni, Khushboo; Patra, Pradeep Kumar

2016-02-01

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 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. '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. 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). 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.

A usability evaluation of four commercial dental computer-based patient record systems

PubMed Central

Thyvalikakath, Thankam P.; Monaco, Valerie; Thambuganipalle, Hima Bindu; Schleyer, Titus

2008-01-01

Background The usability of dental computer-based patient record (CPR) systems has not been studied, despite early evidence that poor usability is a problem for dental CPR system users at multiple levels. Methods The authors conducted formal usability tests of four dental CPR systems by using a purposive sample of four groups of five novice users. The authors measured task outcomes (correctly completed, incorrectly completed and incomplete) in each CPR system while the participants performed nine clinical documentation tasks, as well as the number of usability problems identified in each CPR system and their potential relationship to task outcomes. The authors reviewed the software application design aspects responsible for these usability problems. Results The range for correctly completed tasks was 16 to 64 percent, for incorrectly completed tasks 18 to 38 percent and for incomplete tasks 9 to 47 percent. The authors identified 286 usability problems. The main types were three unsuccessful attempts, negative affect and task incorrectly completed. They also identified six problematic interface and interaction designs that led to usability problems. Conclusion The four dental CPR systems studied have significant usability problems for novice users, resulting in a steep learning curve and potentially reduced system adoption. Clinical Implications The significant number of data entry errors raises concerns about the quality of documentation in clinical practice. PMID:19047669

Integrated Electronic Health Record Database Management System: A Proposal.

PubMed

Schiza, Eirini C; Panos, George; David, Christiana; Petkov, Nicolai; Schizas, Christos N

2015-01-01

eHealth has attained significant importance as a new mechanism for health management and medical practice. However, the technological growth of eHealth is still limited by technical expertise needed to develop appropriate products. Researchers are constantly in a process of developing and testing new software for building and handling Clinical Medical Records, being renamed to Electronic Health Record (EHR) systems; EHRs take full advantage of the technological developments and at the same time provide increased diagnostic and treatment capabilities to doctors. A step to be considered for facilitating this aim is to involve more actively the doctor in building the fundamental steps for creating the EHR system and database. A global clinical patient record database management system can be electronically created by simulating real life medical practice health record taking and utilizing, analyzing the recorded parameters. This proposed approach demonstrates the effective implementation of a universal classic medical record in electronic form, a procedure by which, clinicians are led to utilize algorithms and intelligent systems for their differential diagnosis, final diagnosis and treatment strategies.

WITHDRAWN: Nursing record systems: effects on nursing practice and healthcare outcomes.

PubMed

Urquhart, Christine; Currell, Rosemary; Grant, Maria J; Hardiker, Nicholas R

2018-05-15

A nursing record system is the record of care that was planned or given to individual patients and clients by qualified nurses or other caregivers under the direction of a qualified nurse. Nursing record systems may be an effective way of influencing nurse practice. To assess the effects of nursing record systems on nursing practice and patient outcomes. For the original version of this review in 2000, and updates in 2003 and 2008, we searched: the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register; MEDLINE, EMBASE, CINAHL, BNI, ISI Web of Knowledge, and ASLIB Index of Theses. We also handsearched: Computers, Informatics, Nursing (Computers in Nursing); Information Technology in Nursing; and the Journal of Nursing Administration. For this update, searches can be considered complete until the end of 2007. We checked reference lists of retrieved articles and other related reviews. Randomised controlled trials (RCTs), controlled before and after studies, and interrupted time series comparing one kind of nursing record system with another in hospital, community or primary care settings. The participants were qualified nurses, students or healthcare assistants working under the direction of a qualified nurse, and patients receiving care recorded or planned using nursing record systems. Two review authors (in two pairs) independently assessed trial quality and extracted data. We included nine trials (eight RCTs, one controlled before and after study) involving 1846 people. The studies that evaluated nursing record systems focusing on relatively discrete and focused problems, for example effective pain management in children, empowering pregnant women and parents, reducing loss of notes, reducing time spent on data entry of test results, reducing transcription errors, and reducing the number of pieces of paper in a record, all demonstrated some degree of success in achieving the desired results. Studies of nursing care planning

Digital imaging and electronic patient records in pathology using an integrated department information system with PACS.

PubMed

Kalinski, Thomas; Hofmann, Harald; Franke, Dagmar-Sybilla; Roessner, Albert

2002-01-01

Picture archiving and communication systems have been widely used in radiology thus far. Owing to the progress made in digital photo technology, their use in medicine opens up further opportunities. In the field of pathology, digital imaging offers new possiblities for the documentation of macroscopic and microscopic findings. Digital imaging has the advantage that the data is permanently and readily available, independent of conventional archives. In the past, PACS was a separate entity. Meanwhile, however, PACS has been integrated in DIS, the department information system, which was also run separately in former times. The combination of these two systems makes the administration of patient data, findings and images easier. Moreover, thanks to the introduction of special communication standards, a data exchange between different department information systems and hospital information systems (HIS) is possible. This provides the basis for a communication platform in medicine, constituting an electronic patient record (EPR) that permits an interdisciplinary treatment of patients by providing data of findings and images from clinics treating the same patient. As the pathologic diagnosis represents a central and often therapy-determining component, it is of utmost importance to add pathologic diagnoses to the EPR. Furthermore, the pathologist's work is considerably facilitated when he is able to retrieve additional data from the patient file. In this article, we describe our experience gained with the combined PACS and DIS systems recently installed at the Department of Pathology, University of Magdeburg. Moreover, we evaluate the current situation and future prospects for PACS in pathology.

Identification and Fibrosis Staging of Hepatitis C Patients Using the Electronic Medical Record System.

PubMed

Anand, Vijay; Hyun, Christian; Khan, Qasim M; Hall, Curtis; Hessefort, Norbert; Sonnenberg, Amnon; Fimmel, Claus J

2016-09-01

The aim of this study was to noninvasively assess the severity of chronic hepatitis C virus (HCV) in large patient populations. It would be helpful if fibrosis scores could be calculated solely on the basis of data contained in the patients' electronic medical records (EMR). We performed a pilot study to identify all HCV-infected patients in a large health care system, and predict their fibrosis stage on the basis of demographic and laboratory data using common data from their EMR. HCV-infected patients were identified using the EMR. The liver biopsies of 191 HCV patients were graded using the Ishak and Metavir scoring systems. Demographic and laboratory data were extracted from the EMR and used to calculate the aminotransferase to platelet ratio index, Fib-4, Fibrosis Index, Forns, Göteborg University Cirrhosis Index, Lok Index, and Vira-HepC. In total, 869 HCV-infected patients were identified from a population of over 1 million. In the subgroup of patients with liver biopsies, all 7 algorithms were significantly correlated with the fibrosis stage. The degree of correlation was moderate, with correlation coefficients ranging from 0.22 to 0.60. For the detection of advanced fibrosis (Metavir 3 or 4), the areas under the receiver operating characteristic curve ranged from 0.71 to 0.84, with no significant differences between the individual scores. Sensitivities, specificities, and positive and negative predictive values were within the previously reported range. All scores tended to perform better for higher fibrosis stages. Our study demonstrates that HCV-infected patients can be identified and their fibrosis staged using commonly available EMR-based algorithms.

Comparison of electronic health record system functionalities to support the patient recruitment process in clinical trials.

PubMed

Schreiweis, Björn; Trinczek, Benjamin; Köpcke, Felix; Leusch, Thomas; Majeed, Raphael W; Wenk, Joachim; Bergh, Björn; Ohmann, Christian; Röhrig, Rainer; Dugas, Martin; Prokosch, Hans-Ulrich

2014-11-01

Reusing data from electronic health records for clinical and translational research and especially for patient recruitment has been tackled in a broader manner since about a decade. Most projects found in the literature however focus on standalone systems and proprietary implementations at one particular institution often for only one singular trial and no generic evaluation of EHR systems for their applicability to support the patient recruitment process does yet exist. Thus we sought to assess whether the current generation of EHR systems in Germany provides modules/tools, which can readily be applied for IT-supported patient recruitment scenarios. We first analysed the EHR portfolio implemented at German University Hospitals and then selected 5 sites with five different EHR implementations covering all major commercial systems applied in German University Hospitals. Further, major functionalities required for patient recruitment support have been defined and the five sample EHRs and their standard tools have been compared to the major functionalities. In our analysis of the site's hospital information system environments (with four commercial EHR systems and one self-developed system) we found that - even though no dedicated module for patient recruitment has been provided - most EHR products comprise generic tools such as workflow engines, querying capabilities, report generators and direct SQL-based database access which can be applied as query modules, screening lists and notification components for patient recruitment support. A major limitation of all current EHR products however is that they provide no dedicated data structures and functionalities for implementing and maintaining a local trial registry. At the five sites with standard EHR tools the typical functionalities of the patient recruitment process could be mostly implemented. However, no EHR component is yet directly dedicated to support research requirements such as patient recruitment. We

Do GPs record the occupation of their patients?

PubMed

Richards-Taylor, A; Keay, J; Thorley, K

2013-03-01

General practitioners (GPs) have a central role in providing advice about fitness for work, yet there are concerns about their understanding of the relationship between work and health. To assess whether GPs in one Cornish practice record the occupation of patients of working age and to quantify how important GPs in Cornwall consider recording of occupation in working-age patients. An audit of the notes of 300 working-age patients in one practice, a search of the computer records at a different practice and a questionnaire survey of 202 GPs in practices in Cornwall. Occupation was recorded in 50 (17%) of the 300 patient notes audited. The questionnaire response rate was 31%. Few (8%) respondents reported training in occupational medicine. Most (65%) of GPs recorded their patients' occupation some of the time. A third (32%) of GPs did not consider it important to record patients' occupations. GPs in two Cornish practices recorded the occupation of working-age patients infrequently, but over two-thirds of GPs in Cornwall believe it is important to do so. If these results reflect the practice of UK GPs, the new 'e-fit note' may be of limited value in monitoring and analysing sickness absence.

Computerised patient record with distributed objects.

PubMed

Gornik, T; Orel, A; Roblek, D; Verhovsek, R

1999-01-01

The vast spectrum of information and functionality requirements imposed on a Computerised Patient Record (CPR), fueled by an ever changing and expanding business model demands information system interoperability. The management of information, created across the continuum of care, and associated information system functionality, can not be provided by data interchange to and from monolithic applications. WebDoctor is a Computerised Patient Record (CPR) which is fully used at the Institute of Oncology in Ljubljana, Slovenia--a hospital with 500 beds and more than 200 users, all of them medical professionals. The data are stored in an underlying Oracle hospital data base. For logging the username and password security is used. WebDoctor uses Internationalization APIs. Currently GUI is currently written in Slovenian language, but can be easily adapted to any other language. It is available in either Metal or Windows look. Search for patients is based on CPR No. or partial data from demographics. All the available patients data can be found on a single screen divided into several tab sections. The tab sections cover general and speciality data. The general data include demographics, admissions and diagnoses, meanwhile the speciality data are divided into Labs where data are represented numerically by date or by type and graphically with the ability of detailed view in separate window, Radiology where results are represented in textual form as well as pictures together with a special viewer to provide detailed analyses and Radioisotopes where results are also being represented in textual form together with a graphical representation. WebDoctor is running on virtually any platform. It achieved the 100% Java Certification which places the application among the firsts if not the first of this kind in the healthcare industry. It excels with a small and light client which doesn't exceed the 150K.

Engaging primary care patients to use a patient-centered personal health record.

PubMed

Krist, Alex H; Woolf, Steven H; Bello, Ghalib A; Sabo, Roy T; Longo, Daniel R; Kashiri, Paulette; Etz, Rebecca S; Loomis, John; Rothemich, Stephen F; Peele, J Eric; Cohn, Jeffrey

2014-01-01

Health care leaders encourage clinicians to offer portals that enable patients to access personal health records, but implementation has been a challenge. Although large integrated health systems have promoted use through costly advertising campaigns, other implementation methods are needed for small to medium-sized practices where most patients receive their care. We conducted a mixed methods assessment of a proactive implementation strategy for a patient portal (an interactive preventive health record [IPHR]) offered by 8 primary care practices. The practices implemented a series of learning collaboratives with practice champions and redesigned workflow to integrate portal use into care. Practice implementation strategies, portal use, and factors influencing use were assessed prospectively. A proactive and customized implementation strategy designed by practices resulted in 25.6% of patients using the IPHR, with the rate increasing 1.0% per month over 31 months. Fully 23.5% of IPHR users signed up within 1 day of their office visit. Older patients and patients with comorbidities were more likely to use the IPHR, but blacks and Hispanics were less likely. Older age diminished as a factor after adjusting for comorbidities. Implementation by practice varied considerably (from 22.1% to 27.9%, P <.001) based on clinician characteristics and workflow innovations adopted by practices to enhance uptake. By directly engaging patients to use a portal and supporting practices to integrate use into care, primary care practices can match or potentially surpass the usage rates achieved by large health systems. © 2014 Annals of Family Medicine, Inc.

Doctors' use of electronic medical records systems in hospitals: cross sectional survey

PubMed Central

Lærum, Hallvard; Ellingsen, Gunnar; Faxvaag, Arild

2001-01-01

Objectives To compare the use of three electronic medical records systems by doctors in Norwegian hospitals for general clinical tasks. Design Cross sectional questionnaire survey. Semistructured telephone interviews with key staff in information technology in each hospital for details of local implementation of the systems. Setting 32 hospital units in 19 Norwegian hospitals with electronic medical records systems. Participants 227 (72%) of 314 hospital doctors responded, equally distributed between the three electronic medical records systems. Main outcome measures Proportion of respondents who used the electronic system, calculated for each of 23 tasks; difference in proportions of users of different systems when functionality of systems was similar. Results Most tasks listed in the questionnaire (15/23) were generally covered with implemented functions in the electronic medical records systems. However, the systems were used for only 2-7 of the tasks, mainly associated with reading patient data. Respondents showed significant differences in frequency of use of the different systems for four tasks for which the systems offered equivalent functionality. The respondents scored highly in computer literacy (72.2/100), and computer use showed no correlation with respondents' age, sex, or work position. User satisfaction scores were generally positive (67.2/100), with some difference between the systems. Conclusions Doctors used electronic medical records systems for far fewer tasks than the systems supported. What is already known on this topicElectronic information systems in health care have not undergone systematic evaluation, and few comparisons between electronic medical records systems have been madeGiven the information intensive nature of clinical work, electronic medical records systems should be of help to doctors for most clinical tasksWhat this study addsDoctors in Norwegian hospitals reported a low level of use of all electronic medical records systems

42 CFR 137.178 - May Self-Governance Tribes store patient records at the Federal Records Centers?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false May Self-Governance Tribes store patient records at... SELF-GOVERNANCE Operational Provisions Records § 137.178 May Self-Governance Tribes store patient records at the Federal Records Centers? Yes, at the option of a Self-Governance Tribe, patient records may...

Nursing record systems: effects on nursing practice and health care outcomes.

PubMed

Currell, R; Wainwright, P; Urquhart, C

2000-01-01

A nursing record system is the record of care planned and/or given to individual patients/clients by qualified nurses or other caregivers under the direction of a qualified nurse. Nursing record systems may be an effective way of influencing nurse practice. To assess the effects of nursing record systems on nursing practice and patient outcomes. We searched The Cochrane Library, MEDLINE, Cinahl, Sigle, and databases of the Royal College of Nursing, King's Fund, the NHS Centre for Reviews and Dissemination, and the Institute of Electrical Engineers up to August 1999; and OCLC First Search, Department of Health database, NHS Register of Computer Applications and the Health Visitors' Association database up to the end of 1995. We hand searched the Journal of Nursing Administration (1971-1999), Computers in Nursing (1984-1999), Information Technology in Nursing (1989-1999) and reference lists of articles. We also hand searched the major health informatics conference proceedings. We contacted experts in the field of nursing informatics, suppliers of nursing computer systems, and relevant Internet groups. Randomised trials, controlled before and after studies and interrupted time series comparing one kind of nursing record system with another, in hospital, community or primary care settings. The participants were qualified nurses, students or health care assistants working under the direction of a qualified nurse and patients receiving care recorded and/or planned using nursing record systems. Two reviewers independently assessed trial quality and extracted data. Six trials involving 1407 people were included. In three studies of client held records, there were no overall positive or negative effects, although some administrative benefits through fewer missing notes were suggested. A paediatric pain management sheet study showed a positive effect on the children's pain intensity. A computerised nursing care planning study showed a negative effect on documented nursing

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

Image-based electronic patient records for secured collaborative medical applications.

PubMed

Zhang, Jianguo; Sun, Jianyong; Yang, Yuanyuan; Liang, Chenwen; Yao, Yihong; Cai, Weihua; Jin, Jin; Zhang, Guozhen; Sun, Kun

2005-01-01

We developed a Web-based system to interactively display image-based electronic patient records (EPR) for secured intranet and Internet collaborative medical applications. The system consists of four major components: EPR DICOM gateway (EPR-GW), Image-based EPR repository server (EPR-Server), Web Server and EPR DICOM viewer (EPR-Viewer). In the EPR-GW and EPR-Viewer, the security modules of Digital Signature and Authentication are integrated to perform the security processing on the EPR data with integrity and authenticity. The privacy of EPR in data communication and exchanging is provided by SSL/TLS-based secure communication. This presentation gave a new approach to create and manage image-based EPR from actual patient records, and also presented a way to use Web technology and DICOM standard to build an open architecture for collaborative medical applications.

Nursing record systems: effects on nursing practice and health care outcomes.

PubMed

Currell, R; Urquhart, C

2003-01-01

A nursing record system is the record of care planned and/or given to individual patients/clients by qualified nurses or other caregivers under the direction of a qualified nurse. Nursing record systems may be an effective way of influencing nurse practice. To assess the effects of nursing record systems on nursing practice and patient outcomes. We searched The Cochrane Library, the EPOC trial register (October 2002), MEDLINE, Cinahl, Sigle, and databases of the Royal College of Nursing, King's Fund, the NHS Centre for Reviews and Dissemination, and the Institute of Electrical Engineers up to August 1999; and OCLC First Search, Department of Health database, NHS Register of Computer Applications and the Health Visitors' Association database up to the end of 1995. We hand searched the Journal of Nursing Administration (1971-1999), Computers in Nursing (1984-1999), Information Technology in Nursing (1989-1999) and reference lists of articles. We also hand searched the major health informatics conference proceedings. We contacted experts in the field of nursing informatics, suppliers of nursing computer systems, and relevant Internet groups. To update the review the Medline, Cinahl, British Nursing Index, Aslib Index to Theses databases were all searched from 1998 to 2002. The Journal of Nursing Administration, Computers in Nursing, Information Technology in Nursing were all hand searched up to 2002. The searches of the other databases and grey literature included in the original review, were not updated (except for Health Care Computing Conference and Med Info) as the original searches produced little relevant material. Randomised trials, controlled before and after studies and interrupted time series comparing one kind of nursing record system with another, in hospital, community or primary care settings. The participants were qualified nurses, students or health care assistants working under the direction of a qualified nurse and patients receiving care recorded

Epidemiology of Patient Harms in New Zealand: Protocol of a General Practice Records Review Study

PubMed Central

Leitch, Sharon; Wallis, Katharine A; Eggleton, Kyle S; Cunningham, Wayne K; Williamson, Martyn I; Lillis, Steven; McMenamin, Andrew W; Tilyard, Murray W; Reith, David M; Samaranayaka, Ari; Hall, Jason E

2017-01-01

Background Knowing where and why harm occurs in general practice will assist patients, doctors, and others in making informed decisions about the risks and benefits of treatment options. Research to date has been unable to verify the safety of primary health care and epidemiological research about patient harms in general practice is now a top priority for advancing health systems safety. Objective We aim to study the incidence, distribution, severity, and preventability of the harms patients experience due to their health care, from the whole-of-health-system lens afforded by electronic general practice patient records. Methods “Harm” is defined as disease, injury, disability, suffering, and death, arising from the health system. The study design is a stratified, 2-level cluster, retrospective records review study. Both general practices and patients will be randomly selected so that the study’s results will apply nationally, after weighting. Stratification by practice size and rurality will allow comparisons between 6 study groups (large, medium-sized, small; urban and rural practices). Records of equal numbers of patients from each study group will be included in the study because there may be systematic differences in patient harms in different types of practices. Eight general practitioner investigators will review 3 years of electronic general practice health records (consultation notes, prescriptions, investigations, referrals, and summaries of hospital care) from 9000 patients registered in 60 general practices. Double-blinded reviews will check the concordance of reviewers’ assessments. Study data will comprise demographic data of all 9000 patients and reviewers’ assessments of whether patients experienced harm arising from health care. Where patient harm is identified, their types, preventability, severity, and outcomes will be coded using the Medical Dictionary for Regulatory Activities (MedDRA) 18.0. Results We have recruited practices and

Overcoming barriers to implementing patient-reported outcomes in an electronic health record: a case report.

PubMed

Harle, Christopher A; Listhaus, Alyson; Covarrubias, Constanza M; Schmidt, Siegfried Of; Mackey, Sean; Carek, Peter J; Fillingim, Roger B; Hurley, Robert W

2016-01-01

In this case report, the authors describe the implementation of a system for collecting patient-reported outcomes and integrating results in an electronic health record. The objective was to identify lessons learned in overcoming barriers to collecting and integrating patient-reported outcomes in an electronic health record. The authors analyzed qualitative data in 42 documents collected from system development meetings, written feedback from users, and clinical observations with practice staff, providers, and patients. Guided by the Unified Theory on the Adoption and Use of Information Technology, 5 emergent themes were identified. Two barriers emerged: (i) uncertain clinical benefit and (ii) time, work flow, and effort constraints. Three facilitators emerged: (iii) process automation, (iv) usable system interfaces, and (v) collecting patient-reported outcomes for the right patient at the right time. For electronic health record-integrated patient-reported outcomes to succeed as useful clinical tools, system designers must ensure the clinical relevance of the information being collected while minimizing provider, staff, and patient burden. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A student-centred electronic health record system for clinical education.

PubMed

Elliott, Kristine; Judd, Terry; McColl, Geoff

2011-01-01

Electronic Health Record (EHR) systems are an increasingly important feature of the national healthcare system [1]. However, little research has investigated the impact this will have on medical students' learning. As part of an innovative technology platform for a new masters level program in medicine, we are developing a student-centred EHR system for clinical education. A prototype was trialed with medical students over several weeks during 2010. This paper reports on the findings of the trial, which had the overall aim of assisting our understanding of how trainee doctors might use an EHR system for learning and communication in a clinical setting. In primary care and hospital settings, EHR systems offer potential benefits to medical students' learning: Longitudinal tracking of clinical progress towards established learning objectives [2]; Capacity to search across a substantial body of records [3]; Integration with online medical databases [3]; Development of expertise in creating, accessing and managing high quality EHRs [4]. While concerns have been raised that EHR systems may alter the interaction between teachers and students [3], and may negatively influence physician-patient communication [6], there is general consensus that the EHR is changing the current practice environment and teaching practice needs to respond. Final year medical students on clinical placement at a large university teaching hospital were recruited for the trial. Following a four-week period of use, semi-structured interviews were conducted with 10 participants. Audio-recorded interviews were transcribed and data analysed for emerging themes. Study participants were also surveyed about the importance of EHR systems in general, their familiarity with them, and general perceptions of sharing patient records. Medical students in this pilot study identified a number of educational, practical and administrative advantages that the student-centred EHR system offered over their existing ad

Barriers to Retrieving Patient Information from Electronic Health Record Data: Failure Analysis from the TREC Medical Records Track

PubMed Central

Edinger, Tracy; Cohen, Aaron M.; Bedrick, Steven; Ambert, Kyle; Hersh, William

2012-01-01

Objective: Secondary use of electronic health record (EHR) data relies on the ability to retrieve accurate and complete information about desired patient populations. The Text Retrieval Conference (TREC) 2011 Medical Records Track was a challenge evaluation allowing comparison of systems and algorithms to retrieve patients eligible for clinical studies from a corpus of de-identified medical records, grouped by patient visit. Participants retrieved cohorts of patients relevant to 35 different clinical topics, and visits were judged for relevance to each topic. This study identified the most common barriers to identifying specific clinic populations in the test collection. Methods: Using the runs from track participants and judged visits, we analyzed the five non-relevant visits most often retrieved and the five relevant visits most often overlooked. Categories were developed iteratively to group the reasons for incorrect retrieval for each of the 35 topics. Results: Reasons fell into nine categories for non-relevant visits and five categories for relevant visits. Non-relevant visits were most often retrieved because they contained a non-relevant reference to the topic terms. Relevant visits were most often infrequently retrieved because they used a synonym for a topic term. Conclusions: This failure analysis provides insight into areas for future improvement in EHR-based retrieval with techniques such as more widespread and complete use of standardized terminology in retrieval and data entry systems. PMID:23304287

Barriers to retrieving patient information from electronic health record data: failure analysis from the TREC Medical Records Track.

PubMed

Edinger, Tracy; Cohen, Aaron M; Bedrick, Steven; Ambert, Kyle; Hersh, William

2012-01-01

Secondary use of electronic health record (EHR) data relies on the ability to retrieve accurate and complete information about desired patient populations. The Text Retrieval Conference (TREC) 2011 Medical Records Track was a challenge evaluation allowing comparison of systems and algorithms to retrieve patients eligible for clinical studies from a corpus of de-identified medical records, grouped by patient visit. Participants retrieved cohorts of patients relevant to 35 different clinical topics, and visits were judged for relevance to each topic. This study identified the most common barriers to identifying specific clinic populations in the test collection. Using the runs from track participants and judged visits, we analyzed the five non-relevant visits most often retrieved and the five relevant visits most often overlooked. Categories were developed iteratively to group the reasons for incorrect retrieval for each of the 35 topics. Reasons fell into nine categories for non-relevant visits and five categories for relevant visits. Non-relevant visits were most often retrieved because they contained a non-relevant reference to the topic terms. Relevant visits were most often infrequently retrieved because they used a synonym for a topic term. This failure analysis provides insight into areas for future improvement in EHR-based retrieval with techniques such as more widespread and complete use of standardized terminology in retrieval and data entry systems.

Embedding online patient record access in UK primary care: a survey of stakeholder experiences.

PubMed

Pagliari, Claudia; Shand, Tim; Fisher, Brian

2012-05-01

To explore the integration of online patient Record Access within UK Primary Care, its perceived impacts on workload and service quality, and barriers to implementation. Mixed format survey of clinicians, administrators and patients. Telephone interviews with non-users. Primary care centres within NHS England that had offered online record access for the preceding year. Of the 57 practices initially agreeing to pilot the system, 32 had adopted it and 16 of these returned questionnaires. The 42 individual respondents included 14 practice managers, 15 clinicians and 13 patients. Follow-up interviews were conducted with one participant from 15 of the 25 non-adopter practices. Most professionals believed that the system is easy to integrate within primary care; while most patients found it easy to integrate within their daily lives. Professionals perceived no increase in the volume of patient queries or clinical consultations as a result of Record Access; indeed some believed that these had decreased. Most clinicians and patients believed that the service had improved mutual trust, communication, patients' health knowledge and health behaviour. Inhibiting factors included concerns about security, liability and resource requirements. Non-adoption was most frequently attributed to competing priorities, rather than negative beliefs about the service. Record access has an important role to play in supporting patient-focused healthcare policies in the UK and may be easily accommodated within existing services. Additional materials to facilitate patient recruitment, inform system set-up processes, and assure clinicians of their legal position are likely to encourage more widespread adoption.

