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Practices in maintaining veterinarymedicalrecords have changed greatly during the past decade. Computerization is largely responsible for this trend. This article brings readers up to date on veterinary recordkeeping. PMID:10108644
Iraq is an agricultural country with a large population of animals: sheep, goats, cattle, water buffaloes, horses, donkeys, mules, and camels. In the 1980s, the successful poultry industry managed to produce enough table eggs and meat to satisfy the needs of the entire population; at one time, the thriving fish industry produced different types of fish for Iraqis' yearly fish consumption. There are four veterinary colleges in Iraq, which have been destroyed along with the veterinary services infrastructure. Understandably, improvements to the quality of veterinary education and services in Iraq will be reflected in a healthy and productive animal industry, better food quality and quantity, fewer zoonotic diseases, and more income-generating activities in rural areas. Thus, if undergraduate, graduate, and continuing education programs are improved, the veterinarymedical profession will attract more competent students. This will satisfy the country's increased demand for competent veterinarians in both public and private sectors. Although Iraq has an estimated 5,000-7,000 veterinarians, there is a need for quality veterinary services and for more veterinarians. In addition, there is a need for the improvement of veterinary diagnostic facilities, as zoonotic diseases are always highly probable in this region. This article provides insight into the status of veterinarymedical education and veterinary services in Iraq before and after the 1991 Gulf War and gives suggestions for improvement and implementation of new programs. Suggestions are also offered for improving veterinary diagnostic facilities and the quality of veterinary services. Improving diagnostic facilities and the quality of veterinary services will enhance animal health and production in Iraq and will also decrease the likelihood of disease transmission to and from Iraq. Threats of disease transmission and introduction into the country have been observed and reported by several international organizations. PMID:15551223
The study of veterinary medicine is becoming increasingly important in the progress of human medicine, and as a consequence the literature of veterinary medicine is assuming increased importance in the libraries of schools of human medicine. In the past decade programs in comparative medicine have been initiated in many centers, reestablishing the linkage between veterinary and human medicine. Since 1966 the National Library of Medicine has assumed extra responsibilities in the collection and control of veterinarymedical literature. increased indexing has thus far been the major result, with a resultant increase in the need to consult veterinary journals. Advances in the veterinary curriculum and continued veterinary education have also increased demand for veterinary publications. Such demand must be foreseen and met by medical school libraries if they are to fulfill their obligations to the scholarly medical community.
This annual price study is the seventh derived from the Basic List of Veterinary Serials, 2d edition. The basic list is in three parts-core veterinarymedical serials, an adjunct list of serials in the biomedical and life sciences, and relevant indexing and abstracting services. The Faxon Company supplied prices for all years. With this seventh study, indexing on a base
The VeterinaryMedical Database (VMDB) is a summary of veterinarymedicalrecords from North American veterinary schools, and is a potential source of disease surveillance information for companion animals. A retrospective record search from four U.S. university veterinary teaching hospitals was used to calculate crude disease rates. Our objectives were to evaluate the utility of the database for disease surveillance purposes by comparing the utility of two methodologies for creating disease categories, and to evaluate the database for evidence of referral bias. Summaries of the medicalrecords from November 2006 to October 2007 for 9577 dogs and 4445 cats were retrieved from VMDB for all canines and felines treated at Kansas State University, Colorado State University, Purdue University and Ohio State University. Disease frequency, computed as apparent period-prevalence and as the percentage of veterinary visits, was compiled for 30 disease categories that were formulated by one of two methods. To assess the possible impact of referral bias, disease rates were compared between animals residing in zip codes within 5 miles of the hospitals (zone 1) and those animals living at more distant locations (zone 2). When compared to zone 1 animals, disease conditions commonly associated with primary veterinary care were reduced by 29-76% within zone 2, and selected diseases generally associated with more specialized care were increased from 46 to 80% among zone 2 animals. The major differences in disease prevalence seen between zones suggests that substantial referral bias may exist, and that adjustment on the basis of geographical proximity to the university teaching hospitals may be useful in reducing this type of selection bias in the VMDB, thereby improve the accuracy of prevalence estimates and enhancing the utility of this database for purposes of disease surveillance. PMID:20129684
Bartlett, Paul C; Van Buren, James W; Neterer, Margaret; Zhou, Chun
... paper, through your personal medical history. What Are MedicalRecords? Each time you hop up on a ... place to keep them private. What's in My MedicalRecords? You might picture your medicalrecords as ...
A brief survey was conducted of nearly 900 first-year students in 14 U.S. veterinarymedical schools in order to gather impressions of the first year of veterinarymedical education. Although some students reported that conditions were stressful, the majority did not feel that they were inordinately so. Overall, most students were quite positive…
The American VeterinaryMedical Association's Media Library website is filled with free audio and video media on different topics. The categories under which the topics are organized are "Podcasts", "Timely Audio News", "PSAs", and "Latest Videos". The topics range from highly technical to suitability for a layperson, from livestock concerns to "America's Top Ten Cat Cities". Visitors can see a lengthier list of each of the categories by clicking on "More Podcasts", "More News", etc. at the bottom of the page. In the "Timely Audio News" category are several Spanish Language versions of basic pet care articles, such as "The Benefits of Spaying or Neutering Your Pets" and "Does Your Pet need a Rabies Shot?" At the bottom of the homepage is the section called "Audio Features" that contains over 50 audio files on topics that include equine, pet safety, dog bites, birds, and exotic pets.
This qualitative study seeks to determine the nature of the instruction librarians provide to veterinarymedical students at all 28 United States veterinary colleges. A secondary goal of the study was to determine in what ways and to what extent librarians participated in other instructional activities at their colleges. Over half of the librarians formally taught in one or more
Andrea L. Dinkelman; Ann R. Viera; Danelle A. Bickett-Weddle
|Evaluates the portrayal of males and females in advertisements in veterinarymedical journals. Uses multivariate Chi-square tests to explore gender, occupation or role, practice type, text, and product. Contains 33 references. (DDR)|
Evaluates the portrayal of males and females in advertisements in veterinarymedical journals. Uses multivariate Chi-square tests to explore gender, occupation or role, practice type, text, and product. Contains 33 references. (DDR)
This qualitative study seeks to determine the nature of the instruction librarians provide to veterinarymedical students at all 28 United States veterinary colleges. A secondary goal of the study was to determine in what ways and to what extent librarians participated in other instructional activities at their colleges. Over half of the librarians formally taught in one or more courses, predominantly in the first two years of the veterinary curriculum. One presentation per course was most common. Over half of the librarians interviewed stated that evidence-based veterinary medicine was taught at their colleges, and about half of these librarians collaborated with veterinary faculty in this instruction. Many librarians participated in orientation for first-year veterinary students. The librarians also taught instructional sessions for residents, interns, faculty, graduate students, and practicing veterinarians. This study found that librarians teach information literacy skills both formally and informally, but, in general, instruction by librarians was not well integrated into the curriculum. This study advances several recommendations to help veterinary students develop information literacy skills. These include: encourage veterinary faculty and administrators to collaborate more closely with librarians, incorporate a broader array of information literacy skills into assignments, and add a literature evaluation course to the curriculum. PMID:22023922
Dinkelman, Andrea L; Viera, Ann R; Bickett-Weddle, Danelle A
A bibliography of publications from the USDA Center for Medical, Agricultural and Veterinary Entomology. Cataloged by year and searchable by peer-reviewed journal publications only or all publications. Links to each publication give reference details along with an interpretive summary as well as the technical abstract.
Police in San Jose, CA, seized medicalrecords at a medical marijuana clinic to see if doctors recommended use of the drug. The seizure at Santa Clara County Medical Cannabis Center raised concerns among physicians, who fear their medical licenses may be revoked. Patients were equally concerned that their confidentiality could be compromised. Police said if doctors refuse to confirm that they have recommended marijuana to a patient, the patient will be asked to sign a release. If the patient refuses, other corroboration will be sought. California voters legalized the medical use of marijuana in 1996; however, Federal and State officials continue to try to block implementation of the law. PMID:11365306
Form dictates content, and the manner of recordkeeping imposed on us probably influences how we think about patients. At The New York Hospital, physicians began to maintain permanent patient case records in the early 1800s. Originally proposed and valued as teaching cases for medical students, these freeform patient records varied in quality and often reflected not just the medical care of the time but also the personalities of the physicians composing them. At the end of the 19th century, the change from retrospective to real-time recording of cases and the imposition of a fixed chart structure through the use of forms dramatically reduced the narrative dimension of the hospital course. Gradually, physicians found ways to circumvent these restrictions. Changes in record format, designed to manage increasing volumes of data, and physicians' responses to those changes parallel some of the contemporary threats to documentation posed by the electronic health record. PMID:21079225
In this paper the results are presented from recent developments to increase the role of the HISCOM integrated hospital information system to support direct patient care. This process has resulted in an operational Electronic Obstetric Record System (EVS) and the introduction of a generic system (MDS) to document the medical care process starting in the outpatient clinics. These systems are
The desirable attributes of a computer-based diagnostic aid are proposed. These include ease of use, ready accessibility, sound reasoning, completeness, the ability to justify its recommendations, and a system for updating. These principles are illustrated by examples from the authors' diagnostic system (PROVIDES). PROVIDES is a computer-aided diagnosis and medical information system designed for in-office use on a wide variety of microcomputers using the MS-DOS or PC-DOS operating systems. It is organized by the clinical problems frequently encountered in practice. Relevant historical, physical, and routine laboratory findings are collected through a series of menus. These findings are used to generate a ranked differential diagnostic list. Up-to-date information on diagnostic tests, recommended treatments, and expected outcomes is available for each suggested disease. Imagesp265-ap267-a
This study applies multidimensional scaling (MDS) to a knowledge organization problem involving 12 concepts in pulmonary physiology. The concept structures were derived from individual medical and veterinary students before and after focused instruction. One hundred seventy medical students and 85 veterinarymedical students completed a…
McGaghie, William C.; McCrimmon, Donald R.; Thompson, Jason A.; Ravitch, Michael M.; Mitchell, Gordon
An Inter-Professional Working Group on Access to Personal Health Information in Great Britain has drawn up a draft code intended to safeguard the confidentiality of patients' medicalrecords. The code, which is being circulated to health authorities and consumer groups for comment, permits disclosure without the patient's and/or health professional's consent in seven situations involving public health, national security, biomedical research, court order, statute, law enforcement, or complaints against health professionals or authorities. Passage of the 1984 Data Protection Act had left many health professionals concerned about unauthorizied access to medical information, and the Working Group and its code represent attempts on the part of the government to answer that concern. PMID:11644293
In this article, we describe the state of the art and directions of current development and research with respect to the inclusion of medical narratives in electronic medical-record systems. We used information about 20 electronic medical-record systems as presented in the literature. We divided these systems into `classical' systems that matured before 1990 and are now used in a broad
Huibert J Tange; Arie Hasman; Pieter F de Vries Robbé; Harry C Schouten
|The paper describes an auto-tutorial methodology for training veterinarymedical practitioners to perform differential diagnoses. It describes in detail the three phases of differential diagnosis: sensory pick-up, a combination of cognition and memory; categorization, the process by which diagnosticians group symptoms and signs prior to…
This bibliography on the Problem-Oriented MedicalRecord (POMR) is limited to selected journal articles from June 1964 through July 1973. The POMR format for recording health care data was adopted by the Veterans Administration Department of Medicine and ...
The extent to which Veterinary Aptitude Test (VAT) scores are valid predictors of veterinary student performance and the effect of a summer enrichment program were assessed for Tuskegee Institute and Auburn University students. In addition, attention was directed to predictors of specialty choices and patterns of specialty choices and employment…
The Index-Catalogue of Medical and Veterinary Zoology provides in-depth coverage of the world's literature on human and animal parasitology. It covers parasitic protozoa, helminths, certain arthropods (ticks, mites, insects, copepods, isopods, linguatulid...
S. J. Edwards M. W. Hood J. H. Shaw J. D. Rayburn M. D. Kirby
The Index-Catalogue of Medical and Veterinary Zoology provides in-depth coverage of the world's literature on human and animal parasitology. It covers parasitic protozoa, helminths, certain arthropods (ticks, mites, insects, copepods, isopods, linguatulid...
S. J. Edwards M. W. Hood J. H. Shaw J. D. Rayburn M. D. Kirby
The Index-Catalogue of Medical and Veterinary Zoology provides in-depth coverage of the world's literature on human and animal parasitology. It covers parasitic protozoa, helminths, certain arthropods (ticks, mites, insects, copepods, isopods, linguatulid...
S. J. Edwards M. W. Hood J. H. Shaw J. D. Rayburn M. D. Kirby
The Index-Catalogue of Medical and Veterinary Zoology provides in-depth coverage of the world's literature on human and animal parasitology. It covers parasitic protozoa, helminths, certain arthropods (ticks, mites, insects, copepods, isopods, linguatulid...
S. J. Edwards M. W. Hood J. H. Shaw J. D. Rayburn M. D. Kirby
The Index-Catalogue of Medical and Veterinary Zoology provides in-depth coverage of the world's literature on human and animal parasitology. It covers parasitic protozoa, helminths, certain arthropods (ticks, mites, insects, copepods, isopods, linguatulid...
S. J. Edwards M. W. Hood J. H. Shaw J. D. Rayburn M. D. Kirby
An optical disk filing system is an efficient approach to storing medicalrecords; however, this system has not yet been put to practical use because it is usually a "stand-alone" type indirectly connected to a hospital information system. We have developed a medicalrecord management system with an optical disk filing system connected to the host computer in the hospital information system. We can retrieve and display the medicalrecords through the CRT (Cathode Ray Tube) terminals of the hospital information system at every ward and outpatient clinic. The patient's clinical information can be sent to several areas in the hospital using the hospital information system. PMID:10120548
Recognizing the crucial role of veterinarians in mitigating antimicrobial resistance (AMR), the Centers for Disease Control and Prevention (CDC) has funded the development of a suite of educational materials to promote the responsible veterinarymedical use of antimicrobials. An open-access, Web-based multimedia curriculum regarding antimicrobial resistance in veterinary practice was thus created. The antimicrobial-resistance learning site (AMRLS) for veterinarymedical students was completed and made available for use in January 2011 (http://amrls.cvm.msu.edu/). Designed for integration into existing veterinarymedical courses, the AMRLS is also a resource for continuing education for practicing veterinarians, animal scientists, and food-animal industry specialists. This Web site emphasizes the mechanisms by which AMR emerges and spreads, the significant role of veterinarians in mitigating AMR, and the need to preserve the efficacy of antibiotics for future generations. PMID:22130416
Gordoncillo, Mary Joy N; Bender, Jeff; Noffsinger, Jason; Bartlett, Paul C
Objectives: Grey literature has been perceived by many as belonging to the primary sources of information and has become an accepted method of nonconventional communication in the sciences and medicine. Since little is known about the use and nature of grey literature in veterinary medicine, a systematic study was done to analyze and characterize the bibliographic citations appearing in twelve core veterinary journals. Methods: Citations from 2,159 articles published in twelve core veterinary journals in 2000 were analyzed to determine the portion of citations from grey literature. Those citations were further analyzed and categorized according to the type of publication. Results: Citation analysis yielded 55,823 citations, of which 3,564 (6.38%) were considered to be grey literature. Four veterinary specialties, internal medicine, pathology, theriogenology, and microbiology, accounted for 70% of the total number of articles. Three small-animal clinical practice journals cited about 2.5–3% grey literature, less than half that of journals with basic research orientations, where results ranged from almost 6% to approximately 10% grey literature. Nearly 90% of the grey literature appeared as conferences, government publications, and corporate organization literature. Conclusions: The results corroborate other reported research that the incidence of grey literature is lower in medicine and biology than in some other fields, such as aeronautics and agriculture. As in other fields, use of the Internet and the Web has greatly expanded the communication process among veterinary professionals. The appearance of closed community email forums and specialized discussion groups within the veterinary profession is an example of what could become a new kind of grey literature.
Data on seven aspects of veterinarymedical school libraries are presented and discussed: demographic data on the schools of veterinary medicine the libraries support, number of bound volumes held and number of serial titles received, audiovisual materials, staffing levels and salaries, materials budgets, physical size, and access to computerized bibliographic data bases. The great variability, especially in collection size, is stressed and attributed to such factors as size and programs of the veterinary school, age of the school and library, geographic location, accessibility of other libraries, administrative structure, and exchange programs. PMID:7059713
Data on seven aspects of veterinarymedical school libraries are presented and discussed: demographic data on the schools of veterinary medicine the libraries support, number of bound volumes held and number of serial titles received, audiovisual materials, staffing levels and salaries, materials budgets, physical size, and access to computerized bibliographic data bases. The great variability, especially in collection size, is stressed and attributed to such factors as size and programs of the veterinary school, age of the school and library, geographic location, accessibility of other libraries, administrative structure, and exchange programs.
Augmented reality (AR) is a technology which enables users to see the real world, with virtual objects superimposed upon or composited with it. AR simulators have been developed and used in human medicine, but not in veterinary medicine. The aim of this study was to develop an AR intravenous (IV) injection simulator to train veterinary and pre-veterinary students to perform canine venipuncture. Computed tomographic (CT) images of a beagle dog were scanned using a 64-channel multidetector. The CT images were transformed into volumetric data sets using an image segmentation method and were converted into a stereolithography format for creating 3D models. An AR-based interface was developed for an AR simulator for IV injection. Veterinary and pre-veterinary student volunteers were randomly assigned to an AR-trained group or a control group trained using more traditional methods (n = 20/group; n = 8 pre-veterinary students and n = 12 veterinary students in each group) and their proficiency at IV injection technique in live dogs was assessed after training was completed. Students were also asked to complete a questionnaire which was administered after using the simulator. The group that was trained using an AR simulator were more proficient at IV injection technique using real dogs than the control group (P ? 0.01). The students agreed that they learned the IV injection technique through the AR simulator. Although the system used in this study needs to be modified before it can be adopted for veterinary educational use, AR simulation has been shown to be a very effective tool for training medical personnel. Using the technology reported here, veterinary AR simulators could be developed for future use in veterinary education. PMID:23103217
Lee, S; Lee, J; Lee, A; Park, N; Lee, S; Song, S; Seo, A; Lee, H; Kim, J-I; Eom, K
Admission procedures for veterinary undergraduate training programs often include an interview as well as assessment of previous academic performance. In addition to pre-course factors, within-course factors such as performance in earlier years may play a role in determining success in the veterinary course. This study investigated the relationship between pre-course factors and within-course factors as predictors of success within the course. The study population consisted of six first-year cohorts, five second-year cohorts, four third-year cohorts, three fourth-year cohorts, and two fifth-year cohorts. There were a total of 1,347 students from the five-year Bachelor of Veterinary Medicine (BVetMed) program at the Royal Veterinary College (RVC). Data from these cohorts consisted of pre-entry demographic (sex, age, and nationality) and admission variables and within-course assessments. Logistic regression was used to examine the relationship between predictors and outcome. The study confirmed the value of previous academic performance in selecting students for the veterinary degree course but the value of interviews in the selection process was less clear. Within-course examination results were associated with later course outcome and high marks in continuous assessments were associated with overall success in the course. The study supports selection of students on the basis of previous academic performance but not interview scores. Continuous assessment and within-course examination results may be of value in identifying those students most likely to fail and therefore, those who need to be monitored and advised more closely. PMID:23187031
Muzyamba, Morris Chivwaba; Goode, Nigel; Kilyon, Margaret; Brodbelt, Dave
The purpose of the section of the Index-Catalogue of Medical and Veterinary Zoology is to make available the bibliographic records on nematoda and nematode diseases of animals that have accumulated in the parasite files of the Index-Catalogue during the p...
The purpose of this section of the Index-Catalogue of Medical and Veterinary Zoology is to make available the bibliographic records on Nematoda and nematode diseases of animals that have accumulated in the parasite files of the Index-Catalogue during the ...
This study builds on previous research on predictors of depression and anxiety in veterinarymedical students and reports data on three veterinary cohorts from two universities through their first three semesters of study. Across all three semesters, 49%, 65%, and 69% of the participants reported depression levels at or above the clinical cut-off, suggesting a remarkably high percentage of students experiencing significant levels of depression symptoms. Further, this study investigated the relationship between common stressors experienced by veterinary students and mental health, general health, and academic performance. A factor analysis revealed four factors among stressors common to veterinary students: academic stress, transitional stress, family-health stress, and relationship stress. The results indicated that both academic stress and transitional stress had a robust impact on veterinarymedical students' well-being during their first three semesters of study. As well, academic stress negatively impacted students in the areas of depression and anxiety symptoms, life satisfaction, general health, perception of academic performance, and grade point average (GPA). Transitional stress predicted increased depression and anxiety symptoms and decreased life satisfaction. This study helped to further illuminate the magnitude of the problem of depression and anxiety symptoms in veterinarymedical students and identified factors most predictive of poor outcomes in the areas of mental health, general health, and academic performance. The discussion provides recommendations for considering structural changes to veterinary educational curricula to reduce the magnitude of academic stressors. Concurrently, recommendations are suggested for mental health interventions to help increase students' resistance to environmental stressors. PMID:23187027
Reisbig, Allison M J; Danielson, Jared A; Wu, Tsui-Feng; Hafen, McArthur; Krienert, Ashley; Girard, Destiny; Garlock, Jessica
...MEDICAL Health Care Benefits for Certain Children of Vietnam Veterans and Veterans with Covered Service in Korea-Spina Bifida and Covered Birth Defects Â§ 17.905 Medicalrecords. Copies of medicalrecords generated outside VA...
As efforts to reduce the overpopulation and euthanasia of unwanted and unowned dogs and cats have increased, greater attention has been focused on spay-neuter programs throughout the United States. Because of the wide range of geographic and demographic needs, a wide variety of programs have been developed to increase delivery of spay-neuter services to targeted populations of animals, including stationary and mobile clinics, MASH-style operations, shelter services, feral cat programs, and services provided through private practitioners. In an effort to ensure a consistent level of care, the Association of Shelter Veterinarians convened a task force of veterinarians to develop veterinarymedical care guidelines for spay-neuter programs. The guidelines consist of recommendations for preoperative care (eg, patient transport and housing, patient selection, client communication, record keeping, and medical considerations), anesthetic management (eg, equipment, monitoring, perioperative considerations, anesthetic protocols, and emergency preparedness), surgical care (eg, operating-area environment; surgical-pack preparation; patient preparation; surgeon preparation; surgical procedures for pediatric, juvenile, and adult patients; and identification of neutered animals), and postoperative care (eg, analgesia, recovery, and release). These guidelines are based on current principles of anesthesiology, critical care medicine, microbiology, and surgical practice, as determined from published evidence and expert opinion. They represent acceptable practices that are attainable in spay-neuter programs. PMID:18593314
Looney, Andrea L; Bohling, Mark W; Bushby, Philip A; Howe, Lisa M; Griffin, Brenda; Levy, Julie K; Eddlestone, Susan M; Weedon, James R; Appel, Leslie D; Rigdon-Brestle, Y Karla; Ferguson, Nancy J; Sweeney, David J; Tyson, Kathy A; Voors, Adriana H; White, Sara C; Wilford, Christine L; Farrell, Kelly A; Jefferson, Ellen P; Moyer, Michael R; Newbury, Sandra P; Saxton, Melissa A; Scarlett, Janet M
There is an inherent conflict between the desire to maintain privacy of one's medicalrecords and the need to make those records available during an emergency. To satisfy both objectives, we introduce a flexible architecture for the secure storage of medicalrecords on smart phones. In our system, a person can view her records at any time, and emergency medical
Ryan W. Gardner; Sujata Garera; Matthew W. Pagano; Matthew Green; Aviel D. Rubin
Anthropology is now one of the inter-disciplinary scientific fields that is gaining much attention in forensic, socio-cultural, industrial and bio-medical applications. There is a need for a better awareness of some of the impacts--past and present, in the medical practice, of the records that were obtained by workers in this field in view of their proper applications, and future reference. Compilation of anthropometric works and records was conducted to evaluate the previous and current implications with the aim to highlight the importance of this seemingly old but yet evolving and dynamic subject and to elucidate its usefulness. However, despite the arduous efforts to get reliable data from anthropometric investigations, errors had most times characterized the concluding postulations of many workers in this field in the past, creating skepticism. But with better attention being given to the exercise, possible improvement in the methodology of the study with resultant authentic records and more reliable conclusion is anticipated. PMID:18702249
To maximize their capacity to save lives and optimize resource allocation, animal shelters need to identify highly adoptable animals that are unlikely to be delayed on medical grounds before they can be made available for adoption. In this retrospective cohort study, our objective was to identify risk factors for delays from intake to approval for adoption on medical grounds in shelter puppies and kittens. Shelter medicalrecords from 2008 for 335 puppies and 370 kittens were selected randomly at a large metropolitan adoption-guarantee shelter. Data including signalment, source shelter, intake veterinary examination findings, clinical history and days from intake until approval by a veterinarian for adoption on medical grounds were extracted from shelter records and analyzed using multivariate Cox regression. Puppies and kittens with clinical signs of respiratory or gastrointestinal disease at intake took significantly longer to receive approval for adoption on medical grounds (puppies - respiratory p<0.0001; gastrointestinal p<0.0001; kittens - respiratory p<0.0001; gastrointestinal p=0.002). Stray kittens were more likely to be delayed than owner-relinquished kittens or those transferred from other shelters (p<0.01). Older kittens were less likely to be delayed (p<0.0001). Administration of oral or parenteral antibiotics to puppies and kittens with respiratory and/or ocular signs within 24 hours of intake significantly reduced time to approval on medical grounds for adoption (puppies p=0.02; kittens p=0.03). The analyses suggested that puppies and kittens with respiratory or gastrointestinal signs on intake are more likely to experience delays between intake and veterinary approval for adoption on medical grounds. Prompt antimicrobial treatment of animals with respiratory and/or ocular signs may decrease length of stay in the shelter.
Contents: (1) Documentation of daily patient acuity classification on DA Form 4677 (Clinical Record--Therapeutic Documentation Care Plan (Non-Medication)) (chap 2); (2) Documentation of the nursing discharge summary, DA Form 3888-3 (MedicalRecord--Nursin...
The medicalrecord, as a managerial, historic, and legal document, serves many purposes. Although its form may be well established and many of the cases documented in it ‘routine’ in medical experience, what is written in the medicalrecord nevertheless records decisions and actions of individuals. Viewed as an interpretive ‘text’, it can itself become the object of interpretation. This
The literature describes three categories of health records: the Official MedicalRecords held by healthcare providers, Personal Health Records owned by patients, and--a possible in between case--the Shared Care Record. New complications and challenges arise with electronic storage of this latter class of record; for instance, an electronic shared care record may have multiple authors, which presents challenges regarding the roles and responsibilities for record-keeping. This article discusses the definitions and implementations of official medicalrecords, personal health records and shared care records. We also consider the case of a New Zealand pilot of developing and implementing a shared care record in the National Shared Care Planning Programme. The nature and purpose of an official medicalrecord remains the same whether in paper or electronic form. We maintain that a shared care record is an official medicalrecord; it is not a personal health record that is owned and controlled by patients, although it is able to be viewed and interacted with by patients. A shared care record needs to meet the same criteria for medico-legal and ethical duties in the delivery of shared care as pertain to any official medicalrecord. PMID:24162635
This paper introduces javelin diagrams as an innovative way for depicting the results of medical decision analyses. The methods were used to determine whether, and at which values, blood lactate in Belgian White and Blue or maximum tidal volumes in Holstein calves should be measured before deciding to treat or not a calf suffering from the bovine respiratory disease complex.
The Index-Catalogue of Medical and Veterinary Zoology provides in-depth coverage of the world's literature on human and animal parasitology. It covers parasitic protozoa, helminths, certain arthropods (ticks, mites, insects, copepods, isopods, linguatulid...
S. J. Edwards M. W. Hood J. H. Shaw J. D. Rayburn M. D. Kirby
...Medicalrecords. (a) Health Information Portability and Accountability Act (HIPAA). (1...individually identifiable health information established...adverse effect on the mental or physical health of the individual....
OBJECTIVES--To report on the development of computer assisted methods for linking medicalrecords and record abstracts. DESIGN--The methods include file blocking, to put records in an order which makes searching efficient; matching, which is the process of comparing records to determine whether they do or do not relate to the same person; linkage, which is the process of assembling correctly
L Gill; M Goldacre; H Simmons; G Bettley; M Griffith
The following information has been produced for VeterinaryRecord by the Veterinary Medicines Directorate (VMD) to provide an update for veterinary surgeons on recent changes to marketing authorisations for veterinary medicines in the UK and on other relevant issues. PMID:24097881
The following information has been produced for VeterinaryRecord by the Veterinary Medicines Directorate (VMD) to provide an update for veterinary surgeons on recent changes to marketing authorisations for veterinary medicines in the UK and on other relevant issues. PMID:24014749
In the mid-1960s, the author was assigned the responsibility of modifying American medicalrecord concepts, policies, procedures, and technology for a new university medical center in Berlin. Her basic design is now the law of the land in Germany. Here she describes health record information practices in Germany. PMID:10113925
This study was initiated by a Pastoral Care Department of a large academic medical center in order to establish hospital chaplaincy policies and procedures. Four basic questions were asked about professional hospital chaplains and record keeping. The results of the survey show that the standard of practice is that chaplains access the medicalrecord, enter notes in the record, have access to the electronic medicalrecord, and that no special credentialing beyond Clinical Pastoral Education (CPE) is required for chaplains to have this access. PMID:22029507
Goldstein, H Rafael; Marin, Deborah; Umpierre, Mari
This article focuses on protecting the confidentiality and privacy of workplace medicalrecords. All employers should be concerned about the potential legal liability for unauthorized and improper disclosure of confidential employee medical data. Employers should adapt and follow a corporate policy governing the use and maintenance of confidential employee hiring, benefits, personnel and medical information. If there is any question concerning the confidentiality of records, employers should consult with legal counsel or other outside advisers. PMID:10172873
Until recently, the medicalrecord was seen exclusively as being the property of health institutions and doctors. Its great technical and scientific components, as well as the personal characteristics attributed by each doctor, have been the reasons appointed for that control. However, nowadays throughout the world that paradigm has been changing. In Portugal, since 2007 patients are allowed full and direct access to their medicalrecords. Nevertheless, the Deontological Code of the Portuguese Medical Association (2009) explicitly states that patients' access to their medicalrecords should have a doctor as intermediary and that the records are each physician's intellectual property. Furthermore, several doctors and health institutions, receiving requests from patients to access their medicalrecords, end up requesting the legal opinion of the Commission for access to administrative documents. Each and every time, that opinion goes in line with the notion of full and direct patient access. Sharing medicalrecords with patients seems crucial and inevitable in the current patient-centred care model, having the potential to improve patient empowerment, health literacy, autonomy, self-efficacy and satisfaction with care. With the recent technological developments and the fast dissemination of Personal Health Records, it is foreseeable that a growing number of patients will want to access their medicalrecords. Therefore, promoting awareness on this topic is essential, in order to allow an informed debate between all the stakeholders. PMID:23815842
Laranjo, Liliana; Neves, Ana Luisa; Villanueva, Tiago; Cruz, Jorge; Brito de Sá, Armando; Sakellarides, Constantitno
It is very important for the treating doctor to properly document the management of a patient under his care. Medicalrecord keeping has evolved into a science of itself. This will be the only way for the doctor to prove that the treatment was carried out properly. Moreover, it will also be of immense help in the scientific evaluation and review of patient management issues. Medicalrecords form an important part of the management of a patient. It is important for the doctors and medical establishments to properly maintain the records of patients for two important reasons. The first one is that it will help them in the scientific evaluation of their patient profile, helping in analyzing the treatment results, and to plan treatment protocols. It also helps in planning governmental strategies for future medical care. But of equal importance in the present setting is in the issue of alleged medical negligence. The legal system relies mainly on documentary evidence in a situation where medical negligence is alleged by the patient or the relatives. In an accusation of negligence, this is very often the most important evidence deciding on the sentencing or acquittal of the doctor. With the increasing use of medical insurance for treatment, the insurance companies also require proper record keeping to prove the patient's demand for medical expenses. Improper record keeping can result in declining medical claims. It is disheartening to note that inspite of knowing the importance of proper record keeping it is still in a nascent stage in India. It is wise to remember that “Poor records mean poor defense, no records mean no defense”. Medicalrecords include a variety of documentation of patient's history, clinical findings, diagnostic test results, preoperative care, operation notes, post operative care, and daily notes of a patient's progress and medications. A properly obtained consent will go a long way in proving that the procedures were conducted with the concurrence of the patient. A properly written operative note can protect a surgeon in case of alleged negligence due to operative complications. It is important that the prescription for drugs should be legible with the name of the patient, date, and the signature of the doctor. An undated prescription can land a doctor in trouble if the patient misuses it. There are also many records that are indirectly related to patient management such as accounts records, service records of the staff, and administrative records, which are also useful as evidences for litigation purposes. Medicalrecording needs the concerted effort of a number of people involved in patient care. The doctor is the prime person who has to oversee this process and is primarily responsible for history, physical examination, treatment plans, operative records, consent forms, medications used, referral papers, discharge records, and medical certificates. There should be proper recording of nursing care, laboratory data, reports of diagnostic evaluations, pharmacy records, and billing processes. This means that the paramedical and nursing staff also should be trained in proper maintenance of patient records. The medical scene in India extends from smaller clinics to large hospitals. Medicalrecord keeping is a specialized area in bigger teaching and corporate hospitals with separate medicalrecords officers handling these issues. However, it is yet to develop into a proper process in the large number of smaller clinics and hospitals that cater to a large section of the people in India.
...2013-01-01 false Maintenance of medicalrecords. 712.38 Section 712.38 Energy DEPARTMENT OF ENERGY HUMAN RELIABILITY PROGRAM Medical Standards Â§ 712.38 Maintenance of medicalrecords. (a) The medicalrecords of...
Veterinarymedical students at Iowa State University were surveyed in January of 1997 to determine their general use of the VeterinaryMedical Library and how they sought information in an electronic environment. Comparisons were made between this study and one conducted a decade ago to determine the effect of the growth in electronic resources on student library use and information-seeking behavior. The basic patterns of student activities in the library, resources used to find current information, and resources anticipated for future education needs remained unchanged. The 1997 students used the library most frequently for photocopying, office supplies, and studying coursework; they preferred textbooks and handouts as sources of current information. However, when these students went beyond textbooks and handouts to seek current information, a major shift was seen from the use of print indexes and abstracts in 1987 towards the use of computerized indexes and other electronic resources in 1997. Almost 60% of the students reported using the Internet for locating current information. Overall use of electronic materials was highest among a group of students receiving the problem-based learning method of instruction. Most of the students surveyed in 1997 indicated that electronic resources would have some degree of importance to them for future education needs. The electronic environment has provided new opportunities for information professionals to help prepare future veterinarians, some of whom will be practicing in remote geographical locations, to access the wealth of information and services available on the Internet and Web.
The NLM team used the relevance judgments for the 2011 MedicalRecords track (that focused on finding patients eligible for clinical studies) to analyze the components of our 2011 systems. The analysis showed that the components provided moderate improvem...
A. Jimeno-Yepes D. Demner-Fushman F. Lang R. Loane S. Abhyankar
...Medicationrecords. (6) Hospital discharge summaries, if applicable. (7) Reports of contact with informal support (for example, caregiver, legal guardian, or next of kin). (8) Enrollment Agreement. (9) Physician orders....
...Medicationrecords. (6) Hospital discharge summaries, if applicable. (7) Reports of contact with informal support (for example, caregiver, legal guardian, or next of kin). (8) Enrollment Agreement. (9) Physician orders....
...33 Section 21.33 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF...PRIVACY Requirements for Specific Categories of Records Â§ 21.33 Medical...Systems maintained by the Food and Drug Administration. (b) The...
EMERSE (The Electronic MedicalRecord Search Engine) is an intuitive, powerful search engine for free-text documents in the electronic medicalrecord. It offers multiple options for creating complex search queries yet has an interface that is easy enough to be used by those with minimal computer experience. EMERSE is ideal for retrospective chart reviews and data abstraction and may have potential for clinical care as well.
...medicalrecords that are not otherwise exempt from disclosure, the requesting individual may be advised, if it is deemed necessary by OSC, that the records will be provided only to a physician designated in writing by the individual. Upon receipt of the...
: Given the many efforts currently under way to develop standards for medicalrecords, it is important to step back and re-examine the fundamental principles which shouldunderlie a model of the electronic record. This paper presents an analysis based on theexperience in developing the PEN & PAD prototype clinical workstation. The fundamentalcontention is that the requirements for a medicalrecord must
This paper considers the lessons learnt during the development of the electronic medicalrecord for patient care. It is not a definitive history of medicalrecords but an assessment of what has been learnt, what has to be learnt and how we can move forward. It considers the needs for structured intelligent records that help in individual patient care, the need to provide functionality that fits with the requirements of the clinician-patient interaction and the need to take into account the human factors that affect clinician's uptake of such systems. It outlines the issues of free form input as opposed to controlled input that have to be resolved.
The enhanced availability of health information in an electronic format is strategic for industry-wide efforts to improve the quality and reduce the cost of health care, yet it brings a concomitant concern of greater risk for loss of privacy among health care participants. The authors review the conflicting goals of accessibility and security for electronic medicalrecords and discuss nontechnical and technical aspects that constitute a reasonable security solution. It is argued that with guiding policy and current technology, an electronic medicalrecord may offer better security than a traditional paper record.
The Center for Medical, Agricultural and Veterinary Entomology (CMAVE), U.S. Department of Agriculture – Agricultural Research Service (USDA-ARS), conducts specific research directed at reducing or eliminating the harm caused by insects to humans, animals, and crops. CMAVE is an internationally ren...
The HIPAA privacy rule allows providers to charge for providing copies of medicalrecords to patients and their representatives. Providers need to know which activities in the retrieval and handling of such information can be included in the medicalrecord copy charges. State-mandated fees for copies vary and may be preempted by HIPAA, requiring careful review by providers. Healthcare organizations that use a copy service may need to determine whether bringing the activity in house would be more cost-effective under HIPAA. PMID:14686070
Web-based, consumer-centric electronic medicalrecords (CEMRs) are currently undergoing widespread deployment. Existing CEMRs, however, have limited intelligence and cannot satisfy users' many needs. This paper proposes the concept of intelligent CEMR. We introduce and extend expert system and web search technology into the CEMR domain. The resulting intelligent CEMRs can automatically provide users with personalized healthcare information to facilitate their
Background: Physicians are adopting electronic medicalrecords in much greater numbers today and are escalating the rate of adoption. The American Recovery and Reinvestment Act of 2009 provides incentives for physicians to adopt this technology. Objectives: Determine whether patient satisfaction is affected by computer use in the exam room and whether patients who have experienced computers in the exam room
Christopher Sibona; Jon Brickey; Steven Walczak; Madhavan Parthasarathy
Different compound feeds have to be manufactured in the same production line. As a consequence, traces of the first produced feed may remain in the production and get mixed with the next feed batches. This "carry-over" is unavoidable, and so non-medicated feed can be contaminated with veterinary drugs like antibiotics added to the previous batch of medicated feed. To monitor the carry-over of antibiotics in the Netherlands, 21 feed mills were visited and 140 samples of flushing feeds were collected and analysed for containing residues of antibiotics. Results show that 87% of all samples contain concentrations of antibiotics in the range of 0.1-154 mg/kg. It is expected that these levels - which are in the same range as previously found for the nowadays banned antimicrobial growth promoters (AMGPs) - have an effect on the occurrence of microbial resistance. Analysis of a second set of samples collected at four different feed mills directly after the production of oxytetracycline-medicated feed demonstrated that the first part of a flushing feed has much higher contamination than the last part of the batch. Furthermore, it was demonstrated that the carry-over percentage shows no correlation with the carry-over determined by one of the standard GMP+ procedures. These observations, unavoidable carry-over, inhomogeneous batches of feed with antibiotics and difficulties to predict the carry-over levels, together with the awareness of the increasing problem of microbial resistance, motivated the NEVEDI, association of Dutch Feed Producers, to announce that they will voluntarily stop the production of medicated feed in 2011. The alternatives for medicated feed are for example water or milk medication or the use of top-dressings at the farm. The consequences and possible new risks of carry-over at the farm are not completely clear yet. PMID:23742236
Stolker, A A M; Manti, V; Zuidema, T; van Egmond, H; Deckers, E R; Herbes, R; Hooglugt, J; Olde Heuvel, E; de Jong, J
Following an analysis of the task of transcribing as practiced in a health facility, this study guide was developed to teach the knowledge and skills required of a medical transcriber. The medicalrecord department was identified as a major occupational area, and a task inventory for medicalrecords was developed and used as a basis for a…
p,~~~~~: ~~~~,~~~i~ Abstract The enchanced availability of health information in an electronic format is strategic for industry-wide efforts to improve the quality and reduce the cost of health care, yet it brings a concomitant concern of greater risk for loss of privacy among health care participants. The authors review the conflicting goals of accessibility and security for electronic medicalrecords
The paper presents the initial efforts of description and implementation for a new scheme of electronic patients recording, based on distributed database for chronic ophthalmologic diseases. Structural specifications derived from principal system's goals are the implementation of an efficient and flexible way of patients' data administration, using actual Web technologies, permitting future extensions, without reducing in performances and without exponential cost increasing. A very important aspect, that must be take into consideration is their interfacing with other medical programs and systems, as the systems for recording clinical data, monitoring systems (Patient Administrations Systems - PAS) for demographical data, systems for monitoring of treatment (Hippocrates program), web systems, including wireless. PMID:18543667
In racing and other equine sports, it is possible to increase artificially both the physical capability and the presence of a competitive instinct, using drugs, such as anabolic steroids and agents stimulating the central nervous system. The word doping describes this illegitimate use of drugs and the primary motivation of an equine anti-doping policy is to prevent the use of these substances. However, an anti-doping policy must not impede the use of legitimate veterinarymedications and most regulatory bodies in the world now distinguish the control of illicit substances (doping control) from the control of therapeutic substances (medication control). For doping drugs, the objective is to detect any trace of drug exposure (parent drug or metabolites) using the most powerful analytical methods (generally chromatographic/mass spectrometric techniques). This so-called "zero tolerance rule" is not suitable for medication control, because the high level of sensitivity of current screening methods allows the detection of totally irrelevant plasma or urine concentrations of legitimate drugs for long periods after their administration. Therefore, a new approach for these legitimate compounds, based upon pharmacokinetic/pharmacodynamic (PK/PD) principles, has been developed. It involves estimating the order of magnitude of the irrelevant plasma concentration (IPC) and of the irrelevant urine concentration (IUC) in order to limit the impact of the high sensitivity of analytical techniques used for medication control. The European Horserace Scientific Liaison Committee (EHSLC), which is the European scientific committee in charge of harmonising sample testing and policies for racehorses in Europe, is responsible for estimating the IPCs and IUCs in the framework of a Risk Analysis. A Risk Analysis approach for doping/medication control involves three sequential steps, namely risk assessment, risk management, and risk communication. For medication control, the main task of EHLSC in the risk management procedure is the establishment of harmonised screening limits (HSL). The HSL is a confidential instruction to laboratories from racing authorities to screen in plasma or urine for the presence of drugs commonly used in equine medication. The HSL is derived from the IPC (for plasma) or from the IUC (for urine), established during the risk assessment step. The EHSLC decided to keep HSL confidential and to inform stakeholders of the duration of the detection time (DT) of the main medications when screening is performed with the HSL. A DT is the time at which the urinary (or plasma) concentration of a drug, in all horses involved in a trial conducted according to the EHSLC guidance rules, is shown to be lower than the HSL when controls are performed using routine screening methods. These DTs, as issued by the EHSLC (and adopted by the Fédération Equestre Internationale or FEI) provide guidance to veterinarians enabling them to determine a withdrawal time (WT) for a given horse under treatment. A WT should always be longer than a DT because the WT takes into account the impact of all sources of animal variability as well as the variability associated with the medicinal product actually administered in order to avoid a positive test. The major current scientific challenges faced in horse doping control are those instances of the administration of recombinant biological substances (EPO, GH, growth factors etc.) having putative long-lasting effects while being difficult or impossible to detect for more than a few days. Innovative bioanalytical approaches are now addressing these challenges. Using molecular tools, it is expected in the near future that transcriptional profiling analysis will be able to identify some molecular "signatures" of exposure to doping substances. The application of proteomic (i.e. the large scale investigation of protein biomarkers) and metabolomic (i.e. the study of metabolite profiling in biological samples) techniques also deserve attention for establishing possible unique fingerprints of drug
Text mining projects can be characterized along four parameters: 1) the demands of the market in terms of target domain and specificity and depth of queries; 2) the volume and quality of text in the target domain; 3) the text mining process requirements; and 4) the quality assurance process that validates the extracted data. In this paper, we provide lessons learned and results from a large-scale commercial project using Natural Language Processing (NLP) for mining the transcriptions of dictated clinical records in a variety of medical specialties. We conclude that the current state-of-the-art in NLP is suitable for mining information of moderate content depth across a diverse collection of medical settings and specialties.
...2012-01-01 false Special procedures: Medicalrecords. 4.26 Section 4.26 ...Act Â§ 4.26 Special procedures: Medicalrecords. (a) No response to any request for access to medicalrecords from an individual will be...
...2011-10-01 true Special requirements for medicalrecords. 6.31 Section 6.31 ...Â§ 6.31 Special requirements for medicalrecords. (a) A system manager who...individual for access to those official medicalrecords which belong to the...
The Audit Commission in its publication entitled "Setting the Record Straight - A study of Hospital Records" - HMSO July 1995 states that "badly organised medicalrecords do endanger patients". Much emphasis is placed regarding the safe storage and retrieval of medicalrecords in order, for example, to guarantee that in respect of an incident 15 years ago involving a neonate, that medicalrecords, results etc. are easily retrievable. PMID:10162782
Veterinary schools in the United States are regulated as research facilities under the federal Animal Welfare Act by Animal Care (AC), a division of the USDA's Animal and Plant Health Inspection Service (APHIS). The schools are inspected at least annually by AC inspectors, who are all veterinarians. In a recent poll, these inspectors identified several areas that have caused compliance problems for veterinary schools. In addition, several emerging issues also appear to be posing potential regulatory problems as societal expectations and ethical considerations change. PMID:18326772
The forms of the medicalrecords are different from one institute to another. Moreover, medicalrecords are always stored in free text. Consequently, medicalrecords almost can not be logically analyzed and understood by machines. In this paper, we have applied the information retrieval (IR) technique in the using of medicalrecords. We have implemented an IR system for the users, such as doctors and patients, to query similar or related medicalrecords to support diagnosis and treatment. Knowledge retrieval for reuse is the key idea of this system. PMID:19162949
The Department of the Air Force is amending its regulations by revising Subpart A of Part 880, Subchapter I, 32 CFR. The revision tells how Air Force and NATO personnel may obtain essential medical, dental, and veterinary care from cilivian sources when care from a government facility is unavailable, and tells how to authorize and provide reimbursement at Air Force expense. This revision also changes the policy on active duty maternity episode. The internal effect of this revision is to keep current those rules published in 32 CFR, Chapter VII. PMID:10247838
Aims Accurate recording of medication histories in hospital medicalrecords (HMR) is important when patients are admitted to the hospital. Lack of registration of drugs can lead to unintended discontinuation of drugs and failure to detect drug related problems. We investigated the comprehensiveness of medication histories in HMR with regard to prescription drugs by comparing the registration of drugs in
Hong Sang Lau; Christa Florax; Arijan J. Porsius; Anthonius De Boer
Health information technology (HIT) is engineered to promote improved quality and efficiency of care, and reduce medical errors. Healthcare organizations have made significant investments in HIT tools and the electronic medicalrecord (EMR) is a major technological advance. The Department of Veterans Affairs was one of the first large healthcare systems to fully implement EMR. The Veterans Health Information System and Technology Architecture (VistA) began by providing an interface to review and update a patient’s medicalrecord with its computerized patient record system. However, since the implementation of the VistA system there has not been an overall substantial adoption of EMR in the ambulatory or inpatient setting. In fact, only 23.9% of physicians were using EMRs in their office-based practices in 2005. A sample from the American Medical Association revealed that EMRs were available in an office setting to 17% of physicians in late 2007 and early 2008. Of these, 17% of physicians with EMR, only 4% were considered to be fully functional EMR systems. With the exception of some large aggregate EMR databases the slow adoption of EMR has limited its use in outcomes research. This paper reviews the literature and presents the current status of and forces influencing the adoption of EMR in the office-based practice, and identifies the benefits, limitations, and overall value of EMR in the conduct of outcomes research in the US.
Belletti, Dan; Zacker, Christopher; Mullins, C Daniel
The Problem Oriented Medical Information System was used for initial testing on over one hundred patients. The PROMIS system supported medical activities of the Gynecology ward at the Medical Center Hospital of Vermont and many of the associated supportin...
Entrusted with the records for more than 1.5 million patients, the Regenstrief MedicalRecord System (RMRS) has evolved into a fast and comprehensive data repository used extensively at three hospitals on the Indiana University Medical Center campus and more than 30 Indianapolis clinics. The RMRS routinely captures laboratory results, narrative reports, orders, medications. radiology reports, registration information, nursing assessments, vital
Clement J. McDonald; J. Marc Overhage; William M. Tierney; Paul R. Dexter; Douglas K. Martin; Jeffrey G. Suico; Atif Zafar; Gunther Schadow; Lonnie Blevins; Tull Glazener; Jim Meeks-Johnson; Larry Lemmon; Jill Warvel; Brian Porterfield; Jeff Warvel; Pat Cassidy; Don Lindbergh; Anne Belsito; Mark Tucker; Bruce Williams; Cheryl Wodniak
For more than 20 years, many countries have been trying to set up a standardised medicalrecord at the regional or at the national level. Most of them have not reached this goal, essentially due to two main difficulties related to patient identification and medicalrecords standardisation. Moreover, the issues raised by the centralisation of all gathered medical data have
Most primary-care physicians have adopted electronic medicalrecords (EMRs) for the management of patients in ambulatory care. Observational trials suggest that the use of EMRs improves the achievement of the recommended standards of diabetes care and intermediate outcomes. A French group of general practitioners has shown, in a randomized controlled trial of diabetes care, the beneficial effects of a follow-up module integrated into an EMR. Electronic reminders, eHealth technology and e-mail messaging to patients integrated into the EMR have also been reported to have a beneficial effect on diabetes care. Some recommendations have been devised for the meaningful use of EMRs to improve the process and, possibly, intermediate outcomes of diabetes care as well. Another potential benefit to consider is the extraction and aggregation of data to create diabetes registers. Large regional and national diabetes registers have been set up in the US and Europe for various purposes, including patient recall, description of care patterns and outcomes, improvement of practices, drug safety, observational research and retrospective trials. In France, the government initiative towards an Internet-based personal health record (PHR) provides an appropriate framework for implementing and sharing the information needed to improve diabetes care, such as electronic summaries of health information, personalized health plans (PHPs), and standardized and structured hospital-discharge forms. All of these materials can be generated from EMRs. The widespread and optimalized use of EMRs for diabetes care with links to the national diabetes register and the capacity to supply PHRs are major considerations. Achieving these goals requires a common initiative comprising primary care and diabetes scientific societies in cooperation with diabetes patients'associations. PMID:22208710
Increasingly, medicalrecords are being stored in computer databases that allow for efficiencies in providing treatment and in the processing of clinical and financial services. Computerization of medicalrecords has also diminished patient privacy and, in particular, has increased the potential for misuse, especially in the form of nonconsensual secondary use of personally identifiable records. Organizations that store and use
Context: The MedicalRecords Department (MRD) is an important source for evaluating and planning of healthcare services; therefore, hospital managers should improve their performance not only in the short-term but also in the long-term plans. The Balanced Scorecard (BSC) is a tool in the management system that enables organizations to correct operational functions and provides feedback around both the internal processes and the external outcomes, in order to improve strategic performance and outcomes continuously. Aims: The main goal of this study was to assess the MRD performance with BSC approach in a hospital. Materials and Methods: This research was an analytical cross-sectional study in which data was collected by questionnaires, forms and observation. The population was the staff of the MRD in a hospital in Najafabad, Isfahan, Iran. Statistical Analysis Used: To analyze data, first, objectives of the MRD, according to the mission and perspectives of the hospital, were redefined and, second, indicators were measured. Subsequently, findings from the performance were compared with the expected score. In order to achieve the final target, the programs, activities, and plans were reformed. Results: The MRD was successful in absorbing customer satisfaction. From a customer perspective, score in customer satisfaction of admission and statistics sections were 82% and 83%, respectively. Conclusions: The comprehensive nature of the strategy map makes the MRD especially useful as a consensus building and communication tool in the hospital.
...by the inmate, provided that the inmate gives written authorization for the disclosure. (c) Medicalrecords containing subjective evaluations and opinions of medical staff relating to the inmate's care and treatment will be provided to the...
This article aims at building clinical data groups for Electronic MedicalRecords (EMR) in China. These data groups can be\\u000a reused as basic information units in building the medical sheets of Electronic MedicalRecord Systems (EMRS) and serve as\\u000a part of its implementation guideline. The results were based on medical sheets, the forms that are used in hospitals, which\\u000a were
... accuracy, accessibility, and security in both paper and electronic systems. They use various classification systems to code ... insurance. Additional records, coupled with widespread use of electronic health records by all types of healthcare providers, ...
At the turn of the century, neither hospitals nor physicians routinely kept clinical records. Since then, the medicalrecord has gradually evolved. More recently, as society and medicine have become more complex and sophisticated, inadequacies of the paper medicalrecord have become increasingly apparent. The computer-based medicalrecord addresses many of the deficiencies of the paper record. Meanwhile, barriers to computer-based records have decreased; hardware has become more affordable, powerful, and compact, and software has been refined. Socially, the major payers for health care are demanding verification of the effectiveness and quality of care, information that involves data-intensive research. The electronic medicalrecord promises to improve quality of care by providing point-of-care reminder and decision support tools as well as a database for substantiating the effectiveness of care. In conjunction with the growing integration of computers into all facets of life, government agencies, computer giants, and medical organizations are currently laying the groundwork for the development of standardized elements and formats for computer-based medical information systems. As part of the continuing evolution of the medicalrecord, we foresee these forces culminating in the computerization of the clinical record. In this review, we briefly describe the developments that led us to this conclusion and describe computer-based clinical record systems in use in two family practice settings. PMID:1431772
|This course guide outlines the objectives and content for a professional continuing education course on the literature of veterinary medicine. Topics covered include: (1) an introduction to veterinary medicine as a discipline, including comparison with other medical sciences, veterinary medicine education, licensure, animal models, veterinary…
The purpose of this study was to evaluate the Technology Acceptance Model's (TAM) relevance of the intention of nurses to use electronic medicalrecords in acute health care settings. The basic technology acceptance research of Davis (1989) was applied to the specific technology tool of electronic medicalrecords (EMR) in a specific setting…
Serious medication errors occur commonly in the period after hospital discharge. Medication reconciliation in the postdischarge ambulatory setting may be one way to reduce the frequency of these errors. The authors describe the design and implementation of a novel tool built into an ambulatory electronic medicalrecord (EMR) to facilitate postdischarge medication reconciliation. The tool compares the preadmission medication list
Jeffrey L Schnipper; Catherine L Liang; Claus Hamann; Andrew S Karson; Matvey B Palchuk; Patricia C McCarthy; Melanie Sherlock; Alexander Turchin; David W Bates
Information on health occupations educational programs in Ohio and current and projected employment needs for health professionals are presented. The following health fields are examined: allied health, dentistry, emergency medical service, nursing, optometry, pharmacy, podiatry, and veterinary medicine. Issues and trends affecting each field are…
|Describes a program at the School of Veterinary Medicine, University of California at Davis to give students experience in diagnosis and management of urinary tract diseases. Students request from computer data banks that laboratory information they deem most useful in the medical management of each clinical problem. (JT)|
Over the past two decades, the Faculty of Veterinary Medicine of Utrecht University (FVMU) has introduced major curriculum changes to keep pace with modern veterinary educational developments worldwide. Changes to program outcomes have been proposed according to professional and societal demands, with more attention paid to generic competencies and electives and species/sector differentiation. Furthermore, changes in educational approaches and the educational organization have been proposed, aiming at a transition from teacher-centered education toward more student-centered education. Curriculum development is a complex and difficult process, with many elements interacting. For a new curriculum to become valid, curriculum elements and their interrelation-such as statements of intent (also called outcomes, goals, or objectives), content, teaching and learning strategies, assessment strategies, and context-need to be addressed in the educational philosophy (i.e., the intended curriculum). This paper describes a document analysis of the major curriculum reforms of the FVMU. Curriculum committee reports were critically analyzed to gain insight into the intentions of the curriculum designers and the match between the curriculum elements, as described by Prideaux. The results show that the reports paid considerable attention to generic competency training, especially to academic training, and to the introduction of more student-centered teaching and learning strategies. However, little attention was paid to assessment strategies and the statements of intent were defined rather broadly. Curriculum evaluation (i.e., what is delivered to the students and how is the curriculum experienced) is needed at all curriculum levels. Possible mismatches between levels need to be identified. PMID:19625674
Jaarsma, Debbie A D C; Scherpbier, Albert J J A; van Beukelen, Peter
During the 1980's, the medicalrecord problems had been identified and it was not until 1991 that Queen Elizabeth Hospital was chosen to be the pilot hospital for the development of a new medicalrecord management system for the Hospital Authority hospitals. The new medicalrecords system was implemented in Queen Elizabeth Hospital in December, 1993. Six month after implementation, a pre-implementation and post-implementation review of the medicalrecord services were conducted to compare the results of the new and old system. The results showed that there were significant improvements in the record retrieval and record integrity in the new system. New medicalrecord services such as the delivery of readmission records to the ward, filing of medicalrecords forms in pre-defined order and filing of loose sheets in the relevant hospital notes are able to facilitate the efficient, effective and complete access to patient information. The support and cooperation of the hospital staff are crucial to the success of the new system. Continuous review and improvement of the new system is essential in order to obtain the best results. PMID:10142473
The document contains records of approximately 22,000 chemicals which since 1970 have been mentioned in a significant way in journals indexed in MEDLINE, the National Library of Medicine's online bibliographic database. Originally housed in a manual card ...
BACKGROUND: Accuracy and transportability of the recorded outpatient medication list are important in the continuum of patient care. Classifying discrepancies between the electronic medicalrecord (EMR) and actual drug use by the root cause of discrepancy (either system generated or patient generated) would guide quality improvement initiatives. OBJECTIVES: To quantify and categorize the number and type of medication discrepancies that
Postoperative complications (POC) that developed in dogs and cats that underwent elective ovariohysterectomy, castration, and declaw at a veterinary teaching hospital were determined by examining the computerized abstracts of the medicalrecords and by examining a random sample of the paper medicalrecords. When the computerized abstracts were examined, POC were found to have occurred in 62 (6.1%) of 1,016 dogs. One dog died and 6 others developed major complications. Postoperative complications were found to have occurred in 38 (2.6%) of 1,459 cats. Two cats died and 1 was euthanatized. Four other cats developed major complications. Complete paper medicalrecords for 218 dogs and cats were examined. When the paper medicalrecords were examined, the proportions of dogs and cats with POC were 19.4% and 12.2%, respectively. These proportions were 4 to 7 times higher than when the computerized abstracts were the data source. Results of this study indicate that the frequency of clinically relevant POC of elective surgeries in dogs and cats is substantial. Examination of the computerized abstracts of medicalrecords at this hospital allowed us to rapidly identify cases that could be included in the study but the frequency of POC would be significantly underestimated if paper records were not also assessed. PMID:8675479
Pollari, F L; Bonnett, B N; Bamsey, S C; Meek, A H; Allen, D G
The California Legislature approved a bill banning the disclosure of HIV-related medicalrecords in a workers' compensation claim, unless the injury involved exposure to the virus. The case began when an employee was injured on the job and disclosed his HIV status to the examining physician. The physician noted the infection in the medicalrecord, which was later sent to the employer as evidence in a workers' compensation claim. California's Confidentiality of Medical Information Act does not protect a patient's privacy once the records are used in workers' compensation. The law would ban unauthorized disclosure, and make the patient eligible for compensatory and punitive damages and attorney's fees. PMID:11367023
...for medical/psychiatric/psychological records. 1701.13 Section...for medical/psychiatric/psychological records. Current and...medical, psychiatric or psychological testing records by writing...govern administration of these types of records, including...
ObjectiveTo measure the accuracy of medicationrecords stored in the electronic medicalrecord (EMR) of an outpatient geriatric center. The authors analyzed accuracy from the perspective of a clinician using the data and the perspective of a computer-based medical decision-support system (MDSS).DesignProspective cohort study.MethodsThe EMR at the geriatric center captures medication data both directly from clinicians and indirectly using encounter
Recent advances in computer technology permit the accumulation, analysis, and storage of an unlimited quantity of medicalrecord information, thereby seriously compounding existing controversies surrounding patient confidentiality and privacy. This article surveys both benefits and problems arising from this increased availability of medicalrecords. It examines legal and ethical dilemmas arising from the conflict between the usefulness of patients, in particular their right to privacy. The article suggests guidelines for insuring fair and balanced health information policies. PMID:7320458
There are currently many active movements towards computerizing patient healthcare information. As Electronic MedicalRecord\\u000a (EMR) systems are being increasingly adopted in healthcare facilities, however, there is a big challenge in effectively utilizing\\u000a this massive information source. It is very time-consuming for healthcare providers to dig into the voluminous medicalrecords\\u000a of a patient to find the few that are
Objectives: To use community pharmacy medicationrecords to identify patients whose asthma may not be well managed and then implement and evaluate a multidisciplinary educational intervention to improve asthma management.\\u000aDesign, setting and participants: We used a multisite controlled study design. Forty-two pharmacies throughout Tasmania ran a software application that “data-mined” medicationrecords, generating a list of patients who had
Bonnie J Bereznicki; Gregory M Peterson; Shane L Jackson; E Haydn Walters; Kimbra D Fitzmaurice; Peter R Gee
Introduction: Electronic medicalrecords systems may improve the efficiency and quality of health services in developing countries. However the supporting evidence is limited as there are a number of barriers to their implementation, including lack of infrastructure, resources and skills. The objective of this study was to evaluate the introduction and assess the potential benefits of an Electronic MedicalRecords System in Rural at an NGO-supported health post in rural Nepal. Methods: Original research in the form of a case report was carried out using participant observation of health clinics, semi-structured interviews with health workers and recording of time spent on clinic activities at the pilot and a control site. Results: This evaluation found that the Electronic MedicalRecords System was well used and easy to learn. Health workers thought it improved continuity of care and found decision-support tools useful. Monthly report creation was faster but the system was difficult to integrate with government services, which limited the reduction in paperwork. Other problems identified included minor software issues, a lack of back-up, continuity of power supply and inadequate technical support. There was no significant impact on consultation length or time spent interacting with patients. Conclusions: The introduction of the Electronic MedicalRecords System was largely successful. With adequate technical support and training, Electronic MedicalRecords System could provide a relatively low-cost means of improving patient care and health worker efficiency in developing countries. However they must be designed to fit their intended environment. Keywords: computerized; electronic health records; medicalrecords; medicalrecords systems. PMID:23591253
This research project utilized the qualitative case study method to describe the process, problems, and results of the implementation of the electronic medicalrecord in a large military medical center from the medicalrecord department's perspective. Muc...
With the widely use of healthcare information technology in hospitals, the patients' medicalrecords are more and more complex. To transform the text- or image-based medical information into easily understandable and acceptable form for human, we designed and developed an innovation indexing method which can be used to assign an anatomical 3D structure object to every patient visually to store
This exploratory study consisted of a medicalrecord review of patients with Arabic surnames who utilized outpatient, inpatient, or emergency facilities of a university medical center and a public teaching hospital from 1975 to 1981. The purposes of the study were to describe help-seeking behavior of Arab-American patients, including why they sought care and whether they posed problems for providers,
Juliene G. Lipson; Alice E. Reizian; Afaf I. Meleis
Integrated electronic medicalrecord (EMR) systems are becoming an essential part of the fabric of modern healthcare. EMR systems have evolved from pure record-keeping to an integrated, enterprise-wide system that holds the promise of accurate, real time access to patient healthcare data. EMR systems can provide healthcare administrators and clinicians with the information necessary to improve patient care and lower
The MedicalRecord is the major source of Health information. Therefore, it is necessary to maintain good patient records by documenting all the required information, e.g. history, physical examination, progress notes, investigations, treatment including surgical procedures, complete diagnosis and end result, etc., as per the guidelines stated in the International Classification of Diseases published by World Health Organisation. If the documentation is accurate and complete, the health care information could be obtained and classified accurately and completely according to International Classification of Diseases published by WHO. Hence, International Classification of Diseases plays an important role in managing good medicalrecords. PMID:10177052
|Objective: At the University of California, Davis (UCD), the authors sought to develop an institutional network of reflective educational leaders. The authors wanted to enhance faculty understanding of medical education's complexity, and improve educators' effectiveness as regional/national leaders. Methods: The UCD Teaching Scholars Program is a…
Srinivasan, Malathi; Pratt, Daniel D.; Collins, John; Bowe, Constance M.; Stevenson, Frazier T.; Pinney, Stephen J.; Wilkes, Michael S.
Background Improvements in the quality of health care services are often measured using data present in medicalrecords. Electronic MedicalRecords (EMRs) contain potentially valuable new sources of health data. However, data quality in EMRs may not be optimal and should be assessed. Data reliability (are the same data elements being measured over time?) is a prerequisite for data validity (are the data accurate?). Our objective was to measure the reliability of data for preventive services in primary care EMRs during the transition to EMR. Methods Our data sources were randomly selected eligible patients’ medicalrecords and data obtained from provincial administrative datasets. Eighteen community-based family physicians in Toronto, Ontario that implemented EMRs starting in 2006 participated in this study. We measured the proportion of patients eligible for a service (Pap smear, screening mammogram or influenza vaccination) that received the service. We compared the change in rates of selected preventive services calculated from the medicalrecord audits with the change in administrative datasets. Results In the first year of EMR use (2006) services decreased by 8.7% more (95% CI ?11.0%–???6.4%, p?0.0001) when measured through medicalrecord audits as compared with administrative datasets. Services increased by 2.4% more (95% CI 0%–4.9%, p?=?0.05) in the medicalrecord audits during the second year of EMR use (2007). Conclusion There were differences between the change measured through medicalrecord audits and administrative datasets. Problems could include difficulties with organizing new data entry processes as well as continued use of both paper and EMRs. Data extracted from EMRs had limited reliability during the initial phase of EMR implementation. Unreliable data interferes with the ability to measure and improve health care quality
OBJECTIVE: To measure the accuracy of medicationrecords stored in the electronic medicalrecord (EMR) of an outpatient geriatric center. The authors analyzed accuracy from the perspective of a clinician using the data and the perspective of a computer-based medical decision-support system (MDSS). DESIGN: Prospective cohort study. METHODS: The EMR at the geriatric center captures medication data both directly from clinicians and indirectly using encounter forms and data-entry clerks. During a scheduled office visit for medical care, the treating clinician determined whether the medicationrecords for the patient were an accurate representation of the medications that the patient was actually taking. Using the available sources of information (the patient, the patient's vials, any caregivers, and the medical chart), the clinician determined whether the recorded data were correct, whether any data were missing, and the type and cause for each discrepancy found. RESULTS: At the geriatric center, 83% of medicationrecords represented correctly the compound. dose, and schedule of a current medication; 91% represented correctly the compound. 0.37 current medications were missing per patient. The principal cause of errors was the patient (36.1% of errors), who misreported a medication at a previous visit or changed (stopped, started, or dose-adjusted) a medication between visits. The second most frequent cause of errors was failure to capture changes to medications made by outside clinicians, accounting for 25.9% of errors. Transcription errors were a relatively ucommon cause (8.2% of errors). When the accuracy of records from the center was analyzed from the perspective of a MDSS, 90% were correct for compound identity and 1.38 medications were missing or uncoded per patient. The cause of the additional errors of omission was a free-text "comments" field-which it is assumed would be unreadable by current MDSS applications-that was used by clinicians in 18% of records to record the identity of the medication. CONCLUSIONS: Medicationrecords in an outpatient EMR may have significant levels of data error. Based on an analysis of correctable causes of error, the authors conclude that the most effective extension to the EMR studied would be to expand its scope to include all clinicians who can potentially change medications. Even with EMR extensions, however, ineradicable error due to patients and data entry will remain. Several implications of ineradicable error for MDSSs are discussed. The provision of a free-text "comments" field increased the accuracy of medication lists for clinician users at the expense of accuracy for a MDSS.