Developing Electronic Health Record Algorithms That Accurately Identify Patients With Systemic Lupus Erythematosus.

PubMed

Barnado, April; Casey, Carolyn; Carroll, Robert J; Wheless, Lee; Denny, Joshua C; Crofford, Leslie J

2017-05-01

To study systemic lupus erythematosus (SLE) in the electronic health record (EHR), we must accurately identify patients with SLE. Our objective was to develop and validate novel EHR algorithms that use International Classification of Diseases, Ninth Revision (ICD-9), Clinical Modification codes, laboratory testing, and medications to identify SLE patients. We used Vanderbilt's Synthetic Derivative, a de-identified version of the EHR, with 2.5 million subjects. We selected all individuals with at least 1 SLE ICD-9 code (710.0), yielding 5,959 individuals. To create a training set, 200 subjects were randomly selected for chart review. A subject was defined as a case if diagnosed with SLE by a rheumatologist, nephrologist, or dermatologist. Positive predictive values (PPVs) and sensitivity were calculated for combinations of code counts of the SLE ICD-9 code, a positive antinuclear antibody (ANA), ever use of medications, and a keyword of "lupus" in the problem list. The algorithms with the highest PPV were each internally validated using a random set of 100 individuals from the remaining 5,759 subjects. The algorithm with the highest PPV at 95% in the training set and 91% in the validation set was 3 or more counts of the SLE ICD-9 code, ANA positive (≥1:40), and ever use of both disease-modifying antirheumatic drugs and steroids, while excluding individuals with systemic sclerosis and dermatomyositis ICD-9 codes. We developed and validated the first EHR algorithm that incorporates laboratory values and medications with the SLE ICD-9 code to identify patients with SLE accurately. © 2016, American College of Rheumatology.

Privacy Act System of Records: Federal Lead-Based Paint Program System of Records, EPA-54

EPA Pesticide Factsheets

Learn about the Federal Lead-Based Paint Program System of Records (FLPPSOR), including the security classification, individuals covered by the system, categories of records, routine uses of the records, and other security procedures.

Implementing Patient Access to Electronic Health Records Under HIPAA: Lessons Learned

PubMed Central

Wang, Tiffany; Pizziferri, Lisa; Volk, Lynn A; Mikels, Debra A; Grant, Karen G; Wald, Jonathan S; Bates, David W

2004-01-01

In 2001, the Institute of Medicine (IOM) and the Health Insurance Portability and Accountability Act (HIPAA) emphasized the need for patients to have greater control over their health information. We describe a Boston healthcare system's approach to providing patients access to their electronic health records (EHRs) via Patient Gateway, a secure, Web-based portal. Implemented in 19 clinic sites to date, Patient Gateway allows patients to access information from their medical charts via the Internet in a secure manner. Since 2002, over 19,000 patients have enrolled in Patient Gateway, more than 125,000 patients have logged into the system, and over 37,000 messages have been sent by patients to their practices. There have been no major security concerns. By providing access to EHR data, secure systems like Patient Gateway allow patients a greater role in their healthcare process, as envisioned by the IOM and HIPAA. PMID:18066391

Toward an integrated computerized patient record.

PubMed

Dole, T R; Luberti, A A

2000-04-01

Developing a comprehensive electronic medical record system to serve ambulatory care providers in a large health care enterprise requires significant time and resources. One approach to achieving this system is to devise a series of short-term, workable solutions until a complete system is designed and implemented. The initial solution introduced a basic (mini) medical record system that provided an automated problem/summary sheet and decentralization of ambulatory-based medical records. The next step was to partner with an information system vendor committed to continued development of the long-term system capable of supporting the health care organization well into the future.

Challenges and methodology for indexing the computerized patient record.

PubMed

Ehrler, Frédéric; Ruch, Patrick; Geissbuhler, Antoine; Lovis, Christian

2007-01-01

Patient records contain most crucial documents for managing the treatments and healthcare of patients in the hospital. Retrieving information from these records in an easy, quick and safe way helps care providers to save time and find important facts about their patient's health. This paper presents the scalability issues induced by the indexing and the retrieval of the information contained in the patient records. For this study, EasyIR, an information retrieval tool performing full text queries and retrieving the related documents has been used. An evaluation of the performance reveals that the indexing process suffers from overhead consequence of the particular structure of the patient records. Most IR tools are designed to manage very large numbers of documents in a single index whereas in our hypothesis, one index per record, which usually implies few documents, has been imposed. As the number of modifications and creations of patient records are significant in a day, using a specialized and efficient indexation tool is required.

Design and Development of Patient Monitoring System

NASA Astrophysics Data System (ADS)

Hazwanie Azizulkarim, Azra; Jamil, Muhammad Mahadi Abdul; Ambar, Radzi

2017-08-01

Patient monitoring system allows continuous monitoring of patient vital signs, support decision making among medical personnel and help enhance patient care. This system can consist of devices that measure, display and record human’s vital signs, including body temperature, heart rate, blood pressure and other health-related criteria. This paper proposes a system to monitor the patient’s conditions by monitoring the body temperature and pulse rate. The system consists of a pulse rate monitoring software and a wearable device that can measure a subject’s temperature and pulse rate only by using a fingertip. The device is able to record the measurement data and interface to PC via Arduino microcontroller. The recorded data can be viewed as a historical file or can be archived for further analysis. This work also describes the preliminary experimental results of the selected sensors to show the usefulness of the sensors for the proposed patient monitoring system.

Shared Electronic Health Record Systems: Key Legal and Security Challenges.

PubMed

Christiansen, Ellen K; Skipenes, Eva; Hausken, Marie F; Skeie, Svein; Østbye, Truls; Iversen, Marjolein M

2017-11-01

Use of shared electronic health records opens a whole range of new possibilities for flexible and fruitful cooperation among health personnel in different health institutions, to the benefit of the patients. There are, however, unsolved legal and security challenges. The overall aim of this article is to highlight legal and security challenges that should be considered before using shared electronic cooperation platforms and health record systems to avoid legal and security "surprises" subsequent to the implementation. Practical lessons learned from the use of a web-based ulcer record system involving patients, community nurses, GPs, and hospital nurses and doctors in specialist health care are used to illustrate challenges we faced. Discussion of possible legal and security challenges is critical for successful implementation of shared electronic collaboration systems. Key challenges include (1) allocation of responsibility, (2) documentation routines, (3) and integrated or federated access control. We discuss and suggest how challenges of legal and security aspects can be handled. This discussion may be useful for both current and future users, as well as policy makers.

Minimally disruptive medicine is needed for patients with multimorbidity: time to develop computerised medical record systems to meet this requirement.

PubMed

Schattner, Peter; Barker, Fiona; de Lusignan, Simon

2015-02-19

Minimally disruptive medicine (MDM) is proposed as a method for more appropriately managing people with multiple chronic disease. Much clinical management is currently single disease focussed, with people with multimorbidity being managed according to multiple single disease guidelines. Current initiatives to improve care include education about individual conditions and creating an environment where multiple guidelines might be simultaneously supported. The patient-centred medical home (PCMH) is an example of the latter. However, educational programmes and PCMH may increase the burden on patients. The cumulative workload for patients in managing the impact of multiple disease-specific guidelines is only relatively recently recognised. There is an intellectual vacuum as to how best to manage multimorbidity and how informatics might support implementing MDM. There is currently no alternative to multiple single-condition- specific guidelines and a lack of certainty, should the treatment burden need to be reduced, as to which guideline might be 'dropped'. The best information about multimorbidity is recorded in primary care computerised medical record (CMR) systems and in an increasing number of integrated care organisations. CMR systems have the potential to flag individuals who might be in greatest need. However, CMR systems may also provide insights into whether there are ameliorating factors that might make it easier for them to be resilient to the burden of care. Data from such CMR systems might be used to develop the evidence base about how to better manage multimorbidity. There is potential for these information systems to help reduce the management burden on patients and clinicians. However, substantial investment in research-driven CMR development is needed if we are to achieve this.

Overcoming Structural Constraints to Patient Utilization of Electronic Medical Records: A Critical Review and Proposal for an Evaluation Framework

PubMed Central

Winkelman, Warren J.; Leonard, Kevin J.

2004-01-01

There are constraints embedded in medical record structure that limit use by patients in self-directed disease management. Through systematic review of the literature from a critical perspective, four characteristics that either enhance or mitigate the influence of medical record structure on patient utilization of an electronic patient record (EPR) system have been identified: environmental pressures, physician centeredness, collaborative organizational culture, and patient centeredness. An evaluation framework is proposed for use when considering adaptation of existing EPR systems for online patient access. Exemplars of patient-accessible EPR systems from the literature are evaluated utilizing the framework. From this study, it appears that traditional information system research and development methods may not wholly capture many pertinent social issues that arise when expanding access of EPR systems to patients. Critically rooted methods such as action research can directly inform development strategies so that these systems may positively influence health outcomes. PMID:14633932

Overcoming structural constraints to patient utilization of electronic medical records: a critical review and proposal for an evaluation framework.

PubMed

Winkelman, Warren J; Leonard, Kevin J

2004-01-01

There are constraints embedded in medical record structure that limit use by patients in self-directed disease management. Through systematic review of the literature from a critical perspective, four characteristics that either enhance or mitigate the influence of medical record structure on patient utilization of an electronic patient record (EPR) system have been identified: environmental pressures, physician centeredness, collaborative organizational culture, and patient centeredness. An evaluation framework is proposed for use when considering adaptation of existing EPR systems for online patient access. Exemplars of patient-accessible EPR systems from the literature are evaluated utilizing the framework. From this study, it appears that traditional information system research and development methods may not wholly capture many pertinent social issues that arise when expanding access of EPR systems to patients. Critically rooted methods such as action research can directly inform development strategies so that these systems may positively influence health outcomes.

Lessons about So-Called "Difficult" Patients from the UK Controversy over Patient Access to Electronic Health Records.

PubMed

Lucivero, Federica

2017-04-01

Increasing numbers of patients have direct access to their electronic health records (EHRs). Proponents of direct access argue that it empowers patients by making them more informed and offering them more control over their health and care. According to some proponents of patients' access to EHRs, clinicians' concerns about potential negative implications are grounded in a form of paternalism that protects clinicians' authority. This paper draws upon narratives from patients in the United Kingdom (UK) who have access to their EHRs and suggests strategies for moving beyond these controversies between proponents and critics of the system. It additionally shows that the very organizational, procedural, and technological infrastructure that promises patients' increased access to records can also exacerbate some patients' "difficult" behaviors. © 2017 American Medical Association. All Rights Reserved.

The impact of a medication record sharing program among diabetes patients under a single-payer system: The role of inquiry rate.

PubMed

Lin, Jin-Hung; Cheng, Shou-Hsia

2018-08-01

Taiwan's single health insurer introduced a medication record exchange platform, the PharmaCloud program, in 2013. This study aimed to evaluate the effects of the medication record inquiry rate on medication duplication among patients with diabetes. A retrospective pre-post design with a comparison group was conducted using nationwide health insurance claim data of diabetic patients from 2013 to 2014. Patients whose medication record inquiry rate fell within the upper 25th percentile were classified as the high-inquiry group, and the others as the low-inquiry group. The dependent variables were the likelihood of receiving duplicated medication and the overlapped medication days of the study subjects. Generalized estimation equations with difference-in-difference analysis were calculated to examine the net effect of the PharmaCloud inquiry rate for a matched sub-sample. In total, 106,508 patients with diabetes were randomly selected. From 2013 to 2014, the medication duplication rate was reduced 7.76 percentile (54.12%-46.36%) for the high-inquiry group and 9.58 percentile (63.72%-54.14%) for the low-inquiry group; the average medication overlap periods were shortened 4.36 days (8.49-4.13) and 6.29 days (11.28-4.99), respectively. The regression models showed patients in the high-inquiry group were more likely to receive duplicated medication (OR = 1.11, 95% C.I. = 1.07-1.16) and with longer overlapped days (7.53%, P = 0.0081) after the program. The medication record sharing program has reduced medication duplication among diabetes patients. However, higher inquiry rate did not lead to greater reduction in medication duplication; the overall effect might be due to enhanced internal control via prescription alert system in hospitals rather physician's review of the records. Copyright © 2018 Elsevier B.V. All rights reserved.

“Nothing About Me Without Me”: An Interpretative Review of Patient Accessible Electronic Health Records

PubMed Central

Callahan, Ryan; Sevdalis, Nick; Mayer, Erik K; Darzi, Ara

2015-01-01

Background Patient accessible electronic health records (PAEHRs) enable patients to access and manage personal clinical information that is made available to them by their health care providers (HCPs). It is thought that the shared management nature of medical record access improves patient outcomes and improves patient satisfaction. However, recent reviews have found that this is not the case. Furthermore, little research has focused on PAEHRs from the HCP viewpoint. HCPs include physicians, nurses, and service providers. Objective We provide a systematic review of reviews of the impact of giving patients record access from both a patient and HCP point of view. The review covers a broad range of outcome measures, including patient safety, patient satisfaction, privacy and security, self-efficacy, and health outcome. Methods A systematic search was conducted using Web of Science to identify review articles on the impact of PAEHRs. Our search was limited to English-language reviews published between January 2002 and November 2014. A total of 73 citations were retrieved from a series of Boolean search terms including “review*” with “patient access to records”. These reviews went through a novel scoring system analysis whereby we calculated how many positive outcomes were reported per every outcome measure investigated. This provided a way to quantify the impact of PAEHRs. Results Ten reviews covering chronic patients (eg, diabetes and hypertension) and primary care patients, as well as HCPs were found but eight were included for the analysis of outcome measures. We found mixed outcomes across both patient and HCP groups, with approximately half of the reviews showing positive changes with record access. Patients believe that record access increases their perception of control; however, outcome measures thought to create psychological concerns (such as patient anxiety as a result of seeing their medical record) are still unanswered. Nurses are more likely than

Technical challenges, past and future, in implementing THERESA: a one million patient, one billion item computer-based patient record and decision support system

NASA Astrophysics Data System (ADS)

Camp, Henry N.

1996-02-01

Challenges in implementing a computer-based patient record (CPR)--such as absolute data integrity, high availability, permanent on-line storage of very large complex records, rapid search times, ease of use, commercial viability, and portability to other hospitals and doctor's offices--are given along with their significance, the solutions, and their successes. The THERESA CPR has been used sine 1983 in direct patient care by a public hospital that is the primary care provider to 350,000 people. It has 1000 beds with 45,000 admissions and 750,000 outpatient visits annually. The system supports direct provider entry, including by physicians, of complete medical `documents'. Its demonstration site currently contains 1.1 billion data items on 1 million patients. It is also a clinical decision-aiding tool used for quality assurance and cost containment, for teaching as faculty and students can easily find and `thumb through' all cases similar to a particular study, and for research with over a billion medical items that can be searched and analyzed on-line within context and with continuity. The same software can also run in a desktop microcomputer managing a private practice physician's office.

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…

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.

The impact of using electronic patient records on practices of reading and writing.

PubMed

Laitinen, Heleena; Kaunonen, Marja; Åstedt-Kurki, Paivi

2014-12-01

The aim of this study was to investigate the use of electronic patient records in daily practice. In four wards of a large hospital district in Finland, N = 43 patients' care and activities were observed and analysed in terms of the Grounded Theory method. The findings revealed that using electronic patient records created a particular process of writing and reading. Wireless technology enabled simultaneous patient involvement and point-of-care documentation, additionally supporting real-time reading. Remote and retrospective documentation was distant in terms of both space and time. The remoteness caused double documentation, reduced accuracy and less-efficient use of time. 'Non-reading' practices were witnessed in retrospective reading, causing delays in patient care and increase in workload. Similarly, if documentation was insufficient or non-existent, the consequences were found to be detrimental to the patients. The use of an electronic patient record system has a significant impact on patient care. Therefore, it is crucial to develop wireless technology and interdisciplinary collaboration in order to improve and support high-quality patient care. © The Author(s) 2013.

The design and implementation of a ubiquitous personal health record system for South Africa.

PubMed

Kyazze, Michael; Wesson, Janet; Naude, Kevin

2014-01-01

Doctors can experience difficulty in accessing medical information of new patients. One reason for this is that, the management of medical records is mostly institution-centred. The lack of access to medical information may affect patients in several ways, such as: new medical tests may be carried out at a cost to the patient, and doctors may prescribe drugs to which the patient is allergic. This paper presents the design and implementation of a ubiquitous Personal Health Record system for South Africa. The design was informed by a literature review of existing personal health record standards, applications and the need to ensure patient privacy. Three medical practices in Port Elizabeth were interviewed with the aim of contextualizing the personal health record standards from the literature study. The findings of this research provide an insight as to how patients can bridge the gap created by institution-centred management of medical records.

78 FR 43258 - Privacy Act; System of Records: Human Resources Records, State-31

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-19

... DEPARTMENT OF STATE [Public Notice 8384] Privacy Act; System of Records: Human Resources Records... system of records, Human Resources Records, State- 31, pursuant to the provisions of the Privacy Act of... State proposes that the current system will retain the name ``Human Resources Records'' (previously...

Electronic Health Records: An Enhanced Security Paradigm to Preserve Patient's Privacy

NASA Astrophysics Data System (ADS)

Slamanig, Daniel; Stingl, Christian

In recent years, demographic change and increasing treatment costs demand the adoption of more cost efficient, highly qualitative and integrated health care processes. The rapid growth and availability of the Internet facilitate the development of eHealth services and especially of electronic health records (EHRs) which are promising solutions to meet the aforementioned requirements. Considering actual web-based EHR systems, patient-centric and patient moderated approaches are widely deployed. Besides, there is an emerging market of so called personal health record platforms, e.g. Google Health. Both concepts provide a central and web-based access to highly sensitive medical data. Additionally, the fact that these systems may be hosted by not fully trustworthy providers necessitates to thoroughly consider privacy issues. In this paper we define security and privacy objectives that play an important role in context of web-based EHRs. Furthermore, we discuss deployed solutions as well as concepts proposed in the literature with respect to this objectives and point out several weaknesses. Finally, we introduce a system which overcomes the drawbacks of existing solutions by considering an holistic approach to preserve patient's privacy and discuss the applied methods.

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.

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

Privacy Act System of Records: EPA Telecommunications Detail Records, EPA-32

EPA Pesticide Factsheets

Learn more about the EPA Telecommunications Detail Records System, including who is covered in the system, the purpose of data collection, routine uses for the system's records, and other security procedures.

One positive impact of health care reform to physicians: the computer-based patient record.

PubMed

England, S P

1993-11-01

The health care industry is an information-dependent business that will require a new generation of health information systems if successful health care reform is to occur. We critically need integrated clinical management information systems to support the physician and related clinicians at the direct care level, which in turn will have linkages with secondary users of health information such as health payors, regulators, and researchers. The economic dependence of health care industry on the CPR cannot be underestimated, says Jeffrey Ritter. He sees the U.S. health industry as about to enter a bold new age where our records are electronic, our computers are interconnected, and our money is nothing but pulses running across the telephone lines. Hence the United States is now in an age of electronic commerce. Clinical systems reform must begin with the community-based patient chart, which is located in the physician's office, the hospital, and other related health care provider offices. A community-based CPR and CPR system that integrates all providers within a managed care network is the most logical step since all health information begins with the creation of a patient record. Once a community-based CPR system is in place, the physician and his or her clinical associates will have a common patient record upon which all direct providers have access to input and record patient information. Once a community-level CPR system is in place with a community provider network, each physician will have available health information and data processing capability that will finally provide real savings in professional time and effort. Lost patient charts will no longer be a problem. Data input and storage of health information would occur electronically via transcripted text, voice, and document imaging. All electronic clinical information, voice, and graphics could be recalled at any time and transmitted to any terminal location within the health provider network. Hence

20 CFR 345.208 - System records.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 1 2013-04-01 2012-04-01 true System records. 345.208 Section 345.208... EMPLOYERS' CONTRIBUTIONS AND CONTRIBUTION REPORTS Individual Employer Records § 345.208 System records... charges, pooled credits, and unallocated charges for the experience rating system and will publish a...

20 CFR 345.208 - System records.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 1 2012-04-01 2012-04-01 false System records. 345.208 Section 345.208... EMPLOYERS' CONTRIBUTIONS AND CONTRIBUTION REPORTS Individual Employer Records § 345.208 System records... charges, pooled credits, and unallocated charges for the experience rating system and will publish a...

20 CFR 345.208 - System records.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false System records. 345.208 Section 345.208... EMPLOYERS' CONTRIBUTIONS AND CONTRIBUTION REPORTS Individual Employer Records § 345.208 System records... charges, pooled credits, and unallocated charges for the experience rating system and will publish a...

20 CFR 345.208 - System records.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false System records. 345.208 Section 345.208... EMPLOYERS' CONTRIBUTIONS AND CONTRIBUTION REPORTS Individual Employer Records § 345.208 System records... charges, pooled credits, and unallocated charges for the experience rating system and will publish a...

A framework for the transition from nursing records to a nursing information system.

PubMed

Turley, J P

1992-01-01

The future of patient record keeping is being developed now. Critical aspects are in place with the development of computer communication standards for health care. The Institute of Medicine's report on the computerized patient record has galvanized many in the health care field to rethink their methods of record keeping. Nurses need to examine the history of the nursing record and look toward the development of a comprehensive nursing information system. Nurses, along with the other disciplines, must examine what they want the system of the future to encompass. A suggested framework for the information system has four major nursing components: (1) data storage component, (2) transaction log, (3) nursing decision support systems, and (4) an engine to link and combine the first three components and to present a consistent easy-to-use interface to the nurse. Done properly, this approach will reduce the amount of time nurses spend charting, add dimension to their notation, and increase the efficiency of data usage for clinical practice. The nursing information system must allow information availability in a manner that accentuates quality practice while releasing the nurse from time-consuming record keeping. These goals are possible to meet, but only if nurses plan for the design now, before it becomes a fait accompli.

Tolerability of central nervous system symptoms among HIV-1 infected efavirenz users: analysis of patient electronic medical record data.

PubMed

Rosenblatt, Lisa; Broder, Michael S; Bentley, Tanya G K; Chang, Eunice; Reddy, Sheila R; Papoyan, Elya; Myers, Joel

2017-08-01

Efavirenz (EFV) is a non-nucleoside reverse transcriptase inhibitor indicated for treatment of HIV-1 infection. Despite concern over EFV tolerability in clinical trials and practice, particularly related to central nervous system (CNS) adverse events, some observational studies have shown high rates of EFV continuation at one year and low rates of CNS-related EFV substitution. The objective of this study was to further examine the real-world rate of CNS-related EFV discontinuation in antiretroviral therapy naïve HIV-1 patients. This retrospective cohort study used a nationally representative electronic medical records database to identify HIV-1 patients ≥12 years old, treated with a 1st-line EFV-based regimen (single or combination antiretroviral tablet) from 1 January 2009 to 30 June 2013. Patients without prior record of EFV use during 6-month baseline (i.e., antiretroviral therapy naïve) were followed 12 months post-medication initiation. CNS-related EFV discontinuation was defined as evidence of a switch to a replacement antiretroviral coupled with record of a CNS symptom within 30 days prior, absent lab evidence of virologic failure. We identified 1742 1st-line EFV patients. Mean age was 48 years, 22.7% were female, and 8.1% had a prior report of CNS symptoms. The first year, overall discontinuation rate among new users of EFV was 16.2%. Ten percent of patients (n = 174) reported a CNS symptom and 1.1% (n = 19) discontinued EFV due to CNS symptoms: insomnia (n = 12), headache (n = 5), impaired concentration (n = 1), and somnolence (n = 1). The frequency of CNS symptoms was similar for patients who discontinued EFV compared to those who did not (10.3 vs. 9.9%; P = .86). Our study found that EFV discontinuation due to CNS symptoms was low, consistent with prior reports.

An ECG electrode-mounted heart rate, respiratory rhythm, posture and behavior recording system.

PubMed

Yoshimura, Takahiro; Yonezawa, Yoshiharu; Maki, Hiromichi; Ogawa, Hidekuni; Ninomiya, Ishio; Morton Caldwell, W

2004-01-01

R-R interval, respiration rhythm, posture and behavior recording system has been developed for monitoring a patient's cardiovascular regulatory system in daily life. The recording system consists of three ECG chest electrodes, a variable gain instrumentation amplifier, a dual axis accelerometer, a low power 8-bit single-chip microcomputer and a 1024 KB EEPROM. The complete system is mounted on the chest electrodes. R-R interval and respiration rhythm are calculated by the R waves detected from the ECG. Posture and behavior such as walking and running are detected from the body movements recorded by the accelerometer. The detected data are stored by the EEPROM and, after recording, are downloaded to a desktop computer for analysis.

Neonatal Nurses Experience Unintended Consequences and Risks to Patient Safety With Electronic Health Records.

PubMed

Dudding, Katherine M; Gephart, Sheila M; Carrington, Jane M

2018-04-01

In this article, we examine the unintended consequences of nurses' use of electronic health records. We define these as unforeseen events, change in workflow, or an unanticipated result of implementation and use of electronic health records. Unintended consequences experienced by nurses while using electronic health records have been well researched. However, few studies have focused on neonatal nurses, and it is unclear to what extent unintended consequences threaten patient safety. A new instrument called the Carrington-Gephart Unintended Consequences of Electronic Health Record Questionnaire has been validated, and secondary analysis using the tool explored the phenomena among neonatal nurses (N = 40). The purposes of this study were to describe unintended consequences of use of electronic health records for neonatal nurses and to explore relationships between the phenomena and characteristics of the nurse and the electronic health record. The most frequent unintended consequences of electronic health record use were due to interruptions, followed by a heavier workload due to the electronic health record, changes to the workflow, and altered communication patterns. Neonatal nurses used workarounds most often with motivation to better assist patients. Teamwork was moderately related to higher unintended consequences including patient safety risks (r = 0.427, P = .007), system design (r = 0.419, P = .009), and technology barriers (r = 0.431, P = .007). Communication about patients was reduced when patient safety risks were high (r = -0.437, P = .003). By determining the frequency with which neonatal nurses experience unintended consequences of electronic health record use, future research can be targeted to improve electronic health record design through customization, integration, and refinement to support patient safety and better outcomes.

Enabling Patient Control of Personal Electronic Health Records Through Distributed Ledger Technology.

PubMed

Cunningham, James; Ainsworth, John

2017-01-01

The rise of distributed ledger technology, initiated and exemplified by the Bitcoin blockchain, is having an increasing impact on information technology environments in which there is an emphasis on trust and security. Management of electronic health records, where both conformation to legislative regulations and maintenance of public trust are paramount, is an area where the impact of these new technologies may be particularly beneficial. We present a system that enables fine-grained personalized control of third-party access to patients' electronic health records, allowing individuals to specify when and how their records are accessed for research purposes. The use of the smart contract based Ethereum blockchain technology to implement this system allows it to operate in a verifiably secure, trustless, and openly auditable environment, features crucial to health information systems moving forward.