In the last decade, electronic medicalrecord (EMR) use in academic medical centers has increased. Although many have lauded the clinical and operational benefits of EMRs, few have considered the effect these systems have on medical education. The authors review what has been documented about the effect of EMR use on medical learners through the lens of the Accreditation Council for Graduate Medical Education's six core competencies for medical education. They examine acknowledged benefits and educational risks to use of EMRs, consider factors that promote their successful use when implemented in academic environments, and identify areas of future research and optimization of EMRs' role in medical education. PMID:23619078
Tierney, Michael J; Pageler, Natalie M; Kahana, Madelyn; Pantaleoni, Julie L; Longhurst, Christopher A
...participation: Special medicalrecord requirements for psychiatric hospitals. 482.61 Section 482.61 Public Health...participation: Special medicalrecord requirements for psychiatric hospitals. The medicalrecords maintained by a...
...participation: Special medicalrecord requirements for psychiatric hospitals. 482.61 Section 482.61 Public Health...participation: Special medicalrecord requirements for psychiatric hospitals. The medicalrecords maintained by a...
The multiplication of the requests of the patients for a direct access to their MedicalRecord (MR), the development of Personal MedicalRecord (PMR) supervised by the patients themselves, the increasing development of the patients' electronic medicalrecords (EMRs) and the world wide internet utilization will lead to envisage an access by using technical automatic and scientific way. It will require the addition of different conditions: a unique patient identifier which could base on a familial component in order to get access to the right record anywhere in Europe, very strict identity checks using cryptographic techniques such as those for the electronic signature, which will ensure the authentication of the requests sender and the integrity of the file but also the protection of the confidentiality and the access follow up. The electronic medicalrecord must also be electronically signed by the practitioner in order to get evidence that he has given his agreement and taken the liability for that. This electronic signature also avoids any kind of post-transmission falsification. This will become extremely important, especially in France where patients will have the possibility to mask information that, they do not want to appear in their personal medicalrecord. Currently, the idea of every citizen having electronic signatures available appears positively Utopian. But this is yet the case in eGovernment, eHealth and eShopping, world-wide. The same was thought about smart cards before they became generally available and useful when banks issued them. PMID:17901616
Numerous researchers have expressed concern over the impacts on medicalrecords availability of the newly effective Medical Information Privacy rule, as authorized by the Health Insurance Portability and Accountability Act (HIPAA). The increased costs associated with compliance with the rule, and the increased potential for financial liability, raises the possibility that hospitals may be less likely to participate in such
This paper reflects on the extent to which we are preparing learners for practice in an electronic health record (EHR)-mediated world. We are currently training the last generation to remember a world without the Internet and the first who will practice in a largely EHR-mediated practice environment. We undertook a thematic review of the literature connecting medical education with e-health using the concepts of 'electronic health record' or 'electronic medicalrecord' as a proxy for the broader notion of e-health. Our findings are more equivocal and cautious than earlier commentators might have expected and while there are examples of good practice and successful integration, the majority of articles we reviewed raised issues and problems with the current links between EHRs and medical education. Medical professionals in particular are quite ambivalent about many of the changes brought about by EHRs, and in the absence of changes in perception and practice it is likely that the connections between medical education and e-health will continue to be problematic. We hope that this paper will lead to an improved understanding of these problems and will serve to advance the discourse on how medical education should engage with the world of e-health and the world of e-health with medical education. PMID:23464893
This identification key has been prepared to enable field workers in eastern and centra Africa to identify the species and subspecies of snails acting as intermediate hosts of various flukes causing bilharziasis and related diseases in man and his domestic stock. The area covered by the key is eastern Africa from the Sudan and Somalia in the north to Southern Rhodesia in the south. The key includes all species and subspecies of the three medically and veterinarily important genera, Lymnaea, Bulinus and Biomphalaria. All other freshwater pulmonates of the area can be identified as to genus only. Those features of the shells and soft parts of snails which are used in identification are discussed in some detail, and indications are given as to methods of collection, preservation and dissection of snails.
The first generation of computerized medicalrecords stored the data as text, but these records did not bring any improvement in information manipulation. The use of a relational database management system (DBMS) has largely solved this problem as it allows for data requests by using SQL. However, this requires data structuring which is not very appropriate to medicine. Moreover, the use of templates and icon user interfaces has introduced a deviation from the paper-based record (still existing). The arrival of hypertext user interfaces has proven to be of interest to fill the gap between the paper-based medicalrecord and its electronic version. We think that further improvement can be accomplished by using a fully document-based system. We present the architecture, advantages and disadvantages of classical DBMS-based and Web/DBMS-based solutions. We also present a document-based solution and explain its advantages, which include communication, security, flexibility and genericity. PMID:10431512
We developed an accurate and valid medication order algorithm to identify from electronic health records the definitive medication order intended for dispensing and applied this process to identify a cohort of patients and to stratify them into one of three medication adherence groups: early non-persistence, primary non-adherence, or ongoing adherence. We identified medication order data from electronic health record tables, obtained the orders, and linked the orders to dispensings. These steps were then used to identify patients newly prescribed antihypertensive, antidiabetic, or antihyperlipidemic medications and to determine the adherence group of each patient. Record review validated each process step, thus increasing the accuracy of group assignment as well as the criteria used to select patients. This work is an important first step to accurately identify study-specific patient adherence cohorts and allow more comprehensive estimates of population medication adherence.
Ellis, Jennifer L; Luckett, Capp F; Raebel, Marsha A
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.
Gallegos, J.; Hamilton, V.; Gaylor, T.; McCurley, K.; Meeks, T.
ABSTRACT: The electronic medicalrecord (EMR) is an enabling technology,that allows phy- sician practices to pursue,more powerful quality improvement,programs,than is possible with paper-based records. However, achieving quality improvement through EMR use is nei- ther low-cost nor easy. Based on a qualitative study of physician practices that had imple- mented an EMR, we found that quality improvement depends heavily on physicians’
The extension for the Web applications of the Electronic MedicalRecord seems both interesting and promising. Correlated with the expansion of Internet in our country, it allows the interconnection of physicians of different specialties and their collaboration for better treatment of patients. In this respect, the ophthalmologic medical applications consider the increased possibilities for monitoring chronic ocular diseases and for the identification of some elements for early diagnosis and risk factors supervision. We emphasize in this survey some possible solutions to the problems of interconnecting medical information systems to the Internet: the achievement of interoperability within medical organizations through the use of open standards, the automated input and processing for ocular imaging, the use of data reduction techniques in order to increase the speed of image retrieval in large databases, and, last but not least, the resolution of security and confidentiality problems in medical databases. PMID:18543666
BACKGROUND: New algorithms for disease outbreak detection are being developed to take advantage of full electronic medicalrecords (EMRs) that contain a wealth of patient information. However, due to privacy concerns, even anonymized EMRs cannot be shared among researchers, resulting in great difficulty in comparing the effectiveness of these algorithms. To bridge the gap between novel bio-surveillance algorithms operating on
Most early reports of implemented World-Wide Web (W3) medicalrecord systems describe single institution architectures. We describe W3-EMRS, a multi-institutional architecture, and its implementation. Thorny problems in data sharing underlined by the W3-EMRS project are reviewed.
Kohane, I. S.; van Wingerde, F. J.; Fackler, J. C.; Cimino, C.; Kilbridge, P.; Murphy, S.; Chueh, H.; Rind, D.; Safran, C.; Barnett, O.; Szolovits, P.
Low adoption rate of Electronic MedicalRecord (EMR) systems is hindering achieving a national health care cost reduction estimated at $12 billion over the next 10 years. Physicians' EMR adoption rates are as a low as 10% nation-wide, due in part to poor design of the system user interface. The poor design is impacting EMR usability where physicians are faced
Kushtrim Kuqi; Tim Eveleigh; Thomas Holzer; Shahryar Sarkani
|Recently, the Medical University of South Carolina adopted a lecture recording system (LRS). A retrospective study of LRS was implemented to document the students' perceptions, pattern of usage, and impact on the students' grades in three basic sciences courses (Cell Biology/Histology, Physiology, and Neurosciences). The number of accesses and…
Bacro, Thierry R. H.; Gebregziabher, Mulugeta; Fitzharris, Timothy P.
A major obstacle in deploying computer-based clinical guidelines at the point of care is the variability of electronic medicalrecords and the consequent need to adapt guideline modeling languages, guideline knowledge bases, and execution engines to idiosyncratic data models in the deployment environment. This paper reports an approach, developed jointly by researchers at Newcastle and Stanford, where guideline models are
With the development of electronic systems, privacy has become an important security issue in real-life. In medical systems, privacy of patients' electronic medicalrecords (EMRs) must be fully protected. However, to combine the efficiency and privacy, privacy preserving index is introduced to preserve the privacy, where the EMR can be efficiently accessed by this patient or specific doctor. In the literature, Goh first proposed a secure index scheme with keyword search over encrypted data based on a well-known primitive, Bloom filter. In this paper, we propose a new privacy preserving index scheme, called position index (P-index), with keyword search over the encrypted data. The proposed index scheme is semantically secure against the adaptive chosen keyword attack, and it also provides flexible space, lower false positive rate, and search privacy. Moreover, it does not rely on pairing, a complicate computation, and thus can search over encrypted electronic medicalrecords from the cloud server efficiently. PMID:24158427
Using image scanning as a document capture mechanism at time of treatment or on day of discharge automates the medicalrecord to achieve the larger objectives of simultaneous concurrent access to an electronic chart. This form of keyless document capture, although appearing labor intensive, is justified for improving business management and quality of care. Coupled with optical character recognition or barcode recognition for keyless data capture, medical information may be more easily made available for clinical research. Not merely a microfilm alternative, a medicalrecord management system accelerates chart completion. Labor reduction is realized by eliminating filing and retrieval of active charts, loose sheet handling, photocopying, chart assembly, and chart location control. By reducing the reasons for chart completion delays, accelerated billing of Medicare accounts will occur, resulting in a reduction in receivables. Image-based document management systems accomplish the three things required of a senior manager in health care: (1) solve problems, (2) save money, and (3) make money. PMID:10116256
This exploratory study consisted of a medicalrecord review of patients with Arabic surnames who utilized outpatient, inpatient, or emergency facilities of a university medical center and a public teaching hospital from 1975 to 1981. The purposes of the study were to describe help-seeking behavior of Arab-American patients, including why they sought care and whether they posed problems for providers, and to determine if the medicalrecords identified culturally-related care needs. This report describes data from 106 charts reviewed with reference to demographic data, illness behavior, and use of facilities. The findings revealed more about charting habits of health professionals than about unique characteristics of patients in this ethnic group. PMID:3563553
Numerous researchers have expressed concern over the impacts on medicalrecords availability of the newly effective Medical Information Privacy rule, as authorized by the Health Insurance Portability and Accountability Act (HIPAA). The increased costs associated with compliance with the rule, and the increased potential for financial liability, raises the possibility that hospitals may be less likely to participate in such research, resulting in a decrease of the validity of multisite studies designed to represent an entire population. Our multisite medicalrecord validation study, designed to assess the accuracy of maternally linked birth records, provides an overview of a number of HIPAA implementation challenges. We found that the new HIPAA rule presents new challenges for those who rely on the release of medicalrecord information for epidemiologic research. At the very minimum, increased compliance costs associated with human subjects protection and increased administrative burden for researchers would seem to be inevitable as medical institutions address the requirements of the new HIPAA rule by instituting more complex and thus more cumbersome procedures. Researchers should anticipate increased costs and plan accordingly when budgeting for human subjects review processes. PMID:15125456
...2012-10-01 2012-10-01 false Medical review officer record retention for...and Confidentiality Â§ 382.409 Medical review officer record retention for controlled substances. (a) A medical review officer or third party...
Background As patients often see the data of their medical histories scattered among various medicalrecords hosted in several health-care establishments, the purpose of our multidisciplinary study was to define a pragmatic and secure on-demand based system able to gather this information, with no risk of breaching confidentiality, and to relay it to a medical professional who asked for the information via a specific search engine. Methods Scattered data are often heterogeneous, which makes the task of gathering information very hard. Two methods can be compared: trying to solve the problem by standardizing and centralizing all the information about every patient in a single MedicalRecord system or trying to use the data "as is" and find a way to obtain the most complete and the most accurate information. Given the failure of the first approach, due to the lack of standardization or privacy and security problems, for example, we propose an alternative that relies on the current state of affairs: an on-demand system, using a specific search engine that is able to retrieve information from the different medicalrecords of a single patient. Results We describe the function of MedicalRecord Search Engines (MRSE), which are able to retrieve all the available information regarding a patient who has been hospitalized in different hospitals and to provide this information to health professionals upon request. MRSEs use pseudonymized patient identities and thus never have access to the patient's identity. However, though the system would be easy to implement as it by-passes many of the difficulties associated with a centralized architecture, the health professional would have to validate the information, i.e. read all of the information and create his own synthesis and possibly reject extra data, which could be a drawback. We thus propose various feasible improvements, based on the implementation of several tools in our on-demand based system. Conclusions A system that gathers all of the currently available information regarding a patient on the request of health-care professionals could be of great interest. This low-cost pragmatic alternative to centralized medicalrecords could be developed quickly and easily. It could also be designed to include extra features and should thus be considered by health authorities.
... 2009-07-01 false Recording criteria for cases involving medical removal under OSHA standards... Recordkeeping Forms and Recording Criteria Â§ 1904.9 Recording criteria for cases involving medical removal under OSHA...
... 2010-07-01 false Recording criteria for cases involving medical removal under OSHA standards... Recordkeeping Forms and Recording Criteria Â§ 1904.9 Recording criteria for cases involving medical removal under OSHA...
The electronic medicalrecord (EMR) has been used in Department of Veterans Affairs health care facilities since the mid 1980s. Health care reform is a top priority in the United States, and the adoption of a standardized EMR is a major component and cost-saving tool. From scheduling patients for surgical procedures to provider documentation and production of vital reports for the local facility and the National Veterans Health Administration office, the EMR is successful with less clinical overhead. Use of the EMR reduces redundant tests, medical errors, and improves hand-off communications. PMID:19348817
The idea behind hospital information systems is to make all of a patient's medical reports, lab results, and images electronically available to clinicians, instantaneously, wherever they are. But the higgledy-piggledy evolution of most hospital computer systems makes it hard to integrate all these clinical records. Although several integration standards had been proposed to meet this challenger, none of them is fit to Chinese hospitals. In this paper, we introduce our work of implementing a three-tiered architecture enterprise viewer in Huzhou Central Hospital to integration all existing medical information systems using limited resource. PMID:17282239
Li, Haomin; Duan, Huilong; Lu, Xudong; Zhao, Chenhui; An, Jiye
In summation, some document imaging systems offer the capability to form what may be called electronic medicalrecord (EMR) systems. These systems are adaptations of current paper-based record management systems into the digital environment, but they offer far more capabilities than strictly archival, historical functions. Some of the capabilities that create EMR systems will also be necessary for development of CPRs, these capabilities are listed as follows: mass storage and image management; direct capture, storage, and retrieval of digital information (native format); large volume, high-speed, client-server networks; multi-media information management; high-power, flexible database tools; workflow process software; flexible, full function security; user customizable features; and alerts and reminders. Selection and implementation of document imaging systems should, at present, be undertaken with great care to insure that the platform may be utilized to form an electronic medicalrecord with a clear migration path to the CPR. PMID:10128938
\\u000a Electronic health records (EHRs) provide an opportunity to drastically reduce certain errors related to the prescribing and\\u000a administration of medications. In certain settings, for example, nursing homes, assisted living facilities, and other long-term\\u000a care (LTC) environments, the opportunities to use EHR systems that are optimized for the setting and patient population exist\\u000a now. This chapter describes the advantages in the
The legislation on the Icelandic genetic database provides for an opting-out system for the collection of encoded medical information from individual medicalrecords. From the beginning this has raised criticism, in Iceland itself and abroad. The Supreme Court has now decided that this approach of presumed consent is not unconstitutional per se, but that there are not sufficient safeguards to ensure that the information collected is not traceable to individuals. The decision of the court is of importance for the debate (at national and international level) on the legal and ethical aspects of population-based genetic databases. Furthermore, it is interesting because it recognizes the right of close relatives of a deceased person to oppose the collection and use of his or her medical data for genetic research, at least as long as these data may still be identifiable. PMID:15692191
The Health Insurance Privacy and Portability Act (HIPPA) stipulates that patients must be permitted to review and amend their medicalrecords. As information technology makes medicalrecords 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 medicalrecord by reviewing
Background Text-based patient medicalrecords are a vital resource in medical research. In order to preserve patient confidentiality, however, the U.S. Health Insurance Portability and Accountability Act (HIPAA) requires that protected health information (PHI) be removed from medicalrecords before they can be disseminated. Manual de-identification of large medicalrecord databases is prohibitively expensive, time-consuming and prone to error, necessitating automatic methods for large-scale, automated de-identification. Methods We describe an automated Perl-based de-identification software package that is generally usable on most free-text medicalrecords, e.g., nursing notes, discharge summaries, X-ray reports, etc. The software uses lexical look-up tables, regular expressions, and simple heuristics to locate both HIPAA PHI, and an extended PHI set that includes doctors' names and years of dates. To develop the de-identification approach, we assembled a gold standard corpus of re-identified nursing notes with real PHI replaced by realistic surrogate information. This corpus consists of 2,434 nursing notes containing 334,000 words and a total of 1,779 instances of PHI taken from 163 randomly selected patient records. This gold standard corpus was used to refine the algorithm and measure its sensitivity. To test the algorithm on data not used in its development, we constructed a second test corpus of 1,836 nursing notes containing 296,400 words. The algorithm's false negative rate was evaluated using this test corpus. Results Performance evaluation of the de-identification software on the development corpus yielded an overall recall of 0.967, precision value of 0.749, and fallout value of approximately 0.002. On the test corpus, a total of 90 instances of false negatives were found, or 27 per 100,000 word count, with an estimated recall of 0.943. Only one full date and one age over 89 were missed. No patient names were missed in either corpus. Conclusion We have developed a pattern-matching de-identification system based on dictionary look-ups, regular expressions, and heuristics. Evaluation based on two different sets of nursing notes collected from a U.S. hospital suggests that, in terms of recall, the software out-performs a single human de-identifier (0.81) and performs at least as well as a consensus of two human de-identifiers (0.94). The system is currently tuned to de-identify PHI in nursing notes and discharge summaries but is sufficiently generalized and can be customized to handle text files of any format. Although the accuracy of the algorithm is high, it is probably insufficient to be used to publicly disseminate medical data. The open-source de-identification software and the gold standard re-identified corpus of medicalrecords have therefore been made available to researchers via the PhysioNet website to encourage improvements in the algorithm.
Neamatullah, Ishna; Douglass, Margaret M; Lehman, Li-wei H; Reisner, Andrew; Villarroel, Mauricio; Long, William J; Szolovits, Peter; Moody, George B; Mark, Roger G; Clifford, Gari D
Oncology outcomes research could benefit from the use of an oncology-specific electronic medicalrecord (EMR) network. The benefits and challenges of using EMR in general health research have been investigated; however, the utility of EMR for oncology outcomes research has not been explored. Compared to current available oncology databases and registries, an oncology-specific EMR could provide comprehensive and accurate information on clinical diagnoses, personal and medical histories, planned and actual treatment regimens, and post-treatment outcomes, to address research questions from patients, policy makers, the pharmaceutical industry, and clinicians/researchers. Specific challenges related to structural (eg, interoperability, data format/entry), clinical (eg, maintenance and continuity of records, variety of coding schemes), and research-related (eg, missing data, generalizability, privacy) issues must be addressed when building an oncology-specific EMR system. Researchers should engage with medical professional groups to guide development of EMR systems that would ultimately help improve the quality of cancer care through oncology outcomes research.
This presentation examines the ethical issues raised by computerized image management and communication systems (IMAC), the ethical principals that should guide development of policies, procedures and practices for IMACS systems, and who should be involved in developing a hospital's approach to these issues. The ready access of computerized records creates special hazards of which hospitals must beware. Hospitals must maintain confidentiality of patient's records while making records available to authorized users as efficiently as possible. The general conditions of contemporary health care undermine protecting the confidentiality of patient record. Patients may not provide health care institutions with information about themselves under conditions of informed consent. The field of information science must design sophisticated systems of computer security that stratify access, create audit trails on data changes and system use, safeguard patient data from corruption, and protect the databases from outside invasion. Radiology professionals must both work with information science experts in their own hospitals to create institutional safeguards and include the adequacy of security measures as a criterion for evaluating PACS systems. New policies and procedures on maintaining computerized patient records must be developed that obligate all members of the health care staff, not just care givers. Patients must be informed about the existence of computerized medicalrecords, the rules and practices that govern their dissemination and given the opportunity to give or withhold consent for their use. Departmental and hospital policies on confidentiality should be reviewed to determine if revisions are necessary to manage computer-based records. Well developed discussions of the ethical principles and administrative policies on confidentiality and informed consent and of the risks posed by computer-based patient records systems should be included in initial and continuing staff system training. Administration should develop ways to monitor staff compliance with confidentiality policies and should assess diligence in maintaining patient record confidentiality as part of staff annual performance evaluations. Ethical management of IMAC systems is the business of all members of the health care team. Computerized patient records management (including IMAC) should be scrutinized as any other clinical medial ethical issue. If hospitals include these processes in their planning for RIS, IMACS, and HIS systems, they should have time to develop institutional expertise on these questions before and as systems are installed rather than only as ethical dilemmas develop during their use.
Electronic Health Record (EHR) systems are now being developed in many places. More advanced systems provide also reminder facilities, usually based on if-then rules. In this paper we propose a method how to build the reminder facility directly upon the guideline interchange format (GLIF) model of medical guidelines. The method compares data items on the input of EHR system with medical guidelines GLIF model and is able to reveal if the input data item, that represents patient diagnosis or proposed patient treatment, contradicts with medical guidelines or not. The reminder facility can be part of EHR system itself or it can be realized by a stand-alone reminder system (SRS). The possible architecture of stand-alone reminder system is described in this paper and the advantages of stand-alone solution are discussed. The part of the EHR system could be also a browser that would present graphical GLIF model in easy to understand manner on the user screen. This browser can be data driven and focus attention of user to the relevant part of medical guidelines GLIF model. PMID:16165396
...National Institute of Food and Agriculture, USDA. ACTION: Notice of a proposed new Privacy...1974, the Department of Agriculture (USDA), National Institute of Food and Agriculture...Loan Repayment Program Records System, USDA/NIFA-1.'' This newly...
Implementing an electronic medicalrecord (EMR) is a major initiative that should be undertaken only after a thoughtful analysis of the costs and benefits involved. Unfortunately, demonstrating financial returns on an EMR often is regarded as an inexact science at best, which has caused many healthcare executives to avoid adopting this technology. With the right approach, however, it is possible to demonstrate convincingly that the financial benefits will far outweigh the costs. To do this, it is necessary to involve representatives from operational areas throughout the organization, because they are best able to identify the potential for cost savings and additional revenue opportunities. PMID:11806319
Development of clinical decision support systems (CDS) is a process which highly depends on the local databases, this resulting in low interoperability. To increase the interoperability of CDS a standard representation of clinical information is needed. The paper suggests a CDS architecture which integrates several HL7 standards and the new vMR (virtual MedicalRecord). The clinical information for the CDS systems (the vMR) is represented with Topic Maps technology. Beside the implementation of the vMR, the architecture integrates: a Data Manager, an interface, a decision making system (based on Egadss), a retrieving data module. Conclusions are issued. PMID:22874164
Gomoi, Valentin-Sergiu; Dragu, Daniel; Stoicu-Tivadar, Vasile
The introduction of the electronic medicalrecord (EMR) is widely seen by healthcare policy makers and service managers alike as a key step in the achievement of more efficient and integrated healthcare services. However, our study of inter-service work practices reveals important discrepancies between the presumptions of the role of the EMR in achieving service integration and the ways in
Mark Hartswood; Rob Procter; Mark Rouncefield; Roger Slack
...age of majority. (a) The Air Force must obey state laws protecting medicalrecords of drug or alcohol abuse treatment, abortion, and birth control. If you manage medicalrecords, learn the local laws and coordinate proposed local policies with...
A study of manpower in the medicalrecord field in Illinois is presented. It is based upon examination of the supply and anticipated need for professional medicalrecord personnel, and on an examination of the educational background, age, marital status, ...
... 2 2013-07-01 2013-07-01 false Who controls access to medical monitoring and exposure records? 150... Safety and Health (general) Â§ 150.604 Who controls access to medical monitoring and exposure records?...
The recent development of eHealth platforms across the world, whose main objective is to centralize patient's healthcare information to ensure the best continuity of care, requires the development of advanced tools and techniques for supporting health professionals in retrieving relevant information in this vast quantity of data. However, for preserving patient's privacy, some countries decided to de-identify and encrypt data contained in the shared Electronic Health Records, which reinforces the complexity of proposing efficient medical information retrieval approach. In this paper, we describe an original approach exploiting standards metadata as well as knowledge organizing systems to overcome the barriers of data encryption for improving the results of medical information retrieval in centralized and encrypted Electronic Health Records. This is done through the exploitation of semantic properties provided by knowledge organizing systems, which enable query expansion. Furthermore, we provide an overview of the approach together with illustrating examples and a discussion on the advantages and limitations of the provided framework. PMID:22874185
Adolescents are a group likely to seek and, perhaps, most likely to benefit from electronic access to health information. Despite significant advances in technical capabilities over the past decade, to date neither electronic medicalrecord vendors nor many health care systems have adequately addressed the functionality and process design considerations needed to protect the confidentiality of adolescent patients in an electronic world. We propose a shared responsibility for creating the necessary tools and processes to maintain the adolescent confidentiality required by most states: (1) system vendors must provide key functionality in their products (adolescent privacy default settings, customizable privacy controls, proxy access, and health information exchange compatibility), and (2) health care institutions must systematically address relevant adolescent confidentiality policies and process design issues. We highlight the unique technical and process considerations relevant to this patient population, as well as the collaborative multistakeholder work required for adolescent patients to experience the potential benefits of both electronic medicalrecords and participatory health information technology. PMID:23084160
Anoshiravani, Arash; Gaskin, Gregory L; Groshek, Mark R; Kuelbs, Cynthia; Longhurst, Christopher A
Privacy is a very important issue when storing electronic medicalrecords. According to the definition set out in the Health Insurance Portability and Accountability Act (HIPPA), the confidential section of the electronic medicalrecord needs to be protected. Thus, a mechanism to protect the patient’s privacy is needed during electronic medicalrecord exchange and sharing. The privacy protection mechanism can
Zhuo-Rong Li; En-Chi Chang; Kuo-Hsuan Huang; Feipei Lai
...procedures for notification of or access to medicalrecords. 5b.6 Section 5b.6 ...procedures for notification of or access to medicalrecords. (a) General. An individual...right to notification of or access to his medicalrecords, including...
...2012-10-01 2012-10-01 false Medicalrecords necessary to establish that a...Documentation To Be Deemed Eligible Â§ 102.50 Medicalrecords necessary to establish that a...a requester must submit the following medicalrecords: (1) All physician,...
... 2012-10-01 false Access to medicalrecords for the...INFORMATION Utilization and Quality Control Quality Improvement Organizations...Information Â§ 480.131 Access to medicalrecords for the...to monitor a QIO will have access to medicalrecords...
...2013-07-01 2013-07-01 false Recording criteria for cases involving medical...ADMINISTRATION, DEPARTMENT OF LABOR RECORDING AND REPORTING OCCUPATIONAL INJURIES...ILLNESSES Recordkeeping Forms and Recording Criteria Â§ 1904.9...
...determines that such records are not exempt from disclosure, NACIC will, after consultation with the Director of Medical Services, CIA, determine: (1) Which records may be sent directly to the requester and (2) Which records should not be sent...
To understand and better manage attendance and overtime for a team of veterinary technicians, a retrospective analysis of the attendance and time card records was done over a 2-y period. The findings show that veterinary technicians were in the workplace for a combination of straight time and overtime hours for approximately 89% of all compensated hours. The remainder of paid compensation was for vacation (4%), holidays (4%), and sick leave (3%). This team of veterinary technicians earned significantly more overtime hours, as much as 9% of total annual compensated hours, than the reported 3% standard for animal resources programs nationwide. The majority of overtime hours (61%) were for assigned weekend and holiday duty and after-hours veterinarymedical emergencies. Veterinary technicians expended sick leave at 75% of the amount accrued and at a statistically significantly rate 65% higher than the national average for unscheduled absences for hourly personnel in animal resources programs. Because the direct cost of absenteeism may exceed 645 dollars per employee annually and because work inappropriately done at premium pay outside of business hours is a controllable expense, sound management of attendance and overtime is important in cost containment for animal resources programs. PMID:16995643
Self-reported medical history data are frequently used in epidemiological studies. Self-reported diagnoses may differ from medicalrecord diagnoses due to poor patient-clinician communication, self-diagnosis in the absence of a satisfactory explanation fo...
B. Smith E. J. Boyko L. K. Chu P. J. Amoroso T. C. Smith
Iowa State University's libraries have been compiling electronic subject guides for a number of years, and this is one such guide that users in the field of veterinary medicine will want to bookmark. Organized thematically, the resources are contained within one single list, and they are divided into categories such as websites, electronic journals, online abstracts, and basic pet care and health resources. Some of the gateway sites are quite helpful, particularly the link to the animal diseases database offered by the Karolinska Institutet in Sweden. Both potential veterinarian technicians and laypersons will appreciate the pet care links, which include links to the Healthy Pet site created by the American Animal Hospital Association and an overview to animal care created by the American VeterinaryMedical Association.
We surveyed a nationally representative sample of medical group practices\\u000d\\u000a\\u0009to assess their current use of information technology (IT). Our results\\u000d\\u000a\\u0009suggest that adoption of electronic health records (EHRs) is progressing\\u000d\\u000a\\u0009slowly, at least in smaller practices, although a number of group\\u000d\\u000a\\u0009practices plan to implement an EHR within the next two years. Moreover,\\u000d\\u000a\\u0009the process of choosing and implementing
David Gans; John Kralewski; Terry Hammons; Bryan Dowd
ObjectivesTo investigate the issues raised in applying a preliminary version of the GALEN compositional concept reference (CORE) model to a series of radiographic reports, and to demonstrate that the same underlying concept model could be used in conjunction with both a detailed, fine-grained model of medicalrecords based on that used in the PEN&PAD project and with other more conventional
A. L. Rector; A J Glowinski; W A Nowlan; Angelo Rossi-Mori
The medicalrecords 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 Medicalrecords system in education and research work. The salient aspects of the medicalrecords department were evaluated based on a questionnaire which was evaluated by a team of 40 participants-30 doctors, 5 personnel from MedicalRecords Department and 5 from staff of Hospital administration. Most of the physicians (65%) were partly satisfied with the existing medicalrecord 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 medicalrecords re-engineering process in the form of electronic medicalrecords system and regular review by the audit commission. PMID:21409398
Kumar, B Deepak; Kumari, C M Vinaya; Sharada, M S; Mangala, M S
The antibiograms of 408 Salmonella species isolated from large animals were collected during a three year study from 1981 through 1983. The predominant Salmonella serogroup among these isolates was group B. A consistently high percentage of all isolates were resistant to ampicillin and tetracycline. A pattern of increasing resistance to chloramphenicol and gentamicin was documented for serogroup B isolates while the susceptibility of the isolates to neomycin increased. There was a decrease in the incidence of susceptibility to sulfamethoxazole-trimethoprim among the group E isolates. These changes were not as remarkable, nor as alarming, as the overall decreased susceptibility to chloramphenicol and gentamicin. An evaluation of the principles concerning use of antimicrobial agents in veterinary medicine for treatment of Salmonella infections is recommended.
The aims of the study were to assess theagreement between data from personal interviews andmedical records on selected medical conditions, toevaluate the validity of each source of information, andto estimate the prevalence of these conditions inpancreatobiliary pathology. Between 1992 and 1995, 602patients with pancreatobiliary diseases were included inthe PANKRAS II Study. Information from interview and medicalrecords was available in
M. Soler; N. Malats; M. Porta; E. Fernandez; L. Guarner; A. Maguire; J. L. Pinol; J. Rifa; A. Carrato
Objectives To characterize patterns of electronic medicalrecord (EMR) use at pediatric primary care acute visits. Design Direct observational study of 529 acute visits with 27 experienced pediatric clinician users. Measurements For each 20?s interval and at each stage of the visit according to the Davis Observation Code, we recorded whether the physician was communicating with the family only, using the computer while communicating, or using the computer without communication. Regression models assessed the impact of clinician, patient and visit characteristics on overall visit length, time spent interacting with families, and time spent using the computer while interacting. Results The mean overall visit length was 11:30 (min:sec) with 9:06 spent in the exam room. Clinicians used the EMR during 27% of exam room time and at all stages of the visit (interacting, chatting, and building rapport; history taking; formulation of the diagnosis and treatment plan; and discussing prevention) except the physical exam. Communication with the family accompanied 70% of EMR use. In regression models, computer documentation outside the exam room was associated with visits that were 11% longer (p=0.001), and female clinicians spent more time using the computer while communicating (p=0.003). Limitations The 12 study practices shared one EMR. Conclusions Among pediatric clinicians with EMR experience, conversation accompanies most EMR use. Our results suggest that efforts to improve EMR usability and clinician EMR training should focus on use in the context of doctor–patient communication. Further study of the impact of documentation inside versus outside the exam room on productivity is warranted.
Alessandrini, Evaline A; Forrest, Christopher B; Khan, Saira; Localio, A Russell; Gerber, Andreas
Clinical studies using medicalrecord review should include careful training and quality assurance methods to enhance the reliability and validity of data obtained from the records. Because of time and budget constraints, comprehensive assessments of data quality and reliability, including masking of medicalrecord abstractors, are not always possible. This paper describes the abstractor training and quality control methods and
Lisa M. Reisch; Jessica Scura Fosse; Kevin Beverly; Onchee Yu; William E. Barlow; Emily L. Harris; Sharon Rolnick; Mary B. Barton; Ann M. Geiger; Lisa J. Herrinton; Sarah M. Greene; Suzanne W. Fletcher; Joann G. Elmore
The authors organized a Natural Language Processing (NLP) challenge on automatically determining the smoking status of patients from information found in their discharge records. This challenge was issued as a part of the i2b2 (Informatics for Integrating Biology to the Bedside) project, to survey, facilitate, and examine studies in medical language understanding for clinical narratives. This article describes the smoking challenge, details the data and the annotation process, explains the evaluation metrics, discusses the characteristics of the systems developed for the challenge, presents an analysis of the results of received system runs, draws conclusions about the state of the art, and identifies directions for future research. A total of 11 teams participated in the smoking challenge. Each team submitted up to three system runs, providing a total of 23 submissions. The submitted system runs were evaluated with microaveraged and macroaveraged precision, recall, and F-measure. The systems submitted to the smoking challenge represented a variety of machine learning and rule-based algorithms. Despite the differences in their approaches to smoking status identification, many of these systems provided good results. There were 12 system runs with microaveraged F-measures above 0.84. Analysis of the results highlighted the fact that discharge summaries express smoking status using a limited number of textual features (e.g., "smok", "tobac", "cigar", Social History, etc.). Many of the effective smoking status identifiers benefit from these features. PMID:17947624
Uzuner, Ozlem; Goldstein, Ira; Luo, Yuan; Kohane, Isaac
A World Association for the Advancement of Veterinary Parasitology tradition for its conference is to present some highlights of the country hosting the event, and with an emphasis on the history of, and research in, veterinary parasitology. A review of Canada's peoples, physiography, climate, natural resources, agriculture, animal populations, pioneers in veterinary parasitology, research accomplishments by other veterinary parasitologists, centres
The federal regulations governing confidentiality of alcohol and drug abuse patient records are examined with respect to their applicability to mental health and other medicalrecords. The analysis focuses on the purpose, scope, restrictions, and penalties of the federal statutes, and compares them to the pertinent legislative recommendations of the Privacy Protection Study Commission. PMID:7425102
A review of the literature concerning the problem-oriented medicalrecord (POMR) identifies sources that indicate the advantages of the POMR in improving patient education efforts. The POMR approach is a means by which the patient's records are restructur...
Kay and Purves' proposed narratological model of the medicalrecord is based on the familiar phenomenological insight that the perception of data is conditioned by the conceptual framework of the perceiver. Unfortunately, unless handled very carefully, this approach will make the significance of a medicalrecord unique to the person who constructed it and impermeable to outside scrutiny. However, when integrated into the analog-model of the medicalrecord, the narratological model can be accommodated as the clinician-relative construction of a patient profile within the data that make up the medicalrecord. Some implications for the construction of expert systems and competence analysis are indicated. PMID:8755378
Quality control (QC) validation is used to determine: 1) whether statistical QC procedures are appropriate for detecting medically important errors; and 2) the equality of performance required by different laboratory tests. QC validation is well documented in the medical literature, but we are unaware of studies addressing its application, problems or unique differences in veterinary laboratories. We applied QC validation to automated hematology and biochemistry analyses in our laboratories, with goals of >/= 90% probability of error detection and = 5% probability of false rejection. Analytical quality requirements in the form of total allowable error were defined using regulatory criteria for human proficiency testing; these were later modified based on clinician and pathologist feedback. Initial QC goals were not met for 14 of 49 (28.6%) analyte-control combinations. Subsequent modifications in methodology, analytical quality requirements and technician training achieved QC goals for all but one analyte. For this analyte (platelet count, low control), nonstatistical QC procedures were emphasized. QC validation was beneficial for clarifying statistical QC performance, and for assessing the need and justification for changes in methods and personnel training. The validation exercise allowed simplification of QC rules, enabled machine flagging of abnormal results, and decreased time and expense associated with QC recording, analysis, problem-solving and reruns. QC validation is recommended for all veterinary laboratories as a useful tool in total quality management. PMID:12075513
Objective While essential for patient care, information related to medication is often written as free text in clinical records and, therefore, difficult to use in computerized systems. This paper describes an approach to automatically extract medication information from clinical records, which was developed to participate in the i2b2 2009 challenge, as well as different strategies to improve the extraction. Design Our approach relies on a semantic lexicon and extraction rules as a two-phase strategy: first, drug names are recognized and, then, the context of these names is explored to extract drug-related information (mode, dosage, etc) according to rules capturing the document structure and the syntax of each kind of information. Different configurations are tested to improve this baseline system along several dimensions, particularly drug name recognition—this step being a determining factor to extract drug-related information. Changes were tested at the level of the lexicons and of the extraction rules. Results The initial system participating in i2b2 achieved good results (global F-measure of 77%). Further testing of different configurations substantially improved the system (global F-measure of 81%), performing well for all types of information (eg, 84% for drug names and 88% for modes), except for durations and reasons, which remain problematic. Conclusion This study demonstrates that a simple rule-based system can achieve good performance on the medication extraction task. We also showed that controlled modifications (lexicon filtering and rule refinement) were the improvements that best raised the performance.
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BACKGROUND: Most hospitals keep and update their paper-based medicalrecords after introducing an electronic medicalrecord or a hospital information system (HIS). This case report describes a HIS in a hospital where the paper-based medicalrecords are scanned and eliminated. To evaluate the HIS comprehensively, the perspectives of medical secretaries and nurses are described as well as that of physicians.
A desire for improved quality of care and governmental financial incentives has thrust many healthcare organizations into a heightened sense of urgency to implement electronic medicalrecords. The staff educator plays a key role in the successful implementation of a comprehensive electronic medicalrecord. This author describes the successes, challenges, and lessons learned during implementation at a Midwest critical access hospital. PMID:22261911
Nursing home medical-record documentation of daily-care occurrence may be inaccurate, and information is not documented about important quality-of-life domains. The inadequacy of medicalrecord data creates a barrier to improving care quality, because it supports an illusion of care consistent with regulations, which reduces the motivation and…
Schnelle, John F.; Osterweil, Dan; Simmons, Sandra F.
BACKGROUND: United States academic medical centers are increasingly incorporating electronic health records (EHR) into teaching settings. We report third year medical students' attitudes towards clinical learning using the electronic health record in ambulatory primary care clinics. METHODS: In academic year 2005–06, 60 third year students were invited to complete a questionnaire after finishing the required Ambulatory Medicine\\/Family Medicine clerkship. The
In health care settings, interactions between providers are uncommon. This study shows that electronic medicalrecords currently available do not favor interactive work and thus a model of design rationale applied to health care is proposed. This model works as an extension to electronic medicalrecords and intends to promote collaborative work among health care providers.
Cleo Zanella Billa; Claudia Barsottini; Jacques Wainer
Objectives To compare the use of three electronic medicalrecords 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 medicalrecords systems. Participants 227
Background: Automated health maintenance reminder (HMR) systems embedded in electronic medicalrecords systems have been found to improve utilization of preventive services, but underuse persists. Our goal was to learn how to make HMRs more effective by measuring clinicians' self-reported use of HMRs and attitudes toward an HMR system embedded in an electronic medicalrecord. Methods: We surveyed 43 clinicians
Kenneth G. Schellhase; Thomas D. Koepsell; Thomas E. Norris
The quality of medicalrecord abstracts is often characterized in a reliability substudy. These results usually indicate agreement, but not the extent to which lack of agreement affects associations observed in the complete data. In this study, medicalrecords were reviewed and abstracted for patients diagnosed with stage I or stage II breast cancer between 1990 and 1994 at one
Timothy L. Lash; Matthew P. Fox; Soe Soe Thwin; Ann M. Geiger; Diana S. M. Buist; Feifei Wei; Terry S. Field; Marianne Ulcickas Yood; Floyd J. Frost; Virginia P. Quinn; Marianne N. Prout; Rebecca A. Silliman
Background and Purpose—The aim of our study was to determine whether the National Institutes of Health Stroke Scale (NIHSS) can be estimated retrospectively from medicalrecords. The NIHSS is a quantitative measure of stroke-related neurological deficit with established reliability and validity for use in prospective clinical research. Recently, retrospective observational studies have estimated NIHSS scores from medicalrecords for quantitative
Scott E. Kasner; Julio A. Chalela; Jean M. Luciano; Brett L. Cucchiara; Eric C. Raps; Michael L. McGarvey; Molly B. Conroy; A. Russell Localio
A randomized single-blind experiment was done in a medical subspecialty clinic in order to determine whether a flow-sheet type of summary medicalrecord could validly serve as a means to communicate clinical information in the absence of the traditional medicalrecord. Two groups of outpatient physician-patient encounters were compared: In the 68 study encounters (Group S), physicians were given a flow-sheet summary record with the option to receive the standard medicalrecord if they desired; in the 27 control encounters (Group C), physicians were given the standard medicalrecord plus the flow-sheet summary record. Fifty-nine per cent of study-group physicians did not choose to receive the full medicalrecord. The study group was found not to differ (p = 0.013) from controls significantly with regard to the follow-up of clinical information as measured by pre- and post-encounter chart review. Physician providers in the study group were unable to detect by retrospective chart review overlooked clinical information with greater frequency than control group providers. We conclude that a flow-sheet type of summary medicalrecord can serve as the sole source of clinical information in a substantial number of outpatient follow-up encounters in a medical subspecialty clinic without deterioration in the communication of clinical information. PMID:7412428
OBJECTIVE To assess the ability to identify potential association(s) of diabetes medications with myocardial infarction using usual care clinical data obtained from the electronic medicalrecord. RESEARCH DESIGN AND METHODS We defined a retrospective cohort of patients (n = 34,253) treated with a sulfonylurea, metformin, rosiglitazone, or pioglitazone in a single academic health care network. All patients were aged >18 years with at least one prescription for one of the medications between 1 January 2000 and 31 December 2006. The study outcome was acute myocardial infarction requiring hospitalization. We used a cumulative temporal approach to ascertain the calendar date for earliest identifiable risk associated with rosiglitazone compared with that for other therapies. RESULTS Sulfonylurea, metformin, rosiglitazone, or pioglitazone therapy was prescribed for 11,200, 12,490, 1,879, and 806 patients, respectively. A total of 1,343 myocardial infarctions were identified. After adjustment for potential myocardial infarction risk factors, the relative risk for myocardial infarction with rosiglitazone was 1.3 (95% CI 1.1-1.6) compared with sulfonylurea, 2.2 (1.6-3.1) compared with metformin, and 2.2 (1.5-3.4) compared with pioglitazone. Prospective surveillance using these data would have identified increased risk for myocardial infarction with rosiglitazone compared with metformin within 18 months of its introduction with a risk ratio of 2.1 (95% CI 1.2-3.8). CONCLUSIONS Our results are consistent with a relative adverse cardiovascular risk profile for rosiglitazone. Our use of usual care electronic data sources from a large hospital network represents an innovative approach to rapid safety signal detection that may enable more effective postmarketing drug surveillance. PMID:20009093
Brownstein, John S; Murphy, Shawn N; Goldfine, Allison B; Grant, Richard W; Sordo, Margarita; Gainer, Vivian; Colecchi, Judith A; Dubey, Anil; Nathan, David M; Glaser, John P; Kohane, Isaac S
|The integration of EHR (Electronic Health Records) in IT infrastructures supporting organizations enable improved access to and recording of patient data, enhanced ability to make better and more-timely decisions, and improved quality and reduced errors. Despite these benefits, there are mixed results as to the use of EHR. The literature suggests…
This study addressed how students' undergraduate science courses influence their academic performance in a veterinary program, and examined what implications this may have for the veterinary admissions process. The undergraduate transcripts and veterinary school rankings of current third-year veterinary students at Colorado State University were coded and analyzed. Because the study found no statistically meaningful relationships between the pre-veterinary coursework parameters and class rank, it could be concluded that veterinary schools may be unnecessarily restricting access to the profession by requiring long and complicated lists of prerequisite courses that have a questionable predictive value on performance in veterinary school. If a goal of veterinary schools is to use the admissions process to enhance recruitment and provide the flexibility necessary to admit applicants who have the potential to fill the current and emerging needs of the profession, schools may want to re-evaluate how they view pre-veterinary course requirements. One of the recommendations generated from the results of this study is to create a list of veterinary prerequisite courses common to all schools accredited by the Association of American VeterinaryMedical Colleges. It is suggested that this might simplify pre-veterinary advising, enhance recruitment, and provide flexibility for admitting nontraditional but desirable applicants, without impacting the quality of admitted veterinary students. PMID:19625663
Kogan, Lori R; Stewart, Sherry M; Schoenfeld-Tacher, Regina; Janke, Janet M
BACKGROUND: Self-reported medical history data are frequently used in epidemiological studies. Self-reported diagnoses may differ from medicalrecord diagnoses due to poor patient-clinician communication, self-diagnosis in the absence of a satisfactory explanation for symptoms, or the \\
Besa Smith; Laura K Chu; Tyler C Smith; Paul J Amoroso; Edward J Boyko; Tomoko I Hooper; Gary D Gackstetter; Margaret AK Ryan
ObjectiveTo assess physician–patient communication patterns associated with use of an electronic medicalrecord (EMR) system in an outpatient setting and provide an empirical foundation for larger studies.DesignAn exploratory, observational study involving analysis of videotaped physician–patient encounters, questionnaires, and medical-record reviews.SettingGeneral internal medicine practice at an academic medical center.ParticipantsThree physicians who used an EMR system (EMR physicians) and three who used
ObjectiveThis paper describes natural-language-processing techniques for two tasks: identification of medical concepts in clinical text, and classification of assertions, which indicate the existence, absence, or uncertainty of a medical problem. Because so many resources are available for processing clinical texts, there is interest in developing a framework in which features derived from these resources can be optimally selected for the
Between 1992 and 2002, overall health care spending rose from $827 billion to about $1.6 trillion; it is projected to nearly double to $3.1 trillion in the following decade. This price tag results, in part, from advances in expensive medical technology, including new drug therapies, and the increased use of high-cost services and procedures. Many policymakers, industry experts, and medical
Kenneth J. Trimmer; John C. Beachboard; Carla Wiggins; William Woodhouse
The authors implemented an electronic medicalrecord system in a rural Kenyan health center. Visit data are recorded on a paper encounter form, eliminating duplicate documentation in multiple clinic logbooks. Data are entered into an MS-Access database supported by redundant power systems. The system was initiated in February 2001, and 10,000 visit records were entered for 6,190 patients in six months. The authors present a summary of the clinics visited, diagnoses made, drugs prescribed, and tests performed. After system implementation, patient visits were 22% shorter. They spent 58% less time with providers (p < 0.001) and 38% less time waiting (p = 0.06). Clinic personnel spent 50% less time interacting with patients, two thirds less time interacting with each other, and more time in personal activities. This simple electronic medicalrecord system has bridged the “digital divide.” Financial and technical sustainability by Kenyans will be key to its future use and development.
Rotich, Joseph K.; Hannan, Terry J.; Smith, Faye E.; Bii, John; Odero, Wilson W.; Vu, Nguyen; Mamlin, Burke W.; Mamlin, Joseph J.; Einterz, Robert M.; Tierney, William M.
Background: Attention to the problem of adverse events increases worldwide. The present study aimed to evaluate inter-rater reliability of medicalrecord reviews of adverse events in the Thai context. Material and Method: A total of 279 inpatient records were reviewed by 23 clinical auditors. Each record was examined independently by 3 auditors using a standardised review form. Agreements on the
This study analyzes the workflow and implementation of Electronic Health Record (EHR) systems across different functions in small physician offices. We characterize the differences in the offices with different levels of computerization in terms of workfl...
B. B. Lide E. Subrahmanian M. Ramaiah R. D. Sriram
A pertinent, legible and complete medicalrecord facilitates good patient care. The recording of the symptoms, signs and lab findings which are relevant to a patient's condition contributes importantly to the medicalrecord. The consideration and documentation of other disease states known to be related to the patient's primary illness provide further enhancement. We propose that developing sets of disease-specific core elements which a physician may want to document in the medicalrecord can have many benefits. We hypothesize that for a given disease, terms with high importance (TI) and frequency (TF) in the DX-plain, QMR and Iliad knowledge bases (KBs) are terms which are used commonly in the medicalrecord, and may be, in fact, terms which physicians would find useful to document. A study was undertaken to validate ten such sets of disease-specific core elements. For each of ten prevalent diseases, high TI and TF terms from the three KBs mentioned were pooled to derive the set of core elements. For each disease, all patient records (range 385 to 16,972) from a computerized ambulatory medicalrecord database were searched to document the actual use by physicians of each of these core elements. A significant percentage (range 50 to 86%) of each set of core elements was confirmed as being used by the physicians. In addition, all medical concepts from a selection of full text records were identified, and an average of 65% of the concepts were found to be core elements.(ABSTRACT TRUNCATED AT 250 WORDS)
Personal digital assistants are lightweight computers that capture and display data via tapping on their screens with a stylus and are easily linked to desktop and network computers. They have been used in medicine for a variety of purposes, and many believe personal digital assistant use can improve the provision of medical care. The author created a multimedia dermatology electronic medicalrecord for a PocketPC (Microsoft Corp., Redmond, WA) personal digital assistant that contains patient images, tables of phototherapy, laboratory and systemic medication data, and typed chart notes. Such a record can be created and utilized but requires more time to assemble than a handwritten note, mostly due to capturing and organizing images. Future challenges involve streamlining record assembly, integrating multimedia records with hospital and office medicalrecords, and assessing how having multimedia data available might affect care. PMID:15654162
MARS was a joint developmental effort between Maine Medical Center and Advanced Healthcare Systems, Inc. It has taken nearly three years to get the system (hardware, software, and staff) to a point where it can now meet daily production requirements. This project was truly unique, so there was no opportunity to learn from the experiences of others. The optical disk system has been an attractive solution to some of the problems experienced at Maine Medical Center. The result was worth the effort in terms of both dollars and other less quantifiable benefits that have had a positive impact on patient care. PMID:10106988
This bibliography of in-print veterinarymedical books published in English may be used as an acquisitions or evaluation tool for developing the monograph component of new veterinary medicine collections or existing science, technology, and medicine collections where veterinary medicine is in the scope of the collection. The bibliography is divided into 34 categories and consists of bibliographic information for 419 titles. The appendix contains an author/editor index. Prices for all entries are in US dollars, except where another currency is noted. The total cost of all books in the bibliography is $43,602.13 (US). PMID:15494763
This bibliography of in-print veterinarymedical books published in English may be used as an acquisitions or evaluation tool for developing the monograph component of new veterinary medicine collections or existing science, technology, and medicine collections where veterinary medicine is in the scope of the collection. The bibliography is divided into 34 categories and consists of bibliographic information for 419 titles. The appendix contains an author/editor index. Prices for all entries are in US dollars, except where another currency is noted. The total cost of all books in the bibliography is $43,602.13 (US).
This application is an Intranet-based system. A database has been established utilizing patient information on the basis of age, medical diagnosis and employment history. If a health care provider or support staff states that a patient is over 65 years of age or has been diagnosed with a chronic disease and this limits the patient’s ability to fight off infection,
Intensive care units (ICUs) are high-intensity patient care locations, and consequently contribute both to medical costs and errors. Computerization of order and documentation systems is one way to reduce both. One such solution is telemedicine based intensive care (eICUreg) whereby remote consultation is combined with intelligent data analysis. There are a number of technical and human factor elements that must
Frank D. Sites; Victoria L. Rich; C. William Hanson
The overall goal of Menelas is to provide better access to the information contained in natural language patient discharge summaries, through the design and implementation of a pilot system able to access medical reports through natural languages. A first, experimental version of the Menelas indexing prototype for French has been assembled. Its function is to encode free text PDSs into
The author presents a literature review of two tocolytic agents used in veterinary obstetrics: isoxsuprine and clenbuterol. The medical background from which these drugs emerged for human use and to which is linked their application in animal medicine is described. Each drug is reviewed according to its pharmacology, basic considerations for its clinical use and the reports on its application in the treatment and management of obstetrical disorders in veterinary medicine.
Background: Research exploring the agreement between traditional medicationrecords and electronic records generated by an automated dispensing device has been limited. Objective: To evaluate the extent of agreement between medication administration records written in paper-based emergency department charts and records generated by an automated dispensing device with regard to the presence or absence of a single, prespecified medication. Methods: Medication administration records in paper-based emergency department charts and medication dispensation records generated by an automated dispensing device were evaluated for concordance. The primary outcome measure was agreement between the 2 sources with regard to the presence or absence of a record for salbutamol by metered-dose inhaler (MDI) for randomly selected patients who presented to a pediatric emergency department with wheeze-related illness from January 1, 2008, to December 31, 2009. Results: In total, 1172 patient visits met the inclusion criteria. Of these, records for 1013 visits showed agreement between the paper-based emergency department chart and the dispensation record of the automated dispensing device (kappa = 0.71, 95% confidence interval 0.67–0.75). This value did not meet the target kappa of 0.80. Stratification by time of day, day of week, month, season, or year of presentation at triage or by triage level or disposition (whether or not the patient was admitted to the hospital ward) did not significantly affect the level of agreement between the 2 sources. Conclusions: Agreement between records of salbutamol MDI administration in paper-based charts and dispensation records from an automated dispensing device was substantial, but discrepancies were present. There are significant quality management, legal, clinical, and research reasons to strive for concordance between multiple records with respect to medication use in the emergency department. Data generated by automated dispensing devices have potential value for research, but their strengths and limitations need to be understood.
This article describes a retrospective study of a lecture recording system that was implemented to document the students' perceptions, pattern of usage, and impact on the students' grades in three basic sciences courses (Cell Biology/Histology, Physiology, and Neurosciences). Outcomes, faculty and student experiences, and suggestions regarding use of the system are provided.
Thierry Bacro (University of South Carolina Regenerative Medicine and Cell Biology)
Objective This paper describes natural-language-processing techniques for two tasks: identification of medical concepts in clinical text, and classification of assertions, which indicate the existence, absence, or uncertainty of a medical problem. Because so many resources are available for processing clinical texts, there is interest in developing a framework in which features derived from these resources can be optimally selected for the two tasks of interest. Materials and methods The authors used two machine-learning (ML) classifiers: support vector machines (SVMs) and conditional random fields (CRFs). Because SVMs and CRFs can operate on a large set of features extracted from both clinical texts and external resources, the authors address the following research question: Which features need to be selected for obtaining optimal results? To this end, the authors devise feature-selection techniques which greatly reduce the amount of manual experimentation and improve performance. Results The authors evaluated their approaches on the 2010 i2b2/VA challenge data. Concept extraction achieves 79.59 micro F-measure. Assertion classification achieves 93.94 micro F-measure. Discussion Approaching medical concept extraction and assertion classification through ML-based techniques has the advantage of easily adapting to new data sets and new medical informatics tasks. However, ML-based techniques perform best when optimal features are selected. By devising promising feature-selection techniques, the authors obtain results that outperform the current state of the art. Conclusion This paper presents two ML-based approaches for processing language in the clinical texts evaluated in the 2010 i2b2/VA challenge. By using novel feature-selection methods, the techniques presented in this paper are unique among the i2b2 participants.
An electronic patient file is expected to contribute to individual health care, as well as to policy goals. For acceptance by doctors and patients, some conditions have to be fulfilled. Among them is the appropriate specification of the right of the patient to medical secrecy and privacy. Reference is made to new legal requirements (Wet Bescherming Persoonsgegevens (Act on the protection of personal data)), which e.g. regulate when access to personal medical data is lawful, when consent is required and in what form, in addition to a number of other conditions. The current information and communication technology must not be allowed to dictate the possibilities and limitations of legally applicable standards, but the technical implementation of the electronic patient file must be made to suit and assure the legal standards of medical professional secrecy and patient privacy. Otherwise the advantages of an electronic patient file will be out-weighed by patients withholding important information from their physician and by their being less inclined to consent to their data being used for e.g. scientific investigations. PMID:10707747
Introduction: One of the major issues in hospitals is the period for which the medicalrecords are retained. Health information management professionals traditionally have performed retention and destruction functions using all media, including paper, images, optical disk, microfilm, DVD, and CD-ROM. Health information management departments must maintain a specific program to retain and destruct the records. The purpose of this paper is to investigate the retention and destruction process of medicalrecords in the hospitals in Isfahan and codifying the appropriate guidelines. Materials and Methods: The research was conducted as a cross-sectional descriptive study in 30?hospitals in Isfahan. The data was collected using a Check List. Also 30 medicalrecords experts’ viewpoints were obtained using the Delphi technique. Data entry and statistical analysis was performed using SPSS. Results: The findings indicated that 53.8% of the study population maintained a written policy. A 34.6% maintained a written policy to destruct medicalrecords. And 50% announced that no instructions had been given to the hospitals by qualified authorities to destruct the medicalrecords. Discussion: The majority of the hospitals are still unclear about the retention period of medicalrecords, which could be due to not to mention the retention period for most medicalrecords by the country's National Literature and lack of policy and procedure in hospitals. Conclusions: According to the legislations, hospitals are bound to retain the inpatients’ records for full 15 years but based on the findings of this research, less than half of the study population retained the inpatients’ records for the period mentioned.
Objective The growing importance of electronic medicalrecords (EMRs) to healthcare systems is evident, yet the debate concerning their impact on patient-provider communication during encounters remains unresolved. For this study, we hypothesize that providers' use of the EMR will improve patientprovider communication concerning self-care during the medical encounter. Design Cross-sectional, observational study. Setting A primary-care outpatient clinic of the South Texas Veterans Health Care System in San Antonio, TX, USA. Methods A convenience sample of 50 patient/physician encounters was videotaped, transcribed verbatim, and analyzed to determine the time that the physician spent using the EMR and self-care topics discussed. Self-care topics included medication use, recognition of disease symptoms, diet, exercise, management of physical and emotional distress, self-monitoring activities, cigarette smoking, alcohol consumption, and family support/community resources. Two observers independently coded for the kind of self-care topics (kappa = 0.91) using the Atlas.ti software package. Results Encounters averaged 22.6 minutes (range: 5–47, SD = 8.9). We identified two encounter types based on EMR usage: low use (n = 13), with EMR use of two minutes or less, and moderate to high EMR use (n = 37), with EMR use of five minutes or more. Average time for encounters was 25 minutes for moderate to high EMR use encounters and 16 minutes for low EMR use encounters (t test, p < 0.001). Issues pertaining to facets of self-care management were discussed in every physician-patient interaction (100 percent). The most frequently discussed self-care topics were medication use (100 percent), physical distress (76 percent), and disease symptoms (76 percent). Self-monitoring activities, exercise, and diet were discussed in 62 percent, 60 percent, and 46 percent of the 50 encounters respectively. Emotional distress (26 percent), smoking (30 percent), family support/community resources (26 percent), and alcohol consumption (20 percent) were the least discussed issues. Encounters were similar with respect to the kinds of self-care elements discussed. However, EMR use encounters were more likely to include a higher number of self-care topics raised by physicians than low EMR use encounters, particularly on disease symptoms (odds ratio = 4.4, p = 0.05), and physical distress (odds ratio = 7.4, p = 0.006). A significant correlation was observed between the number of self-care elements discussed and time spent on the EMR (r = 0.6, p < 0.05), but no correlation was observed between the length of the encounter and self-care discussion (r = 0.009, p = 0.90). Conclusions The use of an EMR during encounters is associated with an increase in the number of self-care topics raised by physicians. EMRs offer the opportunity to involve patients and physicians in discussion of self-care during patients' visits. Given the current emphasis on the widespread implementation of EMRs, future EMRs should be designed to systematically facilitate the integration of EMRs into clinical exchanges about self-care.
Wound management is an important and increasingly complex area of nursing practice. Community nurses, in particular, spend a considerable amount of time assessing, evaluating and managing chronic, non-healing wounds. The rapid rise in the number of wound care products, combined with the emphasis on clinical governance and risk management, and increases in litigation have meant that accurate documentation and record keeping have become an essential part of care (UKCC, 1992, 1998). A standardized approach to assessment, classification, measurement and evaluation should be adopted to maximize optimal patient outcomes. There are a number of techniques for measuring wounds, ranging from manual measurement using tracing to computer-based imaging. Photography is a simple and quick form of documentation, which provides an accurate and objective record of the wound. This article highlights the benefits of using the new Polaroid Macro 5 SLR camera in wound documentation. PMID:12066058
This paper describes and analyzes experiments we performed for the MedicalRecords track in the 2012 Text REtrieval Conference (TREC). We mainly investigated three research problems: 1. Evidence Aggregation: In last year's track there were two different m...
Electronic medicalrecords can house patient information gathered over time and at multiple sites, thus they have the potential to increase continuity of care and improve service delivery in a multiclinic system. The New York City Department of Health and Mental Hygiene implemented an electronic medicalrecord system in its 10 sexually transmitted disease clinics during 2004 and 2005. We examine the use of real-time electronic medicalrecord data analyses to evaluate clinical services or program activities and present 3 examples of such analyses that have led to program improvements. Analyses of electronic medicalrecord data have produced changes in clinical practice that in turn have resulted in more effective staff use, increased disease detection, and increased clinic capacity.
Schillinger, Julia A.; Borrelli, Jessica M.; Handel, Shoshanna; Pathela, Preeti; Blank, and Susan
Developing quality indicators (QI) for national purposes (eg, public disclosure, paying-for-performance) highlights the need to find accessible and reliable data sources for collecting standardised data. The most accurate and reliable data source for collecting clinical and organisational information still remains the medicalrecord. Data collection from electronic medicalrecords (EMR) would be far less burdensome than from paper medicalrecords (PMR). However, the development of EMRs is costly and has suffered from low rates of adoption and barriers of usability even in developed countries. Currently, methods for producing national QIs based on the medicalrecord rely on manual extraction from PMRs. We propose and illustrate such a method. These QIs display feasibility, reliability and discriminative power, and can be used to compare hospitals. They have been implemented nationwide in France since 2006. The method used to develop these QIs could be adapted for use in large-scale programmes of hospital regulation in other, including developing, countries.
...of 1974; Department of Homeland Security ALL--034 Emergency Care MedicalRecords System...Department of Homeland Security/ ALL--034 Emergency Care MedicalRecords System...Washington, DC 20528. Instructions: All submissions received must include the...
MARCO, an interfacility communication system, has been designed to promote safe relevant health care delivery to the inner city pediatric patient receiving care in a network consisting of Boston City Hospital and its affiliated Neighborhood Health Centers. This application of computer technology to communication of medical information compiled on an individual patient in multiple locations has implications for private group practice as well as other urban networks similar to our own. This paper provides the MARCO system concept, the system design and evaluation of its success after two years of operation.
Moffatt, P. H.; Heisler, B. D.; Mela, W. D.; Alpert, J. J.; Goldstein, H.M.