EMR management system for patient pulse data.

PubMed

Lee, Junyoung

2012-10-01

The purpose of this study is to build an integrated medical information system for effective database management of clinical information and to improve the existing Electronic Medical Record (EMR)-based system that is currently being used in hospitals. The integrated medical information system of hospitals consists of an Order Communication System (OCS), Picture Archiving Communication System (PACS), and Laboratory Information System (LIS), as well as Electronic Medical Record (EMR). It is designed so that remote health screening and patient data search can be accessed through a high speed network-even in remote areas-in order to effectively manage data on medical treatment that patients received at their respective hospitals. The existing oriental treatment system is one in which the doctor requires the patient to visit the hospital in person, so as to be able to check the patient's pulse and measure it with his hand for proper diagnosis and treatment. However, due to the recent development of digitalized medical measurement equipment, not only can doctors now check a patient's pulse without touching it directly, but the measured data are computerized and stored into the database as the electronic obligation record. Thus, even if a patient cannot visit the hospital, proper medical treatment is available by analyzing the patient's medical history and diagnosis process in the remote area. Furthermore, when a comprehensive medical testing center system including the people medical examination and diverse physical examination is established, the quality of medical service is expected to be improved than now.

Nap polygraphic recordings after partial sleep deprivation in patients with suspected epileptic seizures.

PubMed

Peraita-Adrados, R; Gutierrez-Solana, L; Ruiz-Falcó, M L; García-Peñas, J J

2001-02-01

A review of the literature shows that nap recordings make a significant contribution to epilepsy studies, providing evidence of specific EEG findings in patients suspected of having epilepsy. In addition, sleep deprivation can cause paroxysmal EEG activity and clinical seizures. We studied retrospectively 686 patients, 51.8% males and 48.2% females, who had experienced at least one episode classified from the clinical point of view as epileptic in origin. They were divided into six age groups. Patients underwent a two-hour (1 P.M.-3 P.M.) nap-video-polygraphic recording (EEG 13 channels using the standard 10-20 system, EOG, ECG, EMG and respiration), following a partial sleep deprivation (1 to 3 h) the night before. A second recording was made in 40 patients. In 35.3% of patients, a complete sleep cycle was obtained; in 64.6% sufficient light and deep NREM sleep was obtained, but not REM stage; in 9.3%, we only observed drowsiness and stage 1 of sleep, and this group was excluded from the analysis. Interictal and/or ictal epileptic discharges were observed during the first nap recording in 245 patients (40.4% of the sample). In addition, in 40 patients (11%) with normal or inconclusive first nap EEG, a second recording was able to demonstrate epileptic abnormalities in 35% of cases. Because of its good cost/benefit ratio and availability in most western laboratories, we consider the 'nap plus partial sleep deprivation' method as advantageous over other activation procedures.

Low-Power, 8-Channel EEG Recorder and Seizure Detector ASIC for a Subdermal Implantable System.

PubMed

Do Valle, Bruno G; Cash, Sydney S; Sodini, Charles G

2016-12-01

EEG remains the mainstay test for the diagnosis and treatment of patients with epilepsy. Unfortunately, ambulatory EEG systems are far from ideal for patients who have infrequent seizures. These systems only last up to 3 days and if a seizure is not captured during the recordings, a definite diagnosis of the patient's condition cannot be given. This work aims to address this need by proposing a subdermal implantable, eight-channel EEG recorder and seizure detector that has two modes of operation: diagnosis and seizure counting. In the diagnosis mode, EEG is continuously recorded until a number of seizures are recorded. In the seizure counting mode, the system uses a low-power algorithm to track the number of seizures a patient has, providing doctors with a reliable count to help determine medication efficacy or other clinical endpoint. An ASIC that implements the EEG recording and seizure detection algorithm was designed and fabricated in a 0.18 μm CMOS process. The ASIC includes eight EEG channels and is designed to minimize the system's power and size. The result is a power-efficient analog front end that requires 2.75 μW per channel in diagnosis mode and 0.84 μW per channel in seizure counting mode. Both modes have an input referred noise of approximately 1.1 μVrms.

Validation of a Novel Electronic Health Record Patient Portal Advance Care Planning Delivery System.

PubMed

Bose-Brill, Seuli; Feeney, Michelle; Prater, Laura; Miles, Laura; Corbett, Angela; Koesters, Stephen

2018-06-26

Advance care planning allows patients to articulate their future care preferences should they no longer be able to make decisions on their own. Early advance care planning in outpatient settings provides benefits such as less aggressive care and fewer hospitalizations, yet it is underutilized due to barriers such as provider time constraints and communication complexity. Novel methods, such as patient portals, provide a unique opportunity to conduct advance care planning previsit planning for outpatient care. This follow-up to our pilot study aimed to conduct pragmatic testing of a novel electronic health record-tethered framework and its effects on advance care planning delivery in a real-world primary care setting. Our intervention tested a previsit advance care planning workflow centered around a framework sent via secure electronic health record-linked patient portal in a real-world clinical setting. The primary objective of this study was to determine its impact on frequency and quality of advance care planning documentation. We conducted a pragmatic trial including 2 sister clinical sites, one site implementing the intervention and the other continuing standard care. A total of 419 patients aged between 50 and 93 years with active portal accounts received intervention (n=200) or standard care (n=219). Chart review analyzed the presence of advance care planning and its quality and was graded with previously established scoring criteria based on advance care planning best practice guidelines from multiple nations. A total of 19.5% (39/200) of patients who received previsit planning responded to the framework. We found that the intervention site had statistically significant improvement in new advance care planning documentation rates (P<.01) and quality (P<.01) among all eligible patients. Advance care planning documentation rates increased by 105% (19/39 to 39/39) and quality improved among all patients who engaged in the previsit planning framework (n=39

The Effects of Promoting Patient Access to Medical Records: A Review

PubMed Central

Ross, Stephen E.; Lin, Chen-Tan

2003-01-01

The Health Insurance Privacy and Portability Act (HIPPA) stipulates that patients must be permitted to review and amend their medical records. As information technology makes medical records more accessible to patients, it may become more commonplace for patients to review their records routinely. This article analyzes the potential benefits and drawbacks of facilitating patient access to the medical record by reviewing previously published research. Previous research includes analysis of clinical notes, surveys of patients and practitioners, and studies of patient-accessible medical records. Overall, studies suggest the potential for modest benefits (for instance, in enhancing doctor-patient communication). Risks (for instance, increasing patient worry or confusion) appear to be minimal in medical patients. The studies, however, were of limited quality and low statistical power to detect the variety of outcomes that may result from implementation of a patient-accessible medical record. The data from these studies lay the foundation for future research. PMID:12595402

[Disagreement between physicians' medication records and information given by patients].

PubMed

Rabøl, Rasmus; Arrøe, Gry Rosenkjaer; Folke, Fredrik; Madsen, Kristian Rørbaek; Langergaard, Michael Thøger; Larsen, Annette Højmann; Budek, Tommy; Andersen, Jens Rikardt

2006-03-27

A survey was conducted to evaluate the level of disagreement between the drug records of family doctors and information provided by patients at the time of hospitalisation. One hundred patients acutely admitted to a hospital department of medicine were consecutively included if the patient ingested more than two non-OTC drugs. A second drug interview was performed shortly after admission, and the patient's current medication was recorded. If no written medical record from the referring family doctor was available at the time of admission, the doctor was contacted by phone for supplementary information. Discrepancies between the information given by the patient and the medical records of family doctors were recorded. The results were analysed blindly by two of the authors (one senior and one junior doctor) to determine if the discrepancies were clinically relevant for the patient. We found at least one clinically relevant and potentially dangerous discrepancy in the medical records of 40% (95% CI 30%-50%) of the patients. In all, discrepancies were found in the drug lists of 63% of the patients. The patients with discrepancies were similar in age, sex, way of hospitalization and number of drugs ingested, compared to those without discrepancies. Afterwards the family doctors were invited to a meeting in which these problems were evaluated. We conclude that there is an urgent need for improvement in the communication between the primary and secondary health care sectors concerning medication being prescribed for patients with chronic diseases. The large number of discrepancies in the drug records of patients in this study is discouraging.

21 CFR 820.186 - Quality system record.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Quality system record. 820.186 Section 820.186...) MEDICAL DEVICES QUALITY SYSTEM REGULATION Records § 820.186 Quality system record. Each manufacturer shall maintain a quality system record (QSR). The QSR shall include, or refer to the location of, procedures and...

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

PubMed

Marceglia, S; Fontelo, P; Rossi, E; Ackerman, M J

2015-01-01

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". 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. 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. 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. 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 healthcare professionals, supporting the patient's engagement in self

Meeting the health information needs of prostate cancer patients using personal health records.

PubMed

Pai, H H; Lau, F; Barnett, J; Jones, S

2013-12-01

There is interest in the use of health information technology in the form of personal health record (phr) systems to support patient needs for health information, care, and decision-making, particularly for patients with distressing, chronic diseases such as prostate cancer (pca). We sought feedback from pca patients who used a phr. For 6 months, 22 pca patients in various phases of care at the BC Cancer Agency (bcca) were given access to a secure Web-based phr called provider, which they could use to view their medical records and use a set of support tools. Feedback was obtained using an end-of-study survey on usability, satisfaction, and concerns with provider. Site activity was recorded to assess usage patterns. Of the 17 patients who completed the study, 29% encountered some minor difficulties using provider. No security breaches were known to have occurred. The two most commonly accessed medical records were laboratory test results and transcribed doctor's notes. Of survey respondents, 94% were satisfied with the access to their medical records, 65% said that provider helped to answer their questions, 77% felt that their privacy and confidentiality were preserved, 65% felt that using provider helped them to communicate better with their physicians, 83% found new and useful information that they would not have received by talking to their health care providers, and 88% said that they would continue to use provider. Our results support the notion that phrs can provide cancer patients with timely access to their medical records and health information, and can assist in communication with health care providers, in knowledge generation, and in patient empowerment.

Five-day recorder seismic system

USGS Publications Warehouse

Criley, Ed; Eaton, Jerry P.; Ellis, Jim

1978-01-01

The 10-day recorder seismic system used by the USGS since 1965 has been modified substantially to improve its dynamic range and frequency response, to decrease its power consumption and physical complexity, and to make its recordings more compatible with other NCER systems to facilitate data processing. The principal changes include: 1. increasing tape speed from 15/160 ips to 15/80 ips (reducing running time from 10 days to 5 days with a 14' reel of 1 mil tape), 2. increasing the FM center frequency by a factor of 4, from 84.4 Hz to 337.6 Hz, 3. replacing the original amplifiers and FM modulators with new low-power units, 4. replacing the chronometer with a higher quality time code generator (with IRIG-C) to permit automation of data retrieval, 5. eliminating the amplifier/WWVB radio field case by incorporating these elements, along with the new TCG, in the weatherproof tape-recorder box, 6. reducing the power consumption of the motor-drive circuit by removal of a redundant component. In the new system, the tape-recorder case houses all components except the seismometers, the WWVB antenna, the 70-amp-hour 12-VDC battery (which powers the system for 5 days), and the cables to connect these external elements to the recorder box. The objectives of this report are: 1. to describe the new 5-day-recorder seismic system in terms of its constituent parts and their functions, 2. to describe modifications to parts of the original system that were retained and to document new or replacement components with appropriate circuit diagrams and constructional details, 3. to provide detailed instructions for the correct adjustment or alignment of the system in the laboratory, and 4. to provide detailed instructions for installing and operating the system in the field.

Low Adoption Rates of Electronic Medical Records Systems: A Qualitative Study

ERIC Educational Resources Information Center

Slaughter, Andre

2017-01-01

This qualitative phenomenological research study explored the challenges of physicians working with Electronic Medical Records (EMR) systems for medical documentation. Additionally, this study sought to understand why many providers sought alternate means of patient documentation. Previous research studies focused on the use of EMR systems from…

Patient access to complex chronic disease records on the Internet.

PubMed

Bartlett, Cherry; Simpson, Keith; Turner, A Neil

2012-08-06

Access to medical records on the Internet has been reported to be acceptable and popular with patients, although most published evaluations have been of primary care or office-based practice. We tested the feasibility and acceptability of making unscreened results and data from a complex chronic disease pathway (renal medicine) available to patients over the Internet in a project involving more than half of renal units in the UK. Content and presentation of the Renal PatientView (RPV) system was developed with patient groups. It was designed to receive information from multiple local information systems and to require minimal extra work in units. After piloting in 4 centres in 2005 it was made available more widely. Opinions were sought from both patients who enrolled and from those who did not in a paper survey, and from staff in an electronic survey. Anonymous data on enrollment and usage were extracted from the webserver. By mid 2011 over 17,000 patients from 47 of the 75 renal units in the UK had registered. Users had a wide age range (<10 to >90 yrs) but were younger and had more years of education than non-users. They were enthusiastic about the concept, found it easy to use, and 80% felt it gave them a better understanding of their disease. The most common reason for not enrolling was being unaware of the system. A minority of patients had security concerns, and these were reduced after enrolling. Staff responses were also strongly positive. They reported that it aided patient concordance and disease management, and increased the quality of consultations with a neutral effect on consultation length. Neither patient nor staff responses suggested that RPV led to an overall increase in patient anxiety or to an increased burden on renal units beyond the time required to enroll each patient. Patient Internet access to secondary care records concerning a complex chronic disease is feasible and popular, providing an increased sense of empowerment and understanding

Access control for electronic patient records.

PubMed

Glagola, M J

1998-01-01

The transition from hardcopy records to electronic records is in the forefront for healthcare today. For healthcare facilities, a major issue is determining who can access patients' medical information and how access to this information can be controlled. There are three components to access control: identification, authentication and authorization. Checking proof of identity is a means of authenticating someone--through a driver's license, passport or their fingerprints. Similar processes are needed in a computer environment, through the use of passwords, one-time passwords or smartcards, encryption and kerberos, and call-back procedures. New in the area of access control are biometric devices, which are hardware/software combinations that digitize a physical characteristic and compare the sample with previously stored samples. Fingerprints, voiceprints and facial features are examples. Their cost is currently prohibitive, but in time, they may become more common. Digital certificates and certification authorities are other means used to authenticate identify. When a system challenges a user's identity at log on, the user provides a certification that tells the system to go to the issuing certification authority and find proof the user's claim is valid. Low-level certifications offer little value for sensitive data, but high-level certification is now being introduced. It requires more specific, detailed information on the applicant. Authorization, the final component of access control, establishes what a specific user can and cannot access. To have effective access control, transaction logging and system monitoring are needed to ensure the various techniques are being used and performing properly.

[Electronic versus paper-based patient records: a cost-benefit analysis].

PubMed

Neubauer, A S; Priglinger, S; Ehrt, O

2001-11-01

The aim of this study is to compare the costs and benefits of electronic, paperless patient records with the conventional paper-based charts. Costs and benefits of planned electronic patient records are calculated for a University eye hospital with 140 beds. Benefit is determined by direct costs saved by electronic records. In the example shown, the additional benefits of electronic patient records, as far as they can be quantified total 192,000 DM per year. The costs of the necessary investments are 234,000 DM per year when using a linear depreciation over 4 years. In total, there are additional annual costs for electronic patient records of 42,000 DM. Different scenarios were analyzed. By increasing the time of depreciation to 6 years, the cost deficit reduces to only approximately 9,000 DM. Increased wages reduce the deficit further while the deficit increases with a loss of functions of the electronic patient record. However, several benefits of electronic records regarding research, teaching, quality control and better data access cannot be easily quantified and would greatly increase the benefit to cost ratio. Only part of the advantages of electronic patient records can easily be quantified in terms of directly saved costs. The small cost deficit calculated in this example is overcompensated by several benefits, which can only be enumerated qualitatively due to problems in quantification.

Monitoring Reasons for Encounter via an Electronic Patient Record System: the Case of a Rural Practice Initiative

PubMed Central

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

Clinical records anonymisation and text extraction (CRATE): an open-source software system.

PubMed

Cardinal, Rudolf N

2017-04-26

Electronic medical records contain information of value for research, but contain identifiable and often highly sensitive confidential information. Patient-identifiable information cannot in general be shared outside clinical care teams without explicit consent, but anonymisation/de-identification allows research uses of clinical data without explicit consent. This article presents CRATE (Clinical Records Anonymisation and Text Extraction), an open-source software system with separable functions: (1) it anonymises or de-identifies arbitrary relational databases, with sensitivity and precision similar to previous comparable systems; (2) it uses public secure cryptographic methods to map patient identifiers to research identifiers (pseudonyms); (3) it connects relational databases to external tools for natural language processing; (4) it provides a web front end for research and administrative functions; and (5) it supports a specific model through which patients may consent to be contacted about research. Creation and management of a research database from sensitive clinical records with secure pseudonym generation, full-text indexing, and a consent-to-contact process is possible and practical using entirely free and open-source software.

Redundancy-Aware Topic Modeling for Patient Record Notes

PubMed Central

Cohen, Raphael; Aviram, Iddo; Elhadad, Michael; Elhadad, Noémie

2014-01-01

The clinical notes in a given patient record contain much redundancy, in large part due to clinicians’ documentation habit of copying from previous notes in the record and pasting into a new note. Previous work has shown that this redundancy has a negative impact on the quality of text mining and topic modeling in particular. In this paper we describe a novel variant of Latent Dirichlet Allocation (LDA) topic modeling, Red-LDA, which takes into account the inherent redundancy of patient records when modeling content of clinical notes. To assess the value of Red-LDA, we experiment with three baselines and our novel redundancy-aware topic modeling method: given a large collection of patient records, (i) apply vanilla LDA to all documents in all input records; (ii) identify and remove all redundancy by chosing a single representative document for each record as input to LDA; (iii) identify and remove all redundant paragraphs in each record, leaving partial, non-redundant documents as input to LDA; and (iv) apply Red-LDA to all documents in all input records. Both quantitative evaluation carried out through log-likelihood on held-out data and topic coherence of produced topics and qualitative assessement of topics carried out by physicians show that Red-LDA produces superior models to all three baseline strategies. This research contributes to the emerging field of understanding the characteristics of the electronic health record and how to account for them in the framework of data mining. The code for the two redundancy-elimination baselines and Red-LDA is made publicly available to the community. PMID:24551060

Redundancy-aware topic modeling for patient record notes.

PubMed

Cohen, Raphael; Aviram, Iddo; Elhadad, Michael; Elhadad, Noémie

2014-01-01

The clinical notes in a given patient record contain much redundancy, in large part due to clinicians' documentation habit of copying from previous notes in the record and pasting into a new note. Previous work has shown that this redundancy has a negative impact on the quality of text mining and topic modeling in particular. In this paper we describe a novel variant of Latent Dirichlet Allocation (LDA) topic modeling, Red-LDA, which takes into account the inherent redundancy of patient records when modeling content of clinical notes. To assess the value of Red-LDA, we experiment with three baselines and our novel redundancy-aware topic modeling method: given a large collection of patient records, (i) apply vanilla LDA to all documents in all input records; (ii) identify and remove all redundancy by chosing a single representative document for each record as input to LDA; (iii) identify and remove all redundant paragraphs in each record, leaving partial, non-redundant documents as input to LDA; and (iv) apply Red-LDA to all documents in all input records. Both quantitative evaluation carried out through log-likelihood on held-out data and topic coherence of produced topics and qualitative assessment of topics carried out by physicians show that Red-LDA produces superior models to all three baseline strategies. This research contributes to the emerging field of understanding the characteristics of the electronic health record and how to account for them in the framework of data mining. The code for the two redundancy-elimination baselines and Red-LDA is made publicly available to the community.

Are low income patients receiving the benefits of electronic health records? A statewide survey.

PubMed

Butler, Matthew J; Harootunian, Gevork; Johnson, William G

2013-06-01

There are concerns that physicians serving low-income, Medicaid patients, in the United States are less likely to adopt electronic health records and, if so, that Medicaid patients will be denied the benefits from electronic health record use. This study seeks to determine whether physicians treating Medicaid patients were less likely to have adopted electronic health records. Physician surveys completed during physicians' license renewal process in Arizona were merged with the physician licensing data and Medicaid administrative claims data. Survey responses were received from 50.7 percent (6,780 out of 13,380) of all physicians practicing in Arizona. Physician survey responses were used to identify whether the physician used electronic health records and the degree to which the physician exchanged electronic health records with other health-care providers. Medicaid claims data were used to identify which physicians provided health care to Medicaid beneficiaries. The primary outcome of interest was whether Medicaid providers were more or less likely to have adopted electronic health records. Logistic regression analysis was used to estimate average marginal effects. In multivariate analysis, physicians with 20 or more Medicaid patients during the survey cycle were 4.1 percent more likely to use an electronic health record and 5.2 percent more likely to be able to transmit electronic health records to at least one health-care provider outside of their practice. These effects increase in magnitude when the analysis is restricted to solo practice physicians This is the first study to find a pro-Medicaid gap in electronic health record adoption suggesting that the low income patients served by Arizona's Health Care Cost Containment System are not at a disadvantage with regard to electronic health record access and that Arizona's model of promoting electronic health record adoption merits further study.

Privacy Act System of Records: Libby Asbestos Exposure Assessment Records, EPA-48

EPA Pesticide Factsheets

Learn about the Libby Asbestos Exposure Assessment Records System, including who is covered in the system, the purpose of data collection, routine uses for the system's records, and other security procedure.

Patients' use of digital audio recordings in four different outpatient clinics.

PubMed

Wolderslund, Maiken; Kofoed, Poul-Erik; Holst, René; Ammentorp, Jette

2015-12-01

To investigate a new technology of digital audio recording (DAR) of health consultations to provide knowledge about patients' use and evaluation of this recording method. A cross-sectional feasibility analysis of the intervention using log data from the recording platform and data from a patient-administered questionnaire. Four different outpatient clinics at a Danish hospital: Paediatrics, Orthopaedics, Internal Medicine and Urology. Two thousand seven hundred and eighty-four outpatients having their consultation audio recorded by one of 49 participating health professionals. DAR of outpatient consultations provided to patients permitting replay of their consultation either alone or together with their relatives. Replay of the consultation within 90 days from the consultation. In the adult outpatient clinics, one in every three consultations was replayed; however, the rates were significantly lower in the paediatric clinic where one in five consultations was replayed. The usage of the audio recordings was positively associated with increasing patient age and first time visits to the clinic. Patient gender influenced replays in different ways; for instance, relatives to male patients replayed recordings more often than relatives to female patients did. Approval of future recordings was high among the patients who replayed the consultation. Patients found that recording health consultations was an important information aid, and the digital recording technology was found to be feasible in routine practice. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

An information retrieval system for computerized patient records in the context of a daily hospital practice: the example of the Léon Bérard Cancer Center (France).

PubMed

Biron, P; Metzger, M H; Pezet, C; Sebban, C; Barthuet, E; Durand, T

2014-01-01

A full-text search tool was introduced into the daily practice of Léon Bérard Center (France), a health care facility devoted to treatment of cancer. This tool was integrated into the hospital information system by the IT department having been granted full autonomy to improve the system. To describe the development and various uses of a tool for full-text search of computerized patient records. The technology is based on Solr, an open-source search engine. It is a web-based application that processes HTTP requests and returns HTTP responses. A data processing pipeline that retrieves data from different repositories, normalizes, cleans and publishes it to Solr, was integrated in the information system of the Leon Bérard center. The IT department developed also user interfaces to allow users to access the search engine within the computerized medical record of the patient. From January to May 2013, 500 queries were launched per month by an average of 140 different users. Several usages of the tool were described, as follows: medical management of patients, medical research, and improving the traceability of medical care in medical records. The sensitivity of the tool for detecting the medical records of patients diagnosed with both breast cancer and diabetes was 83.0%, and its positive predictive value was 48.7% (gold standard: manual screening by a clinical research assistant). The project demonstrates that the introduction of full-text-search tools allowed practitioners to use unstructured medical information for various purposes.

The AMPATH Nutritional Information System: Designing a Food Distribution Electronic Record System in Rural Kenya

PubMed Central

Lim, Jason LitJeh; Yih, Yuehwern; Gichunge, Catherine; Tierney, William M.; Le, Tung H.; Zhang, Jun; Lawley, Mark A.; Petersen, Tomeka J.; Mamlin, Joseph J.

2009-01-01

Objective The AMPATH program is a leading initiative in rural Kenya providing healthcare services to combat HIV. Malnutrition and food insecurity are common among AMPATH patients and the Nutritional Information System (NIS) was designed, with cross-functional collaboration between engineering and medical communities, as a comprehensive electronic system to record and assist in effective food distribution in a region with poor infrastructure. Design The NIS was designed modularly to support the urgent need of a system for the growing food distribution program. The system manages the ordering, storage, packing, shipping, and distribution of fresh produce from AMPATH farms and dry food supplements from the World Food Programme (WFP) and U.S. Agency for International Development (USAID) based on nutritionists' prescriptions for food supplements. Additionally, the system also records details of food distributed to support future studies. Measurements Patients fed weekly, patient visits per month. Results With inception of the NIS, the AMPATH food distribution program was able to support 30,000 persons fed weekly, up from 2,000 persons. Patient visits per month also saw a marked increase. Conclusion The NIS' modular design and frequent, effective interactions between developers and users has positively affected the design, implementation, support, and modifications of the NIS. It demonstrates the success of collaboration between engineering and medical communities, and more importantly the feasibility for technology readily available in a modern country to contribute to healthcare delivery in developing countries like Kenya and other parts of sub-Saharan Africa. PMID:19717795

Exploring patients' perceptions of accessing electronic health records: Innovation in healthcare.

PubMed

Wass, Sofie; Vimarlund, Vivian; Ros, Axel

2017-04-01

The more widespread implementation of electronic health records has led to new ways of providing access to healthcare information, allowing patients to view their medical notes, test results, medicines and so on. In this article, we explore how patients perceive the possibility to access their electronic health record online and whether this influences patient involvement. The study includes interviews with nine patients and a survey answered by 56 patients. Our results show that patients perceive healthcare information to be more accessible and that electronic health record accessibility improves recall, understanding and patient involvement. However, to achieve the goal of involving patients as active decision-makers in their own treatment, electronic health records need to be fully available and test results, referrals and information on drug interactions need to be offered. As patient access to electronic health records spreads, it is important to gain a deeper understanding of how documentation practices can be changed to serve healthcare professionals and patients.

Nurses' perceptions of the impact of electronic health records on work and patient outcomes.

PubMed

Kossman, Susan P; Scheidenhelm, Sandra L

2008-01-01

This study addresses community hospital nurses' use of electronic health records and views of the impact of such records on job performance and patient outcomes. Questionnaire, interview, and observation data from 46 nurses in medical-surgical and intensive care units at two community hospitals were analyzed. Nurses preferred electronic health records to paper charts and were comfortable with technology. They reported use of electronic health records enhanced nursing work through increased information access, improved organization and efficiency, and helpful alert screens. They thought use of the records hindered nursing work through impaired critical thinking, decreased interdisciplinary communication, and a high demand on work time (73% reported spending at least half their shift using the records). They thought use of electronic health records enabled them to provide safer care but decreased the quality of care. Administrative implications include involving bedside nurses in system choice, streamlining processes, developing guidelines for consistent documentation quality and location, increasing system speed, choosing hardware that encourages bedside use, and improving system information technology support.

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.

Individualized music played for agitated patients with dementia: analysis of video-recorded sessions.

PubMed

Ragneskog, H; Asplund, K; Kihlgren, M; Norberg, A

2001-06-01

Many nursing home patients with dementia suffer from symptoms of agitation (e.g. anxiety, shouting, irritability). This study investigated whether individualized music could be used as a nursing intervention to reduce such symptoms in four patients with severe dementia. The patients were video-recorded during four sessions in four periods, including a control period without music, two periods where individualized music was played, and one period where classical music was played. The recordings were analysed by systematic observations and the Facial Action Coding System. Two patients became calmer during some of the individualized music sessions; one patient remained sitting in her armchair longer, and the other patient stopped shouting. For the two patients who were most affected by dementia, the noticeable effect of music was minimal. If the nursing staff succeed in discovering the music preferences of an individual, individualized music may be an effective nursing intervention to mitigate anxiety and agitation for some patients.

Realization of a universal patient identifier for electronic medical records through biometric technology.

PubMed

Leonard, D C; Pons, Alexander P; Asfour, Shihab S

2009-07-01

The technology exists for the migration of healthcare data from its archaic paper-based system to an electronic one, and, once in digital form, to be transported anywhere in the world in a matter of seconds. The advent of universally accessible healthcare data has benefited all participants, but one of the outstanding problems that must be addressed is how the creation of a standardized nationwide electronic healthcare record system in the United States would uniquely identify and match a composite of an individual's recorded healthcare information to an identified individual patients out of approximately 300 million people to a 1:1 match. To date, a few solutions to this problem have been proposed that are limited in their effectiveness. We propose the use of biometric technology within our fingerprint, iris, retina scan, and DNA (FIRD) framework, which is a multiphase system whose primary phase is a multilayer consisting of these four types of biometric identifiers: 1) fingerprint; 2) iris; 3) retina scan; and 4) DNA. In addition, it also consists of additional phases of integration, consolidation, and data discrepancy functions to solve the unique association of a patient to their medical data distinctively. This would allow a patient to have real-time access to all of their recorded healthcare information electronically whenever it is necessary, securely with minimal effort, greater effectiveness, and ease.

e-Patients Perceptions of Using Personal Health Records for Self-management Support of Chronic Illness.

PubMed

Gee, Perry M; Paterniti, Debora A; Ward, Deborah; Soederberg Miller, Lisa M

2015-06-01

Chronic illness self-management is largely moving from healthcare professionals and into the hands of the patient. One tool that has been promoted to facilitate self-management support of chronic illness by policymakers, health advocates, providers, and consumers is the personal health record. Little is known about how consumers effectively use personal health records for self-management support and for productive patient-provider interactions. The purpose of this study was to learn from chronically ill engaged, experienced, and educated (e-patient) adults how and why they use personal health records for self-management support and productive patient-provider interactions. Eighteen purposively selected consumers were interviewed in two communities. Qualitative description methods were used, and we used a grounded theory approach to analyzing interview data, which was digitally recorded and transcribed verbatim. We identified four major thematic categories that capture the perceptions of the chronically ill using personal health records: (1) patient engagement and health self-management, (2) access to and control over personal health data, (3) promotion of productive communication, and (4) opportunities for training and education. Knowledge gained from the e-patient personal health record users suggest that making improvements to the portal system and providing education to consumers and providers will increase the utility among the experienced users and encourage new users to embrace adoption and use.

Electronic health record interoperability as realized in the Turkish health information system.

PubMed

Dogac, A; Yuksel, M; Avci, A; Ceyhan, B; Hülür, U; Eryilmaz, Z; Mollahaliloglu, S; Atbakan, E; Akdag, R

2011-01-01

The objective of this paper is to describe the techniques used in developing the National Health Information System of Turkey (NHIS-T), a nation-wide infrastructure for sharing electronic health records (EHRs). The UN/CEFACT Core Components Technical Specification (CCTS) methodology was applied to design the logical EHR structure and to increase the reuse of common information blocks in EHRs. The NHIS-T became operational on January 15, 2009. By June 2010, 99% of the public hospitals and 71% of the private and university hospitals were connected to NHIS-T with daily feeds of their patients' EHRs. Out of the 72 million citizens of Turkey, electronic healthcare records of 43 million citizens have already been created in NHIS-T. Currently, only the general practitioners can access the EHRs of their patients. In the second phase of the implementation and once the legal framework is completed, the proper patient consent mechanisms will be available through the personal health record system that is under development. At this time authorized healthcare professionals in secondary and tertiary healthcare systems can access the patients' EHRs. A number of factors affected the successful implementation of NHIS-T. First, all stakeholders have to adopt the specified standards. Second, the UN/CEFACT CCTS approach was applied which facilitated the development and understanding of rather complex EHR schemas. Finally, the comprehensive testing of vendor-based hospital information systems for their conformance to and interoperability with NHIS-T through an automated testing platform enhanced substantially the fast integration of vendor-based solutions with the NHIS-T.

76 FR 39466 - Privacy Act; System of Records Notice: State-26, Passport Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-06

... DEPARTMENT OF STATE [Public Notice 7516] Privacy Act; System of Records Notice: State-26, Passport... of records, Passport Records, State-26, pursuant to the provisions of the Privacy Act of 1974, as... the current system will retain the name ``Passport Records.'' It is also proposed that the amended...

Medical narratives and patient analogs: the ethical implications of electronic patient records.

PubMed

Kluge, E H

1999-12-01

An electronic patient record consists of electronically stored data about a specific patient. It therefore constitutes a data-space. The data may be combined into a patient profile which is relative to a particular specialty as well as phenomenologically unique to the specific professional who constructs the profile. Further, a diagnosis may be interpreted as a path taken by a health care professional with a certain specialty through the data-space relative to the patient profile constructed by that professional. This way of looking at electronic patient records entails certain ethical implications about privacy and accessibility. However, it also permits the construction of artificial intelligence and competence algorithms for health care professionals relative to their specialties.

Evaluation of the medical records system in an upcoming teaching hospital-a project for improvisation.

PubMed

Kumar, B Deepak; Kumari, C M Vinaya; Sharada, M S; Mangala, M S

2012-08-01

The medical records system of an upcoming teaching hospital in a developing nation was evaluated for its accessibility, completeness, physician satisfaction, presence of any lacunae, suggestion of necessary steps for improvisation and to emphasize the importance of Medical records system in education and research work. The salient aspects of the medical records department were evaluated based on a questionnaire which was evaluated by a team of 40 participants-30 doctors, 5 personnel from Medical Records Department and 5 from staff of Hospital administration. Most of the physicians (65%) were partly satisfied with the existing medical record system. 92.5% were of the opinion that upgradation of the present system is necessary. The need of the hour in the present teaching hospital is the implementation of a hospital-wide patient registration and medical records re-engineering process in the form of electronic medical records system and regular review by the audit commission.

Pragmatic Randomized, Controlled Trial of Patient Navigators and Enhanced Personal Health Records in CKD.

PubMed

Navaneethan, Sankar D; Jolly, Stacey E; Schold, Jesse D; Arrigain, Susana; Nakhoul, Georges; Konig, Victoria; Hyland, Jennifer; Burrucker, Yvette K; Dann, Priscilla Davis; Tucky, Barbara H; Sharp, John; Nally, Joseph V

2017-09-07

Patient navigators and enhanced personal health records improve the quality of health care delivered in other disease states. We aimed to develop a navigator program for patients with CKD and an electronic health record-based enhanced personal health record to disseminate CKD stage-specific goals of care and education. We also conducted a pragmatic randomized clinical trial to compare the effect of a navigator program for patients with CKD with enhanced personal health record and compare their combination compared with usual care among patients with CKD stage 3b/4. Two hundred and nine patients from six outpatient clinics (in both primary care and nephrology settings) were randomized in a 2×2 factorial design into four-study groups: ( 1 ) enhanced personal health record only, ( 2 ) patient navigator only, ( 3 ) both, and ( 4 ) usual care (control) group. Primary outcome measure was the change in eGFR over a 2-year follow-up period. Secondary outcome measures included acquisition of appropriate CKD-related laboratory measures, specialty referrals, and hospitalization rates. Median age of the study population was 68 years old, and 75% were white. At study entry, 54% of patients were followed by nephrologists, and 88% were on renin-angiotensin system blockers. After a 2-year follow-up, rate of decline in eGFR was similar across the four groups ( P =0.19). Measurements of CKD-related laboratory parameters were not significantly different among the groups. Furthermore, referral for dialysis education and vascular access placement, emergency room visits, and hospitalization rates were not statistically significant different between the groups. We successfully developed a patient navigator program and an enhanced personal health record for the CKD population. However, there were no differences in eGFR decline and other outcomes among the study groups. Larger and long-term studies along with cost-effectiveness analyses are needed to evaluate the role of patient navigators

A review of approaches to identifying patient phenotype cohorts using electronic health records

PubMed Central

Shivade, Chaitanya; Raghavan, Preethi; Fosler-Lussier, Eric; Embi, Peter J; Elhadad, Noemie; Johnson, Stephen B; Lai, Albert M

2014-01-01

Objective To summarize literature describing approaches aimed at automatically identifying patients with a common phenotype. Materials and methods We performed a review of studies describing systems or reporting techniques developed for identifying cohorts of patients with specific phenotypes. Every full text article published in (1) Journal of American Medical Informatics Association, (2) Journal of Biomedical Informatics, (3) Proceedings of the Annual American Medical Informatics Association Symposium, and (4) Proceedings of Clinical Research Informatics Conference within the past 3 years was assessed for inclusion in the review. Only articles using automated techniques were included. Results Ninety-seven articles met our inclusion criteria. Forty-six used natural language processing (NLP)-based techniques, 24 described rule-based systems, 41 used statistical analyses, data mining, or machine learning techniques, while 22 described hybrid systems. Nine articles described the architecture of large-scale systems developed for determining cohort eligibility of patients. Discussion We observe that there is a rise in the number of studies associated with cohort identification using electronic medical records. Statistical analyses or machine learning, followed by NLP techniques, are gaining popularity over the years in comparison with rule-based systems. Conclusions There are a variety of approaches for classifying patients into a particular phenotype. Different techniques and data sources are used, and good performance is reported on datasets at respective institutions. However, no system makes comprehensive use of electronic medical records addressing all of their known weaknesses. PMID:24201027

DSN telemetry system data records

NASA Technical Reports Server (NTRS)

Gatz, E. C.

1976-01-01

The DSN telemetry system now includes the capability to provide a complete magnetic tape record, within 24 hours of reception, of all telemetry data received from a spacecraft. This record, the intermediate data record, is processed and generated almost entirely automatically, and provides a detailed accounting of any missing data.

76 FR 77498 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-13

... Force's notices for systems of records subject to the Privacy Act of 1974 (5 U.S.C. 552a), as amended... (HQ USAF/SG), Air Force Medical Service Chief Information Officer's Office (AFMS CIO's office), 5201... Air Force medical facilities. Documentation includes: Patient's medical history, physical examination...

Patient ECG recording control for an automatic implantable defibrillator

NASA Technical Reports Server (NTRS)

Fountain, Glen H. (Inventor); Lee, Jr., David G. (Inventor); Kitchin, David A. (Inventor)

1986-01-01

An implantable automatic defibrillator includes sensors which are placed on or near the patient's heart to detect electrical signals indicative of the physiology of the heart. The signals are digitally converted and stored into a FIFO region of a RAM by operation of a direct memory access (DMA) controller. The DMA controller operates transparently with respect to the microprocessor which is part of the defibrillator. The implantable defibrillator includes a telemetry communications circuit for sending data outbound from the defibrillator to an external device (either a patient controller or a physician's console or other) and a receiver for sensing at least an externally generated patient ECG recording command signal. The patient recording command signal is generated by the hand held patient controller. Upon detection of the patient ECG recording command, DMA copies the contents of the FIFO into a specific region of the RAM.

Recording signs of deterioration in acute patients: The documentation of vital signs within electronic health records in patients who suffered in-hospital cardiac arrest.

PubMed

Stevenson, Jean E; Israelsson, Johan; Nilsson, Gunilla C; Petersson, Göran I; Bath, Peter A

2016-03-01

Vital sign documentation is crucial to detecting patient deterioration. Little is known about the documentation of vital signs in electronic health records. This study aimed to examine documentation of vital signs in electronic health records. We examined the vital signs documented in the electronic health records of patients who had suffered an in-hospital cardiac arrest and on whom cardiopulmonary resuscitation was attempted between 2007 and 2011 (n = 228), in a 372-bed district general hospital. We assessed the completeness of vital sign data compared to VitalPAC™ Early Warning Score and the location of vital signs within the electronic health records. There was a noticeable lack of completeness of vital signs. Vital signs were fragmented through various sections of the electronic health records. The study identified serious shortfalls in the representation of vital signs in the electronic health records, with consequential threats to patient safety. © The Author(s) 2014.

Identifying patients with hypertension: a case for auditing electronic health record data.

PubMed

Baus, Adam; Hendryx, Michael; Pollard, Cecil

2012-01-01

Problems in the structure, consistency, and completeness of electronic health record data are barriers to outcomes research, quality improvement, and practice redesign. This nonexperimental retrospective study examines the utility of importing de-identified electronic health record data into an external system to identify patients with and at risk for essential hypertension. We find a statistically significant increase in cases based on combined use of diagnostic and free-text coding (mean = 1,256.1, 95% CI 1,232.3-1,279.7) compared to diagnostic coding alone (mean = 1,174.5, 95% CI 1,150.5-1,198.3). While it is not surprising that significantly more patients are identified when broadening search criteria, the implications are critical for quality of care, the movement toward the National Committee for Quality Assurance's Patient-Centered Medical Home program, and meaningful use of electronic health records. Further, we find a statistically significant increase in potential cases based on the last two or more blood pressure readings greater than or equal to 140/90 mm Hg (mean = 1,353.9, 95% CI 1,329.9-1,377.9).

A microcomputer-based daily living activity recording system.

PubMed

Matsuoka, Shingo; Yonezawa, Yoshiharu; Maki, Hiromichi; Ogawa, Hidekuni; Hahn, Allen W; Thayer, Julian F; Caldwell, W Morton

2003-01-01

A new daily living activity recording system has been developed for monitoring health conditions and living patterns, such as respiration, posture, activity/rest ratios and general activity level. The system employs a piezoelectric sensor, a dual axis accelerometer, two low-power active filters, a low-power 8-bit single chip microcomputer and a 128 MB compact flash memory. The piezoelectric sensor, whose electrical polarization voltage is produced by mechanical strain, detects body movements. Its high-frequency output components reflect body movements produced by walking and running activities, while the low frequency components are mainly respiratory. The dual axis accelerometer detects, from body X and Y tilt angles, whether the patient is standing, sitting or lying down (prone, supine, left side or right side). The detected respiratory, behavior and posture signals are stored by the compact flash memory. After recording, these data are downloaded to a desktop computer and analyzed.

[Web-based electronic patient record as an instrument for quality assurance within an integrated care concept].

PubMed

Händel, A; Jünemann, A G M; Prokosch, H-U; Beyer, A; Ganslandt, T; Grolik, R; Klein, A; Mrosek, A; Michelson, G; Kruse, F E

2009-03-01

A prerequisite for integrated care programmes is the implementation of a communication network meeting quality assurance standards. Against this background the main objective of the integrated care project between the University Eye Hospital Erlangen and the health insurance company AOK Bayern was to evaluate the potential and the acceptance of a web-based electronic patient record in the context of cataract and retinal surgery. Standardised modules for capturing pre-, intra- and post-operative data on the basis of clinical pathway guidelines for cataract- and retinal surgery have been developed. There are 6 data sets recorded per patient (1 pre-operative, 1 operative, 4-6 post-operative). For data collection, a web-based communication system (Soarian Integrated Care) has been chosen which meets the high requirements in data security, as well as being easy to handle. This teleconsultation system and the embedded electronic patient record are independent of the software used by respective offices and hospitals. Data transmission and storage were carried out in real-time. At present, 101 private ophthalmologists are taking part in the IGV contract with the University Eye Hospital Erlangen. This corresponds to 52% of all private ophthalmologists in the region. During the period from January 1st 2006 to December 31st 2006, 1844 patients were entered. Complete documentation was achieved in 1390 (75%) of all surgical procedures. For evaluation of this data, a multidimensional report and analysis tool (Cognos) was used. The deviation from target refraction as one quality indicator was in the mean 0.09 diopter. The web-based patient record used in this project was highly accepted by the private ophthalmologists. However there are still general concerns against the exchange of medical data via the internet. Nevertheless, the web-based patient record is an essential tool for a functional integration between the ambulatory and stationary health-care units. In addition to the

Wireless recording systems: from noninvasive EEG-NIRS to invasive EEG devices.

PubMed

Sawan, Mohamad; Salam, Muhammad T; Le Lan, Jérôme; Kassab, Amal; Gelinas, Sébastien; Vannasing, Phetsamone; Lesage, Frédéric; Lassonde, Maryse; Nguyen, Dang K

2013-04-01

In this paper, we present the design and implementation of a wireless wearable electronic system dedicated to remote data recording for brain monitoring. The reported wireless recording system is used for a) simultaneous near-infrared spectrometry (NIRS) and scalp electro-encephalography (EEG) for noninvasive monitoring and b) intracerebral EEG (icEEG) for invasive monitoring. Bluetooth and dual radio links were introduced for these recordings. The Bluetooth-based device was embedded in a noninvasive multichannel EEG-NIRS system for easy portability and long-term monitoring. On the other hand, the 32-channel implantable recording device offers 24-bit resolution, tunable features, and a sampling frequency up to 2 kHz per channel. The analog front-end preamplifier presents low input-referred noise of 5 μ VRMS and a signal-to-noise ratio of 112 dB. The communication link is implemented using a dual-band radio frequency transceiver offering a half-duplex 800 kb/s data rate, 16.5 mW power consumption and less than 10(-10) post-correction Bit-Error Rate (BER). The designed system can be accessed and controlled by a computer with a user-friendly graphical interface. The proposed wireless implantable recording device was tested in vitro using real icEEG signals from two patients with refractory epilepsy. The wirelessly recorded signals were compared to the original signals recorded using wired-connection, and measured normalized root-mean square deviation was under 2%.

A new vestibulo-ocular reflex recording system designed for routine vestibular clinical use.

PubMed

Funabiki, K; Naito, Y; Matsuda, K; Honjo, I

1999-01-01

A new vestibulo-ocular reflex (VOR) recording system was developed, which consists of an infrared eye camera, a small velocity sensor and a frequency modulator. Using this system, the head velocity signal was frequency modulated and simultaneously recorded as a sound signal on the audio track of a Hi8 video recorder with eye images. This device enabled recording of the VOR response in routine vestibular clinical practice. The reliability and effectiveness of this system were estimated by recording and analysing the VOR response against manually controlled rotation in normal subjects (n = 22) and in patients with unilateral severe vestibular hypofunction (n = 11). VOR gain on clockwise rotation viewed from the top was defined as R gain, and counterclockwise rotation as L gain. Directional preponderance (DP%) was also calculated. VOR gain towards the diseased side was significantly lower than that towards the intact side, and also significantly lower than that of normal subjects. DP% of unilateral vestibular hypofunction cases was significantly larger than that of normal subjects. These findings indicate that this VOR recording system reliably detects severe unilateral vestibular hypofunction.

A Cloud Computing Based Patient Centric Medical Information System

NASA Astrophysics Data System (ADS)

Agarwal, Ankur; Henehan, Nathan; Somashekarappa, Vivek; Pandya, A. S.; Kalva, Hari; Furht, Borko

This chapter discusses an emerging concept of a cloud computing based Patient Centric Medical Information System framework that will allow various authorized users to securely access patient records from various Care Delivery Organizations (CDOs) such as hospitals, urgent care centers, doctors, laboratories, imaging centers among others, from any location. Such a system must seamlessly integrate all patient records including images such as CT-SCANS and MRI'S which can easily be accessed from any location and reviewed by any authorized user. In such a scenario the storage and transmission of medical records will have be conducted in a totally secure and safe environment with a very high standard of data integrity, protecting patient privacy and complying with all Health Insurance Portability and Accountability Act (HIPAA) regulations.

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

PubMed

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

2016-04-01

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. to determine the minimum data set of echocardiography reporting system to exchange with Iran's electronic health record (EHR) system. 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. 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. 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.

Dynamic modeling of patient and physician eye gaze to understand the effects of electronic health records on doctor-patient communication and attention.

PubMed

Montague, Enid; Asan, Onur

2014-03-01

The aim of this study was to examine eye gaze patterns between patients and physicians while electronic health records were used to support patient care. Eye gaze provides an indication of physician attention to patient, patient/physician interaction, and physician behaviors such as searching for information and documenting information. A field study was conducted where 100 patient visits were observed and video recorded in a primary care clinic. Videos were then coded for gaze behaviors where patients' and physicians' gaze at each other and artifacts such as electronic health records were coded using a pre-established objective coding scheme. Gaze data were then analyzed using lag sequential methods. Results showed that there are several eye gaze patterns significantly dependent to each other. All doctor-initiated gaze patterns were followed by patient gaze patterns. Some patient-initiated gaze patterns were also followed by doctor gaze patterns significantly unlike the findings in previous studies. Health information technology appears to contribute to some of the new significant patterns that have emerged. Differences were also found in gaze patterns related to technology that differ from patterns identified in studies with paper charts. Several sequences related to patient-doctor-technology were also significant. Electronic health records affect the patient-physician eye contact dynamic differently than paper charts. This study identified several patterns of patient-physician interaction with electronic health record systems. Consistent with previous studies, physician initiated gaze is an important driver of the interactions between patient and physician and patient and technology. Published by Elsevier Ireland Ltd.

[Medical records, DRG and intensive care patients].

PubMed

Aardal, Sidsel; Berge, Kjersti; Breivik, Kjell; Flaatten, Hans K

2005-04-07

In order to control the quality of the medical report after a hospital stay with regards to the stay in the intensive care unit (ICU), and to cheque for correct DRG grouping, this study of 428 patients treated in our ICU in 2003 was conducted. All ICU patients from 2003 were found in our database, which includes specific ICD-10 diagnosis and specific ICU procedures. The medical record summarising the hospital stay (epicrisis) was retrieved for each patient from the hospital's electronic patient files and controlled for correct information regarding the ICU stay. DRG groups for each patient were retrieved from the hospital's administrative database. All stays were re-coded, with all information about the ICU stay was also included. The new DRG codes were compared with the old ones, and the difference in DRG points computed. The description of the stay in the ICU was missing or very insufficient in 46% of the records. In the DRG control we found that an additional 347.37 DRG points (18.4% of the original sum of all DRG points) were missing, corresponding to a loss to the hospital of 6.2 million NOK. In addition we discovered missing codes for tracheostomy corresponding to 2.8 million NOK, giving a total loss of 9 million NOK. This study confirms that an adequate description of the stay in the ICU is insufficient in a large number of medical records. This also leads to incorrect DRG grouping of many patients and significant financial losses to the hospital.

Outpatients flow management and ophthalmic electronic medical records system in university hospital using Yahgee Document View.

PubMed

Matsuo, Toshihiko; Gochi, Akira; Hirakawa, Tsuyoshi; Ito, Tadashi; Kohno, Yoshihisa

2010-10-01

General electronic medical records systems remain insufficient for ophthalmology outpatient clinics from the viewpoint of dealing with many ophthalmic examinations and images in a large number of patients. Filing systems for documents and images by Yahgee Document View (Yahgee, Inc.) were introduced on the platform of general electronic medical records system (Fujitsu, Inc.). Outpatients flow management system and electronic medical records system for ophthalmology were constructed. All images from ophthalmic appliances were transported to Yahgee Image by the MaxFile gateway system (P4 Medic, Inc.). The flow of outpatients going through examinations such as visual acuity testing were monitored by the list "Ophthalmology Outpatients List" by Yahgee Workflow in addition to the list "Patients Reception List" by Fujitsu. Patients' identification number was scanned with bar code readers attached to ophthalmic appliances. Dual monitors were placed in doctors' rooms to show Fujitsu Medical Records on the left-hand monitor and ophthalmic charts of Yahgee Document on the right-hand monitor. The data of manually-inputted visual acuity, automatically-exported autorefractometry and non-contact tonometry on a new template, MaxFile ED, were again automatically transported to designated boxes on ophthalmic charts of Yahgee Document. Images such as fundus photographs, fluorescein angiograms, optical coherence tomographic and ultrasound scans were viewed by Yahgee Image, and were copy-and-pasted to assigned boxes on the ophthalmic charts. Ordering such as appointments, drug prescription, fees and diagnoses input, central laboratory tests, surgical theater and ward room reservations were placed by functions of the Fujitsu electronic medical records system. The combination of the Fujitsu electronic medical records and Yahgee Document View systems enabled the University Hospital to examine the same number of outpatients as prior to the implementation of the computerized filing system.

Evaluation of auto incident recording system (AIRS).

DOT National Transportation Integrated Search

2005-05-01

The Auto Incident Recording System (AIRS) is a sound-actuated video recording system. It automatically records potential incidents when activated by sound (horns, clashing metal, squealing tires, etc.). The purpose is to detect patterns of crashes at...

Privacy Act System of Records: Employee Counseling and Assistance Program Records, EPA-27

EPA Pesticide Factsheets

Learn about the Employee Counseling and Assistance Program Records System, including who is covered in the system, the purpose of data collection, routine uses for the system's records, and other security procedures.

Dynamic modeling of patient and physician eye gaze to understand the effects of electronic health records on doctor-patient communication and attention

PubMed Central

Montague, Enid; Asan, Onur

2014-01-01

Objective The aim of this study was to examine eye gaze patterns between patients and physicians while electronic health records were used to support patient care. Background Eye gaze provides an indication of physician attention to patient, patient/physician interaction, and physician behaviors such as searching for information and documenting information. Methods A field study was conducted where 100 patient visits were observed and video recorded in a primary care clinic. Videos were then coded for gaze behaviors where patients’ and physicians’ gaze at each other and artifacts such as electronic health records were coded using a pre-established objective coding scheme. Gaze data were then analyzed using lag sequential methods. Results Results showed that there are several eye gaze patterns significantly dependent to each other. All doctor-initiated gaze patterns were followed by patient gaze patterns. Some patient-initiated gaze patterns were also followed by doctor gaze patterns significantly unlike the findings in previous studies. Health information technology appears to contribute to some of the new significant patterns that have emerged. Differences were also found in gaze patterns related to technology that differ from patterns identified in studies with paper charts. Several sequences related to patient-doctor- technology were also significant. Electronic health records affect the patient-physician eye contact dynamic differently than paper charts. Conclusion This study identified several patterns of patient-physician interaction with electronic health record systems. Consistent with previous studies, physician initiated gaze is an important driver of the interactions between patient and physician and patient and technology. PMID:24380671

77 FR 65049 - Privacy Act; System of Records: Translator and Interpreter Records, State-37

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-24

... DEPARTMENT OF STATE [Public Notice 8066] Privacy Act; System of Records: Translator and... an existing system of records, Translator and Interpreter Records, State-37, pursuant to the... INFORMATION: The Department of State proposes that the current system will retain the name ``Translator and...