Data obtained from the patient medicalrecord are often a component of clinical research led by nurse investigators. The rigor of the data collection methods correlates to the reliability of the data and, ultimately, the analytical outcome of the study. Research strategies for reliable data collection from the patient medicalrecord include the development of a precise data collection tool, the use of a coding manual, and ongoing communication with research staff. PMID:20974093
The inter-rater reliability, cross-source (Medicare claims versus medicalrecord) agreement, and ability to predict all-cause mortality of three aggregate comorbidity indices were evaluated in a group of 404 elderly, incident breast cancer cases identified from the Virginia Cancer Registry and linked to Medicare administrative data files. Comorbidity was based on both medicalrecords and Medicare claims data using indices from
Craig J. Newschaffer; Trudy L. Bush; Lynne T. Penberthy
Abstract , Studies on the,adaptation of Electronic Medical and,Personal Health Records ,in developing countries are scarce. There are sharp differences between,barriers ,to adaptation ,and implementation,in developing ,countries to that of developed,countries. This paper ,examines ,the challenges faced by developing ,countries toward the development, progression and sustainability of Electronic Medical ,Records. The paper ,also provides a review ,of implementation of ,varying
Sanjay P. Sood; Stacie N. Nwabueze; Victor Wacham A. Mbarika; Nupur Prakash; Samir Chatterjee; Pradeep Ray; Saroj Mishra
Structure, standard and efficient methods in paper medicalrecords are important for a successful implementation of computerised medicalrecords. We have conducted a survey among 26 somatic hospitals in a Norwegian region regarding present routines and use of information technology in patients records. The hospitals use six different patient administration systems, six laboratory, six radiology, and approximately 20 different specialist systems. 16 hospitals use three different electronic journal/documentation systems. Ten hospitals use the Word word processor for patient records. The full potential of word processing is not utilised. Digital dictation is seldom used; few hospitals have 24-hours service for documentation, and information technology is not used for documentation in nursing care. Four hospitals use microfilm. The survey shows that improvement is needed in order to achieve coordinated and effective use of information technology and manual routines in hospital medicalrecords. PMID:10574055
Jacobsen, G M; Stangeland, N; Velund, T L; Blørstad, O
To evaluate and improve the quality of medical-record keeping, in clinics and surgery departments. The evaluation involved 66 Operative Units (O.U.) of the "2nd University Hospital" in Naples (Italy). 10 medicalrecords for each O.U. were randomly selected, for a total of 660. The quality was evaluated in all sections of medicalrecords using the criteria of completeness, clarity and traceability of the data. The most critical issues are: unclear handwriting in almost all sections, in the whole scarse presence of a discharge letter (17.0%) in surgery (1.4%), almost total absence of the physicians signature in the clinical diary (2.3%). The completeness of medicalrecords (presence of patient's history, physical examination, informed consent) is significantly higher in the surgery departments. The medicalrecords are significantly righter in the clinic departments. In general, a poor quality of medical-record keeping was detected. This indicates the need to improve the quality by involving the staff in the importance of correct compilation. PMID:19014110
Agozzino, E; Esposito, S; Parmeggiani, C; Piro, A; Grippo, N; Di Palma, M A
Introduction: Studies indicate that using interventions including education may improve medicalrecord documentation and decrease incomplete files. Since physicians play a crucial role in medicalrecord documentation, the researchers intend to examine the effect of educational intervention on physicians’ performance and knowledge about principles of medical diagnosis recording among residents in Hormozgan University of Medical Sciences(HUMS). Methods: This quasi-experimental study was conducted in 2010 on 40 specialty residents (from internal medicine, obstetrics and gynecology, pediatrics, anesthesiology and surgery specialties) in Hormozgan University of Medical Sciences. During a workshop, guidelines for recording diagnostic information related to given specialty were taught. Before and after the intervention, five medicalrecords from each resident were selected to assess physician performance about chart documentation. Using a questionnaire, physicians’ knowledge was investigated before and after intervention. Data were analyzed through one-way ANOVA test. Results: Change in physicians’ knowledge before and after education was not statistically significant (p = 0.15). Residents’ behavior did not have statistically significant changes during three phases of the study. Conclusion: Diversity of related factors which contributes to the quality of documentation compels portfolio of strategies to enhance medical charting. Employing combination of best practice efforts including educating physicians from the beginning of internship and applying targeted strategy focus on problematic areas and existing gap may enhance physicians’ behavior about chart documentation.
Electronic MedicalRecords (EMR) provide increased productivity and convenience for patients, doctors, nurses, pharmacists, lab technicians and other medical professionals. The added accessibility to patient information introduces a multitude of security risks at various levels. The communication infrastructure may be breached by intruders from disparate countries. Loosely protected data entry terminals are susceptible to insider threats. This paper characterizes EMR
The protection of patients’ health information is a very important concern in the information age. The purpose of this study is to ascertain what constitutes an effective legal framework in protecting both the security and privacy of health information, especially electronic medicalrecords. All sorts of bills regarding electronic medical data protection have been proposed around the world including Health
A complete and comprehensive treatment and evaluation system incorporating the Problem Oriented MedicalRecord is described as operationalized on a psychiatric impatient unit at Camarillo State Hospital. The system utilizes a semi-standardized problem list with individualized treatment objectives and plans. The data base consists of hundreds of daily behavioral observations in addition to the more traditional narrative notes and medical
Barringer D Marshall JR; Charles J Wallace; Karen Burke; Robert Paul Liberman
Background: Few studies have reported on the utilization and the effect of electronic health records on the education of medical students. Purpose: The purpose of this study was to describe the current use of electronic health records by medical students in the United States and explore the opportunities and challenges of integrating electronic health records into daily teaching of medical
Maya M. Hammoud; Katherine Margo; Jennifer G. Christner; Jonathan Fisher; Shira H. Fischer; Louis N. Pangaro
Healthcare organizations are deploying increasingly complex clinical information systems to support patient care. Traditional information security practices (e.g., role-based access control) are embedded in enterprise-level systems, but are insufficient to ensure patient privacy. This is due, in part, to the dynamic nature of healthcare, which makes it difficult to predict which care providers need access to what and when. In this paper, we show that modeling operations at a higher level of granularity (e.g., the departmental level) are stable in the context of a relational network, which may enable more effective auditing strategies. We study three months of access logs from a large academic medical center to illustrate that departmental interaction networks exhibit certain invariants, such as the number, strength, and reciprocity of relationships. We further show that the relations extracted from the network can be leveraged to assess the extent to which a patient’s care satisfies expected organizational behavior.
Institutions all want electronic medicalrecord (EMR) systems. They want them to solve their record movement problems, to improve the quality and coherence of the care process, to automate guidelines and care pathways to assist clinical research, outcomes management, and process improvement. EMRs are very difficult to construct because the existing electronic data sources, e.g., laboratory systems, pharmacy systems, and
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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 medicalrecords, 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 medicalrecords research. After extensive deliberation, these patients were united in their inclination to share their medicalrecords for research. Yet they were also united in their recommendations to institute procedures that would give them more control over whether and how their medicalrecords 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 medicalrecords. 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. PMID:17045717
Damschroder, Laura J; Pritts, Joy L; Neblo, Michael A; Kalarickal, Rosemarie J; Creswell, John W; Hayward, Rodney A
Medical reports are converted to document vectors in computing apparatus and sampled by applying a maximum variation sampling function including a fitness function to the document vectors to reduce a number of medicalrecords being processed and to increase the diversity of the medicalrecords being processed. Linguistic phrases are extracted from the medicalrecords and converted to s-grams. A Haar wavelet function is applied to the s-grams over the preselected time interval; and the coefficient results of the Haar wavelet function are examined for patterns representing the likelihood of health abnormalities. This confirms certain s-grams as precursors of the health abnormality and a parameter can be calculated in relation to the occurrence of such a health abnormality.
Patton, Robert M; Potok, Thomas E; Beckerman, Barbara G
Student records flow through medical school offices at a rapid rate. Much of this data is often tracked on paper, spread across multiple departments. The Medical Student Informatics Group at the University of Utah School of Medicine identified offices and organizations documenting student information. We assessed departmental needs, identified records, and researched database software available within the private sector and academic community. Although a host of database applications exist, few publications discuss database models for storage and retrieval of student records. We developed and deployed an Internet based application to meet current requirements, and allow for future expandability. During a test period, users were polled regarding utility, security, stability, ease of use, data accuracy, and potential project expansion. Feedback demonstrated widespread approval, and considerable interest in additional feature development. This experience suggests that many medical schools would benefit from centralized database management of student records. Images Figure 3 Figure 4 Figure 5
Vercillo, D. M.; Holmes, K. C.; Pingree, M. J.; Bray, B. E.; Lincoln, M. J.
Student records flow through medical school offices at a rapid rate. Much of this data is often tracked on paper, spread across multiple departments. The Medical Student Informatics Group at the University of Utah School of Medicine identified offices and organizations documenting student information. We assessed departmental needs, identified records, and researched database software available within the private sector and academic community. Although a host of database applications exist, few publications discuss database models for storage and retrieval of student records. We developed and deployed an Internet based application to meet current requirements, and allow for future expandability. During a test period, users were polled regarding utility, security, stability, ease of use, data accuracy, and potential project expansion. Feedback demonstrated widespread approval, and considerable interest in additional feature development. This experience suggests that many medical schools would benefit from centralized database management of student records. PMID:10566507
Vercillo, D M; Holmes, K C; Pingree, M J; Bray, B E; Lincoln, M J
Cross-sectional study that aimed to compare the data reported in a system for the indication of pressure ulcer (PU) care quality, with the nursing evolution data available in the patients' medicalrecords, and to describe the clinical profile and nursing diagnosis of those who developed PU grade 2 or higher Sample consisted of 188 patients at risk for PU in clinical and surgical units. Data were collected retrospectively from medicalrecords and a computerized system of care indicators and statistically analyzed. Of the 188 patients, 6 (3%) were reported for pressure ulcers grade 2 or higher; however, only 19 (10%) were recorded in the nursing evolution records, thus revealing the underreporting of data. Most patients were women, older adults and patients with cerebrovascular diseases. The most frequent nursing diagnosis was risk of infection. The use of two or more research methodologies such as incident reporting data and retrospective review of patients' records makes the results trustworthy. PMID:23781731
dos Santos, Cássia Teixeira; Oliveira, Magáli Costa; Pereira, Ana Gabriela da Silva; Suzuki, Lyliam Midori; Lucena, Amália de Fátima
To have comprehensive and completed understanding healthcare status of a patient, doctors need to search patient medicalrecords 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 medicalrecord 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 medicalrecords; (3) Applying the knowledge base and NLP engine on medicalrecords 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%.
CAB Abstracts® is the premier database for the veterinarymedical literature. This research evaluated search performance, using recall and precision, and compared interface features and of the CAB Direct®, EBSCOhost®, ISI, and OvidSP interfaces to CAB Abstracts. While differences were found in search formulation, there were no statistically significant differences in precision or recall for ten veterinary searches, and all
Through this article, we propose a mixed management of patients' medicalrecords, so as to share responsibilities between the patient and the Medical Practitioner by making Patients responsible for the validation of their administrative information, and MPs responsible for the validation of their Patients' medical information. Our proposal can be considered a solution to the main problem faced by patients, health practitioners and the authorities, namely the gathering and updating of administrative and medical data belonging to the patient in order to accurately reconstitute a patient's medical history. This method is based on two processes. The aim of the first process is to provide a patient's administrative data, in order to know where and when the patient received care (name of the health structure or health practitioner, type of care: out patient or inpatient). The aim of the second process is to provide a patient's medical information and to validate it under the accountability of the Medical Practitioner with the help of the patient if needed. During these two processes, the patient's privacy will be ensured through cryptographic hash functions like the Secure Hash Algorithm, which allows pseudonymisation of a patient's identity. The proposed MedicalRecord Search Engines will be able to retrieve and to provide upon a request formulated by the Medical Practitioner all the available information concerning a patient who has received care in different health structures without divulging the patient's identity. Our method can lead to improved efficiency of personal medicalrecord management under the mixed responsibilities of the patient and the MP. PMID:20543354
Objective: To determine if the medicalrecord might overestimate the quality of care through false, and potentially unethical, documentation by physicians. Design: Prospective trial comparing two methods for measuring the quality of care for four common outpatient conditions: (1) structured reports by standardised patients (SPs) who presented unannounced to the physicians' clinics, and (2) abstraction of the medicalrecords generated during these visits. Setting: The general medicine clinics of two veterans affairs medical centres. Participants: Twenty randomly selected physicians (10 at each site) from among eligible second and third year internal medicine residents and attending physicians. Main measurements: Explicit criteria were used to score the medicalrecords of physicians and the reports of SPs generated during 160 visits (8 cases x 20 physicians). Individual scoring items were categorised into four domains of clinical performance: history, physical examination, treatment, and diagnosis. To determine the false positive rate, physician entries were classified as false positive (documented in the record but not reported by the SP), false negative, true positive, and true negative. Results: False positives were identified in the medicalrecord for 6.4% of measured items. The false positive rate was higher for physical examination (0.330) and diagnosis (0.304) than for history (0.166) and treatment (0.082). For individual physician subjects, the false positive rate ranged from 0.098 to 0.397. Conclusions: These data indicate that the medicalrecord falsely overestimates the quality of important dimensions of care such as the physical examination. Though it is doubtful that most subjects in our study participated in regular, intentional falsification, we cannot exclude the possibility that false positives were in some instances intentional, and therefore fraudulent, misrepresentations. Further research is needed to explore the questions raised but incompletely answered by this research.
Records of hospital inpatients were abstracted for 5,000 newly diagnosed cancer patients admitted in 1982-83 to 17 Comprehensive Cancer Centers and 17 Community Hospital Oncology Programs. Generally available data items (silent record rate less than 5 per cent for the typical institution) included: age, race, sex, dates of hospitalization, zip code of residence, pathological stage, dates of biopsy and surgery, numbers of nodes examined and positive, certain diagnostic procedures, and some radiotherapy descriptors. For other data items, there was enormous variability in completeness and high institution-to-institution variation. Record completeness did not differ consistently between comprehensive and community cancer centers. We conclude that the hospital patient record is useful for tracking the frequency of surgical and related events. However, studies of diagnostic and therapeutic procedures should not rely solely on the hospital medicalrecord due to the high rates of silent records.
Librarians from Exempla Healthcare hospitals initiated contact with the chief medical information officer regarding evidence-based medicine activities related to the development of the system's Electronic MedicalRecord (EMR). This column reviews the librarians' involvement in specific initiatives that included providing comparative information on point-of-care resources to integrate into the EMR, providing evidence as needed for the order sets being developed, and participating with clinicians on an evidence-based advisory committee. PMID:23869640
This paper introduces the work on the design and implementation of a medicalrecord management subsystem, which is a part of a telemedicine system based on Microsoft .NET. First, an analysis is given on components and structure of medicalrecord, together with an explanation for what is needed in a teleconsultation, how they should be organized and realized in a database, and how to deal with consultation data granularity using XML in combination with database; second, the work done during the realization stage is expatiated, including system analysis and design, database design, and system implementation. PMID:17039944
Transitioning health care information to an electronic medicalrecord is one of the newest policies to reach the health care agenda. Nursing leaders are at the forefront to affect the design, development, implementation, and reception of an electronic medicalrecord. Because of their clinical workflow knowledge, decision-making capacity, and leadership role, nursing leaders are able to achieve high-quality EMRs. Being proactive in the reception, design, development, and implementation of an EMR plays a role in creating an organizational culture that allows for the flow of data efficiently and accurately. PMID:22673079
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Hospitals implement electronic medicalrecord systems (EMRSs) that are intended to support medical and nursing staff in their daily work. Evolution toward more computerization seems inescapable. Nevertheless, this evolution introduced new problems of organization. This before-and-after observational study evaluated the door-to-first-medical-contact (FMC) times before and after the introduction of EMRS. A satisfaction questionnaire, administered after the "after" period, measured clinicians' satisfaction concerning computerization in routine clinical use. The following 5 questions were asked: Do you spare time in your note taking with EMRS? Do you spare time in the medical care that you provide to the patients with EMRS? Does EMRS improve the quality of medical care for your patients? Are you satisfied with the EMRS implementation? Would you prefer a return to handwritten records? Results showed an increase in door-to-FMC time induced by EMRS and a lower triage capacity. In the satisfaction questionnaire, clinicians reported minimal satisfaction but refused to return to handwritten records. The increase in door-to-FMC time may be explained by the improved quantity/quality of data and by the many interruptions due to the software. Medical reorganization was requested after the installation of the EMRS. PMID:22030205
Claret, Pierre-Géraud; Sebbanne, Mustapha; Bobbia, Xavier; Bonnec, Jean-Marie; Pommet, Stéphane; Jebali, Chawki; de La Coussaye, Jean-Emmanuel
BackgroundThe electronic medicalrecord (EMR) contains a rich source of information that could be harnessed for epidemic surveillance. We asked if structured EMR data could be coupled with computerized processing of free-text clinical entries to enhance detection of acute respiratory infections (ARI).MethodologyA manual review of EMR records related to 15,377 outpatient visits uncovered 280 reference cases of ARI. We used
Sylvain DeLisle; Brett South; Jill A. Anthony; Ericka Kalp; Adi Gundlapallli; Frank C. Curriero; Greg E. Glass; Matthew Samore; Trish M. Perl
There are constraints embedded in medicalrecord 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 medicalrecord structure on patient utilization of an electronic patient record (EPR) system have been identified: environmental pressures, physician centeredness, collaborative organizational culture,
The use of medicalrecords in research can yield information that is difficult to obtain by other means. When such records are released to investigators in identifiable form, however, substantial privacy and confidentiality risks may be created. These risks become more common and more serious as medicalrecords move to an electronic format. In 1996, the state of Minnesota enacted
We reviewed all of the paper records on all of the animals treated at the military veterinary clinics on mainland Japan from 2000 to 2010 and present a review of the parasites and pathogens of zoonotic potential. Over 16,764 veterinary visits from more than 5,400 animals were recorded. Zoonotic protozoa were detected in both military working dogs and pets. Parasitic helminthes included numerous nematodes and tapeworms. We discuss the limitations of veterinaryrecords and the relevance of zoonotic disease reporting for public health. PMID:23277444
Reeves, Will K; Yore, Kimberly; Paul, Robert; Lloyd, Laurel
Objectives As a baseline study to aid in the development of proper policy, we investigated the current condition of unpreparedness of documents required when issuing copies of medicalrecords and related factors. Methods The study was comprised of 7,203 cases in which copies of medicalrecords were issued from July 1st, 2007 through June 30th, 2008 to 5 tertiary referral hospitals. Data from these hospitals was collected using their established electronic databases and included study variables such as unpreparedness of the required documents as a dependent variable and putative covariates. Results The rate of unpreparedness of required documents was 14.9%. Multiple logistic regression analysis revealed the following factors as being related to the high rate of unpreparedness: patient age (older patients had a higher rate), issuance channels (on admission > via out-patient clinic), type of applicant (others such as family members > for oneself > insurers), type of original medicalrecord (utilization records on admission > other records), issuance purpose (for providing insurer > medical use), residential area of applicant (Seoul > Honam province and Jeju), and number of copied documents (more documents gave a lower rate). The rate of unpreparedness differed significantly among the hospitals; suggesting that they may have followed their own conventional protocols rather than legal procedures in some cases. Conclusions The study results showed that the level of compliance to the required legal procedure was high, but that problems occurred in assuring the safety of the medical information. A proper legislative approach is therefore required to balance the security of and access to medical information.
Moon, Myong-Mo; Seo, Sun-Won; Park, Woo-Sung; Kim, Yoon; Kim, Sung-Soo; Choi, Eun-Mi; Park, Jong; Park, Il-Soon
Objective To examine the impact of billing and clinical data extracted from an electronic medicalrecord system on the calculation of an adverse drug event (ADE) quality measure approved for use in The Joint Commission's ORYX program, a mandatory national hospital quality reporting system. Design The Child Health Corporation of America's “Use of Rescue Agents—ADE Trigger” quality measure uses medication billing data contained in the Pediatric Health Information Systems (PHIS) data warehouse to create The Joint Commission-approved quality measure. Using a similar query, we calculated the quality measure using PHIS plus four data sources extracted from our electronic medicalrecord (EMR) system: medications charged, medication orders placed, medication orders with associated charges (orders charged), and medications administered. Measurements Inclusion and exclusion criteria were identical for all queries. Denominators and numerators were calculated using the five data sets. The reported quality measure is the ADE rate (numerator/denominator). Results Significant differences in denominators, numerators, and rates were calculated from different data sources within a single institution's EMR. Differences were due to both common clinical practices that may be similar across institutions and unique workflow practices not likely to be present at any other institution. The magnitude of the differences would significantly alter the national comparative ranking of our institution compared to other PHIS institutions. Conclusions More detailed clinical information may result in quality measures that are not comparable across institutions due institution-specific workflow, differences that are exposed using EMR-derived data.
Objectives Electronic medicalrecords (EMRs) are increasingly being used by health care services. Currently, if an EMR shutdown occurs, even for a moment, patient safety and care can be seriously impacted. Our goal was to determine the methodology needed to develop an effective and reliable EMR backup system. Methods Our "independent backup system by medical organizations" paradigm implies that individual medical organizations develop their own EMR backup systems within their organizations. A "personal independent backup system" is defined as an individual privately managing his/her own medicalrecords, whereas in a "central backup system by the government" the government controls all the data. A "central backup system by private enterprises" implies that individual companies retain control over their own data. A "cooperative backup system among medical organizations" refers to a networked system established through mutual agreement. The "backup system based on mutual trust between an individual and an organization" means that the medical information backup system at the organizational level is established through mutual trust. Results Through the use of SWOT analysis it can be shown that cooperative backup among medical organizations is possible to be established through a network composed of various medical agencies and that it can be managed systematically. An owner of medical information only grants data access to the specific person who gave the authorization for backup based on the mutual trust between an individual and an organization. Conclusions By employing SWOT analysis, we concluded that a linkage among medical organizations or between an individual and an organization can provide an efficient backup system.
Objectives Improvement activities, surveillance and research in maternal and neonatal health in Afghanistan rely heavily on medicalrecord data. This study investigates accuracy in delivery care records from three hospitals across workshifts. Design Observational cross-sectional study. Setting The study was conducted in one maternity hospital, one general hospital maternity department and one provincial hospital maternity department. Researchers observed vaginal deliveries and recorded observations to later check against data recorded in patient medicalrecords and facility registers. Outcome measures We determined the sensitivity, specificity, area under the receiver operator characteristics curves (AUROCs), proportions correctly classified and the tendency to make performance seem better than it actually was. Results 600 observations across the three shifts and three hospitals showed high compliance with active management of the third stage of labour, measuring blood loss and uterine contraction at 30?min, cord care, drying and wrapping newborns and Apgar scores and low compliance with monitoring vital signs. Compliance with quality indicators was high and specificity was lower than sensitivity. For adverse outcomes in birth registries, specificity was higher than sensitivity. Overall AUROCs were between 0.5 and 0.6. Of 17 variables that showed biased errors, 12 made performance or outcomes seem better than they were, and five made them look worse (71% vs 29%, p=0.143). Compliance, sensitivity and specificity varied less among the three shifts than among hospitals. Conclusions Medicalrecord accuracy was generally poor. Errors by clinicians did not appear to follow a pattern of self-enhancement of performance. Because successful improvement activities, surveillance and research in these settings are heavily reliant on collecting accurate data on processes and outcomes of care, substantial improvement is needed in medicalrecord accuracy.
Broughton, Edward I; Ikram, Abdul Naser; Sahak, Ihsanullah
Essential elements of the problem-oriented medicalrecord (POMR) are examined as they relate to the role of nursing personnel. Historical trends in the development of uniform recordkeeping methods are traced. The POMR system, introduced by Weed in 1962, i...
BACKGROUND: Consenting for retrospective medicalrecords-based research (MR) and leftover tissue-based research (TR) continues to be controversial. Our objective was to survey Saudis attending outpatient clinics at a tertiary care hospital on their personal preference and perceptions of norm and current practice in relation to consenting for MR and TR. METHODS: We surveyed 528 Saudis attending clinics at a tertiary
Mohammad M Al-Qadire; Muhammad M Hammami; Hunida M Abdulhameed; Eman A Al Gaai
A system based on a relational database with administrative and clinical information and integrated with an information system, where the system covers the role of a functional island, is routinely used in our Institution. To analyze how electronic medicalrecords (EMR) may help physicians in organizing and reducing time waste in a busy outpatient clinic, a sample of 1000 reports
S. Dalmiani; M. A. Morales; C. Carpeggiani; A. Macerata; P. Marcheschi
Since 2004, increasing importance has been placed on the adoption of electronic medicalrecords by healthcare providers for documentation of patient care. Recent federal regulations have shifted the focus from adoption alone to meaningful use of an electronic medicalrecord system. As proposed by the Technology Acceptance Model, the behavioral intention to use technology is determined by the person's attitude toward usage. The purpose of this quality improvement project was to devise and implement customized templates into an existent electronic medicalrecord system in a single clinic and measure the satisfaction of the clinic providers with the system before and after implementation. Provider satisfaction with the electronic medicalrecord system was evaluated prior to and following template implementation using the current version 7.0 of the Questionnaire for User Interaction Satisfaction tool. Provider comments and improvement in the Questionnaire for User Interaction Satisfaction levels of rankings following template implementation indicated a positive perspective by the providers in regard to the templates and customization of the system. PMID:23321480
Background and Objectives: It is unknown whether an electronic medicalrecord (EMR) improves the management of test results in primary care offices. Methods: As part of a larger assessment using observations, interviews, and chart audits at eight family medicine offices in SW Ohio, we documented five results management steps (right place in chart, signature, interpretation, patient notification, and abnormal result
Nancy C. Elder; Timothy R. McEwen; John Flach; Jennie Gallimore; Harini Pallerla
Provides details pertaining to the Occupational Safety and Health Administration (OSHA) ruling that gives employees, their designated representatives, and OSHA the right to examine their on-the-job medicalrecords. Discusses the effects the ruling may have on organizations. (Author/MLF)
Background: Some older adults receive potentially inappropriate medications (PIMs), increasing their risk for adverse events. A literature search did not find any US multicenter studies that measured the prevalence of PIMs in outpatient practices based on data from electronic health records (EHRs), using both the Beers and Zhan criteria.Objectives: The aims of the present study were to compare the prevalence
Michael D Buck; Ashish Atreja; Cherie P. Brunker; Anil Jain; Theodore T. Suh; Robert M. Palmer; David A. Dorr; C. Martin Harris; Adam B. Wilcox
|Examination of medicalrecords from 40 patients who reported unusual experiences during an illness or injury revealed that only 18 patients were judged to have had serious, life-threatening conditions, while 33 believed they had been dead or near death. Findings suggest that an important precipitator of so-called near-death experience is belief…
The explosive growth in technology usage has put growing pressure on organizations to serve customers electronically. Healthcare service, as one of data intensive industries, tries to serve their patients with excellent service in the timely manner when the data volume is growing faster than organizational infrastructure development. Because the hospital information system called Electronic MedicalRecord (EMR) is a powerful
The University of Saint Francis (USF) has partnered with Parkview Health System, an acute care facility, to integrate an electronic medicalrecord (EMR) system into the undergraduate nursing curriculum at USF. Through an Internet connect account designed by Parkview Health, students and faculty have access to Parkview's EMR training system anywhere they have an Internet connection. Parkview Health has agreed
Objective To examine users' attitudes to implementation of an electronic medicalrecord system in Kaiser Permanente Hawaii. Design Qualitative study based on semistructured interviews. Setting Four primary healthcare teams in four clinics, and four specialty departments in one hospital, on Oahu, Hawaii. Shortly before the interviews, Kaiser Permanente stopped implementation of the initial system in favour of a competing one.
J Tim Scott; Thomas G Rundall; Thomas M Vogt; John Hsu
This study compares the documentation of ambulatory care visits and diagnoses in Medicaid paid claims and in medicalrecords. Data were obtained from Maryland Medicaid's 1988 paid claims files for 2407 individuals who were continuously enrolled for the fiscal year, had at least one billed visit for one of six indicator conditions, and had received the majority of their care
Donald M. Steinwachs; Mary E. Stuart; Sarah Scholle; Barbara Starfield; Michael H. Fox; Jonathan P. Weiner
Objective. To evaluate the quality of pe- diatric primary care, including preventive services, be- fore and after the introduction of an electronic medicalrecord (EMR) developed for use in an urban pediatric primary care center. Methods. A pre-postintervention analysis was used in the study. The intervention was a pediatric EMR. Routine health care maintenance visits for children <5 years old
William G. Adams; Adriana M. Mann; Howard Bauchner
Objective To determine the incidence and types of preventable adverse events in elderly patients. Design Review of random sample of medicalrecords in two stage process by nurses and physicians to detect adverse events. Two study investigators then judged preventability. Setting Hospitals in US states of Utah and Colorado, excluding psychiatric and Veterans Administration hospitals. Subjects 15 000 hospitalised patients
Although many trauma centers across the country have implemented electronic medicalrecords (EMRs) for inpatient documentation, they have avoided the use of EMR during the fast-paced trauma resuscitations. The objective of this study was to determine whether documenting electronically during trauma resuscitations has resulted in improvement or degradation of the completeness of data recorded. Forty critical data points were evaluated in 100 pre-EMR charts and 100 post-EMR charts. There was improvement in completeness of charting in 25% of the electronic records reviewed and degradation of completeness of charting in 18% of the records, for a net improvement in completeness of charting of 7% in the electronic records reviewed. PMID:24005122
This paper presents the study done to evaluate the accuracy of drug interaction (DI) alerts triggered by two Electronic MedicalRecord (EMR) systems used in primary heal th care . Elderly patients commonly find it onerous to recollect their medications during medical interrogation. P hysicians and pharmacists find it hard to keep abreast with the expanding medical and pharmacologic knowledge
The Veterans Affairs Hypertension Primary Care Longitudinal Cohort (VAHC) was initiated in 2003 as a pilot study designed to link the VA electronic medicalrecord system with individual genetic data. Between June 2003 and December 2004, 1,527 hypertensive participants were recruited. Protected health information (PHI) was extracted from the regional VA data warehouse. Differences between the clinic and mail recruits suggested that clinic recruitment resulted in an over-sampling of African Americans. A review of medicalrecords in a random sample of study participants confirmed that the data warehouse accurately captured most selected diagnoses. Genomic DNA was acquired non-invasively from buccal cells in mouthwash; ~ 96.5 per cent of samples contained DNA suitable for genotyping, with an average DNA yield of 5.02 ± 0.12 micrograms, enough for several thousand genotypes. The coupling of detailed medical databases with genetic information has the potential to facilitate the genetic study of hypertension and other complex diseases.
Salem, Rany M.; Pandey, Braj; Richard, Erin; Fung, Maple M.; Garcia, Erin P.; Brophy, Victoria H.; Schork, Nicholas J.; O'Connor, Daniel T.; Bhatnagar, Vibha
Clinical data in Electronic MedicalRecords (EMRs) is a potential source of longitudinal clinical data for research. The Electronic MedicalRecords and Genomics Network or eMERGE investigates whether data captured through routine clinical care using EMRs can identify disease phenotypes with sufficient positive and negative predictive values for use in genome wide association studies (GWAS). Using data from five different sets of EMRs, we have identified five disease phenotypes with positive predictive values of 73–98% and negative predictive values of 98–100%. A majority of EMRs captured key information (diagnoses, medications, laboratory tests) used to define phenotypes in a structured format. We identified natural language processing as an important tool to improve case identification rates. Efforts and incentives to increase the implementation of interoperable EMRs will markedly improve the availability of clinical data for genomics research.
Kho, Abel N.; Pacheco, Jennifer A.; Peissig, Peggy L.; Rasmussen, Luke; Newton, Katherine M.; Weston, Noah; Crane, Paul K.; Pathak, Jyotishman; Chute, Christopher G.; Bielinski, Suzette J.; Kullo, Iftikhar J.; Li, Rongling; Manolio, Teri A.; Chisholm, Rex L.; Denny, Joshua C.
This study examines a new approach of using the Design Structure Matrix (DSM) modeling technique to improve the design of Electronic MedicalRecord (EMR) user interfaces. The usability of an EMR medication dosage calculator used for placing orders in an academic hospital setting was investigated. The proposed method captures and analyzes the interactions between user interface elements of the EMR system and groups elements based on information exchange, spatial adjacency, and similarity to improve screen density and time-on-task. Medication dose adjustment task time was recorded for the existing and new designs using a cognitive simulation model that predicts user performance. We estimate that the design improvement could reduce time-on-task by saving an average of 21 hours of hospital physicians' time over the course of a month. The study suggests that the application of DSM can improve the usability of an EMR user interface. PMID:23965597
Kuqi, Kushtrim; Eveleigh, Tim; Holzer, Thomas; Sarkani, Shahryar; Levin, James E; Crowley, Rebecca S
Abstract Objective: To examine the concordance between parent report and electronic medicalrecord documentation of asthma health education provided during a single clinic visit and second-hand tobacco smoke exposure among children with asthma. Methods: Parents of children with asthma were recruited from two types of clinics using different electronic medicalrecord systems: asthma-specialty or general pediatric health department clinics. After their child's outpatient visit, parents were interviewed by trained study staff. Interview data were compared to electronic medicalrecords for agreement in five categories of asthma health education and for the child's environmental tobacco smoke exposure. Kappa statistics were used to identify strength of agreement. Chi square and t-tests were used to examine differences between clinic types. Results: Of 255 parents participating in the study 90.6% were African American and 96.1% were female. Agreement was poor across all clinics but was higher within the asthma specialty clinics than the health department clinics for smoke exposure (??=?0.410 versus 0.205), asthma diagnosis/disease process (??=?0.213 versus -0.016) and devices reviewed (??=?0.253 versus -0.089) with parents generally reporting more education provided. For the 203 children with complete medicalrecords, 40.5% did not have any documentation regarding smoking exposure in the home and 85.2% did not have any documentation regarding exposure elsewhere. Conclusions: We found low concordance between the parent's report and the electronic medicalrecord for smoke exposure and asthma education provided. Un- or under-documented smoke exposure and health education have the potential to affect continuity of care for pediatric patients with asthma. PMID:23883356
Harrington, Kathleen F; Haven, Kristen M; Nuño, Velia Leybas; Magruder, Theresa; Bailey, William C; Gerald, Lynn B
Background Many natural phenomena demonstrate power-law distributions, where very common items predominate. Problems, medications and lab results represent some of the most important data elements in medicine, but their overall distribution has not been reported. Objective Our objective is to determine whether problems, medications and lab results demonstrate a power law distribution. Methods Retrospective review of electronic medicalrecord data for 100,000 randomly selected patients seen at least twice in 2006 and 2007 at the Brigham and Women’s Hospital in Boston and its affiliated medical practices. Results All three data types exhibited a power law distribution. The 12.5% most frequently used problems account for 80% of all patient problems, the top 11.8% of medications account for 80% of all medication orders and the top 4.5% of lab result types account for all lab results. Conclusion These three data elements exhibited power law distributions with a small number of common items representing a substantial proportion of all orders and observations, which has implications for electronic health record design.