Design of an Electronic Reminder System for Supporting the Integerity of Nursing Records.

PubMed

Chen, Chien-Min; Hou, I-Ching; Chen, Hsiao-Ping; Weng, Yung-Ching

2016-01-01

The integrity of electronic nursing records (ENRs) stands for the quality of medical records. But patients' conditions are varied (e.g. not every patient had wound or need fall prevention), to achieve the integrity of ENRs depends much on clinical nurses' attention. Our study site, an one 2,300-bed hospital in northern Taiwan, there are a total of 20 ENRs including nursing assessments, nursing care plan, discharge planning etc. implemented in the whole hospital before 2014. It become important to help clinical nurses to decrease their human recall burden to complete these records. Thus, the purpose of this study was to design an ENRs reminder system (NRS) to facilitate nursing recording process. The research team consisted of an ENR engineer, a clinical head nurse and a nursing informatics specialist began to investigate NRS through three phases (e.g. information requirements; design and implementation). In early 2014, a qualitative research method was used to identify NRS information requirements through both groups (e.g. clinical nurses and their head nurses) focus interviews. According to the their requirements, one prototype was created by the nursing informatics specialist. Then the engineer used Microsoft Visual Studio 2012, C#, and Oracle to designed a web-based NRS (Figure 1). Then the integrity reminder system which including a total of twelve electronic nursing records was designed and the preliminary accuracy validation of the system was 100%. NRS could be used to support nursing recording process and prepared for implementing in the following phase.

76 FR 55388 - Privacy Act System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-07

... FEDERAL COMMUNICATIONS COMMISSION Privacy Act System of Records AGENCY: Federal Communications..., consolidated system of records, FCC/OMD-28, ``Time and Attendance Records,'' in the Federal Register in which the numbering of the system of records was incorrectly identified as FCC/ OMD-14. The correct...

The standard data model approach to patient record transfer.

PubMed Central

Canfield, K.; Silva, M.; Petrucci, K.

1994-01-01

This paper develops an approach to electronic data exchange of patient records from Ambulatory Encounter Systems (AESs). This approach assumes that the AES is based upon a standard data model. The data modeling standard used here is IDEFIX for Entity/Relationship (E/R) modeling. Each site that uses a relational database implementation of this standard data model (or a subset of it) can exchange very detailed patient data with other such sites using industry standard tools and without excessive programming efforts. This design is detailed below for a demonstration project between the research-oriented geriatric clinic at the Baltimore Veterans Affairs Medical Center (BVAMC) and the Laboratory for Healthcare Informatics (LHI) at the University of Maryland. PMID:7949973

[Implementation of a new electronic patient record in surgery].

PubMed

Eggli, S; Holm, J

2001-12-01

The increasing amount of clinical data, intensified interest of patients in medical information, medical quality management and the recent cost explosion in health care systems have forced medical institutions to improve their strategy in handling medical data. In the orthopedic department (3,600 surgeries, 75 beds, 14,000 consultations) software application for comprehensive patient data management has been developed. When implementing the electronic patient history following criteria were evaluated: 1. software evaluation, 2. implementation, 3. work flow, 4. data security/system stability. In the first phase the functional character was defined. Implementation required 3 months after parametrization. The expense amounted to 130,000 DM (30 clients). The training requirements were one afternoon for the secretaries and a 2-h session for the residents. The access speed on medically relevant data averaged under 3 s. The average saving in working hours was approximately 5 h/week for the secretaries and 4 h/week for the residents. The saving in paper amounted to 36,000 sheets/year. In 3 operational years there were 3 server breakdowns. Evaluation of the saving on working hours showed that such a system can amortize within a year. The latest improvements in hardware and software technology made the electronic medical record with integrated quality-control practicable without massive expenditure. The system supplies an extensive platform of information for patient treatment and an instrument to evaluate the efficiency of therapy strategies independent of the clinical field.

Ensuring Privacy When Integrating Patient-Based Datasets: New Methods and Developments in Record Linkage.

PubMed

Brown, Adrian P; Ferrante, Anna M; Randall, Sean M; Boyd, James H; Semmens, James B

2017-01-01

In an era where the volume of structured and unstructured digital data has exploded, there has been an enormous growth in the creation of data about individuals that can be used for understanding and treating disease. Joining these records together at an individual level provides a complete picture of a patient's interaction with health services and allows better assessment of patient outcomes and effectiveness of treatment and services. Record linkage techniques provide an efficient and cost-effective method to bring individual records together as patient profiles. These linkage procedures bring their own challenges, especially relating to the protection of privacy. The development and implementation of record linkage systems that do not require the release of personal information can reduce the risks associated with record linkage and overcome legal barriers to data sharing. Current conceptual and experimental privacy-preserving record linkage (PPRL) models show promise in addressing data integration challenges. Enhancing and operationalizing PPRL protocols can help address the dilemma faced by some custodians between using data to improve quality of life and dealing with the ethical, legal, and administrative issues associated with protecting an individual's privacy. These methods can reduce the risk to privacy, as they do not require personally identifying information to be shared. PPRL methods can improve the delivery of record linkage services to the health and broader research community.

77 FR 18205 - Privacy Act System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-27

... DEPARTMENT OF COMMERCE [Docket No. 111115680-2197-02] Privacy Act System of Records AGENCY: U.S. Census Bureau, Department of Commerce. ACTION: Notice of amended Privacy Act System of Records: COMMERCE... date of an amended Privacy Act System of Records titled, ``COMMERCE/CENSUS-6, Population Census Records...

Design of the SGML-based electronic patient record system with the use of object-oriented analysis methods.

PubMed

Kuikka, E; Eerola, A; Porrasmaa, J; Miettinen, A; Komulainen, J

1999-01-01

Since a patient record is typically a document updated by many users, required to be represented in many different layouts, and transferred from place to place, it is a good candidate to be represented structured and coded using the SGML document standard. The use of the SGML requires that the structure of the document is defined in advance by a Document Type Definition (DTD) and the document follows it. This paper represents a method which derives an SGML DTD by starting from the description of the usage of the patient record in medical care and nursing.

Visualizing collaborative electronic health record usage for hospitalized patients with heart failure.

PubMed

Soulakis, Nicholas D; Carson, Matthew B; Lee, Young Ji; Schneider, Daniel H; Skeehan, Connor T; Scholtens, Denise M

2015-03-01

To visualize and describe collaborative electronic health record (EHR) usage for hospitalized patients with heart failure. We identified records of patients with heart failure and all associated healthcare provider record usage through queries of the Northwestern Medicine Enterprise Data Warehouse. We constructed a network by equating access and updates of a patient's EHR to a provider-patient interaction. We then considered shared patient record access as the basis for a second network that we termed the provider collaboration network. We calculated network statistics, the modularity of provider interactions, and provider cliques. We identified 548 patient records accessed by 5113 healthcare providers in 2012. The provider collaboration network had 1504 nodes and 83 998 edges. We identified 7 major provider collaboration modules. Average clique size was 87.9 providers. We used a graph database to demonstrate an ad hoc query of our provider-patient network. Our analysis suggests a large number of healthcare providers across a wide variety of professions access records of patients with heart failure during their hospital stay. This shared record access tends to take place not only in a pairwise manner but also among large groups of providers. EHRs encode valuable interactions, implicitly or explicitly, between patients and providers. Network analysis provided strong evidence of multidisciplinary record access of patients with heart failure across teams of 100+ providers. Further investigation may lead to clearer understanding of how record access information can be used to strategically guide care coordination for patients hospitalized for heart failure. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association.

8 CFR 103.34 - Security of records systems.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Security of records systems. 103.34 Section 103.34 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS POWERS AND DUTIES; AVAILABILITY OF RECORDS § 103.34 Security of records systems. The security of records systems...

A multimedia electronic patient record (ePR) system for image-assisted minimally invasive spinal surgery.

PubMed

Documet, Jorge; Le, Anh; Liu, Brent; Chiu, John; Huang, H K

2010-05-01

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. 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. A step-by-step approach was introduced to develop a multimedia 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.

76 FR 52378 - Privacy Act; System of Records: State-76, Personal Services Contractor Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-22

... Services Contractor Records SUMMARY: Notice is hereby given that the Department of State proposes to create a new system of records, Personal Services Contractor Records, State-76, pursuant to the provisions... July 20, 2011. It is proposed that the new system be named ``Personal Services Contractor Records.'' It...

Analysis of cost and assessment of computerized patient record systems in Japan based on questionnaire survey.

PubMed

Zhang, W P; Yamauchi, K; Mizuno, S; Zhang, R; Huang, D M

2004-01-01

The purpose of this study was to clarify the implementation and maintenance costs of a computerized patient record (CPR) system by means of a questionnaire survey. Moreover, the benefits of CPR systems were evaluated to determine their contribution to enhancing the quality of medical care and hospital management. Data were collected by a questionnaire survey mailed out to participants. The per-bed mean cost for implementation was 14,308 dollars (range: 3538-38,077 dollars). The mean annual maintenance cost for the CPR system was 457,615 dollars (range: 39,769-2,307,692 dollars). The multivariate analysis (Hayashi's Quantification Type I) revealed high partial correlation coefficients between implementation cost and the CPR system maker. In addition, the multiple correlation coefficient for four factors (CPR system maker, number of servers, institution type and implementation date) in predicting implementation cost was 0.798. Over 60% of respondents replied that their satisfaction with the CPR system was 'very high' or 'high.' Eighty-two percent of the hospitals responded positively that CPR systems improve the quality of medical care, and 70% felt that the systems help prevent medical errors. Our findings indicate that the maker of CPR system, number of servers, institution type and implementation date had a strong influence on per-bed implementation costs in that order. Finally, it was found that CPR systems were considered effective for hospital administration and medical examinations, based on the high assessments of the results of installing a CPR system.

How Accurate is Information that Patients Contribute to their Electronic Health Record?

PubMed Central

Wuerdeman, Lisa; Volk, Lynn; Pizziferri, Lisa; Tsurikova, Ruslana; Harris, Cathyann; Feygin, Raisa; Epstein, Marianna; Meyers, Kimberly; Wald, Jonathan S.; Lansky, David; Bates, David W.

2005-01-01

Increased patient interaction with medical records and the advent of personal health records (PHRs) may increase patients’ ability to contribute valid information to their Electronic Health Record (EHR) medical record. Patient input through a secure connection, whether it is a patient portal or PHR, will integrate many aspects of a patient’s health and may help lessen the information gap between patients and providers. Patient reported data should be considered a viable method of enhancing documentation but will not likely be as complete and accurate as more comprehensive data-exchange between providers. PMID:16779157

Electronic medical records in humanitarian emergencies - the development of an Ebola clinical information and patient management system.

PubMed

Jobanputra, Kiran; Greig, Jane; Shankar, Ganesh; Perakslis, Eric; Kremer, Ronald; Achar, Jay; Gayton, Ivan

2016-01-01

By November 2015, the West Africa Ebola epidemic had caused 28598 infections and 11299 deaths in the three countries most affected. The outbreak required rapid innovation and adaptation. Médecins sans Frontières (MSF) scaled up its usual 20-30 bed Ebola management centres (EMCs) to 100-300 beds with over 300 workers in some settings. This brought challenges in patient and clinical data management resulting from the difficulties of working safely with high numbers of Ebola patients. We describe a project MSF established with software developers and the Google Social Impact Team to develop context-adapted tools to address the challenges of recording Ebola clinical information. We share the outcomes and key lessons learned in innovating rapidly under pressure in difficult environmental conditions. Information on adoption, maintenance, and data quality was gathered through review of project documentation, discussions with field staff and key project stakeholders, and analysis of tablet data. In March 2015, a full prototype was deployed in Magburaka EMC, Sierra Leone. Inpatient data were captured on 204 clinical interactions with 34 patients from 5 March until 10 April 2015. Data continued to also be recorded on paper charts, creating theoretically identical record "pairs" on paper and tablet. 83 record pairs for 33 patients with 22 data items (temperature and symptoms) per pair were analysed. The overall Kappa coefficient for agreement between sources was 0.62, but reduced to 0.59 when rare bleeding symptoms were excluded, indicating moderate to good agreement. The time taken to deliver the product was more than that anticipated by MSF (7 months versus 6 weeks). Deployment of the tablet coincided with a dramatic drop in patient numbers and thus had little impact on patient care. We have identified lessons specific to humanitarian-technology collaborative projects and propose a framework for emergency humanitarian innovation. Time and effort is required to bridge

Identifying Patients with Hypertension: A Case for Auditing Electronic Health Record Data

PubMed Central

Baus, Adam; Hendryx, Michael; Pollard, Cecil

2012-01-01

Problems in the structure, consistency, and completeness of electronic health record data are barriers to outcomes research, quality improvement, and practice redesign. This nonexperimental retrospective study examines the utility of importing de-identified electronic health record data into an external system to identify patients with and at risk for essential hypertension. We find a statistically significant increase in cases based on combined use of diagnostic and free-text coding (mean = 1,256.1, 95% CI 1,232.3–1,279.7) compared to diagnostic coding alone (mean = 1,174.5, 95% CI 1,150.5—1,198.3). While it is not surprising that significantly more patients are identified when broadening search criteria, the implications are critical for quality of care, the movement toward the National Committee for Quality Assurance's Patient-Centered Medical Home program, and meaningful use of electronic health records. Further, we find a statistically significant increase in potential cases based on the last two or more blood pressure readings greater than or equal to 140/90 mm Hg (mean = 1,353.9, 95% CI 1,329.9—1,377.9). PMID:22737097

Usage experience with the document archiving and communication system for the storage and retrieval of medical records.

PubMed

Takeda, Toshihiro; Ueda, Kanayo; Manabe, Shiro; Teramoto, Kei; Mihara, Naoki; Matsumura, Yasushi

2013-01-01

Standard Japanese electronic medical record (EMR) systems are associated with major shortcomings. For example, they do not assure lifelong readability of records because each document requires its own viewing software program, a system that is difficult to maintain over long periods of time. It can also be difficult for users to comprehend a patient's clinical history because different classes of documents can only be accessed from their own window. To address these problems, we developed a document-based electronic medical record that aggregates all documents for a patient in a PDF or DocuWorks format. We call this system the Document Archiving and Communication System (DACS). There are two types of viewers in the DACS: the Matrix View, which provides a time line of a patient's history, and the Tree View, which stores the documents in hierarchical document classes. We placed 2,734 document classes into 11 categories. A total of 22,3972 documents were entered per month. The frequency of use of the DACS viewer was 268,644 instances per month. The DACS viewer was used to assess a patient's clinical history.

Bootstrapping a de-identification system for narrative patient records: cost-performance tradeoffs.

PubMed

Hanauer, David; Aberdeen, John; Bayer, Samuel; Wellner, Benjamin; Clark, Cheryl; Zheng, Kai; Hirschman, Lynette

2013-09-01

We describe an experiment to build a de-identification system for clinical records using the open source MITRE Identification Scrubber Toolkit (MIST). We quantify the human annotation effort needed to produce a system that de-identifies at high accuracy. Using two types of clinical records (history and physical notes, and social work notes), we iteratively built statistical de-identification models by annotating 10 notes, training a model, applying the model to another 10 notes, correcting the model's output, and training from the resulting larger set of annotated notes. This was repeated for 20 rounds of 10 notes each, and then an additional 6 rounds of 20 notes each, and a final round of 40 notes. At each stage, we measured precision, recall, and F-score, and compared these to the amount of annotation time needed to complete the round. After the initial 10-note round (33min of annotation time) we achieved an F-score of 0.89. After just over 8h of annotation time (round 21) we achieved an F-score of 0.95. Number of annotation actions needed, as well as time needed, decreased in later rounds as model performance improved. Accuracy on history and physical notes exceeded that of social work notes, suggesting that the wider variety and contexts for protected health information (PHI) in social work notes is more difficult to model. It is possible, with modest effort, to build a functioning de-identification system de novo using the MIST framework. The resulting system achieved performance comparable to other high-performing de-identification systems. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Considering Governance for Patient Access to E-Medical Records.

PubMed

Day, Karen; Wells, Susan

2015-01-01

People having access to their medical records could have a transformative improvement effect on healthcare delivery and use. Our research aimed to explore the concerns and attitudes of giving people electronic access to their medical records through patient portals. We conducted 28 semi-structured interviews with 30 people, asking questions about portal design, organisational implications and governance. We report the findings of the governance considerations raised during the interviews. These revealed that (1) there is uncertainty about the possible design and extent of giving people access to their medical records to view/use, (2) existing policies about patient authentication, proxy, and privacy require modification, and (3) existing governance structures and functions require further examination and adjustment. Future research should include more input from patients and health informaticians.

A novel system architecture for the national integration of electronic health records: a semi-centralized approach.

PubMed

AlJarullah, Asma; El-Masri, Samir

2013-08-01

The goal of a national electronic health records integration system is to aggregate electronic health records concerning a particular patient at different healthcare providers' systems to provide a complete medical history of the patient. It holds the promise to address the two most crucial challenges to the healthcare systems: improving healthcare quality and controlling costs. Typical approaches for the national integration of electronic health records are a centralized architecture and a distributed architecture. This paper proposes a new approach for the national integration of electronic health records, the semi-centralized approach, an intermediate solution between the centralized architecture and the distributed architecture that has the benefits of both approaches. The semi-centralized approach is provided with a clearly defined architecture. The main data elements needed by the system are defined and the main system modules that are necessary to achieve an effective and efficient functionality of the system are designed. Best practices and essential requirements are central to the evolution of the proposed architecture. The proposed architecture will provide the basis for designing the simplest and the most effective systems to integrate electronic health records on a nation-wide basis that maintain integrity and consistency across locations, time and systems, and that meet the challenges of interoperability, security, privacy, maintainability, mobility, availability, scalability, and load balancing.

Maternity patients' access to their electronic medical records: use and perspectives of a patient portal.

PubMed

Megan Forster, Megan; Dennison, Kerrie; Callen, Joanne; Andrew, Andrew; Westbrook, Johanna I

Patients have been able to access clinical information from their paper-based health records for a number of years. With the advent of Electronic Medical Records (EMRs) access to this information can now be achieved online using a secure electronic patient portal. The purpose of this study was to investigate maternity patients' use and perceptions of a patient portal developed at the Mater Mothers' Hospital in Brisbane, Australia. A web-based patient portal, one of the first developed and deployed in Australia, was introduced on 26 June 2012. The portal was designed for maternity patients booked at Mater Mothers' Hospital, as an alternative to the paper-based Pregnancy Health Record. Through the portal, maternity patients are able to complete their hospital registration form online and obtain current health information about their pregnancy (via their EMR), as well as access a variety of support tools to use during their pregnancy such as tailored public health advice. A retrospective cross-sectional study design was employed. Usage statistics were extracted from the system for a one year period (1 July 2012 to 30 June 2013). Patients' perceptions of the portal were obtained using an online survey, accessible by maternity patients for two weeks in February 2013 (n=80). Descriptive statistics were employed to analyse the data. Between July 2012 and June 2013, 10,892 maternity patients were offered a patient portal account and access to their EMR. Of those 6,518 created one (60%; 6,518/10,892) and 3,104 went on to request access to their EMR (48%; 3,104/6,518). Of these, 1,751 had their access application granted by 30 June 2013. The majority of maternity patients submitted registration forms online via the patient portal (56.7%). Patients could view their EMR multiple times: there were 671 views of the EMR, 2,781 views of appointment schedules and 135 birth preferences submitted via the EMR. Eighty survey responses were received from EMR account holders, (response

Application of KinectTM and wireless technology for patient data recording and viewing system in the course of surgery

NASA Astrophysics Data System (ADS)

Ong, Aira Patrice R.; Bugtai, Nilo T.; Aldaba, Luis Miguel M.; Madrangca, Astrid Valeska H.; Que, Giselle V.; Que, Miles Frederick L.; Tan, Kean Anderson. S.

2017-02-01

In modern operating room (OR) conditions, a patient's computed tomography (CT) or magnetic resonance imaging (MRI) scans are some of the most important resources during surgical procedures. In practice, the surgeon is impelled to scrub out and back in every time he needs to scroll through scan images in mid-operation. To prevent leaving the operating table, many surgeons rely on assistants or nurses and give instructions to manipulate the computer for them, which can be cumbersome and frustrating. As a motivation for this study, the use of touchless (non-contact) gesture-based interface in medical practice is incorporated to have aseptic interactions with the computer systems and with the patient's data. The system presented in this paper is composed of three main parts: the Trek Ai-Ball Camera, the Microsoft Kinect™, and the computer software. The incorporation of these components and the developed software allows the user to perform 13 hand gestures, which have been tested to be 100 percent accurate. Based on the results of the tests performed on the system performance, the conclusions made regarding the time efficiency of the viewing system, the quality and the safety of the recording system has gained positive feedback from consulting doctors.

How do nurses record pedagogical activities? Nurses' documentation in patient records in a cardiac rehabilitation unit for patients who have undergone coronary artery bypass surgery.

PubMed

Bergh, Anne-Louise; Bergh, Claes-Håkan; Friberg, Febe

2007-10-01

To describe the use of pedagogically related keywords and the content of notes connected to these keywords, as they appear in nursing records in a coronary artery bypass graft (CABG) surgery rehabilitation unit. Nursing documentation is an important component of clinical practice and is regulated by law in Sweden. Studies have been carried out in order to evaluate the educational and rehabilitative needs of patients following CABG surgery but, as yet, no study has contained an in-depth evaluation of how nurses document pedagogical activities in the records of these patients. The records of 265 patients admitted to a rehabilitation unit following CABG surgery were analysed. The records were structured in accordance with the VIPS model. Using this model, pedagogically related keywords: communication, cognition/development and information/education were selected. The analysis of the data consisted of three parts: the frequency with which pedagogically related keywords are used, the content and the structure of the notes. Apart from the term 'communication', pedagogically related keywords were seldom used. Communication appeared in all records describing limitations, although no explicit reference was made to pedagogical activities. The notes related to cognition/development were grouped into the following themes: nurses' actions, assessment of knowledge and provision of information, advice and instructions as well as patients' wishes and experiences. The themes related to information were the provision of information and advice in addition to relevant nursing actions. The structure of the documentation was simple. The documentation of pedagogical activities in nursing records was infrequent and inadequate. The patients' need for knowledge and the nurses' teaching must be documented in the patient records so as to clearly reflect the frequency and quality of pedagogical activities.

76 FR 81950 - Privacy Act; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-29

... ``Consolidated Data Repository'' (09-90-1000). This system of records is being amended to include records... Repository'' (SORN 09-90-1000). OIG is adding record sources to the system. This system fulfills our..., and investigations of the Medicare and Medicaid programs. SYSTEM NAME: Consolidated Data Repository...

Proposed Criteria for Reimbursing eVisits: Content Analysis of Secure Patient Messages in a Personal Health Record System

PubMed Central

Tang, Paul C.; Black, William; Young, Charles Y.

2006-01-01

The Institute of Medicine called for healthcare organizations to provide care whenever needed, using the Internet as appropriate. Few organizations currently offer clinical electronic messaging services for their patients. Many believe that broader adoption of online services will not occur without a change in reimbursement policies. We propose modified Evaluation and Management (eVisit E&M) criteria derived from the current office-based E&M codes as a means of qualifying whether an online encounter should be reimbursed. Physician reviewers applied the proposed eVisit criteria to 120 randomly selected electronic messages sent by 112 patients to 69 physicians through a personal health record system. Twenty-two percent of clinical messages to physicians contained sufficient patient-history data and medical decision-making components to warrant reimbursement according to our eVisit criteria. Among a subset of patients with multiple chronic diseases, this would have generated an estimated 1.2 eVisits per patient annually. Across a broader patient population, we estimate that 0.7 eVisit encounters would be generated annually per patient. Sixty-five percent (65%) of patients felt that electronic communication with their physicians saved one or more office visits per year. Reimbursing for qualified eVisits may encourage broader use of electronic communication to improve access to care and reduce overall healthcare costs. PMID:17238444

Comparison of video-recorded consultations with those in which patients' consent is withheld.

PubMed Central

Coleman, T; Manku-Scott, T

1998-01-01

BACKGROUND: Video-recorded consultations are widely used for research in general practice. Recently, video recordings have begun to be used for the purposes of general practitioner (GP) registrar assessment. It is unknown, however, whether consultations in which patients withhold consent for recording differ from those that are recorded. AIM: To compare clinical problems and demographic characteristics of adult patients who consent to the video recording of consultations with those who withhold consent. METHOD: This was prospective study of 538 adult patients consulting 42 GPs, based in practices throughout Leicestershire. Each patient attended a surgery session with one of the 42 GPs between April 1995 and March 1996. Clinical presentations and demographic characteristics of patients consenting and withholding consent to the video recording of their consultations were compared. GPs' perceptions of whether patients in these two groups were distressed/upset or embarrassed were also compared. RESULTS: A total of 85.9% (462/538) of adults consented to video recording, and 14.1% (76/538) withheld consent. Multiple logistic regression revealed that patients who presented with a mental health problem were more likely to withhold consent to recording (odds ratio 2.5, 95% confidence interval 1.4-4.6). Younger patients were also more likely to withhold consent to video recording. Additionally, where patients' consent was withheld, GPs perceived patients to be more distressed or embarrassed. CONCLUSION: Younger patients and those suffering from mental health problems are more likely than others to withhold consent to being video recorded for research purposes in general practice. The implications of this study for the assessment of registrar GPs using video-recorded consultations are discussed. PMID:9624767

45 CFR 705.3 - Procedures for requests pertaining to individual records in a system of records.

Code of Federal Regulations, 2010 CFR

2010-10-01

... the requester, the system in which the record is thought to be included. Requested information that is... records in a system of records. 705.3 Section 705.3 Public Welfare Regulations Relating to Public Welfare... requests pertaining to individual records in a system of records. (a) An individual seeking notification of...

[Automated anesthesia record systems].

PubMed

Heinrichs, W; Mönk, S; Eberle, B

1997-07-01

The introduction of electronic anaesthesia documentation systems was attempted as early as in 1979, although their efficient application has become reality only in the past few years. The advantages of the electronic protocol are apparent: Continuous high quality documentation, comparability of data due to the availability of a data bank, reduction in the workload of the anaesthetist and availability of additional data. Disadvantages of the electronic protocol have also been discussed in the literature. By going through the process of entering data on the course of the anaesthetic procedure on the protocol sheet, the information is mentally absorbed and evaluated by the anaesthetist. This information may, however, be lost when the data are recorded fully automatically-without active involvement on the part of the anaesthetist. Recent publications state that by using intelligent alarms and/or integrated displays manual record keeping is no longer necessary for anaesthesia vigilance. The technical design of automated anaesthesia records depends on an integration of network technology into the hospital. It will be appropriate to connect the systems to the internet, but safety requirements have to be followed strictly. Concerning the database, client server architecture as well as language standards like SQL should be used. Object oriented databases will be available in the near future. Another future goal of automated anaesthesia record systems will be using knowledge based technologies within these systems. Drug interactions, disease related anaesthetic techniques and other information sources can be integrated. At this time, almost none of the commercially available systems has matured to a point where their purchase can be recommended without reservation. There is still a lack of standards for the subsequent exchange of data and a solution to a number of ergonomic problems still remains to be found. Nevertheless, electronic anaesthesia protocols will be required in

Corridor consultations and the medical microbiological record: is patient safety at risk?

PubMed Central

Heard, S R; Roberts, C; Furrows, S J; Kelsey, M; Southgate, L

2003-01-01

The performance procedures of the General Medical Council are aimed at identifying seriously deficient performance in a doctor. The performance procedures require the medical record to be of a standard that enables the next doctor seeing the patient to give adequate care based on the available information. Setting standards for microbiological record keeping has proved difficult. Over one fifth of practising medical microbiologists (including virologists) in the UK (139 of 676) responded to a survey undertaken by the working group developing the performance procedures for microbiology, to identify current practice and to develop recommendations for agreement within the profession about the standards of the microbiological record. The cumulative frequency for the surveyed recording methods used indicated that at various times 65% (90 of 139) of respondents used a daybook, 62% (86 of 139) used the back of the clinical request card, 57% (79 of 139) used a computer record, and 22% (30 of 139) used an index card system to record microbiological advice, suggesting wide variability in relation to how medical microbiologists maintain clinical records. PMID:12499432

[Nutritional status recording in hospitalized patient notes].

PubMed

Matos, L; Teixeira, M A; Henriques, A; Tavares, M M; Alvares, L; Antunes, A; Amaral, Teresa F

2007-01-01

The prevalence of disease-related malnutrition (DRM) is described to be of 30-60% on admission to hospital, and of 10% in the community. It has been associated with worse clinical outcomes, namely higher morbidity and mortality as well as higher frequency of health care and its associated costs. The lack of screening and monitoring of nutritional status have been said to be risk factors for the increased prevalence of DRM during hospital stay. The aims of this study were to evaluate the importance given by health care professionals to certain aspects related with nutritional status (weight, food intake) of hospital patients and to see if there were any differences between the under and non undernourished ones. A systematic sample of patients from six hospitals was collected. Pregnancy, paediatric age and critical illness were exclusion criteria as well as incapacity to fulfil nutritional risk screening protocol and length-of-stay less than 24h. Socio-demographic, anthropometric data and clinical notes (e.g. weight, food/nutrient intake) from medical records were collected and Nutritional Risk Screening 2002 protocol was applied. A total of 1152 patients were included in this study. The prevalence of nutritional risk varied between 28.5% and 47.3% while undernutrition classified by anthropometrical parameters was considerably lower (6.3% to 14.9%). Two thirds of the patients had their food intake monitored and registered in medical records but only one third were weighted. Undernourished patients had their food intake more frequently monitored but their weight was less frequently measured, than the well-nourished ones. DRM prevalence amongst hospital patients on admission is significantly high. Clinical notes regarding nutritional status is rather infrequent on medical records. This study showed that urges the need to empower health care providers of the importance of the screening and monitoring of weight and food intake, on admission and during hospital stay.

Italy’s Electronic Health Record System for Opioid Agonist Treatment

PubMed Central

Serpelloni, Giovanni; Gomma, Maurizio; Genetti, Bruno; Zermiani, Monica; Rimondo, Claudia; Mollica, Roberto; Gryczynski, Jan; O’Grady, Kevin E.; Schwartz, Robert P.

2013-01-01

Electronic health record systems (EHRs) play an increasingly important role in opioid agonist treatment. In Italy, an EHR called the Multi Functional Platform (MFP) is in use in 150 opioid-agonist treatment facilities in 8 of Italy’s 23 regions. This report describes MFP and presents 2010 data from 65 sites that treated 8,145 patients, of whom 72.3% were treated with methadone and 27.7% with buprenorphine. Patients treated with buprenorphine compared to methadone were more likely to be male (p < 0.01) and younger (p < 0.001). Methadone compared to buprenorphine patients had a higher percentage of opioid-positive urine tests (p < 0.001) and longer mean length of stay (p = 0.004). MFP has been implemented widely in Italy and has been able to track patient outcomes across treatment facilities. In the future, this EHR system can be used for performance improvement initiatives. PMID:23518287

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

PubMed

Ahmadi, Maryam; Ghazisaeidi, Marjan; Bashiri, Azadeh

2015-03-18

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. 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. 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. 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. 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.

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

PubMed

Bouamrane, Matt-Mouley; Mair, Frances S

2013-05-21

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. 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. 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. 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.

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

Joint development of evidence-based medical record by doctors and patients through integrated Chinese and Western medicine on digestive system diseases.

PubMed

Li, Bo; Gao, Hong-yang; Gao, Rui; Zhao, Ying-pan; Li, Qing-na; Zhao, Yang; Tang, Xu-dong; Shang, Hong-cai

2016-02-01

Building the clinical therapeutic evaluation system by combing the evaluation given by doctors and patients can form a more comprehensive and objective evaluation system. A literature search on the practice of evidence-based evaluation was conducted in key biomedical databases, i.e. PubMed, Excerpt Medica Database, China Biology Medicine disc and China National Knowledge Infrastructure. However, no relevant study on the subjects of interest was identified. Therefore, drawing on the principles of narrative medicine and expert opinion from systems of Chinese medicine and Western medicine, we propose to develop and pilot-test a novel evidence-based medical record format that captures the perspectives of both patients and doctors in a clinical trial. Further, we seek to evaluate a strategic therapeutic approach that integrates the wisdom of Chinese medicine with the scientific basis of Western medicine in the treatment of digestive system disorders. Evaluation of therapeutic efficacy of remedies under the system of Chinese medicine is an imperative ongoing research. The present study intends to identify a novel approach to assess the synergistic benefits achievable from an integrated therapeutic approach combining Chinese and Western system of medicine to treat digestive system disorders.

Validation of an Electronic System for Recording Medical Student Patient Encounters

PubMed Central

Nkoy, Flory L.; Petersen, Sarah; Matheny Antommaria, Armand H.; Maloney, Christopher G.

2008-01-01

The Liaison Committee for Medical Education requires monitoring of the students’ clinical experiences. Student logs, typically used for this purpose, have a number of limitations. We used an electronic system called Patient Tracker to passively generate student encounter data. The data contained in Patient Tracker was compared to the information reported on student logs and data abstracted from the patients’ charts. Patient Tracker identified 30% more encounters than the student logs. Compared to the student logs, Patient Tracker contained a higher average number of diagnoses per encounter (2.28 vs. 1.03, p<0.01). The diagnostic data contained in Patient Tracker was also more accurate under 4 different definitions of accuracy. Only 1.3% (9/677) of diagnoses in Patient Tracker vs. 16.9% (102/601) diagnoses in the logs could not be validated in patients’ charts (p<0.01). Patient Tracker is a more effective and accurate tool for documenting student clinical encounters than the conventional student logs. PMID:18999155

75 FR 27294 - Privacy Act System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-14

... DEPARTMENT OF COMMERCE [Docket No. 100427198-2060-01] Privacy Act System of Records AGENCY: U.S. Census Bureau, Department of Commerce. ACTION: Notice of amended Privacy Act System of Records: COMMERCE... effective date of a Privacy Act System of Records notice entitled COMMERCE/CENSUS-5, Decennial Census...

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

Consumers' Perceptions of Patient-Accessible Electronic Medical Records

PubMed Central

Vaughon, Wendy L; Czaja, Sara J; Levy, Joslyn; Rockoff, Maxine L

2013-01-01

Background Electronic health information (eHealth) tools for patients, including patient-accessible electronic medical records (patient portals), are proliferating in health care delivery systems nationally. However, there has been very limited study of the perceived utility and functionality of portals, as well as limited assessment of these systems by vulnerable (low education level, racial/ethnic minority) consumers. Objective The objective of the study was to identify vulnerable consumers’ response to patient portals, their perceived utility and value, as well as their reactions to specific portal functions. Methods This qualitative study used 4 focus groups with 28 low education level, English-speaking consumers in June and July 2010, in New York City. Results Participants included 10 males and 18 females, ranging in age from 21-63 years; 19 non-Hispanic black, 7 Hispanic, 1 non-Hispanic White and 1 Other. None of the participants had higher than a high school level education, and 13 had less than a high school education. All participants had experience with computers and 26 used the Internet. Major themes were enhanced consumer engagement/patient empowerment, extending the doctor’s visit/enhancing communication with health care providers, literacy and health literacy factors, improved prevention and health maintenance, and privacy and security concerns. Consumers were also asked to comment on a number of key portal features. Consumers were most positive about features that increased convenience, such as making appointments and refilling prescriptions. Consumers raised concerns about a number of potential barriers to usage, such as complex language, complex visual layouts, and poor usability features. Conclusions Most consumers were enthusiastic about patient portals and perceived that they had great utility and value. Study findings suggest that for patient portals to be effective for all consumers, portals must be designed to be easy to read, visually

Patient safety in out-of-hours primary care: a review of patient records.

PubMed

Smits, Marleen; Huibers, Linda; Kerssemeijer, Brian; de Feijter, Eimert; Wensing, Michel; Giesen, Paul

2010-12-10

Most patients receive healthcare in primary care settings, but relatively little is known about patient safety. Out-of-hours contacts are of particular importance to patient safety. Our aim was to examine the incidence, types, causes, and consequences of patient safety incidents at general practice cooperatives for out-of-hours primary care and to examine which factors were associated with the occurrence of patient safety incidents. A retrospective study of 1,145 medical records concerning patient contacts with four general practice cooperatives. Reviewers identified records with evidence of a potential patient safety incident; a physician panel determined whether a patient safety incident had indeed occurred. In addition, the panel determined the type, causes, and consequences of the incidents. Factors associated with incidents were examined in a random coefficient logistic regression analysis. In 1,145 patient records, 27 patient safety incidents were identified, an incident rate of 2.4% (95% CI: 1.5% to 3.2%). The most frequent incident type was treatment (56%). All incidents had at least partly been caused by failures in clinical reasoning. The majority of incidents did not result in patient harm (70%). Eight incidents had consequences for the patient, such as additional interventions or hospitalisation. The panel assessed that most incidents were unlikely to result in patient harm in the long term (89%). Logistic regression analysis showed that age was significantly related to incident occurrence: the likelihood of an incident increased with 1.03 for each year increase in age (95% CI: 1.01 to 1.04). Patient safety incidents occur in out-of-hours primary care, but most do not result in harm to patients. As clinical reasoning played an important part in these incidents, a better understanding of clinical reasoning and guideline adherence at GP cooperatives could contribute to patient safety.

The Future of the Perfusion Record: Automated Data Collection vs. Manual Recording

PubMed Central

Ottens, Jane; Baker, Robert A.; Newland, Richard F.; Mazzone, Annette

2005-01-01

Abstract: The perfusion record, whether manually recorded or computer generated, is a legal representation of the procedure. The handwritten perfusion record has been the most common method of recording events that occur during cardiopulmonary bypass. This record is of significant contrast to the integrated data management systems available that provide continuous collection of data automatically or by means of a few keystrokes. Additionally, an increasing number of monitoring devices are available to assist in the management of patients on bypass. These devices are becoming more complex and provide more data for the perfusionist to monitor and record. Most of the data from these can be downloaded automatically into online data management systems, allowing more time for the perfusionist to concentrate on the patient while simultaneously producing a more accurate record. In this prospective report, we compared 17 cases that were recorded using both manual and electronic data collection techniques. The perfusionist in charge of the case recorded the perfusion using the manual technique while a second perfusionist entered relevant events on the electronic record generated by the Stockert S3 Data Management System/Data Bahn (Munich, Germany). Analysis of the two types of perfusion records showed significant variations in the recorded information. Areas that showed the most inconsistency included measurement of the perfusion pressures, flow, blood temperatures, cardioplegia delivery details, and the recording of events, with the electronic record superior in the integrity of the data. In addition, the limitations of the electronic system were also shown by the lack of electronic gas flow data in our hardware. Our results confirm the importance of accurate methods of recording of perfusion events. The use of an automated system provides the opportunity to minimize transcription error and bias. This study highlights the limitation of spot recording of perfusion events in

75 FR 78211 - Privacy Act System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-15

... DEPARTMENT OF COMMERCE [Docket No. 101207607-0607-02] Privacy Act System of Records AGENCY: U.S. Census Bureau, Department of Commerce. ACTION: Notice of amended Privacy Act System of Records: COMMERCE... notice to announce the effective date of a Privacy Act System of Records notice entitled COMMERCE/CENSUS...

77 FR 18205 - Privacy Act System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-27

... DEPARTMENT OF COMMERCE [Docket No. 111115679-2197-02] Privacy Act System of Records AGENCY: U.S. Census Bureau, Department of Commerce. ACTION: Notice of amended Privacy Act System of Records: COMMERCE... Commerce publishes this notice to announce the effective date of a Privacy Act System of Records notice...

Integrating cockpit display and video recorder systems

NASA Astrophysics Data System (ADS)

Bailey, David C.; Jones, Romie; Testerman, David

1995-06-01

A pair of flight data recording and playback systems are described for the F-22 and F-15. These systems employ multiplexing techniques to expand the amount of data recorded and inherent benefit therefrom. Variations between the system accommodate the different avionics architecture of each aircraft.

User's Satisfaction of Multiple Accounting Record System.

PubMed

Chen, M C; Yu, H C

2016-01-01

The study hospital had developed a multiple account recording system that generates the accounting information of the consumed materials based on daily nursing records. A questionnaire survey was delivered to further investigate the impact of the system. Four concepts of the system were investigated. (1) Supportive and time saving; (2) impact on workflows and job satisfactions; (3) ease of use; and (4) overall satisfactions. The system scored 4.03 out of 5 as the highest for helpfulness for daily practices, 3.98 for decrease the time for recording material consumptions, 3.98 for actually changed the way they work. Users mostly expressed positive attitude towards the system.

Crucial factors preceding compulsory psychiatric admission: a qualitative patient-record study.

PubMed

de Jong, Mark H; Oorschot, Margreet; Kamperman, Astrid M; Brussaard, Petra E; Knijff, Esther M; van de Sande, Roland; Van Gool, Arthur R; Mulder, Cornelis L

2017-10-24

Compulsory admissions have a strong effect on psychiatric patients and represent a deprivation of personal liberty. Although the rate of such admissions is tending to rise in several Western countries, there is little qualitative research on the mental health-care process preceding compulsory admission. The objective of the study was to identify crucial factors in the mental health-care process preceding compulsory admission of adult psychiatric patients. This retrospective, qualitative multiple-case study was based on the patient records of patients with severe mental illness, mainly schizophrenia and other psychotic disorders. Twenty two patient records were analyzed. Patients' demographic and clinical characteristics were heterogeneous. All were treated by Flexible Assertive Community Treatment teams (FACT teams) at two mental health institutions in the greater Rotterdam area in the Netherlands and had a compulsory admission in a predefined inclusion period. The data were analyzed according to the Prevention and Recovery System for Monitoring and Analysis (PRISMA) method, assessing acts, events, conditions, and circumstances, failing protective barriers and protective recovery factors. The most important patient factors in the process preceding compulsory admission were psychosis, aggression, lack of insight, care avoidance, and unauthorized reduction or cessation of medication. Neither were health-care professionals as assertive as they could be in managing early signs of relapse and care avoidance of these particular patients. The health-care process preceding compulsory admission is complex, being influenced by acts, events, conditions and circumstances, failing barriers, and protective factors. The most crucial factors are patients' lack of insight and cessation of medication, and health-care professionals' lack of assertiveness.

7 CFR 400.403 - Required system of records.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 6 2010-01-01 2010-01-01 false Required system of records. 400.403 Section 400.403... and Storage of Social Security Account Numbers and Employer Identification Numbers § 400.403 Required system of records. Insurance providers are required to implement a system of records for obtaining, using...

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.

Cockpit Ocular Recording System (CORS)

NASA Technical Reports Server (NTRS)

Rothenheber, Edward; Stokes, James; Lagrossa, Charles; Arnold, William; Dick, A. O.

1990-01-01

The overall goal was the development of a Cockpit Ocular Recording System (CORS). Four tasks were used: (1) the development of the system; (2) the experimentation and improvement of the system; (3) demonstrations of the working system; and (4) system documentation. Overall, the prototype represents a workable and flexibly designed CORS system. For the most part, the hardware use for the prototype system is off-the-shelf. All of the following software was developed specifically: (1) setup software that the user specifies the cockpit configuration and identifies possible areas in which the pilot will look; (2) sensing software which integrates the 60 Hz data from the oculometer and heat orientation sensing unit; (3) processing software which applies a spatiotemporal filter to the lookpoint data to determine fixation/dwell positions; (4) data recording output routines; and (5) playback software which allows the user to retrieve and analyze the data. Several experiments were performed to verify the system accuracy and quantify system deficiencies. These tests resulted in recommendations for any future system that might be constructed.

Electronic health records and online medical records: an asset or a liability under current conditions?

PubMed

Allen-Graham, Judith; Mitchell, Lauren; Heriot, Natalie; Armani, Roksana; Langton, David; Levinson, Michele; Young, Alan; Smith, Julian A; Kotsimbos, Tom; Wilson, John W

2018-02-01

Objective The aim of the present study was to audit the current use of medical records to determine completeness and concordance with other sources of medical information. Methods Medical records for 40 patients from each of five Melbourne major metropolitan hospitals were randomly selected (n=200). A quantitative audit was performed for detailed patient information and medical record keeping, as well as data collection, storage and utilisation. Using each hospital's current online clinical database, scanned files and paperwork available for each patient audited, the reviewers sourced as much relevant information as possible within a 30-min time allocation from both the record and the discharge summary. Results Of all medical records audited, 82% contained medical and surgical history, allergy information and patient demographics. All audited discharge summaries lacked at least one of the following: demographics, medication allergies, medical and surgical history, medications and adverse drug event information. Only 49% of records audited showed evidence the discharge summary was sent outside the institution. Conclusions The quality of medical data captured and information management is variable across hospitals. It is recommended that medical history documentation guidelines and standardised discharge summaries be implemented in Australian healthcare services. What is known about this topic? Australia has a complex health system, the government has approved funding to develop a universal online electronic medical record system and is currently trialling this in an opt-out style in the Napean Blue Mountains (NSW) and in Northern Queensland. The system was originally named the personally controlled electronic health record but has since been changed to MyHealth Record (2016). In Victoria, there exists a wide range of electronic health records used to varying degrees, with some hospitals still relying on paper-based records and many using scanned medical records

Optimization of visual evoked potential (VEP) recording systems.

PubMed

Karanjia, Rustum; Brunet, Donald G; ten Hove, Martin W

2009-01-01

To explore the influence of environmental conditions on pattern visual evoked potential (VEP) recordings. Fourteen subjects with no known ocular pathology were recruited for the study. In an attempt to optimize the recording conditions, VEP recordings were performed in both the seated and recumbent positions. Comparisons were made between recordings using either LCD or CRT displays and recordings obtained in silence or with quiet background music. Paired recordings (in which only one variable was changed) were analyzed for changes in P100 latency, RMS noise, and variability. Baseline RMS noise demonstrated a significant decrease in the variability during the first 50msec accompanied by a 73% decrease in recording time for recumbent position when compared to the seated position (p<0.05). Visual evoked potentials recorded using LCD monitors demonstrated a significant increase in the P100 latency when compared to CRT recordings in the same subjects. The addition of background music did not affect the amount of RMS noise during the first 50msec of the recordings. This study demonstrates that the use of the recumbent position increases patient comfort and improves the signal to noise ratio. In contrast, the addition of background music to relax the patient did not improve the recording signal. Furthermore, the study illustrates the importance of avoiding low-contrast visual stimulation patterns obtained with LCD as they lead to higher latencies resulting in false positive recordings. These findings are important when establishing or modifying a pattern VEP recording protocol.

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

[Cooperation with the electronic medical record and accounting system of an actual dose of drug given by a radiology information system].

PubMed

Yamamoto, Hideo; Yoneda, Tarou; Satou, Shuji; Ishikawa, Toru; Hara, Misako

2009-12-20

By input of the actual dose of a drug given into a radiology information system, the system converting with an accounting system into a cost of the drug from the actual dose in the electronic medical record was built. In the drug master, the first unit was set as the cost of the drug, and we set the second unit as the actual dose. The second unit in the radiology information system was received by the accounting system through electronic medical record. In the accounting system, the actual dose was changed into the cost of the drug using the dose of conversion to the first unit. The actual dose was recorded on a radiology information system and electronic medical record. The actual dose was indicated on the accounting system, and the cost for the drug was calculated. About the actual dose of drug, cooperation of the information in a radiology information system and electronic medical record were completed. It was possible to decide the volume of drug from the correct dose of drug at the previous inspection. If it is necessary for the patient to have another treatment of medicine, it is important to know the actual dose of drug given. Moreover, authenticity of electronic medical record based on a statute has also improved.

76 FR 39394 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-06

...: The Department of the Navy is deleting a system of records notice in its existing inventory of record... Navy proposes to delete a systems of records notice from its inventory of record systems subject to the... operation. This system, Personnel Action Reporting System (PARS) was a sunset system and all records...

Electronic medical records and communication with patients and other clinicians: are we talking less?

PubMed

O'Malley, Ann S; Cohen, Genna R; Grossman, Joy M

2010-04-01

Commercial electronic medical records (EMRs) both help and hinder physician interpersonal communication--real-time, face-to-face or phone conversations--with patients and other clinicians, according to a new Center for Studying Health System Change (HSC) study based on in-depth interviews with clinicians in 26 physician practices. EMRs assist real-time communication with patients during office visits, primarily through immediate access to patient information, allowing clinicians to talk with patients rather than search for information from paper records. For some clinicians, however, aspects of EMRs pose a distraction during visits. Moreover, some indicated that clinicians may rely on EMRs for information gathering and transfer at the expense of real-time communication with patients and other clinicians. Given time pressures already present in many physician practices, EMR and office-work flow modifications could help ensure that EMRs advance care without compromising interpersonal communication. In particular, policies promoting EMR adoption should consider incorporating communication-skills training for medical trainees and clinicians using EMRs.

A computer-based medical record system and personal digital assistants to assess and follow patients with respiratory tract infections visiting a rural Kenyan health centre.

PubMed

Diero, Lameck; Rotich, Joseph K; Bii, John; Mamlin, Burke W; Einterz, Robert M; Kalamai, Irene Z; Tierney, William M

2006-04-10

Clinical research can be facilitated by the use of informatics tools. We used an existing electronic medical record (EMR) system and personal data assistants (PDAs) to assess the characteristics and outcomes of patients with acute respiratory illnesses (ARIs) visiting a Kenyan rural health center. We modified the existing EMR to include details on patients with ARIs. The EMR database was then used to identify patients with ARIs who were prospectively followed up by a research assistant who rode a bicycle to patients' homes and entered data into a PDA. A total of 2986 clinic visits for 2009 adult patients with respiratory infections were registered in the database between August 2002 and January 2005; 433 patients were selected for outcome assessments. These patients were followed up in the villages and assessed at 7 and 30 days later. Complete follow-up data were obtained on 381 patients (88%) and merged with data from the enrollment visit's electronic medical records and subsequent health center visits to assess duration of illness and complications. Symptoms improved at 7 and 30 days, but a substantial minority of patients had persistent symptoms. Eleven percent of patients sought additional care for their respiratory infection. EMRs and PDA are useful tools for performing prospective clinical research in resource constrained developing countries.

36 CFR 903.11 - Routine uses of records maintained in the system of records.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Routine uses of records maintained in the system of records. 903.11 Section 903.11 Parks, Forests, and Public Property PENNSYLVANIA AVENUE DEVELOPMENT CORPORATION PRIVACY ACT § 903.11 Routine uses of records maintained in the system of...

Patients, privacy and trust: patients' willingness to allow researchers to access their medical records.

PubMed

Damschroder, Laura J; Pritts, Joy L; Neblo, Michael A; Kalarickal, Rosemarie J; Creswell, John W; Hayward, Rodney A

2007-01-01

The federal Privacy Rule, implemented in the United States in 2003, as part of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), created new restrictions on the release of medical information for research. Many believe that its restrictions have fallen disproportionately on researchers prompting some to call for changes to the Rule. Here we ask what patients think about researchers' access to medical records, and what influences these opinions. A sample of 217 patients from 4 Veteran Affairs (VA) facilities deliberated in small groups at each location with the opportunity to question experts and inform themselves about privacy issues related to medical records research. After extensive deliberation, these patients were united in their inclination to share their medical records for research. Yet they were also united in their recommendations to institute procedures that would give them more control over whether and how their medical records are used for research. We integrated qualitative and quantitative results to derive a better understanding of this apparent paradox. Our findings can best be presented as answers to questions related to five dimensions of trust: Patients' trust in VA researchers was the most powerful determinant of the kind of control they want over their medical records. More specifically, those who had lower trust in VA researchers were more likely to recommend a more stringent process for obtaining individual consent. Insights on the critical role of trust suggest actions that researchers and others can take to more fully engage patients in research.

Mach-Zehnder interferometer-based recording system for WACO

NASA Astrophysics Data System (ADS)

Woerner, R.

1988-06-01

EG and G Energy Measurements, Inc., Los Alamos Operations (LAO) designed and built a Mach-Zehnder-interferometer-based recording system to record low-bandwidth pulses. This work was undertaken at the request of the Los Alamos National Laboratory, P-14 Fast Transient Plasma Measurement group. The system was fielded on WACO and its performance compared with that of a conventional recording system fielded on the same event. The results of the fielding showed that for low bandwidth applications like the WACO experiment, the M-Z-based system provides the same data quality and dynamic range as the conventional oscilloscope system, but it is far less complex and uses fewer recorders.

Accuracy of dialysis medical records in determining patients' interest in and suitability for transplantation.

PubMed

Huml, Anne M; Sullivan, Catherine M; Pencak, Julie A; Sehgal, Ashwini R

2013-01-01

We sought to determine the accuracy of dialysis medical records in identifying patients' interest in and suitability for transplantation. Cluster randomized controlled trial. A total of 167 patients recruited from 23 hemodialysis facilities. Navigators met with intervention patients to provide transplant information and assistance. Control patients continued to receive usual care. Agreement at study initiation between medical records and (i) patient self-reported interest in transplantation and (ii) study assessments of medical suitability for transplant referral. Medical record assessments, self-reports, and study assessments of patient's interest in and suitability for transplantation. There was disagreement between medical records and patient self-reported interest in transplantation for 66 (40%) of the 167 study patients. In most of these cases, patients reported being more interested in transplantation than their medical records indicated. The study team determined that all 92 intervention patients were medically suitable for transplant referral. However, for 38 (41%) intervention patients, medical records indicated that they were not suitable. About two-thirds of these patients successfully moved forward in the transplant process. Dialysis medical records are frequently inaccurate in determining patient's interest in and suitability for transplantation. © 2013 John Wiley & Sons A/S.

Finding Trapped Miners by Using a Prototype Seismic Recording System Made from Music-Recording Hardware

USGS Publications Warehouse

Pratt, Thomas L.