There are tendencies in universities globally to change undergraduate teaching in veterinary parasitology. To be able to give considered advice to universities, faculties, governmental bodies and professional societies about a discipline and to establish how particular changes may impact on the quality of a course, is the requirement to record and review its current status. The present paper contributes toward
R. B. Gasser; I. Beveridge; N. C. Sangster; G. Coleman
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT Physicians undertake the documentation of medication history during clerking; where all the necessary information that guides the diagnostic and patient management tasks are obtained. Medication histories documented by physicians are often incomplete and generally sketchy; however, the impact of a physician's specialty on the frequency and depth of medication history they document has not been studied. WHAT THIS STUDY ADDS The depth and frequency of medication history documented by physicians is significantly influenced by their specialties. Physicians appear more interested in documenting more frequently and in greater depth medication history information that appears to aid diagnostic tasks in their specific specialty. AIMS To determine the impact of a physician's specialty on the frequency and depth of medication history documented in patient medicalrecords. METHODS A cross-sectional assessment of the frequency and depth of medication history information documented by 123 physicians for 900 randomly selected patients stratified across Cardiology, Chest, Dermatology, Endocrine, Gastroenterology, Haematology, Neurology, Psychiatry and Renal specialties was carried out at a 900-bed teaching hospital located in Ibadan, Nigeria. RESULTS Four hundred and forty-three (49.2%) of the cohort were males and 457 (50.8%) were females; with mean ages 43.2 ± 18.6 and 43.1 ± 17.9 years respectively. Physicians' specialties significantly influenced the depth of documentation of the medication history information across the nine specialties (P < 0.0001). Post hoc pair-wise comparisons with Tukey's HSD test showed that the mean scores for adverse drug reactions and adherence to medicines was highest in the Cardiology specialty; while the Chest specialty had the highest mean scores for allergy to drugs, food, chemicals and cigarette smoking. Mean scores for the use of alcohol; illicit drugs; dietary restrictions was highest for Gastroenterology, Psychiatry and Endocrine specialties respectively. Physicians' specialties also significantly influenced the frequency of documentation of the medication history across the nine specialties (P < 0.0001). CONCLUSIONS Physicians appear to document more frequently and in greater depth medication history information that may aid the diagnostic tasks in their specific specialty. Researchers and other users of medication history data documented in patients' medicalrecords by physicians may want to take special cognizance of this phenomenon.
We genotyped 326 “frequently medicated” individuals of European-descent in Vanderbilt’s biorepository linked to de-identified electronic medicalrecords, BioVU, on the ADME Core Panel to assess quality and performance of the assay. We compared quality control metrics and determined the extent of direct and indirect marker overlap between the ADME Core Panel and the Illumina Omni1-Quad. We found the quality of the ADME Core Panel data to be high, with exceptions in select copy number variants (CNVs) and markers in certain genes (notably CYP2D6). Most of the common variants on the ADME panel are genotyped by the Omni1, but absent rare variants and CNVs could not be accurately tagged by single markers. Finally, our frequently medicated study population did not convincingly differ in allele frequency from reference populations, suggesting that heterogeneous clinical samples (with respect to medications) follow similar allele frequency distributions in pharmacogenetics genes as their appropriate reference populations.
Oetjens, Matthew T.; Denny, Joshua C.; Ritchie, Marylyn D.; Gillani, Niloufar B.; Richardson, Danielle M.; Restrepo, Nicole A.; Pulley, Jill M.; Dilks, Holli H.; Basford, Melissa A.; Bowton, Erica; Masys, Dan R.; Wilke, Russ A.; Roden, Dan M.; Crawford, Dana C.
OBJECTIVE: The purpose of this study is to examine the attitudes of clinicians in a large HMO toward the effect of an outpatient Electronic MedicalRecord system on the quality of patient care. Attitudes toward a Results Reporting system and an online charting and ordering system are also compared. DESIGN: A cross-sectional study was performed using a survey of Kaiser Permanente Northwest clinicians. In addition, interviews were conducted with the physician leaders of the clinical departments at Kaiser Permanente Northwest. MEASUREMENTS: Clinician attitudes are measured regarding the effects of a Results Reporting system and an online charting and ordering system on the overall quality of patient care and other care-related indices. RESULTS: Most clinicians feel that the outpatient Electronic MedicalRecord has improved the overall quality of patient care, with 72% reporting an improvement with the use of the Results Reporting system, and 60% reporting an improvement with the use of the online charting and ordering system. On average, clinicians feel that the EMR has also improved the quality of the patient-clinician interaction, the ability to coordinate the care of patients with other departments, the ability to detect medication errors, the timeliness of referrals, and the ability to act on test results in a timely fashion. CONCLUSION: Clinicians perceive an improvement in patient care as a result of using an outpatient Electronic MedicalRecord system. Clinicians have higher opinions, however, of the effects of a Results Reporting system compared to an online charting and ordering system.
Background To evaluate the vigilance of medical specialists as to the lifestyle of their cardiovascular outpatients by comparing lifestyle screening as registered in medicalrecords versus a lifestyle questionnaire (LSQ), a study was carried out at the cardiovascular outpatient clinic of the university hospital of Nijmegen, The Netherlands, between June 2004 and June 2005. Methods For 209 patients information from medicalrecords on lifestyle habits, physician feedback, and interventions in the past year was compared to data gathered in the last month by a self-report LSQ. Results Doctors register smoking habits most consistently (90.4%), followed by alcohol use (81.8%), physical activity (50.2%), and eating habits (27.3%). Compared to the LSQ, smoking, unhealthy alcohol use, physical activity, and unhealthy eating habits are underreported in medicalrecords by 31, 83, 54 and 97%, respectively. Feedback, advice or referral was documented in 8% for smoking, 3% for alcohol use, 12% for physical activity, and 26% for eating habits. Conclusion Lifestyle is insufficiently registered or recognized by doctors providing routine care in a cardiovascular outpatient setting. Of the unhealthy lifestyle habits that are registered, few are accompanied by notes on advice or intervention. A lifestyle questionnaire facilitates screening and interventions in target patients and should therefore be incorporated in the cardiovascular setting as a routine patient intake procedure.
Background The growth in the number of patients seeking health information online has given rise to new direct-to-patient research methods, including direct patient recruitment and study conduct without use of physician sites. While such patient-centric designs offer time and cost efficiencies, the absence of physician-reported data is a key concern, with potential impact on both scientific rigor and operational feasibility. Objective To (1) gain insight into the viability of collecting patient-reported outcomes and medicalrecord information in a sample of gout patients through a direct-to-patient approach (ie, without the involvement of physician sites), and (2) evaluate the validity of patient-reported diagnoses collected during a patient-reported outcomes plus medicalrecord (PRO+MR) direct-to-patient study. Methods We invited a random sample of MediGuard.org members aged 18 to 80 years to participate via email based on a gout treatment or diagnosis in their online profiles. Interested members clicked on an email link to access study information, consent to participate electronically, and be screened for eligibility. The first 50 consenting participants completed an online survey and provided electronic and wet signatures on medicalrecord release forms for us to obtain medical charts from their managing physicians. Results A total of 108 of 1250 MediGuard.org members (8.64%) accessed study information before we closed the study at 50 completed surveys. Of these 108 members who took the screener, 50 (46.3%) completed the study, 19 (17.6%) did not pass the screening, 5 (4.6%) explicitly declined to participate due to the medicalrecord requirement, and 34 (31.5%) closed the browser without completing the survey screener. Ultimately, we obtained 38 of 50 charts (76%): 28 collected using electronic signature and 10 collected based on wet signature on a paper form. Of the 38 charts, 37 cited a gout diagnosis (35 charts) or use of a gout medication (2 charts). Only 1 chart lacked any mention of gout. Conclusions Patients can be recruited directly for observational study designs that include patient-reported outcomes and medicalrecord data with over 75% data completeness. Although the validity of self-reported diagnosis is often a concern in Internet-based studies, in this PRO+MR study pilot, nearly all (37 of 38) charts confirmed patient-reported data.
Background Failure or delay in diagnosis is a common preventable source of error. The authors sought to determine the frequency with which high-information clinical findings (HIFs) suggestive of a high-risk diagnosis (HRD) appear in the medicalrecord before HRD documentation. Methods A knowledge base from a diagnostic decision support system was used to identify HIFs for selected HRDs: lumbar disc disease, myocardial infarction, appendicitis, and colon, breast, lung, ovarian and bladder carcinomas. Two physicians reviewed at least 20 patient records retrieved from a research patient data registry for each of these eight HRDs and for age- and gender-compatible controls. Records were searched for HIFs in visit notes that were created before the HRD was established in the electronic record and in general medical visit notes for controls. Results 25% of records reviewed (61/243) contained HIFs in notes before the HRD was established. The mean duration between HIFs first occurring in the record and time of diagnosis ranged from 19?days for breast cancer to 2?years for bladder cancer. In three of the eight HRDs, HIFs were much less likely in control patients without the HRD. Conclusions In many records of patients with an HRD, HIFs were present before the HRD was established. Reasons for delay include non-compliance with recommended follow-up, unusual presentation of a disease, and system errors (eg, lack of laboratory follow-up). The presence of HIFs in clinical records suggests a potential role for the integration of diagnostic decision support into the clinical workflow to provide reminder alerts to improve the diagnostic focus.
Hoffer, Edward P; Barnett, G Octo; Kim, Richard J; Famiglietti, Kathleen T; Chueh, Henry
Background: Student decisions about lecture attendance are based on anticipated effect on learning. Factors involved in decision-making, the use of recorded lectures and their effect on lecture attendance, all warrant investigation. Aim: This study was designed to identify factors in student decisions to attend live lectures, ways in which students use recorded lectures, and if their use affects live lecture attendance. Methods: A total of 213 first (M1) and second year (M2) medical students completed a survey about lecture attendance, and rated factors related to decisions to attend live lectures and to utilize recorded lectures. Responses were analyzed overall and by class year and gender. Results: M1 attended a higher percentage of live lectures than M2, while both classes used the same percentage of recorded lectures. Females attended more live lectures, and used a smaller percentage of recorded lectures. The lecturer was a key in attendance decisions. Also considered were the subject and availability of other learning materials. Students use recorded lectures as replacement for live lectures and as supplement to them. Conclusions: Lectures, both live and recorded, are important for student learning. Decisions about lecture placement in the curriculum need to be based on course content and lecturer quality. PMID:23869431
In compliance with the Medical Council of India, preclinical medical students maintain a record of their laboratory work in physiology. The physiology record books also contain a set of questions to be answered by the students. Faculty members and students had indicated that responding to these questions did not serve the intended purpose of being…
BACKGROUND: Electronic medicalrecords contain valuable clinical information not readily available elsewhere. Accordingly, they hold important potential for contributing to and enhancing chronic disease registries with the goal of improving chronic disease management; however a standard for diagnoses of conditions such as diabetes remains to be developed. The purpose of this study was to establish a validated electronic medicalrecord
Stewart B Harris; Richard H Glazier; Jordan W Tompkins; Andrew S Wilton; Vijaya Chevendra; Moira A Stewart; Amardeep Thind
The purpose of this study was to assess whether an electronic prompt promoting BMD testing affected the proportion of patients who received BMD and/or bone health medication. Rheumatology providers of patients 40+, on prednisone, with no record of BMD testing in the past 2 years, were targeted with the message: 'This patient is at risk for osteoporosis due to prednisone use. We have no record of a recent Dexa scan.' We also surveyed providers on the prompt's value. The use of prednisone remained stable; BMD testing was quite low in all periods but increased slightly (non-statistically) over time, as did bone health medication use. Providers found the prompt not tailored enough to be clinically meaningful. Electronic prompts seem beneficial in theory; however, putting them into practice has challenges. While the EMR has great potential to improve care, more needs to be done to ensure optimal use. PMID:20007654
Rolnick, Sharon J; Jackson, Jody M; Amundson, Jerry H
Question: What is the process of developing a clinical information tool to be embedded in the electronic health record of a very large and diverse academic medical center? Setting: The development took place at the University of Pittsburgh Health Sciences Library System. Method: The clinical information tool developed is a search box with subject tabs to provide quick access to designated full-text information resources. Each subject tab offers a federated search of a different pool of resources. Search results are organized “on the fly” into meaningful categories using clustering technology and are directly accessible from the results page. Results: After more than a year of discussion and planning, a clinical information tool was embedded in the academic medical center's electronic health record. Conclusion: The library successfully developed a clinical information tool, called Clinical-e, for use at the point of care. Future development will refine the tool and evaluate its impact and effectiveness.
Epstein, Barbara A; Wessel, Charles B; Yarger, Frances; LaDue, John; Fiorillo, Anthony B
We developed a Web-based system to interactively display image-based electronic patient records (EPR) for 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). We have successfully used this system two times for the teleconsultation on Severe acute respiratory syndrome (SARS) in Shanghai Xinhua Hospital and Shanghai Infection Hospital. During the consultation, both the physicians in infection control area and the experts outside the control area could interactively study, manipulate and navigate the EPR of the SARS patients to make more precise diagnosis on images with this system assisting. 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.
Zhang, Jianguo; Sun, Jianyong; Yong, Yuanyuan; Chen, Xiaomeng; Yu, Fenghai; Zhang, Xiaoyan; Lian, Ping; Sun, Kun; Huang, H. K.
Computerized medicalrecord systems require structured database architectures for information processing. However, the data must be able to be transferred across heterogeneous platform and software systems. Client-Server architecture allows for distributive processing of information among networked computers and provides the flexibility needed to link diverse systems together effectively. We have incorporated this client-server model with a graphical user interface into an outpatient medicalrecord system, known as SuperChart, for the Department of Family Medicine at SUNY Health Science Center at Syracuse. SuperChart was developed using SuperCard and Oracle SuperCard uses modern object-oriented programming to support a hypermedia environment. Oracle is a powerful relational database management system that incorporates a client-server architecture. This provides both a distributed database and distributed processing which improves performance.
OBJECTIVE: To identify high-risk patients with heart disease by using data stored in an electronic medicalrecord system to predict\\u000a six-year mortality.\\u000a \\u000a \\u000a DESIGN: Retrospective cohort study.\\u000a \\u000a \\u000a \\u000a \\u000a SETTING: Academic primary care general internal medicine practice affiliated with an urban teaching hospital with a state-of-the-art\\u000a electronic medicalrecord system.\\u000a \\u000a \\u000a \\u000a \\u000a PATIENTS: Of 2,434 patients with evidence of ischemic heart disease or heart failure
William M. Tierney; Blaine Y. Takesue; Dennis L. Vargo; Xiao-Hua Zhou
Background Electronic medicalrecords (EMRs) represent a potentially rich source of health information for research but the free-text in EMRs often contains identifying information. While de-identification tools have been developed for free-text, none have been developed or tested for the full range of primary care EMR data Methods We used deid open source de-identification software and modified it for an Ontario context for use on primary care EMR data. We developed the modified program on a training set of 1000 free-text records from one group practice and then tested it on two validation sets from a random sample of 700 free-text EMR records from 17 different physicians from 7 different practices in 5 different cities and 500 free-text records from a group practice that was in a different city than the group practice that was used for the training set. We measured the sensitivity/recall, precision, specificity, accuracy and F-measure of the modified tool against manually tagged free-text records to remove patient and physician names, locations, addresses, medicalrecord, health card and telephone numbers. Results We found that the modified training program performed with a sensitivity of 88.3%, specificity of 91.4%, precision of 91.3%, accuracy of 89.9% and F-measure of 0.90. The validations sets had sensitivities of 86.7% and 80.2%, specificities of 91.4% and 87.7%, precisions of 91.1% and 87.4%, accuracies of 89.0% and 83.8% and F-measures of 0.89 and 0.84 for the first and second validation sets respectively. Conclusion The deid program can be modified to reasonably accurately de-identify free-text primary care EMR records while preserving clinical content.
Dermatophytes are significant pathogens in animal health due to their zoonotic potential, the economic consequences of infection in farm animal and fur production systems, and the distressing lesions they cause in small domestic pets. Malassezia spp are normal commensal and occasional pathogens of the skin of many veterinary species. Malassezia pachydermatis is a very common cause of otitis and pruritic dermatitis in dogs but is of less importance in other veterinary species. Dermatophytosis, and Malassezia otitis and dermatitis, represent the superficial mycoses of greatest significance in companion and farm animal health. Although the dermatophytes and Malassezia spp both exist in the stratum corneum of mammalian skin, there are important differences in the epidemiology, pathogenesis, and clinical consequences of infection. Dermatophytes are significant due to their zoonotic potential, the economic consequences of infection in farm animal and fur production systems, and the concern for owners of pets with inflammatory skin disease that is sometimes severe. Malassezia spp are normal commensals and occasional pathogens of the skin for many veterinary species, and M pachydermatis is a very common cause of otitis and pruritic dermatitis in dogs. This chapter will focus on the epidemiologic, clinical, diagnostic, and therapeutic aspects of dermatophytosis and Malassezia dermatitis in veterinary species. There are generally only sporadic reports of other superficial mycoses, such as candidiasis, piedra, and Rhodotorula dermatitis in veterinary medicine, and these are not included here. PMID:20347667
As perinatal events have been linked with diseases of later onset, epidemiological studies on child development and adult\\u000a health require information on the perinatal period. When national neonatal registers do not exist, review of medicalrecords\\u000a may be impractical. However, neonatal information could be obtained by asking mothers to complete a postal questionnaire using\\u000a data from the Personal Child Health
Pénélope Troude; Laurence Foix L’Hélias; Anne-Marie Raison-Boulley; Christine Castel; Christine Pichon; Jean Bouyer; Elise de La Rochebrochard
ObjectivesThis study sought to describe the evolution, use, and user satisfaction of a patient Web site providing a shared medicalrecord between patients and health professionals at Group Health Cooperative, a mixed-model health care financing and delivery organization based in Seattle, Washington.DesignThis study used a retrospective, serial, cross-sectional study from September 2002 through December 2005 and a mailed satisfaction survey
James D. Ralston; David Carrell; Robert Reid; Melissa A. Anderson; Maureena Moran; James Hereford
BACKGROUND: Residential address is a common element in patient electronic medicalrecords. Guidelines from the U.S. Centers for Disease Control and Prevention specify that residence in a nursing home, skilled nursing facility, or hospice within a year prior to a positive culture date is among the criteria for differentiating healthcare-acquired from community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections. Residential addresses may
Jeffrey S Wilson; David C Shepherd; Marc B Rosenman; Abel N Kho
Electronic medicalrecord systems (EMRSs) currently do not lend themselves easily to cross-institutional clinical care and research. Unique system designs coupled with a lack of standards have led to this difficulty. The authors have designed a preliminary EMRS architecture (W3-EMRS) that exploits the multiplatform, multiprotocol, client-server technology of the World Wide Web. The architecture abstracts the clinical information model and
ISAAC S. KOHANE; Philip Greenspun; James Fackler; Christopher Cimino; Peter Szolovits
Objectives To assess patients' preferred method of consent for the use of information from electronic medicalrecords for research. Design Interviews and a structured survey of patients in practices with electronic medicalrecords. Setting Family practices in southern Ontario, Canada. Participants 123 patients: 17 were interviewed and 106 completed a survey. Main outcome measures Patients' opinions and concerns on use of information from their medicalrecords for research and their preferences for method of consent. Results Most interviewees were willing to allow the use of their information for research purposes, although the majority preferred that consent was sought first. The seeking of consent was considered an important element of respect for the individual. Most interviewees made little distinction between identifiable and anonymised data. Research sponsored by private insurance firms generated the greatest concern, and research sponsored by foundation the least. Sponsorship by drug companies evoked negative responses during interview and positive responses in the survey. Conclusions Patients are willing to allow information from their medicalrecords to be used for research, but most prefer to be asked for consent either verbally or in writing. What is already known on this topicLegislation is being introduced worldwide to restrict the circumstances under which personal information may be used for secondary purposes without consentLittle empirical information exists about patients' concerns over privacy and preferences for consent for use of such information for researchWhat this study addsPatients are willing to allow personal information to be used for research purposes but want to be actively consulted firstPatients make little distinction between identifiable and non-identifiable informationMost patients prefer a time limit for their consent
Willison, Donald J; Keshavjee, Karim; Nair, Kalpana; Goldsmith, Charlie; Holbrook, Anne M
Cancer registries routinely collect data on clinicopathologic factors, but rarely abstract anthropometric variables. We conducted\\u000a a chart review study, examining the feasibility of abstracting weight, height, alcohol use, and smoking from medicalrecords\\u000a in women (n = 1,974) diagnosed with invasive breast cancer, and investigated the association between the abstracted variables with clinicopathologic\\u000a features. Qualitative data were reviewed and categorized. Frequencies of
Archana J. McEligot; Theresa Im; Robert O. Dillman; John G. West; Rana Salem; Reina Haque; Hoda Anton-Culver
Background. Self-reported data are often used to determine cancer screening test utilization, but self-report may be inaccurate.Methods. We interviewed members of three health maintenance organizations and reviewed their medicalrecords for information on digital rectal exam (DRE), prostate-specific antigen (PSA) test, fecal occult blood test (FOBT), sigmoidoscopy, and colonoscopy (response rate 65%). We calculated the sensitivity, specificity, concordance, and kappa
H. Irene Hall; Stephen K Van Den Eeden; Dennis D Tolsma; Kate Rardin; Trevor Thompson; Amber Hughes Sinclair; Diane J Madlon-Kay; Marion Nadel
A study was conducted to determine the feasibility of using emergency room and emergency medical service records in quantifying rural non- motor-vehicle pedestrian accidents and in developing countermeasures to reduce injuries resulting from such accidents. A literature review indicated that although non-motor-vehicle pedestrian accidents are a significant injury problem in the United States, there does not appear to be an
Electronic medicalrecord (EMR) implementation is a complex process depending on many factors for success. Organizational culture is one such factor. We assessed the organizational culture of an integrated healthcare delivery system prior to EMR conversion and then at 12, 24 & 36 months post-conversion. Contrary to our hypothesis, findings suggest that the perceived organizational culture has become more, rather than less, hierarchical. This poster presents a subset of findings from our four-year, observational project.
Reynolds, Katherine; Nowinski, Cindy; Becker, Susan; Beaumont, Jennifer
The aim of this study was to investigate the extent to which the symptoms experienced by advanced cancer patients were covered by the medicalrecords. Fifty-eight patients participated in the study. On the day of first encounter with our palliative care department, a medical history was taken, and on this or the following day, the patients completed the EORTC Quality
Annette S Strömgren; Mogens Groenvold; Lise Pedersen; Alf K Olsen; Marianne Spile; Per Sjøgren
Objective The use of electronic medicalrecord (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 medicalrecords 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 improved the reliability of the results.
Background The Institute of Medicine (IOM) reports that at least a fourth of all medication related injuries are preventable. Therefore, the IOM recommends healthcare organizations and providers implement electronic prescribing and clinical decision support systems in practices to aid in medication error prevention. Objective To assess the impact of noninstrusive-intrusive prompts from an electronic medicalrecord on recommended baseline and follow up laboratory monitoring, CK and liver transaminase levels (AST and ALT), in patients initiated on statin therapy. Methods Hybrid nonintrusive-intrusive prompts for laboratory monitoring specific for statin initiation were implemented in the electronic medicalrecord system in a community based, university affiliated family medicine residency program. A retrospective chart review was conducted to compare and assess laboratory monitoring in patients initiated on statin therapy from two specific time periods: a six month period prior to initiation of the prompts and a six month period after initiation of the prompts. Results One hundred seventy three patients met inclusion criteria. There were no significant differences in assessment of baseline liver transaminases and CK levels from the initial study period to the follow up study period. There were significant differences in follow up liver transaminase levels (18% vs 33%, p = 0.035) and CK levels (none vs 7%, p = 0.03) from the initial study period to the activated prompt interval. Conclusion A hybrid nonintrusive-intrusive specific prompts for laboratory monitoring triggered by statin initiation within an electronic medicalrecord improved follow up lab assessments for liver transaminases and CK but did not improve baseline assessments of CK or liver transaminases.
Bench testing with databases of pre-recorded physiological signals is a common step in the verification and validation of medical devices. For example, in the case of an electrocardiographic (ECG) monitor to be tested, the physiological signals are ECG tracings that have previously been recorded from patients using other ECG monitors. Human overreaders then annotate the tracings to determine the occurrence of significant clinical events such as ventricular tachycardia. These annotations can be used to determine the sensitivity and specificity of the ECG monitor to be tested. This article aims to highlight some issues associated with such bench testing, such as the way the pre-recorded signals are presented to the medical device to be tested, the adequacy of single channel versus dual channel versus multi-channel testing in the bench testing, and the need for the human overreaders and the medical device to use the same set of rules for determining the occurrence of a clinical event. These issues are also applicable to other monitors such as the apnea monitor. Some suggestions for addressing the issues are presented. PMID:12724888
BACKGROUND: Hospitals have responsibility for responding to legitimate demands for release of health information while protecting the confidentiality of the patient health records. There have always been challenges concerning medicalrecords confidentiality and their disclosure and release type in medicalrecord departments. This study investigated and compared laws and policies of disclosure of health information in Iran and selected countries and tried to identify the differences and the similarities between them. METHODS: This is a descriptive and comparative study. The scope of study included related laws and policies of disclosure of health information in selected countries such as United States, Australia, England, Malaysia and Iran. Data were gathered from systematic internet search, library resources and communication with health information professionals. Data analysis was done using comparative tables and qualitative method. RESULTS: Study results showed that legislative institutions of each country have ordained laws and policies concerning disclosure and release of health information and in turn hospitals developed policies and procedures based on these laws. In Iran, however, there are few laws and policies concerning disclosure of health information in the form of formal letters and bylaws. There are no specific written policies and procedures for disclosure of health information in the hospitals. CONCLUSIONS: It is necessary to develop legitimate and appropriate laws and policies in different levels for information utilization by hospitals, medical universities and others. Meanwhile in all of the selected countries there are ordained limitations for release of health information for protecting health information in regard to patient rights.
Yarmohammadian, Mohammad Hossein; Raeisi, Ahmad Reza; Tavakoli, Nahid; Nansa, Leila Ghaderi
The Electronic MedicalRecords and Genomics Network is a National Human Genome Research Institute-funded consortium engaged in the development of methods and best practices for using the electronic medicalrecord as a tool for genomic research. Now in its sixth year and second funding cycle, and comprising nine research groups and a coordinating center, the network has played a major role in validating the concept that clinical data derived from electronic medicalrecords can be used successfully for genomic research. Current work is advancing knowledge in multiple disciplines at the intersection of genomics and health-care informatics, particularly for electronic phenotyping, genome-wide association studies, genomic medicine implementation, and the ethical and regulatory issues associated with genomics research and returning results to study participants. Here, we describe the evolution, accomplishments, opportunities, and challenges of the network from its inception as a five-group consortium focused on genotype-phenotype associations for genomic discovery to its current form as a nine-group consortium pivoting toward the implementation of genomic medicine.Genet Med 15 10, 761-771.Genetics in Medicine (2013); 15 10, 761-771. doi:10.1038/gim.2013.72. PMID:23743551
Gottesman, Omri; Kuivaniemi, Helena; Tromp, Gerard; Faucett, W Andrew; Li, Rongling; Manolio, Teri A; Sanderson, Saskia C; Kannry, Joseph; Zinberg, Randi; Basford, Melissa A; Brilliant, Murray; Carey, David J; Chisholm, Rex L; Chute, Christopher G; Connolly, John J; Crosslin, David; Denny, Joshua C; Gallego, Carlos J; Haines, Jonathan L; Hakonarson, Hakon; Harley, John; Jarvik, Gail P; Kohane, Isaac; Kullo, Iftikhar J; Larson, Eric B; McCarty, Catherine; Ritchie, Marylyn D; Roden, Dan M; Smith, Maureen E; Böttinger, Erwin P; Williams, Marc S
Background The fifth i2b2/VA Workshop on Natural Language Processing Challenges for Clinical Records conducted a systematic review on resolution of noun phrase coreference in medicalrecords. Informatics for Integrating Biology and the Bedside (i2b2) and the Veterans Affair (VA) Consortium for Healthcare Informatics Research (CHIR) partnered to organize the coreference challenge. They provided the research community with two corpora of medicalrecords for the development and evaluation of the coreference resolution systems. These corpora contained various record types (ie, discharge summaries, pathology reports) from multiple institutions. Methods The coreference challenge provided the community with two annotated ground truth corpora and evaluated systems on coreference resolution in two ways: first, it evaluated systems for their ability to identify mentions of concepts and to link together those mentions. Second, it evaluated the ability of the systems to link together ground truth mentions that refer to the same entity. Twenty teams representing 29 organizations and nine countries participated in the coreference challenge. Results The teams' system submissions showed that machine-learning and rule-based approaches worked best when augmented with external knowledge sources and coreference clues extracted from document structure. The systems performed better in coreference resolution when provided with ground truth mentions. Overall, the systems struggled in solving coreference resolution for cases that required domain knowledge.
This Web site contains the online version of the Merck Veterinary Manual, provided on a not-for-profit basis by pharmaceutical manufacturers Merial and Merck and Co., Inc. This "single most comprehensive electronic reference for animal care information" covers over 12,000 veterinary topics. The scrollable table of contents and advanced search tool allow for quick access to the enormous body of information provided in this site. Users may also view detailed reference tables and over 1200 photographs and illustrations. A short video introduction and a helpful User's Guide will help users take advantage of all available features.
At Hakodate National General Hospital, a medical course (Hakodate Medical School) existed from 1872 to 1874 with governmental support, which was guided and lectured by Dr. Stuart Erdridge from Philadelphia. From many records concerning this course written by a student who attended during this period, real features of this course were clarified. Dr. S. Erdridge gave lectures in English about the fundamental as well as clinical aspects of medicine, including surgery, and gave guidance on clinical practise and treatments. These lectures were translated into Japanese simultaneously by an interpreter for the convenience of students writing in Japanese in their notebooks. His lectures were on a high level for that time, so later they were published in 3 volumes by the government (Kaitakushi). The nine of those 20 students who were supported by government expense were obligated to do medical services in Hokkaido for 5 years afterward. At the end of the course, students who took the course were engaged for 50 days in medical service which included a round trip for vaccination of small pox to children living near the Hakodate area and 2558 children were vaccinated. From the diary of this trip, the schedule and mode of vaccination at that time were clarified. The student who wrote this diary had to retire from this course at the last period, due to the death of his father and familial duties. However, the certificate for medical occupation was issued to him by Dr. S. Erdridge in 1886 for governmental necessity. PMID:11639782
BACKGROUND Advanced care planning (ACP) is considered an essential component of medical care in the United States, especially in patients with incurable diseases. However, little is known about clinical practices in outpatient oncology settings related to discussing end-of-life care and documenting code status preferences in ambulatory medicalrecords. OBJECTIVE To assess the rate of documentation of code status in the electronic longitudinal medicalrecords (LMR) of patients with metastatic cancer. DESIGN Retrospective review of 2,498 patients with metastatic solid tumors at an academic cancer center. An electronic patient database and the LMR were queried to identify demographic information, cancer type, number of clinic visits, and documentation of code status. PARTICIPANTS The sample consisted of adult patients with metastatic prostate, breast, ovarian, bladder kidney, colorectal, non-colorectal gastrointestinal (GI), and lung cancers. MEASUREMENTS Primary outcome was the percentage of documented code status in the LMR. MAIN RESULTS Among the 2,498 patients, 20.3% had a documented code status. Code status was designated most frequently in patients with non-colorectal GI (193/609, 31.7%) and lung (179/583, 30.7%) cancers and least frequently in patients with genitourinary malignancies [bladder/kidney (4/89, 4.5%), ovarian (4/93, 4.3%), and prostate (7/365, 1.9%) cancers]. Independent predictors of having documented code status included religious affiliation, cancer type, and a greater number of visits to the cancer center. Younger patients and black patients were less likely to be designated as DNR/DNI. CONCLUSIONS Despite the incurable nature of metastatic cancer, only a minority of patients had a code status documented in the electronic medicalrecord.
Greer, Joseph A.; Admane, Sonal; Solis, Jessica; Cashavelly, Barbara J.; Doherty, Stephen; Heist, Rebecca; Pirl, William F.
The traditional veterinary curriculum has little room for business courses. Yet the success of many veterinary practice owners depends on their knowledge and application of fundamental business skills and principles. This article reports on a veterinary business systems curriculum that has been implemented at Iowa State University to address the business and life skills needs of veterinarians. PMID:12143023
A major transition is underway in documentation of patient-related data in clinical settings with rapidly accelerating adoption of the electronic health record and electronic medicalrecord. This article examines the history of the development of medicalrecords in the West in order to suggest lessons applicable to the current transition. The first documented major transition in the evolution of the clinical medicalrecord occurred in antiquity, with the development of written case history reports for didactic purposes. Benefiting from Classical and Hellenistic models earlier than physicians in the West, medieval Islamic physicians continued the development of case histories for didactic use. A forerunner of modern medicalrecords first appeared in Paris and Berlin by the early 19th century. Development of the clinical record in America was pioneered in the 19th century in major teaching hospitals. However, a clinical medicalrecord useful for direct patient care in hospital and ambulatory settings was not developed until the 20th century. Several lessons are drawn from the 4000-year history of the medicalrecord that may help physicians improve patient care in the digital age. PMID:24054954
Background: Hospital electronic medicalrecord (EMR) systems are becoming increasingly integrated for management of patient data, especially given recent policy changes issued by the Centers for Medicaid and Medicare Services. In addition to data management, these data provide evidence for patient-centered outcomes research for a range of diseases, including cancer. Integrating EMR patient data with existing disease registries strengthens all essential components for assuring optimal health outcomes. Objectives: To identify the mechanisms for extracting, linking, and processing hospital EMR data with the Florida Cancer Data System (FCDS); and to assess the completeness of existing registry treatment data as well as the potential for data enhancement. Methods: A partnership among the Florida Department of Health, FCDS, and a large Florida hospital system was established to develop methods for hospital EMR extraction and transmission. Records for admission years between 2007 and 2010 were extracted using ICD-9-CM codes as the trigger and were linked with the cancer registry for patients with invasive cancers of the breast. Results: A total of 11,506 unique patients were linked with a total of 12,804 unique breast tumors. Evaluation of existing registry treatment data against the hospital EMR produced a total of 5 percent of registry records with updated surgery information, 1 percent of records with updated radiation information, and 7 percent of records updated with chemotherapy information. Enhancement of registry treatment information was particularly affected by the availability of chemotherapy medications data. Conclusion: Hospital EMR linkages to cancer disease registries is feasible but challenged by lack of standards for data collection, coding and transmission, comprehensive description of available data, and the exclusion of certain hospital datasets. The FCDS standard treatment data variables are highly robust and complete but can be enhanced by the addition of detailed chemotherapy regimens that are commonly used in patient centered outcomes research. PMID:23778697
Hernandez, Monique N; Voti, Lydia; Feldman, Jason D; Tannenbaum, Stacey L; Scharber, Wendy; Mackinnon, Jill A; Lee, David J; Huang, Youjie X
INTRODUCTION: The paper and electronic medicalrecord (EMR) have evolved with little scientific inquiry into what effect the informant (clinician or patient) has on the validity of the recorded information. We have previously reported on an electronic interview program that facilitated parents' direct reporting of past medical history data. We sought to define additional data elements that parents could report electronically and to compare parents' electronically entered data to that charted by physicians using the current EMR system. METHODS: A convenience sample of parents was recruited to enter data on history of present illness (HPI) and review of systems (ROS) elements using an electronic interview. Data from the electronic parental interview and information abstracted from the physician EMR were compared to data derived from a face-to-face criterion standard interview. Validity, sensitivity and specificity of each mode of data entry were calculated. RESULTS: 100 of 140 eligible parents (71.4%) participated. Validity of information from the electronic interview was comparable to that charted by emergency physicians for HPI regarding fever and ROS questions. Sensitivity of parents' electronic interview was superior to physicians' charting for ROS elements specific to hydration status. CONCLUSIONS: Improved sensitivity for detection of historical risk factors for illness can be achieved by augmenting the pediatric EMR with a section for direct parental direct data input. Direct parental data input to the EMR should be considered to improve the quality of documentation for medical histories.
|This study guide was developed for use by male and female vocational agriculture cooperative education students, 16 to 20 years old, preparing to become veterinary assistants. It was designed by subject-matter specialists on the basis of state advisory committee recommendations and refined after being tested in operational programs. Units, to be…
|Describes the history, research, teaching strategies, and specialties of the University of California at Davis School of Veterinary Medicine. Documents effects of changing societal attitudes toward wildlife, pets, working animals, and food animals on curriculum, the systems approach to disease, comparative genetics, biotechnology, the ecology of…
|Calls for a new model for veterinary education, drawn from engineering education, which imparts a strong core of fundamental biomedical knowledge and multi-species clinical experience to all students than allows a genuine opportunity for differentiation into strongly focused subject areas that provide in-depth education and training appropriate…
It has always been a research interest to solve hospital management problems with systematic approach by using modern management tools. Almost all the Hospital Information System (HIS) software packages in Turkey keep track of local transactions in administrative activities and material flow. In state hospitals in Turkey, very little medical information is processed and most of the records are still kept manually and archived on papers. In this paper, a cost-effective, flexible and easy-to-use Hospital Information System model is proposed in order to give better diagnostic and treatment services. It is also demonstrated that this model makes it possible to exchange information between and within the hospitals over Transmission Control Protocol/Internet Protocol (TCP/IP) network. User needs are taken into consideration during model development and the benefits of model implementation to the hospital administration are stated. According to the model proposed in this paper, only a single health care record number (HCRN) is required for a patient to access all her/his medicalrecords stored in different locations, from any state hospital in Turkey. PMID:11604155
Mounting research supports the use of peer-assisted learning (PAL) as a teaching method in human and veterinary medicine. PAL can be a cost-efficient educational tool, saving both financial resources and faculty time. This article reviews a PAL model for teaching communication skills to veterinarymedical students. In this model, junior veterinary students served as simulated clients for sophomore veterinary students. Details regarding methods of program delivery as well as evaluation data are presented. Differences between two student cohorts who participated in the PAL educational model and their subsequent evaluation results are discussed. Overall, veterinarymedical students reported that this approach was beneficial and that the topic was critical to their success as veterinarians. Students also showed improvement in communication knowledge and reported that peer feedback was a strength of the program. Finally, future directions to assess and strengthen the use of PAL for communication training in veterinarymedical education are proposed. PMID:23975077
Strand, Elizabeth B; Johnson, Beth; Thompson, James
This paper aims to investigate the efficacy and feasibility of Template-based Electronic MedicalRecord System (TEMRS) and factors for its successful implementation. A TEMRS was designed and implemented in one core clinic of a Hong Kong professional multi-disciplinary medical services provider with four core clinics located in different parts of Hong Kong. Eight doctors participated in the study. Surveys and interviews were conducted to acquire the users' feedback and satisfaction level. The design, development, and the factors related to the success of the implementation of TEMRS were analyzed. In the study period, 3,032 cases were collected. The most encountered diagnosis were upper respiratory tract infection (50.59%), gastroenteritis (10.19%), dermatitis (5.87%), dyspepsia (5.28%) and rhinitis (4.82%). The system gained an overall satisfaction by the users and the most satisfied areas were rapid retrieving the necessary information of patient (75%) and fasten the diagnostic selection (75%). TEMRS is an enabling system which can reduce the user resistance in new technology with its flexibility. The consideration of cost, security, human, technical, data migration and standardization issues are essential in the implementation of the TEMRS and further research should be conducted to expand the TEMRS's implementation in health care system. PMID:20703758
Ting, S L; Kwok, S K; Tsang, Albert H C; Lee, W B; Yee, K F
Introduction: This study compared the frequency of oral counseling and written information by primary care physicians at paper medicalrecord (PMR) clinics and electronic medicalrecord (EMR) clinics, and assessed relationships between medication counseling and medication outcomes (knowledge, questions, reported adherence and side effects, and medication fill). Methods: A cross-sectional study with two convenience samples of English-speaking adult patients receiving
Grace M. Kuo; Patricia Dolan Mullen; Amy McQueen; Paul R. Swank; John C. Rogers
The effect of electronic medicalrecords (EMRs) on quality of care in physicians' offices is uncertain. This study used the 2008-2009 National Ambulatory Medical Care Survey to examine the relationship between EMRs features and quality in physician offices. The relationship between selected EMRs features and 7 quality measures was evaluated by testing 25 associations in multivariate models. Significant relationships include reminders for guideline-based interventions or screening tests associated with lower odds of inappropriate urinalysis and prescription of antibiotics for upper respiratory infection (URI), prescription order entry associated with lower odds of prescription of antibiotics for URI, and patient problem list associated with higher odds of inappropriate prescribing for elderly patients. EMRs system level was associated with lower odds of blood pressure check, inappropriate urinalysis, and prescription of antibiotics for URI compared with no EMRs. The results show both positive and inverse relationships between EMRs features and quality of care. PMID:23610232
Background Electronic personal health records offer a promising way to communicate medical test results to patients. We compared the usability of tables and horizontal bar graphs for presenting medical test results electronically. Methods We conducted experiments with a convenience sample of 106 community-dwelling adults. In the first experiment, participants viewed either table or bar graph formats (between subjects) that presented medical test results with normal and abnormal findings. In a second experiment, participants viewed table and bar graph formats (within subjects) that presented test results with normal, borderline, and abnormal findings. Results Participants required less viewing time when using bar graphs rather than tables. This overall difference was due to superior performance of bar graphs in vignettes with many test results. Bar graphs and tables performed equally well with regard to recall accuracy and understanding. In terms of ease of use, participants did not prefer bar graphs to tables when they viewed only one format. When participants viewed both formats, those with experience with bar graphs preferred bar graphs, and those with experience with tables found bar graphs equally easy to use. Preference for bar graphs was strongest when viewing tests with borderline results. Conclusions Compared to horizontal bar graphs, tables required more time and experience to achieve the same results, suggesting that tables can be a more burdensome format to use. The current practice of presenting medical test results in a tabular format merits reconsideration.
Brewer, Noel T.; Gilkey, Melissa B.; Lillie, Sarah E.; Hesse, Bradford W.; Sheridan, Stacey L.
In 2007, about 5,900 of the 14,500 providers of home health or hospice care (41%) had electronic medicalrecords (EMRs), and an additional 2,200 (15%) planned to have EMRs within the next year. Providers who offered both hospice and home health care were more likely to have EMRs than providers offering only home health care, but did not differ from providers of hospice care only. Among providers with EMRs, 98% used components for recording patient demographics and 83% for clinical notes, and over one-half used clinical decision support systems or computerized physician order entry. Nonprofit and government providers, providers jointly owned or operated with other health care organizations, and providers with over 150 patients were more likely to have EMRs. PMID:21050535
Electronic medicalrecords (EMRs) are increasingly common in pediatric patient care. EMR data represent a relatively novel and rich resource for clinical research. The fact, however, that pediatric EMR data are collected for the purposes of clinical documentation and billing rather than research creates obstacles to their use in scientific investigation. Particular issues include accuracy, completeness, comparability between settings, ease of extraction, and context of recording. Although these problems can be addressed through standard strategies for dealing with partially accurate and incomplete data, a longer term solution will involve work with pediatric clinicians to improve data quality. As research becomes one of the explicit purposes for which pediatricians collect EMR data, the pediatric clinician will play a central role in future pediatric clinical research.
It is accepted that intravenous fluid (IVF) therapy can result in hospital-acquired dysnatremias in pediatric patients, with associated morbidity and mortality. There is interest in improving IVF therapy to prevent dysnatremias, but the optimal approach is controversial. In this study, we develop Natremia Deviation and Intravenous Renderer (NaDIR), a tool that preprocesses large volumes of electronic medicalrecord data obtained from an academic pediatric hospital in order to analyze (1) IVF therapy, (2) the epidemiology of dysnatremias, and (3) the impact of IVFs on changes in serum sodium (?SNa). We then applied NaDIR to 3,256 inpatient records over a 3 month period, which revealed (1) a 19.9% incidence of dysnatremias, (2) a significant increase in lengths of stay associated with dysnatremias, and (3) a novel linear relationship between ?SNa and IVF tonicity. This demonstrates that EMR data that can be readily analyzed to discover epidemiologic and predictive knowledge.
Pham, Steve L.; Bickel, Jonathan P.; Moritz, Michael L.; Levin, James E.
To broadly examine the potential health and financial benefits of health information technology (HIT), this paper compares health care with the use of IT in other industries. It estimates potential savings and costs of widespread adoption of electronic medicalrecord (EMR) systems, models important health and safety benefits, and concludes that effective EMR implementation and networking could eventually save more than $81 billion annually--by improving health care efficiency and safety--and that HIT-enabled prevention and management of chronic disease could eventually double those savings while increasing health and other social benefits. However, this is unlikely to be realized without related changes to the health care system. PMID:16162551
To probe into training of the clinical thinking of the students of modern acupuncture and moxibustion speciality, analyze YANG Ji-zhou's clinical thinking of acupuncture and moxibustion from YANG Ji-zhou's medicalrecords in Zhenjiu Dacheng. Results indicate that YANG Ji-zhou's many points of view in clinical acupuncture and moxibustion still can enlighten the train of thought of later generations, suggesting that YANG Ji-zhou's clinical thinking is of an important practical significance for training of the clinical thinking of the students of the acupuncture and moxibustion speciality. PMID:19358509
Aims We performed a systematic analysis of which drugs, prescribed, over the counter (OTC), and\\/or natural remedies, children had\\u000a used prior to visiting a pediatric emergency room (ER), and to compare this information with the documentation of drug use\\u000a in the medicalrecords.\\u000a \\u000a \\u000a \\u000a \\u000a Methods A questionnaire study was performed at a pediatric ER in a Swedish university hospital during 3 weeks in April
Introduction Electronic patient records are becoming more common in critical care. As their design and implementation are optimized for single users rather than for groups, we aimed to understand the differences in interaction between members of a multidisciplinary team during ward rounds using an electronic, as opposed to paper, patient medicalrecord. Methods A qualitative study of morning ward rounds of an intensive care unit that triangulates data from video-based interaction analysis, observation, and interviews. Results Our analysis demonstrates several difficulties the ward round team faced when interacting with each other using the electronic record compared with the paper one. The physical setup of the technology may impede the consultant's ability to lead the ward round and may prevent other clinical staff from contributing to discussions. Conclusions We discuss technical and social solutions for minimizing the impact of introducing an electronic patient record, emphasizing the need to balance both. We note that awareness of the effects of technology can enable ward-round teams to adapt their formations and information sources to facilitate multidisciplinary communication during the ward round.
BACKGROUND: The need for closer coordination between primary care medical and dental services has been recognized. AIM: To assess the attitudes of general medical practitioners (GMPs), general dental practitioners (GDPs), and patients to an integrated medical-dental patient-held record (integrated medical-dental PHR); to examine patients' use of these records, and the utility of the records for doctors and dentists. METHOD: A three-phase study was carried out: (1) postal survey of GMPs and GDPs; (2) randomized trial of patients, using postal questionnaires before and one year after the issue of integrated medical-dental PHRs to cases; (3) assessment by doctors and dentists of anonymized integrated medical-dental PHRs from this trial. The study was carried out in medical and dental practices in affluent and deprived areas in Greater Glasgow Health Board. Two hundred and thirteen GMPs, 183 GDPs, and 369 patients registered with GMPs and GDPs were surveyed. Eighteen GDPs and GMPs assessed the integrated medical-dental PHRs. RESULTS: Eighty per cent of dentists had contacted a doctor and 16% of doctors had contacted a dentist in the previous three months; 87% of dentists and 68% of doctors thought an integrated medical-dental PHR would be of some use. Twenty-one per cent of dentists and 85% of doctors had practice computers. Most patients wanted to be able to see and read their own records. Twenty-four per cent of patients said there were mistakes and 30% noticed omissions in the integrated medical-dental PHR issued. Experience of having an integrated medical-dental PHR made patients more positive towards the idea of having a patient-held record and being able to check the accuracy of records. Integrated medical-dental PHRs contained important information for half the GDPs and one-third of the GMPs. CONCLUSION: Both professionals and patients have reasonably positive attitudes towards the use of patient-held records. Among patients, the experience of having the integrated medical-dental PHR led to greater enthusiasm towards the idea. Dentists in particular would benefit from the transfer of information from doctors, but better methods are needed to ensure that patients take the integrated medical-dental PHR with them. Given the current lack of ability to easily produce an integrated medical-dental PHR, further examination of the routine issue of a copy of their medical summary, by GMPs, to all patients would be worthwhile.
This paper describes an experiment performed on a medicalrecord data set, using an information retrieval (IR) tool that applies the techniques of exploration and learning, to assist a researcher in identifying the most relevant cohorts. The paper present...
38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01...related medicalrecords in Department of Veterans Affairs custody. 1.513 Section 1.513 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF...
For 1051 chronically ill outpatients the authors performed (1) a controlled trial of reminders to discuss advance directives (ADs), and (2) prospective studies of the effects of completed AD forms, placed in patients' electronic medicalrecords, on emerge...
A medicalrecord and radiographic image transmission system has been developed using a high-speed communication network. The databases are designed to store and transmit the data acquired from the scanner. To maximally utilize the communication bandwidth, the medicalrecords and radiographic images are compressed using the G3 facsimile and JPEG coding standard method, respectively. TCP/IP, OOP and Windows-based system software enable a modular design, future expandability, open system interconnectivity, and diverse image manipulation functions. PMID:10384462
Kim, N H; Yoo, S K; Kim, K M; Kang, Y T; Bae, S H; Kim, S R
INTRODUCTION: The eMERGE (electronic MEdicalRecords and GEnomics) Network is an NHGRI-supported consortium of five institutions to explore the utility of DNA repositories coupled to Electronic MedicalRecord (EMR) systems for advancing discovery in genome science. eMERGE also includes a special emphasis on the ethical, legal and social issues related to these endeavors. ORGANIZATION: The five sites are supported by
Catherine A McCarty; Rex L Chisholm; Christopher G Chute; Iftikhar J Kullo; Gail P Jarvik; Eric B Larson; Rongling Li; Daniel R Masys; Marylyn D Ritchie; Dan M Roden; Jeffery P Struewing; Wendy A Wolf
Many primary care physicians are not providing care that is consistent with recommendations to prevent, to identify, and to manage childhood obesity. This report presents modifications made to the electronic medicalrecord system of a large pediatric health care system, using a quality improvement approach, to support these recommendations and office system changes. Although it is possible to make practice changes secondary to electronic medicalrecord system enhancements, challenges to development and implementation exist. PMID:19088224
The quality of medicalrecord abstracts is often characterized in a reliability substudy. These results usually indicate agreement, but not the extent to which lack of agreement affects associations observed in the complete data. In this study, medicalrecords were reviewed and abstracted for patients diagnosed with stage I or stage II breast cancer between 1990 and 1994 at one of six US Cancer Research Network sites. For a subsample, interrater reliability data were available. The authors calculated conventional hazard ratios and 95% confidence intervals for the association of demographic, tumor, and treatment characteristics with recurrence rate. These conventional estimates of effect were compared with three sets of estimates and 95% simulation intervals that took account of the uncertainty assessed by lack of agreement in the reliability substudy. The rate of recurrence was associated with increasing cancer stage and with treatment modality but not with demographic characteristics. The hazard ratios and simulation intervals that took account of the reliability data showed that the simulation interval grew wider as the sources of uncertainty taken into account grew more complete, but the associations expected a priori remained readily apparent. While many investigators use reliability data only as a metric for data quality, a more thorough approach can also quantitatively depict the uncertainty in the observed associations. PMID:17406006
Lash, Timothy L; Fox, Matthew P; Thwin, Soe Soe; Geiger, Ann M; Buist, Diana S M; Wei, Feifei; Field, Terry S; Yood, Marianne Ulcickas; Frost, Floyd J; Quinn, Virginia P; Prout, Marianne N; Silliman, Rebecca A
Purpose: The quality of any medical treatment depends on the accurate processing of multiple complex components of information, with proper delivery to the patient. This is true for radiation oncology, in which treatment delivery is as complex as a surgical procedure but more dependent on hardware and software technology. Uncorrected errors, even if small or infrequent, can result in catastrophic consequences for the patient. We developed electronic checklists (ECLs) within the oncology electronic medicalrecord (EMR) and evaluated their use and report on our initial clinical experience. Methods: Using the Mosaiq EMR, we developed checklists within the clinical assessment section. These checklists are based on the process flow of information from one group to another within the clinic and enable the processing, confirmation, and documentation of relevant patient information before the delivery of radiation therapy. The clinical use of the ECL was documented by means of a customized report. Results: Use of ECL has reduced the number of times that physicians were called to the treatment unit. In particular, the ECL has ensured that therapists have a better understanding of the treatment plan before the initiation of treatment. An evaluation of ECL compliance showed that, with additional staff training, > 94% of the records were completed. Conclusion: The ECL can be used to ensure standardization of procedures and documentation that the pretreatment checks have been performed before patient treatment. We believe that the implementation of ECLs will improve patient safety and reduce the likelihood of treatment errors.
Albuquerque, Kevin V.; Miller, Alexis A.; Roeske, John C.
The Electronic MedicalRecords and Genomics (eMERGE) Network is a National Human Genome Research Institute (NHGRI)-funded consortium engaged in the development of methods and best-practices for utilizing the Electronic MedicalRecord (EMR) as a tool for genomic research. Now in its sixth year, its second funding cycle and comprising nine research groups and a coordinating center, the network has played a major role in validating the concept that clinical data derived from EMRs can be used successfully for genomic research. Current work is advancing knowledge in multiple disciplines at the intersection of genomics and healthcare informatics, particularly electronic phenotyping, genome-wide association studies, genomic medicine implementation and the ethical and regulatory issues associated with genomics research and returning results to study participants. Here we describe the evolution, accomplishments, opportunities and challenges of the network since its inception as a five-group consortium focused on genotype-phenotype associations for genomic discovery to its current form as a nine-group consortium pivoting towards implementation of genomic medicine.
Gottesman, Omri; Kuivaniemi, Helena; Tromp, Gerard; Faucett, W. Andrew; Li, Rongling; Manolio, Teri A.; Sanderson, Saskia C.; Kannry, Joseph; Zinberg, Randi; Basford, Melissa A.; Brilliant, Murray; Carey, David J.; Chisholm, Rex L.; Chute, Christopher G.; Connolly, John J.; Crosslin, David; Denny, Joshua C.; Gallego, Carlos J.; Haines, Jonathan L.; Hakonarson, Hakon; Harley, John; Jarvik, Gail P.; Kohane, Isaac; Kullo, Iftikhar J.; Larson, Eric B.; McCarty, Catherine; Ritchie, Marylyn D.; Roden, Dan; Smith, Maureen E.; Bottinger, Erwin P.; Williams, Marc S.
Purpose Electronic medicalrecords (EMR) have become part of daily practice for many physicians. Attempts have been made to apply electronic search engine technology to speed EMR review. This was a prospective, observational study to compare the speed and accuracy of electronic search engine vs. manual review of the EMR. Methods Three raters reviewed 49 cases in the EMR to screen for eligibility in a depression study using the electronic search engine (EMERSE). One week later raters received a scrambled set of the same patients including 9 distractor cases, and used manual EMR review to determine eligibility. For both methods, accuracy was assessed for the original 49 cases by comparison with a gold standard rater. Results Use of EMERSE resulted in considerable time savings; chart reviews using EMERSE were significantly faster than traditional manual review (p=0.03). The percent agreement of raters with the gold standard (e.g. concurrent validity) using either EMERSE or manual review was not significantly different. Conclusions Using a search engine optimized for finding clinical information in the free-text sections of the EMR can provide significant time savings while preserving reliability. The major power of this search engine is not from a more advanced and sophisticated search algorithm, but rather from a user interface designed explicitly to help users search the entire medicalrecord in a way that protects health information.
Seyfried, Lisa; Hanauer, David; Nease, Donald; Albeiruti, Rashad; Kavanagh, Janet; Kales, Helen C.
The processes for acquiring medicalrecords from healthcare facilities in longitudinal cohort studies have not been well examined post-HIPAA Privacy Rule. We examined the response rates, correlates of response rates, and response times for obtaining patient medicalrecords from healthcare facilities under the HIPAA Privacy Rule. Medicalrecords were requested from facilities across the country on adults 45 or older enrolled in the national longitudinal cohort study REGARDS (Reasons for Geographic and Racial Differences in Stroke) who reported physician encounters for potential stroke events. From October 2003 to October 2006, 1,439 medicalrecords were received out of 1,518 reported eligible events (94.7%), with 39 (2.6%) requests pending at the time of the analysis. The refusal rate for record requests from healthcare facilities was only 0.4%. The median length of time to receipt of a record was 26 days (range 1-679 days). Hospitals had the fastest return time (22 days from date of request to date of receipt) compared with outpatient clinics (28 days), doctor's offices (31 days), and long-term care facilities (55 days, p < 0.01). Healthcare facilities located in the Southern region had fastest return time compared with those in the Northwestern region (23 vs. 46 days, p = 0.048). Medicalrecords retrieval in prospective research studies is still feasible under HIPAA regulation. PMID:17536228
Houser, Shannon H; Howard, Virginia J; Hovater, Martha K; Safford, Monika M
|Background: Medical problems are described in a population of persons with Down syndrome. Health surveillance is compared to the recommendations of national guidelines. Method: Case records from the specialised and primary healthcare and disability services were analysed. Results: A wide spectrum of age-specific medical and surgical problems was…
Introduction Hospital managers and personnel need to Hospital Information System (HIS) to increase the efficiency and effectiveness in their organization. Accurate, appropriate, precise, timely, valid information, and Suitable Information system for their tasks is required and the basis for decision making in various levels of the hospital management, since, this study was conducted to Assess of Selected HIS in Isfahan University of Medical Science Hospitals According to ISO 9241-10. Methods This paper obtained from an applied, descriptive cross sectional study, in which the medicalrecords module of IUMS selected HIS in Isfahan University of Medical Science affiliated seven hospitals were assessed with ISO 9241-10 questionnaire contained 7 principles and 74 items. The obtained data were analyzed with SPSS software and descriptive statistics were used to examine measures of central tendencies. Results The analysis of data revealed the following about the software: Suitability for user tasks, self descriptiveness, controllability by user, Conformity with user expectations, error tolerance, suitability for individualization, and suitability for user learning, respectively, was 68, 67, 70, 74, 69, 53, and 68 percent. Total compliance with ISO 9241-10 was 67 percent. Conclusion Information is the basis for policy and decision making in various levels of the hospital management. Consequently, it seems that HIS developers should decrease HIS errors and increase its suitability for tasks, self descriptiveness, controllability, conformity with user expectations, error tolerance, suitability for individualization, suitability for user learning.
An electronic medicalrecord (EMR) system was introduced to the University of Miyazaki Hospital, in Japan, in 2006. This hospital is the only one in Japan to store digital photographs of patients within EMRs. In this paper, we report on the utility of these digital photographs for disease diagnosis. Digital photographs of patients were taken at the time of hospitalization, and have been used for patient identification by medical staff. More than 20,000 digital photographs have been saved, along with examination data and medical history classified by disease, since the introduction of EMR. In the first part of the present study, we analyzed the facial cheek color of patients using photographs taken at the time of hospitalization in relation to diagnoses in six disease categories that were considered to lead to characteristic facial skin characteristics. We verified the presence or absence of a characteristic color for each disease category. Next, we focused on four diseases, Analysis of the facial skin color of 1268 patients found the same patterns of characteristic color. Overall, we found significant differences in complexion according to disease type, based on the analysis of color from digital photos and other EMR information. We propose that color analysis data should become an additional item of information stored in EMRs. PMID:22351112
This paper proposes a patient-identity security mechanism, including an identity cipher/decipher and a user-authentication protocol, to ensure the confidentiality and authentication of patients' electronic medicalrecords (EMRs) during transit and at rest. To support the confidentiality of an EMR, the identity cipher/decipher uses a data-hiding function and three logical-based functions to encrypt/decrypt a patient's identifying data and medical details in an EMR. The ciphertext of the patient's identifying data is patient-EMR related, whereas that of medical details is healthcare agent-EMR related. To support the authentication of an EMR, the user-authentication protocol based on a public key infrastructure uses certificates and dynamic cookies for verification/identification. The identity cipher has been simulated using C programming language running on a 1500 MHz Pentium PC with 512 MB of RAM. The experimental results show that healthcare agents can install large amounts of patients' encrypted EMRs in healthcare databases efficiently. In addition, separately storing the keys in a user's token and an EMR database for decryption increases the safety of patients' EMRs. For each user-authentication trail, the use of certificates and dynamic cookies for verification/identification ensures that only authorized users can obtain access to the EMR, and anyone involved cannot make false claims on the transmission made. PMID:16403711
This Note addresses the issue of a patient's right to access her own medicalrecords in the United States and Australia. Part I discusses the background of a right of patient access to medicalrecords through case law in the United States. Part I gives a historical perspective on US and Australian legislation regarding access to medicalrecords. Part II
Background: Follow-up of abnormal outpatient laboratory test results is a major patient safety concern. Electronic medicalrecords can potentially address this concern through automated notification. We examined whether automated notifications of abnormal laboratory results (alerts) in an integrated electronic medicalrecord resulted in timely follow-up actions. Methods: We studied four alerts: hemoglobin A1c (HbA1c) ?15%, positive hepatitis C antibody (HCV), prostate specific antigen (PSA) ?15 ng/mL, and thyroid stimulating hormone (TSH) ? 15 mIU/L. An alert tracking system determined whether the alert was acknowledged (i.e. provider clicked on and opened the message) within two weeks of transmission; acknowledged alerts were considered read. Within 30 days of result transmission, record review and provider contact determined follow-up actions (e.g. patient contact, treatment etc.). Multivariable logistic regression models analyzed predictors for lack of timely follow-up. Results: Between May 2008 and December 2008, 78,158 tests (HbA1c, HCV, TSH and PSA) were performed, of which 1163 (1.48%) were transmitted as alerts; 10.2% of these (119/1163) were unacknowledged. Timely follow-up was lacking in 79 (6.8%) and was statistically not different for acknowledged and unacknowledged alerts (6.4% vs. 10.1%; p =.13). Two-hundred two alerts (17.4% of 1163) arose from unnecessarily ordered (redundant) tests. Alerts for a new versus known diagnosis were more likely to lack timely follow-up (OR: 7.35; 95% CI: 4.16-12.97) whereas alerts related to redundant tests were less likely to lack timely follow-up (OR: 0.24; 95% CI: 0.07-0.84). Conclusions: Safety concerns related to timely patient follow-up remain despite automated notification of non-life threatening abnormal laboratory results in the outpatient setting.
Singh, Hardeep; Thomas, Eric J.; Sittig, Dean F.; Wilson, Lindsey; Espadas, Donna; Khan, Myrna M.; Petersen, Laura A.
Patient condition is a key element in communication between clinicians. However, there is no generally accepted definition of patient condition that is independent of diagnosis and that spans acuity levels. We report the development and validation of a continuous measure of general patient condition that is independent of diagnosis, and that can be used for medical-surgical as well as critical care patients. A survey of Electronic MedicalRecord data identified common, frequently collected non-static candidate variables as the basis for a general, continuously updated patient condition score. We used a new methodology to estimate in-hospital risk associated with each of these variables. A risk function for each candidate input was computed by comparing the final pre-discharge measurements with 1-year post-discharge mortality. Step-wise logistic regression of the variables against 1-year mortality was used to determine the importance of each variable. The final set of selected variables consisted of 26 clinical measurements from four categories: nursing assessments, vital signs, laboratory results and cardiac rhythms. We then constructed a heuristic model quantifying patient condition (overall risk) by summing the single-variable risks. The model's validity was assessed against outcomes from 170,000 medical-surgical and critical care patients, using data from three US hospitals. Outcome validation across hospitals yields an area under the receiver operating characteristic curve(AUC) of ?0.92when separating hospice/deceased from all other discharge categories, an AUC of ?0.93 when predicting 24-h mortalityand an AUC of 0.62 when predicting 30-day readmissions. Correspondence with outcomesreflective of patient condition across the acuity spectrum indicates utility in both medical-surgical unitsand critical care units. The model output, which we call the Rothman Index, may provide clinicians witha longitudinal view of patient condition to help address known challenges in caregiver communication,continuity of care, and earlier detection of acuity trends. PMID:23831554
Rothman, Michael J; Rothman, Steven I; Beals, Joseph
The turnover of veterinary technicians within an animal resources program averaged 33% annually over 18 y, peaking at 67% in 1998 to 1999. Insufficient retention of veterinary technicians led to diversion of veterinarian effort to technical tasks and to increased allocation of administrative resources for supervising and managing an expanding team of veterinary technicians. To identify factors and trends related to poor retention, address any causes, and reduce turnover, a retrospective analysis of employment records was done. The retention of veterinary technicians was significantly greater for the 9 technicians hired from veterinary private practice rather than for any of 3 other general sources: promotions from the animal care staff, transfers from other research institutions, and miscellaneous sources. Veterinary technician turnover was reduced from a mean of 60% over 1995 to 1999 to an average of 26% during 2000 to 2004. Higher retention was associated with management practices that included renewed concentration on recruiting and interviewing strategies and emphasis on training and career development including merit raises for technician certification through the American Association for Laboratory Animal Science. Higher retention yielded correspondingly greater experience on the job as the mean tenure increased from 1.1 y in 2000 to 2.8 y in 2004. The most valued attributes related to employment by veterinary technicians as determined by survey were to do meaningful work, earn a good living, and have a committed team of coworkers. PMID:16995642
\\u000a Veterinary medicines may be emitted either directly or indirectly into the environment, following its use. As veterinary medicines\\u000a are biologically active compounds, there is a concern that their occurrence in the environment may have an adverse impact\\u000a on aquatic and terrestrial organisms. This chapter reviews the major sources by which veterinary medicines enter the environment,\\u000a the fate, behaviour and occurrence
Objective To study how mortality varies with different degrees of anticoagulation reflected by the international normalised ratio (INR). Design Record linkage analysis with death hazard estimated as a continuous function of INR. Data sources 46 anticoagulation clinics in Sweden with computerised medicalrecords. Subjects Records for 42?451 patients, 3533 deaths, and 1.25 million INR measurements. Main outcome measures Mortality from all causes and from intracranial haemorrhage. Results Mortality from all causes of death was strongly related to level of INR. Minimum risk of death was attained at 2.2 INR for all patients and 2.3 INR for patients with mechanical heart valve prostheses. A high INR was associated with an excess mortality: with an increase of 1 unit of INR above 2.5, the risks of death from cerebral bleeding (149 deaths) and from any cause were about doubled. Among patients with an INR of ?3.0, 1069 deaths occurred within 7 weeks; if the risk coincided with that with an INR of 2.9, the expected number of deaths would have been 569. Thus at least 500 deaths were associated with a high INR value, but not necessarily caused by the treatment. Conclusions The excess mortality associated with high INR values supports the use of less intensive treatment and a small therapeutic window, with INR close to 2.2-2.3 irrespective of the indication for anticoagulant treatment. More preventive actions should be taken to avoid episodes of high INR. What is already known on this topicThe optimal degree of anticoagulation (expressed as the international normalised ratio (INR)) for different indications is still unclear, but the increased risk of death due to bleeding at high INR values is well knownWhat this study addsThis large study of medicalrecords from anticoagulation clinics in Sweden confirmed the substantial excess mortality at high INR values and indicated optimal treatment to be in a small therapeutic window with INR close to 2.2-2.3, irrespective of the indication for anticoagulant treatment
Background Incident reporting is the most common method for detecting adverse events in a hospital. However, under-reporting or non-reporting and delay in submission of reports are problems that prevent early detection of serious adverse events. The aim of this study was to determine whether it is possible to promptly detect serious injuries after inpatient falls by using a natural language processing method and to determine which data source is the most suitable for this purpose. Methods We tried to detect adverse events from narrative text data of electronic medicalrecords by using a natural language processing method. We made syntactic category decision rules to detect inpatient falls from text data in electronic medicalrecords. We compared how often the true fall events were recorded in various sources of data including progress notes, discharge summaries, image order entries and incident reports. We applied the rules to these data sources and compared F-measures to detect falls between these data sources with reference to the results of a manual chart review. The lag time between event occurrence and data submission and the degree of injury were compared. Results We made 170 syntactic rules to detect inpatient falls by using a natural language processing method. Information on true fall events was most frequently recorded in progress notes (100%), incident reports (65.0%) and image order entries (12.5%). However, F-measure to detect falls using the rules was poor when using progress notes (0.12) and discharge summaries (0.24) compared with that when using incident reports (1.00) and image order entries (0.91). Since the results suggested that incident reports and image order entries were possible data sources for prompt detection of serious falls, we focused on a comparison of falls found by incident reports and image order entries. Injury caused by falls found by image order entries was significantly more severe than falls detected by incident reports (p<0.001), and the lag time between falls and submission of data to the hospital information system was significantly shorter in image order entries than in incident reports (p<0.001). Conclusions By using natural language processing of text data from image order entries, we could detect injurious falls within a shorter time than that by using incident reports. Concomitant use of this method might improve the shortcomings of an incident reporting system such as under-reporting or non-reporting and delayed submission of data on incidents.