2009-01-01

The goal of this project was to use off-the-shelf music recording equipment to build and test a prototype seismic system to listen for people trapped in underground chambers (mines, caves, collapsed buildings). Previous workers found that an array of geophones is effective in locating trapped miners; displaying the data graphically, as well as playing it back into an audio device (headphones) at high speeds, was found to be effective for locating underground tapping. The desired system should record the data digitally to allow for further analysis, be capable of displaying the data graphically, allow for rudimentary analysis (bandpass filter, deconvolution), and allow the user to listen to the data at varying speeds. Although existing seismic reflection systems are adequate to record, display and analyze the data, they are relatively expensive and difficult to use and do not have an audio playback option. This makes it difficult for individual mines to have a system waiting on the shelf for an emergency. In contrast, music recording systems, like the one I used to construct the prototype system, can be purchased for about 20 percent of the cost of a seismic reflection system and are designed to be much easier to use. The prototype system makes use of an ~$3,000, 16-channel music recording system made by Presonus, Inc., of Baton Rouge, Louisiana. Other manufacturers make competitive systems that would serve equally well. Connecting the geophones to the recording system required the only custom part of this system - a connector that takes the output from the geophone cable and breaks it into 16 microphone inputs to be connected to the music recording system. The connector took about 1 day of technician time to build, using about $300 in off-the-shelf parts. Comparisons of the music recording system and a standard seismic reflection system (A 24-channel 'Geode' system manufactured by Geometrics, Inc., of San Jose, California) were carried out at two locations. Initial

Profiling Lung Cancer Patients Using Electronic Health Records.

PubMed

Menasalvas Ruiz, Ernestina; Tuñas, Juan Manuel; Bermejo, Guzmán; Gonzalo Martín, Consuelo; Rodríguez-González, Alejandro; Zanin, Massimiliano; González de Pedro, Cristina; Méndez, Marta; Zaretskaia, Olga; Rey, Jesús; Parejo, Consuelo; Cruz Bermudez, Juan Luis; Provencio, Mariano

2018-05-31

If Electronic Health Records contain a large amount of information about the patient's condition and response to treatment, which can potentially revolutionize the clinical practice, such information is seldom considered due to the complexity of its extraction and analysis. We here report on a first integration of an NLP framework for the analysis of clinical records of lung cancer patients making use of a telephone assistance service of a major Spanish hospital. We specifically show how some relevant data, about patient demographics and health condition, can be extracted; and how some relevant analyses can be performed, aimed at improving the usefulness of the service. We thus demonstrate that the use of EHR texts, and their integration inside a data analysis framework, is technically feasible and worth of further study.

42 CFR 2.2 - Statutory authority for confidentiality of alcohol abuse patient records.

Code of Federal Regulations, 2013 CFR

2013-10-01

... abuse patient records. 2.2 Section 2.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS Introduction § 2.2 Statutory authority for confidentiality of alcohol abuse patient records. The restrictions of...

42 CFR 2.2 - Statutory authority for confidentiality of alcohol abuse patient records.

Code of Federal Regulations, 2010 CFR

2010-10-01

... abuse patient records. 2.2 Section 2.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS Introduction § 2.2 Statutory authority for confidentiality of alcohol abuse patient records. The restrictions of...

42 CFR 2.2 - Statutory authority for confidentiality of alcohol abuse patient records.

Code of Federal Regulations, 2011 CFR

2011-10-01

... abuse patient records. 2.2 Section 2.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS Introduction § 2.2 Statutory authority for confidentiality of alcohol abuse patient records. The restrictions of...

42 CFR 2.2 - Statutory authority for confidentiality of alcohol abuse patient records.

Code of Federal Regulations, 2012 CFR

2012-10-01

... abuse patient records. 2.2 Section 2.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS Introduction § 2.2 Statutory authority for confidentiality of alcohol abuse patient records. The restrictions of...

42 CFR 2.2 - Statutory authority for confidentiality of alcohol abuse patient records.

Code of Federal Regulations, 2014 CFR

2014-10-01

... abuse patient records. 2.2 Section 2.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS Introduction § 2.2 Statutory authority for confidentiality of alcohol abuse patient records. The restrictions of...

An analysis of electronic health record-related patient safety incidents.

PubMed

Palojoki, Sari; Mäkelä, Matti; Lehtonen, Lasse; Saranto, Kaija

2017-06-01

The aim of this study was to analyse electronic health record-related patient safety incidents in the patient safety incident reporting database in fully digital hospitals in Finland. We compare Finnish data to similar international data and discuss their content with regard to the literature. We analysed the types of electronic health record-related patient safety incidents that occurred at 23 hospitals during a 2-year period. A procedure of taxonomy mapping served to allow comparisons. This study represents a rare examination of patient safety risks in a fully digital environment. The proportion of electronic health record-related incidents was markedly higher in our study than in previous studies with similar data. Human-computer interaction problems were the most frequently reported. The results show the possibility of error arising from the complex interaction between clinicians and computers.

78 FR 21599 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-11

...-05, 403-03 Injury Records, and K232.02, Injury Record File, are covered by the Government wide system of records notice OPM/GOVT-10, Employee Medical File System Records (June 21, 2010, 75 FR 35099...; System of Records AGENCY: Defense Information Systems Agency, DoD. ACTION: Notice to delete three Systems...

42 CFR 2.1 - Statutory authority for confidentiality of drug abuse patient records.

Code of Federal Regulations, 2012 CFR

2012-10-01

... HUMAN SERVICES GENERAL PROVISIONS CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS Introduction § 2.1 Statutory authority for confidentiality of drug abuse patient records. The restrictions of these regulations upon the disclosure and use of drug abuse patient records were initially authorized by section 408...

42 CFR 2.1 - Statutory authority for confidentiality of drug abuse patient records.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HUMAN SERVICES GENERAL PROVISIONS CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS Introduction § 2.1 Statutory authority for confidentiality of drug abuse patient records. The restrictions of these regulations upon the disclosure and use of drug abuse patient records were initially authorized by section 408...

42 CFR 2.1 - Statutory authority for confidentiality of drug abuse patient records.

Code of Federal Regulations, 2011 CFR

2011-10-01

... HUMAN SERVICES GENERAL PROVISIONS CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS Introduction § 2.1 Statutory authority for confidentiality of drug abuse patient records. The restrictions of these regulations upon the disclosure and use of drug abuse patient records were initially authorized by section 408...

42 CFR 2.1 - Statutory authority for confidentiality of drug abuse patient records.

Code of Federal Regulations, 2013 CFR

2013-10-01

... HUMAN SERVICES GENERAL PROVISIONS CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS Introduction § 2.1 Statutory authority for confidentiality of drug abuse patient records. The restrictions of these regulations upon the disclosure and use of drug abuse patient records were initially authorized by section 408...

42 CFR 2.1 - Statutory authority for confidentiality of drug abuse patient records.

Code of Federal Regulations, 2014 CFR

2014-10-01

... HUMAN SERVICES GENERAL PROVISIONS CONFIDENTIALITY OF ALCOHOL AND DRUG ABUSE PATIENT RECORDS Introduction § 2.1 Statutory authority for confidentiality of drug abuse patient records. The restrictions of these regulations upon the disclosure and use of drug abuse patient records were initially authorized by section 408...

Mach-Zehnder interferometer-based recording system for WACO

DOE Office of Scientific and Technical Information (OSTI.GOV)

Woerner, R.

1988-06-01

EG and G Energy Measurements, Inc., Los Alamos Operations (LAO) designed and built a Mach-Zehnder-interferometer-based recording system to record low-bandwidth pulses. This work was undertaken at the request of the Los Alamos National Laboratory, P-14 Fast Transient Plasma Measurement group. The system was fielded on WACO and its performance compared with that of a conventional recording system fielded on the same event. The results of the fielding showed that for low bandwidth applications like the WACO experiment, the M-Z-based system provides the same data quality and dynamic range as the conventional oscilloscope system, but it is far less complex andmore » uses fewer recorders. 4 figs.« less

Electronic medical records and the transgender patient: recommendations from the World Professional Association for Transgender Health EMR Working Group

PubMed Central

Deutsch, Madeline B; Green, Jamison; Keatley, JoAnne; Mayer, Gal; Hastings, Jennifer; Hall, Alexandra M

2013-01-01

Transgender patients have particular needs with respect to demographic information and health records; specifically, transgender patients may have a chosen name and gender identity that differs from their current legally designated name and sex. Additionally, sex-specific health information, for example, a man with a cervix or a woman with a prostate, requires special attention in electronic health record (EHR) systems. The World Professional Association for Transgender Health (WPATH) is an international multidisciplinary professional association that publishes recognized standards for the care of transgender and gender variant persons. In September 2011, the WPATH Executive Committee convened an Electronic Medical Records Working Group comprised of both expert clinicians and medical information technology specialists, to make recommendations for developers, vendors, and users of EHR systems with respect to transgender patients. These recommendations and supporting rationale are presented here. PMID:23631835

77 FR 2052 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-13

...; System of Records AGENCY: U.S. Strategic Command, DoD. ACTION: Notice to Add a System of Records. SUMMARY: The U.S. Strategic Command proposes to add a system of records to its inventory of record systems...: The U.S. Strategic Command systems of records notices subject to the Privacy Act of 1974 (5 U.S.C...

Increased patient communication using a process supplementing an electronic medical record.

PubMed

Garvey, Thomas D; Evensen, Ann E

2015-02-01

Importance: Patients with cervical cytology abnormalities may require surveillance for many years, which increases the risk of management error, especially in clinics with multiple managing clinicians. National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH) certification requires tracking of abnormal results and communicating effectively with patients. The purpose of this study was to determine whether a computer-based tracking system that is not embedded in the electronic medical record improves (1) accurate and timely communication of results and (2) patient adherence to follow-up recommendations. Design: Pre/post study using data from 2005-2012. Intervention implemented in 2008. Data collected via chart review for at least 18 months after index result. Participants: Pre-intervention: all women (N = 72) with first abnormal cytology result from 2005-2007. Post-intervention: all women (N = 128) with first abnormal cytology result from 2008-2010. Patients were seen at a suburban, university-affiliated, family medicine residency clinic. Intervention: Tracking spreadsheet reviewed monthly with reminders generated for patients not in compliance with recommendations. Main Outcome and Measures: (1) rates of accurate and timely communication of results and (2) rates of patient adherence to follow-up recommendations. Intervention decreased absent or erroneous communication from clinician to patient (6.4% pre- vs 1.6% post-intervention [P = 0.04]), but did not increase patient adherence to follow-up recommendations (76.1% pre- vs 78.0% post-intervention [ P= 0.78]). Use of a spreadsheet tracking system improved communication of abnormal results to patients, but did not significantly improve patient adherence to recommended care. Although the tracking system complies with NCQA PCMH requirements, it was insufficient to make meaningful improvements in patient-oriented outcomes.

77 FR 47641 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-09

...In accordance with the requirements of the Privacy Act of 1974, as amended (Privacy Act), the Federal Housing Finance Agency (FHFA) gives notice of and requests comments on the proposed revision of one existing system of records, the establishment of four new systems of records, and the removal of three existing systems of records notices. The revised existing system of records is ``Fraud Reporting System'' (FHFA-6). The proposed systems of records are: ``Visitor Badge, Employee and Contractor Personnel Day Pass, and Trackable Mail System'' (FHFA-17), ``Reasonable Accommodation Information System'' (FHFA-18), ``Computer Systems Activity and Access Records System'' (FHFA-19), and ``Telecommunications System'' (FHFA-20). In addition, upon the effective date of this notice, the Office of Federal Housing Enterprise Oversight systems of records notices, ``OFHEO-10 Reasonable Accommodation Information System'' (73 FR 19236 (April 9, 2008)), ``OFHEO-08 Computer Systems Activity and Access Records System'' (71 FR 6085 (February 6, 2006)), and ``OFHEO-09 Telecommunications System'' (71 FR 39123 (July 11, 2006)) will be removed.

Healthtrak(tm): Technology Enhanced Human Interface to the Computerized Patient Record

DTIC Science & Technology

2002-07-01

and/or findings contained in this report are those of the author( s ) and should not be construed as an official Department of the Army position...34: Technology Enhanced Human Interface to the DAMDI17-02-C-0032 Computerized Patient Record 6. AUTHOR( S ) Azad M. Madni, Ph.D. Doctor Weiwen Lin Carla...C. Madni 7. PERFORMING ORGANIZATION NAME( S ) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION REPORT NUMBER Intelligent Systems Technology, Incorporated

76 FR 76215 - Privacy Act; System of Records: State-78, Risk Analysis and Management Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-06

... network. Vetting requests, analyses, and results will be stored separately on a classified computer... DEPARTMENT OF STATE [Public Notice 7709] Privacy Act; System of Records: State-78, Risk Analysis... a system of records, Risk Analysis and Management Records, State-78, pursuant to the provisions of...

14 CFR 1212.605 - Safeguarding information in systems of records.

Code of Federal Regulations, 2010 CFR

2010-01-01

... requirements applicable to the system of records. (c) When records or copies of records are distributed to... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Safeguarding information in systems of... systems of records. (a) Safeguards appropriate for a NASA system of records shall be developed by the...

Ensuring Privacy When Integrating Patient-Based Datasets: New Methods and Developments in Record Linkage

PubMed Central

Brown, Adrian P.; Ferrante, Anna M.; Randall, Sean M.; Boyd, James H.; Semmens, James B.

2017-01-01

In an era where the volume of structured and unstructured digital data has exploded, there has been an enormous growth in the creation of data about individuals that can be used for understanding and treating disease. Joining these records together at an individual level provides a complete picture of a patient’s interaction with health services and allows better assessment of patient outcomes and effectiveness of treatment and services. Record linkage techniques provide an efficient and cost-effective method to bring individual records together as patient profiles. These linkage procedures bring their own challenges, especially relating to the protection of privacy. The development and implementation of record linkage systems that do not require the release of personal information can reduce the risks associated with record linkage and overcome legal barriers to data sharing. Current conceptual and experimental privacy-preserving record linkage (PPRL) models show promise in addressing data integration challenges. Enhancing and operationalizing PPRL protocols can help address the dilemma faced by some custodians between using data to improve quality of life and dealing with the ethical, legal, and administrative issues associated with protecting an individual’s privacy. These methods can reduce the risk to privacy, as they do not require personally identifying information to be shared. PPRL methods can improve the delivery of record linkage services to the health and broader research community. PMID:28303240

All together now: findings from a PCORI workshop to align patient-reported outcomes in the electronic health record

PubMed Central

Jensen, Roxanne E; Snyder, Claire F; Basch, Ethan; Frank, Lori; Wu, Albert W

2016-01-01

In recent years, patient-reported outcomes have become increasingly collected and integrated into electronic health records. However, there are few cross-cutting recommendations and limited guidance available in this rapidly developing research area. Our goal is to report key findings from a 2013 Patient-Centered Outcomes Research Institute workshop on this topic and a summary of actions that followed from the workshop, and present resulting recommendations that address patient, clinical and research/quality improvement barriers to regular use. These findings provide actionable guidance across research and practice settings to promote and sustain widespread adoption of patient-reported outcomes across patient populations, healthcare settings and electronic health record systems. PMID:27586855

All together now: findings from a PCORI workshop to align patient-reported outcomes in the electronic health record.

PubMed

Jensen, Roxanne E; Snyder, Claire F; Basch, Ethan; Frank, Lori; Wu, Albert W

2016-11-01

In recent years, patient-reported outcomes have become increasingly collected and integrated into electronic health records. However, there are few cross-cutting recommendations and limited guidance available in this rapidly developing research area. Our goal is to report key findings from a 2013 Patient-Centered Outcomes Research Institute workshop on this topic and a summary of actions that followed from the workshop, and present resulting recommendations that address patient, clinical and research/quality improvement barriers to regular use. These findings provide actionable guidance across research and practice settings to promote and sustain widespread adoption of patient-reported outcomes across patient populations, healthcare settings and electronic health record systems.

Privacy Act System of Records: Medical and Research Study Records of Human Volunteers, EPA-34

EPA Pesticide Factsheets

Learn about the Medical and Research Study Records of Human Volunteers System, including who is covered in the system, the purpose of data collection, routine uses for the system's records, and other security procedures.

75 FR 33791 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-15

...; System of Records AGENCY: Defense Intelligence Agency, DoD. ACTION: Notice to add a system of records. SUMMARY: The Defense Intelligence Agency proposes to add a system of records to its inventory of record...: The Defense Intelligence Agency systems of records notices subject to the Privacy Act of 1974, (5 U.S...

Using the eXtensible Markup Language (XML) in a regional electronic patient record for patients with malignant diseases.

PubMed

Wolff, A C; Mludek, V; van der Haak, M; Bork, W; Bülzebruck, H; Drings, P; Schmücker, P; Wannenmacher, M; Haux, R

2001-01-01

Communication between different institutions which are responsible for the treatment of the same patient is of outstanding significance, especially in the field of tumor diseases. Regional electronic patient records could support the co-operation of different institutions by providing ac-cess to all necessary information whether it belongs to the own institution or to a partner. The Department of Medical Informatics, University of Heidelberg is performing a project in co-operation with the Thoraxclinic-Heidelberg and the Department of Clinical Radiology, University of Heidelberg with the goal: to define an architectural concept for interlinking the electronic patient record of the two clinical institutions to build a common virtual electronic patient record and carry out an exemplary implementation, to examine composition, structure and content of medical documents for tumor patients with the aim of defining an XML-based markup language allowing summarizing overviews and suitable granularities, and to integrate clinical practice guidelines and other external knowledge with the electronic patient record using XML-technologies to support the physician in the daily decision process. This paper will show, how a regional electronic patient record could be built on an architectural level and describe elementary steps towards a on content-oriented structuring of medical records.

Patient-Centered Personal Health Record and Portal Implementation Toolkit for Ambulatory Clinics: A Feasibility Study.

PubMed

Nahm, Eun-Shim; Diblasi, Catherine; Gonzales, Eva; Silver, Kristi; Zhu, Shijun; Sagherian, Knar; Kongs, Katherine

2017-04-01

Personal health records and patient portals have been shown to be effective in managing chronic illnesses. Despite recent nationwide implementation efforts, the personal health record and patient portal adoption rates among patients are low, and the lack of support for patients using the programs remains a critical gap in most implementation processes. In this study, we implemented the Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit in a large diabetes/endocrinology center and assessed its preliminary impact on personal health record and patient portal knowledge, self-efficacy, patient-provider communication, and adherence to treatment plans. Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit is composed of Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit-General, clinic-level resources for clinicians, staff, and patients, and Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit Plus, an optional 4-week online resource program for patients ("MyHealthPortal"). First, Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit-General was implemented, and all clinicians and staff were educated about the center's personal health record and patient portal. Then general patient education was initiated, while a randomized controlled trial was conducted to test the preliminary effects of "MyHealthPortal" using a small sample (n = 74) with three observations (baseline and 4 and 12 weeks). The intervention group showed significantly greater improvement than the control group in patient-provider communication at 4 weeks (t56 = 3.00, P = .004). For other variables, the intervention group tended to show greater improvement; however, the differences were not significant. In this preliminary study, Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit showed potential for filling the gap in the current

Intraoperative non-record-keeping usage of anesthesia information management system workstations and associated hemodynamic variability and aberrancies.

PubMed

Wax, David B; Lin, Hung-Mo; Reich, David L

2012-12-01

Anesthesia information management system workstations in the anesthesia workspace that allow usage of non-record-keeping applications could lead to distraction from patient care. We evaluated whether non-record-keeping usage of the computer workstation was associated with hemodynamic variability and aberrancies. Auditing data were collected on eight anesthesia information management system workstations and linked to their corresponding electronic anesthesia records to identify which application was active at any given time during the case. For each case, the periods spent using the anesthesia information management system record-keeping module were separated from those spent using non-record-keeping applications. The variability of heart rate and blood pressure were also calculated, as were the incidence of hypotension, hypertension, and tachycardia. Analysis was performed to identify whether non-record-keeping activity was a significant predictor of these hemodynamic outcomes. Data were analyzed for 1,061 cases performed by 171 clinicians. Median (interquartile range) non-record-keeping activity time was 14 (1, 38) min, representing 16 (3, 33)% of a median 80 (39, 143) min of procedure time. Variables associated with greater non-record-keeping activity included attending anesthesiologists working unassisted, longer case duration, lower American Society of Anesthesiologists status, and general anesthesia. Overall, there was no independent association between non-record-keeping workstation use and hemodynamic variability or aberrancies during anesthesia either between cases or within cases. Anesthesia providers spent sizable portions of case time performing non-record-keeping applications on anesthesia information management system workstations. This use, however, was not independently associated with greater hemodynamic variability or aberrancies in patients during maintenance of general anesthesia for predominantly general surgical and gynecologic procedures.

77 FR 4025 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-26

...; System of Records AGENCY: U.S. Central Command, DoD. ACTION: Notice to Amend a System of Records. SUMMARY: The U.S. Central Command is amending a system of records notice in its existing inventory of record... INFORMATION: The U.S. Central Command systems of records notices subject to the Privacy Act of 1974 (5 U.S.C...

77 FR 51949 - Privacy Act, Exempt Record System

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-28

.... FDA-2011-N-0252] Office of the Secretary 45 CFR Part 5b Privacy Act, Exempt Record System AGENCY... Drug Administration (FDA) of the Department of Health and Human Services (HHS) will be implementing a new system of records, 09-10-0020, ``FDA Records Related to Research Misconduct Proceedings, HHS/FDA...

77 FR 51910 - Privacy Act, Exempt Record System

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-28

.... FDA-2011-N-0252] Office of the Secretary 45 CFR Part 5b Privacy Act, Exempt Record System AGENCY... and Drug Administration (FDA) of the Department of Health and Human Services (HHS) will be implementing a new system of records, 09-10-0020, ``FDA Records Related to Research Misconduct Proceedings, HHS...

12 CFR 310.3 - Procedures for requests pertaining to individual records in a system of records.

Code of Federal Regulations, 2010 CFR

2010-01-01

... individual records in a system of records. 310.3 Section 310.3 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE PRIVACY ACT REGULATIONS § 310.3 Procedures for requests pertaining to individual records in a system of records. (a) Any present or former employee of the Corporation...

12 CFR 310.3 - Procedures for requests pertaining to individual records in a system of records.

Code of Federal Regulations, 2011 CFR

2011-01-01

... individual records in a system of records. 310.3 Section 310.3 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE PRIVACY ACT REGULATIONS § 310.3 Procedures for requests pertaining to individual records in a system of records. (a) Any present or former employee of the Corporation...

12 CFR 310.3 - Procedures for requests pertaining to individual records in a system of records.

Code of Federal Regulations, 2014 CFR

2014-01-01

... individual records in a system of records. 310.3 Section 310.3 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE PRIVACY ACT REGULATIONS § 310.3 Procedures for requests pertaining to individual records in a system of records. (a) Any present or former employee of the Corporation...

12 CFR 310.3 - Procedures for requests pertaining to individual records in a system of records.

Code of Federal Regulations, 2013 CFR

2013-01-01

... individual records in a system of records. 310.3 Section 310.3 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE PRIVACY ACT REGULATIONS § 310.3 Procedures for requests pertaining to individual records in a system of records. (a) Any present or former employee of the Corporation...

12 CFR 310.3 - Procedures for requests pertaining to individual records in a system of records.

Code of Federal Regulations, 2012 CFR

2012-01-01

... individual records in a system of records. 310.3 Section 310.3 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION PROCEDURE AND RULES OF PRACTICE PRIVACY ACT REGULATIONS § 310.3 Procedures for requests pertaining to individual records in a system of records. (a) Any present or former employee of the Corporation...

Patients' Online Access to Their Primary Care Electronic Health Records and Linked Online Services: Implications for Research and Practice.

PubMed

Mold, Freda; de Lusignan, Simon

2015-12-04

Online access to medical records and linked services, including requesting repeat prescriptions and booking appointments, enables patients to personalize their access to care. However, online access creates opportunities and challenges for both health professionals and their patients, in practices and in research. The challenges for practice are the impact of online services on workload and the quality and safety of health care. Health professionals are concerned about the impact on workload, especially from email or other online enquiry systems, as well as risks to privacy. Patients report how online access provides a convenient means through which to access their health provider and may offer greater satisfaction if they get a timely response from a clinician. Online access and services may also result in unforeseen consequences and may change the nature of the patient-clinician interaction. Research challenges include: (1) Ensuring privacy, including how to control inappropriate carer and guardian access to medical records; (2) Whether online access to records improves patient safety and health outcomes; (3) Whether record access increases disparities across social classes and between genders; and (4) Improving efficiency. The challenges for practice are: (1) How to incorporate online access into clinical workflow; (2) The need for a business model to fund the additional time taken. Creating a sustainable business model for a safe, private, informative, more equitable online service is needed if online access to records is to be provided outside of pay-for-service systems.

77 FR 74851 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-18

... Corporation (FDIC) deletes one system of records from its existing inventory of systems of records subject to... FEDERAL DEPOSIT INSURANCE CORPORATION Privacy Act of 1974; System of Records AGENCY: Federal Deposit Insurance Corporation. ACTION: Notice to Delete a System of Records. SUMMARY: In accordance with...

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

75 FR 70342 - Privacy Act; System of Records: Equal Employment Opportunity Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-17

... users are given cyber security awareness training which covers the procedures for handling Sensitive but.... State-09 SYSTEM NAME: Equal Employment Opportunity Records. SECURITY CLASSIFICATION: Unclassified... apply to the Equal Employment Opportunity Records, State-09. DISCLOSURE TO CONSUMER REPORTING AGENCIES...

32 CFR 505.3 - Privacy Act systems of records.

Code of Federal Regulations, 2010 CFR

2010-07-01

... AND PUBLIC RELATIONS ARMY PRIVACY ACT PROGRAM § 505.3 Privacy Act systems of records. (a) Systems of... Register in a system of records notice, which will provide the public an opportunity to comment before DA... Register on new, amended, altered, or deleted systems of records to inform the public of the Privacy Act...

32 CFR 505.3 - Privacy Act systems of records.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 3 2014-07-01 2014-07-01 false Privacy Act systems of records. 505.3 Section... AUTHORITIES AND PUBLIC RELATIONS ARMY PRIVACY ACT PROGRAM § 505.3 Privacy Act systems of records. (a) Systems... assigned to an individual. (2) Privacy Act systems of records must be— (i) Authorized by Federal statute or...

32 CFR 505.3 - Privacy Act systems of records.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 3 2013-07-01 2013-07-01 false Privacy Act systems of records. 505.3 Section... AUTHORITIES AND PUBLIC RELATIONS ARMY PRIVACY ACT PROGRAM § 505.3 Privacy Act systems of records. (a) Systems... assigned to an individual. (2) Privacy Act systems of records must be— (i) Authorized by Federal statute or...

Digital Recording and Documentation of Endoscopic Procedures: Do Patients and Doctors Think Alike?

PubMed

Willner, Nadav; Peled-Raz, Maya; Shteinberg, Dan; Shteinberg, Michal; Keren, Dean; Rainis, Tova

2016-01-01

Aims and Methods. Conducting a survey study of a large number of patients and gastroenterologists aimed at identifying relevant predictors of interest in digital recording and documentation (DRD) of endoscopic procedures. Outpatients presenting to the endoscopy unit at our institution for an endoscopy examination were anonymously surveyed, regarding their views and opinions of a possible recording of the procedure. A parallel survey for gastroenterologists was conducted. Results. 417 patients and 62 gastroenterologists participated in two parallel surveys regarding DRD of endoscopic procedures. 66.4% of the patients expressed interest in digital documentation of their endoscopic procedure, with 90.5% of them requesting a copy. 43.6% of the physicians supported digital recording while 27.4% opposed it, with 48.4% opposing to making a copy of the recording available to the patient. No sociodemographic or background factors predicted patient's interest in DRD. 66% of the physicians reported having recording facilities in their institutions, but only 43.6% of them stated performing recording. Having institutional guidelines for DRD was found to be the only significant predictor for routine recording. Conclusions. Our study exposes patients' positive views of digital recording and documentation of endoscopic procedures. In contrast, physicians appear to be much more reluctant towards DRD and are centrally motivated by legal concerns when opposing DRD, as well as when supporting it.

77 FR 60400 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-03

...; System of Records AGENCY: Defense Finance and Accounting Service. ACTION: Notice to delete two systems of records. SUMMARY: The Defense Finance and Accounting Service is deleting two systems of records notices in.... SUPPLEMENTARY INFORMATION: The Defense Finance and Accounting Service systems of records notices subject to the...

78 FR 6078 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-29

...; System of Records AGENCY: Defense Finance and Accounting Service, DoD. ACTION: Notice to delete a system of records. SUMMARY: The Defense Finance and Accounting Service is deleting a system of records.... SUPPLEMENTARY INFORMATION: The Defense Finance and Accounting Service systems of records notices subject to the...

77 FR 65370 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-26

...; System of Records AGENCY: Defense Finance and Accounting Service, DoD. ACTION: Notice to delete a Systems of Records. SUMMARY: The Defense Finance and Accounting Service is deleting a system of records.... SUPPLEMENTARY INFORMATION: The Defense Finance and Accounting Service systems of records notices subject to the...

76 FR 7825 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-11

... practices for storing, retrieving, accessing, retaining, and disposing of records in the system: Storage..., accessing, retaining, and disposing of records in the system: Storage: Paper file folders. Retrievability...; System of Records AGENCY: Office of the Secretary, DoD. ACTION: Notice to alter a system of records...

75 FR 17910 - Privacy Act of 1974; Systems of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-08

...; Systems of Records AGENCY: Defense Logistics Agency, DoD. ACTION: Notice to delete a system of records. SUMMARY: The Defense Logistics Agency proposes to delete a system of records notice in its existing...-5045. SUPPLEMENTARY INFORMATION: The Defense Logistics Agency systems of records notices subject to the...

75 FR 15694 - Privacy Act of 1974; Systems of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-30

...; Systems of Records AGENCY: Defense Logistics Agency, DoD. ACTION: Notice to delete a system of records. SUMMARY: The Defense Logistics Agency proposes to delete a system of records notice in its existing...-5045. SUPPLEMENTARY INFORMATION: The Defense Logistics Agency systems of records notices subject to the...

75 FR 33792 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-15

... instructions for submitting comments. Mail: Federal Docket Management System Office, 1160 Defense Pentagon...; System of Records AGENCY: Defense Intelligence Agency, DoD. ACTION: Notice to add a system of records. SUMMARY: The Defense Intelligence proposes to add a system of records notice to its inventory of record...

75 FR 19377 - Privacy Act of 1974; Systems of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-14

...; Systems of Records AGENCY: Defense Logistics Agency, DoD. ACTION: Notice to alter a system of records. SUMMARY: The Defense Logistics Agency proposes to alter a system of records notice in its existing...-5045. SUPPLEMENTARY INFORMATION: The Defense Logistics Agency systems of records notices subject to the...

75 FR 10473 - Privacy Act of 1974; Systems of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-08

...; Systems of Records AGENCY: Defense Logistics Agency, DoD. ACTION: Notice to amend a system of records. SUMMARY: The Defense Logistics Agency proposes to amend a system of records notice in its existing...-5045. SUPPLEMENTARY INFORMATION: The Defense Logistics Agency systems of records notices subject to the...

75 FR 30791 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-02

...; System of Records AGENCY: Defense Intelligence Agency, DoD. ACTION: Notice to alter a system of records. SUMMARY: The Defense Intelligence Agency is proposing to alter a system of records in its existing... Lowery at (202) 231-1193. SUPPLEMENTARY INFORMATION: The Defense Intelligence Agency system of records...

Efficacy of monitoring patient's position during neurosurgical procedures: introduction of real-time display and record.

PubMed

Hasegawa, Mitsuhiro; Nouri, Mohsen; Fujisawa, Hironori; Hayashi, Yutaka; Inamasu, Joji; Hirose, Yuichi; Yamashita, Junkoh

2015-01-01

There are many reports on position-related complications in neurosurgical literature but so far, continuous quantification of the patient's position during the surgery has not been reported. This study aims to explore the utility of a new surgical table system and its software in displaying the patient's body positions during surgery on real-time basis. More than 200 neurosurgical cases were monitored for their positions intra-operatively. The position was digitally recorded and could be seen by all the members in the operating team. It also displayed the three-dimensional relationship between the head and the heart positions. No position-related complications were observed during the study. The system was able to serve as an excellent indicator for monitoring the patient's position. The recordings were analyzed and even used to reproduce or improve the position in the subsequent operations. The novel technique of monitoring the position of the head and the heart of the patients and the operating table planes are considered to be useful during delicate neurosurgical procedures thereby, preventing inadvertent procedural errors. This can be used to quantify various surgical positions in the future and define safety measures accordingly.

32 CFR 505.3 - Privacy Act systems of records.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 3 2011-07-01 2009-07-01 true Privacy Act systems of records. 505.3 Section 505... AND PUBLIC RELATIONS ARMY PRIVACY ACT PROGRAM § 505.3 Privacy Act systems of records. (a) Systems of... assigned to an individual. (2) Privacy Act systems of records must be— (i) Authorized by Federal statute or...

32 CFR 505.3 - Privacy Act systems of records.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 3 2012-07-01 2009-07-01 true Privacy Act systems of records. 505.3 Section 505... AND PUBLIC RELATIONS ARMY PRIVACY ACT PROGRAM § 505.3 Privacy Act systems of records. (a) Systems of... assigned to an individual. (2) Privacy Act systems of records must be— (i) Authorized by Federal statute or...

78 FR 27194 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-09

...; System of Records AGENCY: Defense Finance and Accounting Service, DoD. ACTION: Notice to delete a System of Records. SUMMARY: The Defense Finance and Accounting Service is deleting a system of records...: The Defense Finance and Accounting Service systems of records notices subject to the Privacy Act of...

78 FR 69392 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-19

...; System of Records AGENCY: Defense Finance and Accounting Service, DoD. ACTION: Notice to delete a system of records. SUMMARY: The Defense Finance and Accounting Service is deleting a system of records... INFORMATION: The Defense Finance and Accounting Service systems of records notices subject to the Privacy Act...

78 FR 27194 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-09

...; System of Records AGENCY: Defense Finance and Accounting Service, DoD. ACTION: Notice to delete two Systems of Records. SUMMARY: The Defense Finance and Accounting Service is deleting two systems of records...: The Defense Finance and Accounting Service systems of records notices subject to the Privacy Act of...

75 FR 20580 - Privacy Act of 1974; Systems of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-20

...; Systems of Records AGENCY: Defense Logistics Agency, DoD. ACTION: Notice to amend a system of records. SUMMARY: The Defense Logistics Agency proposes to amend a system of records notice in its existing.... SUPPLEMENTARY INFORMATION: The Defense Logistics Agency systems of records notices subject to the Privacy Act of...

77 FR 77048 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-31

...; System of Records AGENCY: Defense Contract Audit Agency, DoD. ACTION: Notice to amend a System of Records. SUMMARY: The Defense Contract Audit Agency is amending a system of records notice in its existing.... SUPPLEMENTARY INFORMATION: The Defense Contract Audit Agency systems of records notices subject to the Privacy...

78 FR 27195 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-09

...; System of Records AGENCY: Defense Finance and Accounting Service, DoD. ACTION: Notice to delete two Systems of Records. SUMMARY: The Defense Finance and Accounting Service is deleting two systems of records...: The Defense Finance and Accounting Service systems of records notices subject to the Privacy Act of...

78 FR 31905 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-28

...; System of Records AGENCY: Defense Finance and Accounting Service, DoD. ACTION: Notice to amend a System of Records. SUMMARY: The Defense Finance and Accounting Service is amending a system of records...: The Defense Finance and Accounting Service systems of records notices subject to the Privacy Act of...

78 FR 31909 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-28

... (703) 428-6185. SUPPLEMENTARY INFORMATION: The Department of the Army systems of records notices...; System of Records AGENCY: Department of the Army, DoD. ACTION: Notice to delete two Systems of Records. SUMMARY: The Department of the Army is deleting two systems of records notices in its existing inventory...

Using standardised patients to measure physicians' practice: validation study using audio recordings

PubMed Central

Luck, Jeff; Peabody, John W

2002-01-01

Objective To assess the validity of standardised patients to measure the quality of physicians' practice. Design Validation study of standardised patients' assessments. Physicians saw unannounced standardised patients presenting with common outpatient conditions. The standardised patients covertly tape recorded their visit and completed a checklist of quality criteria immediately afterwards. Their assessments were compared against independent assessments of the recordings by a trained medical records abstractor. Setting Four general internal medicine primary care clinics in California. Participants 144 randomly selected consenting physicians. Main outcome measures Rates of agreement between the patients' assessments and independent assessment. Results 40 visits, one per standardised patient, were recorded. The overall rate of agreement between the standardised patients' checklists and the independent assessment of the audio transcripts was 91% (κ=0.81). Disaggregating the data by medical condition, site, level of physicians' training, and domain (stage of the consultation) gave similar rates of agreement. Sensitivity of the standardised patients' assessments was 95%, and specificity was 85%. The area under the receiver operator characteristic curve was 90%. Conclusions Standardised patients' assessments seem to be a valid measure of the quality of physicians' care for a variety of common medical conditions in actual outpatient settings. Properly trained standardised patients compare well with independent assessment of recordings of the consultations and may justify their use as a “gold standard” in comparing the quality of care across sites or evaluating data obtained from other sources, such as medical records and clinical vignettes. What is already known on this topicStandardised patients are valid and reliable reporters of physicians' practice in the medical education settingHowever, validating standardised patients' measurements of quality of care in

The patient perspective on the effects of medical record accessibility: a systematic review.

PubMed

Vermeir, Peter; Degroote, Sophie; Vandijck, Dominique; Van Tiggelen, Hanne; Peleman, Renaat; Verhaeghe, Rik; Mariman, An; Vogelaers, Dirk

2017-06-01

Health care is shifting from a paternalistic to a participatory model, with increasing patient involvement. Medical record accessibility to patients may contribute significantly to patient comanagement. To systematically review the literature on the patient perspective of effects of personal medical record accessibility on the individual patient, patient-physician relationship and quality of medical care. Screening of PubMed, Web of Science, Cinahl, and Cochrane Library on the keywords 'medical record', 'patient record', 'communication', 'patient participation', 'doctor-patient relationship', 'physician-patient relationship' between 1 January 2002 and 31 January 2016; systematic review after assessment for methodological quality. Out of 557 papers screened, only 12 studies qualified for the systematic review. Only a minority of patients spontaneously request access to their medical file, in contrast to frequent awareness of this patient right and the fact that patients in general have a positive view on open visit notes. The majority of those who have actually consulted their file are positive about this experience. Access to personal files improves adequacy and efficiency of communication between physician and patient, in turn facilitating decision-making and self-management. Increased documentation through patient involvement and feedback on the medical file reduces medical errors, in turn increasing satisfaction and quality of care. Information improvement through personal medical file accessibility increased reassurance and a sense of involvement and responsibility. From the patient perspective medical record accessibility contributes to co-management of personal health care.

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

An information system for epidemiology based on a computer-based medical record.

PubMed

Verdier, C; Flory, A

1994-12-01

A new way is presented to build an information system addressed to problems in epidemiology. Based on our analysis of current and future requirements, a system is proposed which allows for collection, organization and distribution of data within a computer network. In this application, two broad communities of users-physicians and epidemiologists-can be identified, each with their own perspectives and goals. The different requirements of each community lead us to a client-service centered architecture which provides the functionality requirements of the two groups. The resulting physician workstation provides help for recording and querying medical information about patients and from a pharmacological database. All information is classified and coded in order to be retrieved for pharmaco-economic studies. The service center receives information from physician workstations and permits organizations that are in charge of statistical studies to work with "real" data recorded during patient encounters. This leads to a new approach in epidemiology. Studies can be carried out with a more efficient data acquisition. For modelling the information system, we use an object-oriented approach. We have observed that the object-oriented representation, particularly its concepts of generalization, aggregation and encapsulation, are very usable for our problem.

75 FR 4788 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-29

... practices for storing, retrieving, accessing, retaining, and disposing of records in the system: Storage...; System of Records AGENCY: Office of the Secretary, DoD. ACTION: Notice to add a system of records. SUMMARY: The Office of the Secretary of Defense is proposing to add a system of records notice to its...

77 FR 35945 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-15

...; System of Records AGENCY: Defense Logistics Agency, DoD. ACTION: Notice To Amend a system of records. SUMMARY: The Defense Logistics Agency is proposing to amend a system of records in its inventory of record.... Mail: Federal Docket Management System Office, 4800 Mark Center Drive, East Tower, 2nd Floor, Suite...

77 FR 21755 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-11

...; System of Records AGENCY: Defense Logistics Agency, DoD. ACTION: Notice to amend a system of records. SUMMARY: The Defense Logistics Agency is proposing to amend a system of records in its inventory of record.... Mail: Federal Docket Management System Office, 4800 Mark Center Drive, East Tower, 2nd Floor, Suite...

75 FR 13089 - Privacy Act of 1974; Systems of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-18

...; Systems of Records AGENCY: Defense Intelligence Agency, (DoD). ACTION: Notice to amend a system of records. SUMMARY: The Defense Intelligence Agency proposes to amend a system of records notice of its inventory of... INFORMATION: The Defense Intelligence Agency notices for systems of records subject to the Privacy Act of 1974...

78 FR 14282 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-05

...; System of Records AGENCY: Defense Contract Audit Agency, DoD. ACTION: Notice to alter a System of Records. SUMMARY: The Defense Contract Audit Agency proposes to alter a system of records in its inventory of.... SUPPLEMENTARY INFORMATION: The Defense Contract Audit Agency notices for systems of records subject to the...

78 FR 14284 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-05

...; System of Records AGENCY: Defense Contract Audit Agency, DoD. ACTION: Notice to alter a System of Records. SUMMARY: The Defense Contract Audit Agency proposes to alter a system of records in its inventory of.... SUPPLEMENTARY INFORMATION: The Defense Contract Audit Agency notices for systems of records subject to the...

78 FR 47309 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-05

...; System of Records AGENCY: Defense Finance and Accounting Service, DoD. ACTION: Notice to amend a System of Records. SUMMARY: The Defense Finance and Accounting Service proposes to alter a system of records... Defense Finance and Accounting Service systems of records notices subject to the Privacy Act of 1974 (5 U...

78 FR 41921 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-12

... amended. This system serves as a legal basis for confinement and correctional records. DATES: This...; System of Records AGENCY: Department of the Navy, DoD. ACTION: Notice to alter a System of Records. SUMMARY: The Department of the Navy proposes to alter a system of records, NM01640-1, Individual...

77 FR 26260 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-03

.... * Mail: Federal Docket Management System Office, 4800 Mark Center Drive, East Tower, 2nd Floor, Suite...; System of Records AGENCY: Defense Logistics Agency, DoD. ACTION: Notice to alter a system of records. SUMMARY: The Defense Logistics Agency proposes to alter a system of records in its inventory of record...

Patient Core Data Set. Standard for a longitudinal health/medical record.

PubMed

Renner, A L; Swart, J C

1997-01-01

Blue Chip Computers Company, in collaboration with Wright State University-Miami Valley College of Nursing and Health, with support from the Agency for Health Care Policy and Research, Public Health Service, completed Small Business innovative Research research to design a comprehensive integrated Patient information System. The Wright State University consultants undertook the development of a Patient Core Data Set (PCDS) in response to the lack of uniform standards of minimum data sets, and lack of standards in data transfer for continuity of care. The purpose of the Patient Core Data Set is to develop a longitudinal patient health record and medical history using a common set of standard data elements with uniform definitions and coding consistent with Health Level 7 (HL7) protocol and the American Society for Testing and Materials (ASTM) standards. The PCDS, intended for transfer across all patient-care settings, is essential information for clinicians, administrators, researchers, and health policy makers.

13 CFR 102.33 - Security of systems of records.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Security of systems of records....33 Security of systems of records. (a) Each Program/Support Office Head or designee shall establish administrative and physical controls to prevent unauthorized access to its systems of records, to prevent...

Integration of healthcare information: from enterprise PACS to patient centered multimedia health record.

PubMed

Soriano, Enrique; Plazzotta, Fernando; Campos, Fernando; Kaminker, Diego; Cancio, Alfredo; Aguilera Díaz, Jerónimo; Luna, Daniel; Seehaus, Alberto; Carcía Mónaco, Ricardo; de Quirós, Fernán González Bernaldo

2010-01-01

Every single piece of healthcare information should be fully integrated and transparent within the electronic health record. The Italian Hospital of Buenos Aires initiated the project Multimedia Health Record with the goal to achieve this integration while maintaining a holistic view of current structure of the systems of the Hospital, where the axis remains are the patient and longitudinal history, commencing with section Computed Tomography. Was implemented DICOM standard for communication and image storage and bought a PACS. It was necessary adapt our generic reporting system for live up to the commercial RIS. The Computerized Tomography (CT) Scanners of our hospital were easily integrated into the DICOM network and all the CT Scans generated by our radiology service were stored in the PACS, reported using the Structured Reporting System (we installed diagnostic terminals equipped with 3 monitors) and displayed in the EHR at any point of HIBA's healthcare network.

Recording stereoscopic 3D neurosurgery with a head-mounted 3D camera system.

PubMed

Lee, Brian; Chen, Brian R; Chen, Beverly B; Lu, James Y; Giannotta, Steven L

2015-06-01

Stereoscopic three-dimensional (3D) imaging can present more information to the viewer and further enhance the learning experience over traditional two-dimensional (2D) video. Most 3D surgical videos are recorded from the operating microscope and only feature the crux, or the most important part of the surgery, leaving out other crucial parts of surgery including the opening, approach, and closing of the surgical site. In addition, many other surgeries including complex spine, trauma, and intensive care unit procedures are also rarely recorded. We describe and share our experience with a commercially available head-mounted stereoscopic 3D camera system to obtain stereoscopic 3D recordings of these seldom recorded aspects of neurosurgery. The strengths and limitations of using the GoPro(®) 3D system as a head-mounted stereoscopic 3D camera system in the operating room are reviewed in detail. Over the past several years, we have recorded in stereoscopic 3D over 50 cranial and spinal surgeries and created a library for education purposes. We have found the head-mounted stereoscopic 3D camera system to be a valuable asset to supplement 3D footage from a 3D microscope. We expect that these comprehensive 3D surgical videos will become an important facet of resident education and ultimately lead to improved patient care.

42 CFR 491.10 - Patient health records.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Patient health records. 491.10 Section 491.10 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CERTIFICATION OF CERTAIN HEALTH FACILITIES Rural Health Clinics...

42 CFR 491.10 - Patient health records.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Patient health records. 491.10 Section 491.10 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CERTIFICATION OF CERTAIN HEALTH FACILITIES Rural Health Clinics...

42 CFR 491.10 - Patient health records.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Patient health records. 491.10 Section 491.10 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CERTIFICATION OF CERTAIN HEALTH FACILITIES Rural Health Clinics...

42 CFR 491.10 - Patient health records.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 5 2013-10-01 2013-10-01 false Patient health records. 491.10 Section 491.10 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CERTIFICATION OF CERTAIN HEALTH FACILITIES Rural Health Clinics...

42 CFR 491.10 - Patient health records.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 5 2012-10-01 2012-10-01 false Patient health records. 491.10 Section 491.10 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CERTIFICATION OF CERTAIN HEALTH FACILITIES Rural Health Clinics...

Compact reflection holographic recording system with high angle multiplexing

NASA Astrophysics Data System (ADS)

Kanayasu, Mayumi; Yamada, Takehumi; Takekawa, Shunsuke; Akieda, Kensuke; Goto, Akiyo; Yamamoto, Manabu

2011-02-01

Holographic memory systems have been widely researched since 1963. However, the size of the drives required and the deterioration of reconstructed data resulting from shrinkage of the medium have made practical use of a hologram memory difficult. In light of this, we propose a novel holographic recording/reconstructing system: a dual-reference beam reflection system that is smaller than conventional systems such as the off-axis or co-axis types, and which is expected to increase the number of multiplexing in angle multiplexed recording. In this multiplex recording system, two laser beams are used as reference beams, and the recorded data are reconstructed stably, even if there is shrinkage of the recording medium. In this paper, a reflection holographic memory system is explained in detail. In addition, the change in angle selectivity resulting from shrinkage of the medium is analyzed using the laminated film three-dimensional simulation method. As a result, we demonstrate that a dual-reference beam multiplex recording system is effective in reducing the influence of medium shrinkage.

Examination of an Electronic Patient Record Display Method to Protect Patient Information Privacy.

PubMed

Niimi, Yukari; Ota, Katsumasa

2017-02-01

Electronic patient records facilitate the provision of safe, high-quality medical care. However, because personnel can view almost all stored information, this study designed a display method using a mosaic blur (pixelation) to temporarily conceal information patients do not want shared. This study developed an electronic patient records display method for patient information that balanced the patient's desire for personal information protection against the need for information sharing among medical personnel. First, medical personnel were interviewed about the degree of information required for both individual duties and team-based care. Subsequently, they tested a mock display method that partially concealed information using a mosaic blur, and they were interviewed about the effectiveness of the display method that ensures patient privacy. Participants better understood patients' demand for confidentiality, suggesting increased awareness of patients' privacy protection. However, participants also indicated that temporary concealment of certain information was problematic. Other issues included the inconvenience of removing the mosaic blur to obtain required information and risk of insufficient information for medical care. Despite several issues with using a display method that temporarily conceals information according to patient privacy needs, medical personnel could accept this display method if information essential to medical safety remains accessible.

76 FR 6767 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-08

... DEPARTMENT OF DEFENSE Department of the Navy [Docket ID USN-2011-0002] Privacy Act of 1974; System of Records AGENCY: Department of the Navy, DoD. ACTION: Notice to Alter a System of Records. SUMMARY: The Department of the Navy proposes to alter a system of records in its inventory of record systems...

75 FR 81247 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-27

...; System of Records AGENCY: Defense Intelligence Agency, DoD. ACTION: Notice to delete a system of records. SUMMARY: The Defense Intelligence Agency proposes to delete a system of records notice in its existing... Defense Intelligence Agency systems of records notices subject to the Privacy Act of 1974, (5 U.S.C. 552a...

77 FR 26260 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-03

...; System of Records AGENCY: Defense Intelligence Agency, DoD. ACTION: Notice to Delete a System of Records. SUMMARY: The Defense Intelligence Agency proposes to delete a system of records notice in its existing...: The Defense Intelligence Agency systems of records notices subject to the Privacy Act of 1974 (5 U.S.C...

76 FR 10010 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-23

...; System of Records AGENCY: Defense Intelligence Agency, DoD. ACTION: Notice to Delete a System of Records. SUMMARY: The Defense Intelligence Agency proposes to delete a system of records notice in its existing... Defense Intelligence Agency systems of records notices subject to the Privacy Act of 1974, (5 U.S.C. 552a...

76 FR 115 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-03

...; System of Records AGENCY: Defense Contract Audit Agency, DoD. ACTION: Notice to amend a system of records. SUMMARY: The Defense Contract Audit Agency is proposing to amend a system of records notice in its... INFORMATION: The Defense Contract Audit Agency systems of records notices subject to the Privacy Act of 1974...

76 FR 114 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-03

...; System of Records AGENCY: Defense Contract Audit Agency, DoD. ACTION: Notice to amend a system of records. SUMMARY: The Defense Contract Audit Agency is proposing to amend a system of records notice in its... INFORMATION: The Defense Contract Audit Agency systems of records notices subject to the Privacy Act of 1974...

78 FR 73514 - Privacy Act of 1974; System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-06

...; System of Records AGENCY: Department of the Navy, DoD. ACTION: Notice to alter a System of Records. SUMMARY: The Department of the Navy proposes to alter the system of records, N01001-1, entitled ``Database of Reserve/Retired Judge Advocates and Legalmen'' in its inventory of record systems subject to the...

The Role of Personal Health Record Systems in Chronic Disease Management.

PubMed

Prashad, Reshma

2017-01-01

Chronic illnesses account for the largest portion of healthcare spending in Canada; they are the leading cause of premature death. As a result, healthcare organizations are focused on improving both health and financial outcomes. Addressing chronic illnesses involves more frequent and impactful interactions with both current patients and those at risk of developing a chronic condition. This transformation requires that healthcare organizations shift from a system based solely on in-person interactions to one that leverages digital solutions that support interactions regardless of the patients' location. Personal health record systems (PHRS) can facilitate patients' access to their health data at any time of the day, anywhere in the world. PHRS also offers a myriad of features to help providers' engage, educate and empower patients to make proactive and preventive care a reality. Discussed in this paper are the ways in which PHRS can support the optimal management of chronic conditions and the current barriers to widespread adoption.

Leveraging the Value of Human Relationships to Improve Health Outcomes. Lessons learned from the OpenMRS Electronic Health Record System.

PubMed

Kasthurirathne, Suranga N; Mamlin, Burke W; Cullen, Theresa

2017-02-01

Despite significant awareness on the value of leveraging patient relationships across the healthcare continuum, there is no research on the potential of using Electronic Health Record (EHR) systems to store structured patient relationship data, or its impact on enabling better healthcare. We sought to identify which EHR systems supported effective patient relationship data collection, and for systems that do, what types of relationship data is collected, how this data is used, and the perceived value of doing so. We performed a literature search to identify EHR systems that supported patient relationship data collection. Based on our results, we defined attributes of an effective patient relationship model. The Open Medical Record System (OpenMRS), an open source medical record platform for underserved settings met our eligibility criteria for effective patient relationship collection. We performed a survey to understand how the OpenMRS patient relationship model was used, and how it brought value to implementers. The OpenMRS patient relationship model has won widespread adoption across many implementations and is perceived to be valuable in enabling better health care delivery. Patient relationship information is widely used for community health programs and enabling chronic care. Additionally, many OpenMRS implementers were using this feature to collect custom relationship types for implementation specific needs. We believe that flexible patient relationship data collection is critical for better healthcare, and can inform community care and chronic care initiatives across the world. Additionally, patient relationship data could also be leveraged for many other initiatives such as patient centric care and in the field of precision medicine.

Communication and the electronic health record training: a comparison of three healthcare systems.