Identification of patients’ drug exposure information is critical to drug-related research that is based on electronic medicalrecords (EMRs). Drug information is often embedded in clinical narratives and drug regimens change frequently because of various reasons like intolerance or insurance issues, making accurate modeling challenging. Here, we developed an informatics framework to determine patient drug exposure histories from EMRs by combining natural language processing (NLP) and machine learning (ML) technologies. Our framework consists of three phases: 1) drug entity recognition - identifying drug mentions; 2) drug event detection - labeling drug mentions with a status (e.g., “on” or “stop”); and 3) drug exposure modeling - predicting if a patient is taking a drug at a given time using the status and temporal information associated with the mentions. We applied the framework to determine patient warfarin exposure at hospital admissions and achieved 87% precision, 79% recall, and an area under the receiver-operator characteristic curve of 0.93.
Liu, Mei; Jiang, Min; Kawai, Vivian K.; Stein, Charles M.; Roden, Dan M.; Denny, Joshua C.; Xu, Hua
Submission of data into clinical trial electronic data capture (EDC) systems currently requires redundant entry of data that already exist in the electronic medicalrecord (EMR). Being able to automatically transfer data from the EMR to the EDC system would save many hours of arduous effort, especially for multisite data-intensive oncology trials. Standardization of the way in which data are stored in and retrieved from the EMR and techniques for mining data from the unstructured narrative will provide opportunities for transferring data from the EMR to the EDC system. As different EMRs proliferate, other technology in the form of data mining or middle-tier applications is certain to provide assistance in this effort. PMID:22907283
Kaiser Permanente, Northwest, evaluated the use of laptop computers to access our existing comprehensive Electronic MedicalRecord in exam rooms via a wireless radiofrequency (RF) network. Eleven of 22 clinicians who were offered the laptops successfully adopted their use in the exam room. These clinicians were able to increase their exam room time with the patient by almost 4 minutes (25%), apparently without lengthening their overall work day. Patient response to exam room computing was overwhelmingly positive. The RF network response time was similar to the hardwired network. Problems cited by some laptop users and many of the eleven non-adopters included battery issues, different equipment layout and function, and inadequate training. IT support needs for the RF laptops were two to four times greater than for hardwired desktops. Addressing the reliability and training issues should increase clinician acceptance, making a successful general roll-out for exam room computing more likely.
Dworkin, L. A.; Krall, M.; Chin, H.; Robertson, N.; Harris, J.; Hughes, J.
The Institut Municipal d'Assistència Sanitària (IMAS) is a health care organization in Barcelona, comprising two general hospitals, a psychiatric hospital, a surgical clinic, a geriatric center, some primary care clinics, and a research institute. Since 1984, IMAS has been engaged in creating a multicenter integrated hospital information system (IMASIS). Currently, IMASIS offers the possibility to manage administrative data, laboratory results, pathology and cytology reports, radiology reports, and pharmacy inpatient orders; it also shares this information on-line among IMAS centers. IMASIS users may also work with a word processor, a spreadsheet, a database, or a statistical package and have access to MEDLINE. A second phase of IMASIS development began in December 1993 focused on clinical information management. The goal was to move towards an integrated multimedia medicalrecord . As a first step, the implementation experiences of the most advanced hospital information systems around the world were studied. Some of these experiences detected behavioral, cultural, and organizational factors  as the main sources of delay, or even failure, in HIS projects. A preliminary analysis to define such factors, assess their potential impact, and introduce adequate measures to deal with them seemed unavoidable before structuring of the project. In our approach to physician attitudes analysis, two survey techniques were applied. First, every hospital service head was contacted to schedule an interview, with either a service representative or a group of staff physicians and residents. The aim was to provide detailed information about project objectives and collect personal opinions, problems encountered in the current HIS, and specific needs of every medical and surgical specialty (including imaging needs). Every service head was asked to distribute a questionnaire among all clinicians, which assessed frequency of use of IMASIS current applications, user's satisfaction level, problems to be solved in utilization of the system, errors detected in the systems' database, and the personal interest in participating in the IMASIS project. The questionnaire was also intended to be a tool to monitor IMASIS evolution. Our study showed that medical staff had a lack of information about the current HIS, leading to a poor utilization of some system options. Another major characteristic, related to the above, was the feeling that the project would negatively affect the organization of work at the hospitals. A computer-based medicalrecord was feared to degrade physician-patient relationship, introduce supplementary administrative burden in clinicians day-to-day work, unnecessarily slow history taking, and imply too-rigid patterns of work. The most frequent problems in using the current system could be classified into two groups: problems related to lack of agility and consistency in user interface design, and those derived from lack of a common patient identification number. Duplication of medicalrecords was the most frequent error detected by physicians. Analysis of physicians' attitudes towards IMASIS revealed a lack of confidence globally. This was probably the consequence of two current features: a lack of complete information about IMASIS possibilities and problems faced when using the system. To deal with such factors, three types of measures have been planned. First, an effort is to be done to ensure that every physician is able to adequately use the current system and understands long-term benefits of the project. This task will be better accomplished by personal interaction between clinicians and a physician from the Informatics Department than through formal teaching of IMASIS. Secondly, a protocol for evaluating the HIS is being developed and will be systematically applied to detect both database errors and systemUs design pitfalls. Finally, the IMASIS project has to find a convenient point for starting, to offer short-term re PMID:8591191
Objective To determine the agreement between patient-reported symptoms of chest pain, dyspnea and cough and the documentation of these symptoms by physicians in the electronic medicalrecord (EMR). Methods Symptoms reported by patients on patient provided information forms between January 1, 2006 and June 30, 2006 were compared to those identified with natural language processing (NLP) of the text of clinical notes from care providers. Terms that represent the three symptoms were used to search clinical notes electronically with subsequent manual identification of the context (e.g. affirmative, negated, family history) in which they occur. Results are reported using positive and negative agreement, and kappa statistics. Results Symptoms reported by 1,119 patients 18 years or older were compared to the non-negated terms identified in their clinical notes. Positive agreement was 74, 70 and 63 for chest pain, dyspnea, and cough, while negative agreement was 76, 76 and 75, respectively. Kappa statistics were 0.50 (95%CI 0.41-0.59) for chest pain, 0.46 (95%CI 0.37-0.54) for dyspnea and 0.38 (95%CI 0.28-0.48) for cough. Positive agreement was higher for older men (p>0.05) while negative agreement was higher for younger women (p>0.05). Conclusions We found discordance between patient self report and documentation of symptoms in the medicalrecord. This has important implications for research studies that rely on symptom information for patient identification and may have clinical implications that must be evaluated for potential impact on quality of care, patient safety and outcomes.
Pakhomov, Serguei; Jacobsen, Steven J.; Chute, Christopher G.; Roger, Veronique L.
Large-scale DNA databanks linked to electronic medicalrecord (EMR) systems have been proposed as an approach for rapidly generating large, diverse cohorts for discovery and replication of genotype-phenotype associations. However, the extent to which such resources are capable of delivering on this promise is unknown. We studied whether an EMR-linked DNA biorepository can be used to detect known genotype-phenotype associations for five diseases. Twenty-one SNPs previously implicated as common variants predisposing to atrial fibrillation, Crohn disease, multiple sclerosis, rheumatoid arthritis, or type 2 diabetes were successfully genotyped in 9483 samples accrued over 4 mo into BioVU, the Vanderbilt University Medical Center DNA biobank. Previously reported odds ratios (ORPR) ranged from 1.14 to 2.36. For each phenotype, natural language processing techniques and billing-code queries were used to identify cases (n = 70–698) and controls (n = 808–3818) from deidentified health records. Each of the 21 tests of association yielded point estimates in the expected direction. Previous genotype-phenotype associations were replicated (p < 0.05) in 8/14 cases when the ORPR was > 1.25, and in 0/7 with lower ORPR. Statistically significant associations were detected in all analyses that were adequately powered. In each of the five diseases studied, at least one previously reported association was replicated. These data demonstrate that phenotypes representing clinical diagnoses can be extracted from EMR systems, and they support the use of DNA resources coupled to EMR systems as tools for rapid generation of large data sets required for replication of associations found in research cohorts and for discovery in genome science.
Ritchie, Marylyn D.; Denny, Joshua C.; Crawford, Dana C.; Ramirez, Andrea H.; Weiner, Justin B.; Pulley, Jill M.; Basford, Melissa A.; Brown-Gentry, Kristin; Balser, Jeffrey R.; Masys, Daniel R.; Haines, Jonathan L.; Roden, Dan M.
Psychiatric disorders frequently make the patient unable to perform their work. It is estimated that psychiatric disorders are the third most frequent reason for an expert's decision concerning long-term inability to work justifying the granting of a disability pension. Unfortunately, not all patients are certified positively, i.e. are granted disability pension or receive disability benefits in the expected amount; usually, they are lower than those they applied for. The paper discusses the premises applied by the Social Insurance Institution (ZUS) physicians and court appointed experts in their examination of patients applying for disability benefits. Some patients are positively certified already at the time of the initial contact. Their mode of behavior, functioning and patterns of speech leave no doubt as to the significant exacerbation of their mental disturbances. Another group of patients manifests situational "exacerbation" connected with the stressful nature of a meeting with an expert physician. In such cases, the patient's medicalrecords are of great importance. Evaluation of medicalrecords takes into account regular and systematic character of treatment, as well as the kind of pharmacotherapy applied in the treatment. The patient's discontinuation of treatment just after having been granted disability benefits and restarting it a short time before check-up examination is regarded rather critically. Rare appointments taking place once or twice a year are not recognized as corresponding with the existence of intense and debilitating mental disorders. Duration of treatment before applying for disability pension is also evaluated. The author discusses particular cases in the context of ethical and deontological principles. PMID:17571520
Background The electronic medicalrecord (EMR) contains a rich source of information that could be harnessed for epidemic surveillance. We asked if structured EMR data could be coupled with computerized processing of free-text clinical entries to enhance detection of acute respiratory infections (ARI). Methodology A manual review of EMR records related to 15,377 outpatient visits uncovered 280 reference cases of ARI. We used logistic regression with backward elimination to determine which among candidate structured EMR parameters (diagnostic codes, vital signs and orders for tests, imaging and medications) contributed to the detection of those reference cases. We also developed a computerized free-text search to identify clinical notes documenting at least two non-negated ARI symptoms. We then used heuristics to build case-detection algorithms that best combined the retained structured EMR parameters with the results of the text analysis. Principal Findings An adjusted grouping of diagnostic codes identified reference ARI patients with a sensitivity of 79%, a specificity of 96% and a positive predictive value (PPV) of 32%. Of the 21 additional structured clinical parameters considered, two contributed significantly to ARI detection: new prescriptions for cough remedies and elevations in body temperature to at least 38°C. Together with the diagnostic codes, these parameters increased detection sensitivity to 87%, but specificity and PPV declined to 95% and 25%, respectively. Adding text analysis increased sensitivity to 99%, but PPV dropped further to 14%. Algorithms that required satisfying both a query of structured EMR parameters as well as text analysis disclosed PPVs of 52–68% and retained sensitivities of 69–73%. Conclusion Structured EMR parameters and free-text analyses can be combined into algorithms that can detect ARI cases with new levels of sensitivity or precision. These results highlight potential paths by which repurposed EMR information could facilitate the discovery of epidemics before they cause mass casualties.
OBJECTIVE To describe physicians’ patterns of using an Electronic MedicalRecord (EMR) system; to reveal the underlying cognitive elements involved in EMR use, possible resulting errors, and influences on patient–doctor communication; to gain insight into the role of expertise in incorporating EMRs into clinical practice in general and communicative behavior in particular. DESIGN Cognitive task analysis using semi-structured interviews and field observations. PARTICIPANTS Twenty-five primary care physicians from the northern district of the largest health maintenance organization (HMO) in Israel. RESULTS The comprehensiveness, organization, and readability of data in the EMR system reduced physicians’ need to recall information from memory and the difficulty of reading handwriting. Physicians perceived EMR use as reducing the cognitive load associated with clinical tasks. Automaticity of EMR use contributed to efficiency, but sometimes resulted in errors, such as the selection of incorrect medication or the input of data into the wrong patient’s chart. EMR use interfered with patient–doctor communication. The main strategy for overcoming this problem involved separating EMR use from time spent communicating with patients. Computer mastery and enhanced physicians’ communication skills also helped. CONCLUSIONS There is a fine balance between the benefits and risks of EMR use. Automaticity, especially in combination with interruptions, emerged as the main cognitive factor contributing to errors. EMR use had a negative influence on communication, a problem that can be partially addressed by improving the spatial organization of physicians’ offices and by enhancing physicians’ computer and communication skills.
Background The electronic medicalrecord (EMR) is one of the most promising components of health information technology. However, the overall impact of EMR adoption on outcomes at US hospitals remains unknown. This study examined the relationship between basic EMR adoption and 30-day rehospitalization, 30-day mortality, inpatient mortality and length of stay. Methods Our overall approach was to compare outcomes for the two years before and two years after the year of EMR adoption, at 708 acute-care hospitals in the US from 2000 to 2007. We looked at the effect of EMR on outcomes using two methods. First, we compared the outcomes by quarter for the period before and after EMR adoption among hospitals that adopted EMR. Second, we compared hospitals that adopted EMR to those that did not, before and after EMR adoption, using a generalized linear model. Results Hospitals adopting EMR experienced 0.11 (95% CI: -0.218 to ?0.002) days’ shorter length of stay and 0.182 percent lower 30-day mortality, but a 0.19 (95% CI: 0.0006 to 0.0033) percent increase in 30-day rehospitalization in the two years after EMR adoption. The association of EMR adoption with outcomes also varied by type of admission (medical vs. surgical). Conclusions Previous studies using observational data from large samples of hospitals have produced conflicting results. However, using different methods, we found a small but statistically significant association of EMR adoption with outcomes of hospitalization.
Background In most European countries and North America the number of home visits carried out by GPs has been decreasing sharply. This has been influenced by non-medical factors such as mobility and pressures on time. The objective of this study was to investigate changes in home visiting rates, looking at the level of diagnoses in1987 and in 2001. Methods We analysed routinely collected data on diagnoses in home visits and surgery consultations from electronic medicalrecords by general practitioners. Data were used from 246,738 contacts among 124,791 patients in 103 practices in 1987, and 77,167 contacts among 58,345 patients in 80 practices in 2001. There were 246 diagnoses used. The main outcome measure was the proportion of home visits per diagnosis in 2001. Results Within the period studied, the proportion of home visits decreased strongly. The size of this decrease varied across diagnoses. The relation between the proportion of home visits for a diagnosis in 1987 and the same proportion in 2001 is curvilinear (J-shaped), indicating that the decrease is weaker at the extreme points and stronger in the middle. Conclusion By comparison with 1987, the proportion of home visits shows a distinct decline. However, the results show that this decline is not necessarily a problem. The finding that this decline varied mainly between diagnoses for which home visits are not always urgent, shows that medical considerations still play an important role in the decision about whether or not to carry out a home visit.
van den Berg, Michael J; Cardol, Mieke; Bongers, Frans JM; de Bakker, Dinny H
Objectives Although Electronic MedicalRecord (EMR) systems provide various benefits, there are both advantages and disadvantages regarding its cost-effectiveness. This study analyzed the economic effects of EMR systems using a cost-benefit analysis based on the differential costs of managerial accounting. Methods Samsung Medical Center (SMC) is a general hospital in Korea that developed an EMR system for outpatients from 2006 to 2008. This study measured the total costs and benefits during an 8-year period after EMR adoption. The costs include the system costs of building the EMR and the costs incurred in smoothing its adoption. The benefits included cost reductions after its adoption and additional revenues from both remodeling of paper-chart storage areas and medical transcriptionists' contribution. The measured amounts were discounted by SMC's expected interest rate to calculate the net present value (NPV), benefit-cost ratio (BCR), and discounted payback period (DPP). Results During the analysis period, the cumulative NPV and the BCR were US$3,617 thousand and 1.23, respectively. The DPP was about 6.18 years. Conclusions Although the adoption of an EMR resulted in overall growth in administrative costs, it is cost-effective since the cumulative NPV was positive. The positive NPV was attributed to both cost reductions and additional revenues. EMR adoption is not so attractive to management in that the DPP is longer than 5 years at 6.18 and the BCR is near 1 at 1.23. However, an EMR is a worthwhile investment, seeing that this study did not include any qualitative benefits and that the paper-chart system was cost-centric.
Forty-six veterinary surgeons were given a full clinical examination, serological examinations with estimates of immunoglobulins, and supplementary haematological and radiological investigations. Thirty-five complained of one or more symptoms, and eight had abnormal physical signs which might have been caused by infection with Brucella abortus, but neither sereological tests results nor immunoglobulin estimates bore any special relation to the clinical features. The soundest way of assessing ill health which had possibly been caused by brucellosis seemed to be thorough clinical examination and disregard of serologican findings. Interpreting results by the usual serological tests in the absence of a clinical examination is probably of doubtful value and may even be misleading.
Henderson, R J; Hill, D M; Vickers, A A; Edwards, J M; Tillett, H E
Colorectal cancer (CRC) screening rates are low despite confirmed benefits. The authors investigated the use of natural language processing (NLP) to identify previous colonoscopy screening in electronic records from a random sample of 200 patients at least 50?years old. The authors developed algorithms to recognize temporal expressions and ‘status indicators’, such as ‘patient refused’, or ‘test scheduled’. The new methods were added to the existing KnowledgeMap concept identifier system, and the resulting system was used to parse electronic medicalrecords (EMR) to detect completed colonoscopies. Using as the ‘gold standard’ expert physicians' manual review of EMR notes, the system identified timing references with a recall of 0.91 and precision of 0.95, colonoscopy status indicators with a recall of 0.82 and precision of 0.95, and references to actually completed colonoscopies with recall of 0.93 and precision of 0.95. The system was superior to using colonoscopy billing codes alone. Health services researchers and clinicians may find NLP a useful adjunct to traditional methods to detect CRC screening status. Further investigations must validate extension of NLP approaches for other types of CRC screening applications.
Personalized medicine promises patient-tailored treatments that enhance patient care and decrease overall treatment costs by focusing on genetics and "-omics" data obtained from patient biospecimens and records to guide therapy choices that generate good clinical outcomes. The approach relies on diagnostic and prognostic use of novel biomarkers discovered through combinations of tissue banking, bioinformatics, and electronic medicalrecords (EMRs). The analytical power of bioinformatic platforms combined with patient clinical data from EMRs can reveal potential biomarkers and clinical phenotypes that allow researchers to develop experimental strategies using selected patient biospecimens stored in tissue banks. For cancer, high-quality biospecimens collected at diagnosis, first relapse, and various treatment stages provide crucial resources for study designs. To enlarge biospecimen collections, patient education regarding the value of specimen donation is vital. One approach for increasing consent is to offer publically available illustrations and game-like engagements demonstrating how wider sample availability facilitates development of novel therapies. The critical value of tissue bank samples, bioinformatics, and EMR in the early stages of the biomarker discovery process for personalized medicine is often overlooked. The data obtained also require cross-disciplinary collaborations to translate experimental results into clinical practice and diagnostic and prognostic use in personalized medicine. PMID:23818899
The TMI system was implemented at our main campus on March 4, 1991, and at this point we are very pleased with all aspects of system performance. Since the conversion, the number of jobs dictated by our physicians has increased 20%, and we interpret this increase as an objective measure of physician satisfaction with the system. An increasing number of physicians are accessing lab results and documents from home via modem to review the next day's patients or while on-call. Transcription productivity has improved and enthusiasm for the system is high. Requests for chart documentation from our business office have decreased 60% due to the ability to access and print documents directly from the mainframe. The next phase in our information plan involves the installation of the TMI system at our regional clinics and our inpatient transcription unit. Further steps in the transition to on-line medicalrecords, such as the conversion of 600,000 active and archived records, awaits the further development of technology in order to be feasible and cost effective. Our experience has shown that developing complex applications such as the TMI demands perseverance and a willingness to work closely with multiple vendors and products in order to identify the best options in a rapidly developing field. Extensive involvement of end users early in the planning process helped us to secure and implement a system with a high level of user acceptance and satisfaction. PMID:10119973
Barnhart, D M; Jordan, D; McCrary, P S; Troast, J M
Background United States academic medical centers are increasingly incorporating electronic health records (EHR) into teaching settings. We report third year medical students' attitudes towards clinical learning using the electronic health record in ambulatory primary care clinics. Methods In academic year 2005–06, 60 third year students were invited to complete a questionnaire after finishing the required Ambulatory Medicine/Family Medicine clerkship. The authors elicited themes for the questionnaire by asking a focus group of third year students how using the EHR had impacted their learning. Five themes emerged: organization of information, access to online resources, prompts from the EHR, personal performance (charting and presenting), and communication with patients and preceptors. The authors added a sixth theme: impact on student and patient follow-up. The authors created a 21-item questionnaire, based on these themes that used a 5-point Likert scale from "Strongly Agree" to "Strongly Disagree". The authors emailed an electronic survey link to each consenting student immediately following their clerkship experience in Ambulatory Medicine/Family Medicine. Results 33 of 53 consenting students (62%) returned completed questionnaires. Most students liked the EHR's ability to organize information, with 70% of students responding that essential information was easier to find electronically. Only 36% and 33% of students reported accessing online patient information or clinical guidelines more often when using the EHR than when using paper charts. Most students (72%) reported asking more history questions due to EHR prompts, and 39% ordered more clinical preventive services. Most students (69%) reported that the EHR improved their documentation. 39% of students responded that they received more feedback on their EHR notes compared to paper chart notes. Only 64% of students were satisfied with the doctor-patient communication with the EHR, and 48% stated they spent less time looking at the patient. Conclusion Third year medical students reported generally positive attitudes towards using the EHR in the ambulatory setting. They reported receiving more feedback on their electronic charts than on paper charts. However, students reported significant concerns about the potential impact of the EHR on their ability to conduct the doctor-patient encounter.
In some jurisdictions attempts have been made to limit or deny access to medicalrecords for victims of torture seeking remedy or reparations or for individuals who have been accused of crimes based on confessions allegedly extracted under torture. The following article describes the importance of full disclosure of all medical and other health records, as well as legal documents, in any case in which an individual alleges that they have been subjected to torture or other forms of cruel, inhuman or degrading treatment of punishment. A broad definition of what must be included in the terms medical and health records is put forward, and an overview of why their full disclosure is an integral part of international standards for the investigation and documentation of torture (the Istanbul Protocol). The fact that medicalrecords may reveal the complicity or direct participation of healthcare professionals in acts of torture and other ill-treatment is discussed. A summary of international law and medical ethics surrounding the right of access to personal information, especially health information in connection with allegations of torture is also given. PMID:23472795
Alempijevic, D; Beriashvili, R; Beynon, J; Duque, M; Duterte, P; Fernando, R; Fincanci, S; Hansen, S; Hardi, L; Hougen, H; Iacopino, V; Mendonça, M; Modvig, J; Mendez, M; Özkalipci, Ö; Payne-James, J; Peel, M; Rasmussen, O; Reyes, H; Rogde, S; Sajantila, A; Treue, F; Vanezis, P; Vieira, D
Current evidence suggests research in veterinary parasitology is in decline despite its importance. This is particularly true in the UK where research funds have been diverted into BSE. Decline in interest in veterinary parasitology is at least in part due to the success of major pharmaceutical companies in producing a range of effective and safe anti-parasitic drugs. Research is needed
The personal health record has potential to improve health care transition for an emerging population of pediatric patients with complex chronic conditions who survive to adulthood. In this study qualitative techniques were used to assess how young adults with spina bifida and their parents interact with their medicalrecords. Condensation and categorization strategies for inductive research based on Grounded Theory were used to analyze 1) Who is involved in record keeping 2) How the information is stored 3) What information is kept and shared among the different constituencies and 4) When patients and parents need the information. Theme analysis revealed that mothers play a central role in the medicalrecord management of adolescents with spina bifida. The parent-maintained home based records served as a linking pin in a heterogeneous healthcare information environment. These records tended to be organized as time-lines. Both parents and patients were concerned about how best to transition health information management to adult children. Patients and parents uniformly supported the idea of accessing medicalrecord on-line.
The personal health record has potential to improve health care transition for an emerging population of pediatric patients with complex chronic conditions who survive to adulthood. In this study qualitative techniques were used to assess how young adults with spina bifida and their parents interact with their medicalrecords. Condensation and categorization strategies for inductive research based on Grounded Theory were used to analyze 1) Who is involved in record keeping 2) How the information is stored 3) What information is kept and shared among the different constituencies and 4) When patients and parents need the information. Theme analysis revealed that mothers play a central role in the medicalrecord management of adolescents with spina bifida. The parent-maintained home based records served as a linking pin in a heterogeneous healthcare information environment. These records tended to be organized as time-lines. Parent and patients were concerned about how best to transition their health information management from parent to adult children. Patients and parents uniformly supported the idea of having access to the medicalrecord on-line. PMID:16779106
In cooperation with the American VeterinaryMedical Association, questionnaires were sent to twentyone veterinary schools in the United States and Canada. Statistics on user population, the library collection, personnel, the institutional expenditures for educational and general purposes, as well as operating expenditures, were tabulated for fifteen of these schools. PMID:6041831
The rinderpest epizootic produced in the Cape Colony a crisis of knowledge about animal disease and its control. The Cape government drew on the knowledge and expertise of veterinary and medical scientists to devise means of dealing with the epizootic. This article examines veterinary policy and research into rinderpest at the Cape. Policy was initially based on the British model
The National Ambulatory Medical Care Survey (NAMCS) conducted by the National Center for Health Statistics (NCHS) is an annual nationally representative survey of patient visits to office-based physicians that collects information on use of EMR/EHR. In 20...
C. J. Hsiao D. A. Woodwell E. A. Rechtsteiner E. S. Hing P. C. Beatty
Ideas about centers of emphasis and veterinarymedical teaching consortia have resurfaced to attract students into food-supply veterinary medicine (FSVM). From 1988 to 2000 a multiple veterinary school consortium approach to food-animal production medicine (FAPM) teaching was conducted to handle regional differences in case load, faculty strengths, and student interests. Six universities developed a memorandum of understanding to provide a wide variety of in-depth, species-specific clinical experiences in FAPM to balance their individual strengths and weakness in addressing food-animal agriculture, to provide for student exchange and faculty development, and to conduct research in food safety. Changes in leadership, redirection of funds, failure to publicize the program to faculty and students, and a focus on research as opposed to teaching led to dissolution of the consortium. However, this approach could work to improve recruitment and retention of students in FSVM if it focused on student exchange, fostered a more integrated curriculum across schools, encouraged faculty involvement, garnered institutional support, and used modern technology in teaching. Private veterinary practices as well as public/corporate practices could be integrated into a broader food-animal curriculum directed at building competency among FSVM students by providing the in-depth training they require. Requirements for the success of this type of program will include funding, marketing, leadership, communication, coordination, integration, and dedicated people with the time to make it work. PMID:17220493
Electronic medicalrecord (EMR) systems have been proposed as technology to improve the quality of patient care, decrease medical errors, control and reduce medical expenditure, however the financial effects have not yet been as well documented in China. We presented a net financial cost-benefit analysis of implementing electronic medicalrecord systems in general hospital in China. The data, which were obtained from studies of the general hospital and the published literature, collected from 15 consecutive fiscal months from May 1, 2009 to August 30, 2010. We performed a perspective cost-benefit study to analyze the financial effects of EMR system implementing. The reference strategy for comparisons was the traditional paper-based medicalrecord. The net financial benefits or costs for a 6-year period were calculated. All data were adjusted for inflation. The totally assessed net benefit from implementing an EMR system for a 6-year period was $559,025 in the general hospital. Benefits accrue primarily from savings in new medicalrecord creation, decreased full-time-equivalent (FTE) employees, saving of adverse drug events (ADEs) and dose errors, improved charge capture and decreased billing errors. In this model, the time of return on investment is 3.00 years. In one-way sensitivity analysis, the model was most sensitive in new medicalrecord creation; the net benefit varied from $398,057 to $719,992. The five-way sensitivity analysis with the most pessimistic and optimistic assumptions showed results ranging from a $76,970 net cost to a $1,062,122 net benefit; the pessimistic time of return on investment is 5.38 years. An EMR system cost-benefit analysis can rapidly demonstrate a positive return on investment when implemented in hospitals. The magnitude of the return is sensitive to several key factors. PMID:22212632
Data from an electronic medicalrecord were used to demonstrate a large variation in the proportion of patients treated with vancomycin in 56 newborn intensive care units, which ranged from 18% to 70% . Use of oxacillin or nafcillin instead of vancomycin was rare during the first few years of the study period but was routine in 13% of the newborn intensive care units during the last few years of the study period. The use of electronic medicalrecord data for studies of antibiotic use is discussed here. PMID:18518667
Arnold, Cody; Clark, Reese; Bosco, Jaclyn; Shoemaker, Craig; Spitzer, Alan R
Abstract Background: Passive reporting and laboratory testing delays may limit gastrointestinal (GI) disease outbreak detection. Healthcare systems routinely collect clinical data in electronic medicalrecords (EMRs) that could be used for surveillance. This study's primary objective was to identify data streams from EMRs that may perform well for GI outbreak detection. Methods: Zip code-specific daily episode counts in 2009 were generated for 22 syndromic and laboratory-based data streams from Kaiser Permanente Northern California EMRs, covering 3.3 million members. Data streams included outpatient and inpatient diagnosis codes, antidiarrheal medication dispensings, stool culture orders, and positive microbiology tests for six GI pathogens. Prospective daily surveillance was mimicked using the space-time permutation scan statistic in single and multi-stream analyses, and space-time clusters were identified. Serotype relatedness was assessed for isolates in two Salmonella clusters. Results: Potential outbreaks included a cluster of 18 stool cultures ordered over 5 days in one zip code and a Salmonella cluster in three zip codes over 9 days, in which at least five of six cases had the same rare serotype. In all, 28 potential outbreaks were identified using single stream analyses, with signals in outpatient diagnosis codes most common. Multi-stream analyses identified additional potential outbreaks and in one example, improved the timeliness of detection. Conclusions: GI disease-related data streams can be used to identify potential outbreaks when generated from EMRs with extensive regional coverage. This process can supplement traditional GI outbreak reports to health departments, which frequently consist of outbreaks in well-defined settings (e.g., day care centers and restaurants) with no laboratory-confirmed pathogen. Data streams most promising for surveillance included microbiology test results, stool culture orders, and outpatient diagnoses. In particular, clusters of microbiology tests positive for specific pathogens could be identified in EMRs and used to prioritize further testing at state health departments, potentially improving outbreak detection.
Huang, Jie; Abrams, Allyson M.; Gilliss, Debra; Reed, Mary; Platt, Richard; Huang, Susan S.; Kulldorff, Martin
In collaboration with a broad range of stakeholders, the Canadian Institute for Health Information (CIHI) led the development of the draft pan-Canadian primary health care (PHC) electronic medicalrecord (EMR) content standard to be used in EMR applications across the country to support PHC data capture and information use and improved health system management. To achieve this goal, CIHI initiated the following activities: stakeholder engagement, information requirements gathering and adoption and implementation promotion of the common content standard for wide-spread use. The resulting pan-Canadian standardized data set will allow consistent data capture that will improve understanding and ability to report on PHC utilization and access, chronic disease prevention and management, health promotion, medication usage, patient safety, quality of care including patient safety and outcomes. The standard will improve patient care information by providing the structured comparable information needed to care for patients over time and across the continuum of care. Standards support clinical practice reminders and alerts, improvements in operating efficiencies, onscreen feedback reports to PHC providers and the ability to look at clinical trends over time. This standard will improve the flow of information by providing standardized information to providers at points on the continuum of care leading to better coordination of care and a reduction of repeat tests. Lastly, a common content standard will improve the health system use of data; by enabling aggregation and analysis of comparable standardized health information, clinicians, jurisdictions, and regions can benefit from using this data for more effective planning and policy decisions. The jurisdictions and clinicians, supported by CIHI and Canada Health Infoway will continue to work together with other key stakeholders, such as vendors to support the adoption and implementation of this standard into future jurisdictional EMR vendor specifications. PMID:21335741
The University of British Columbia Hospital Clinic for Alzheimer Disease and Related Disorders (UBCH-CARD) invests significant\\u000a effort to obtain medicalrecords for the confirmation of patient–reported family histories of dementia. The effectiveness\\u000a of requesting these records was assessed through a review of the 275 requests made by UBCH-CARD genetic counselors during\\u000a the 24-month period of January 1, 2005–December 31, 2006.
Emily L. R. Alexander; Rachel K. Butler; Colleen Guimond; Blair Butler; A. Dessa Sadovnick
Recent developments in networking and computing technologies and the expansion of the electronic health record system have\\u000a enabled the possibility of online collaboration between geographically distributed medical personnel. In this context, the\\u000a paper presents a Web-based application, which implements a collaborative working environment for physicians by enabling the\\u000a peer-to-peer exchange of electronic health records. The paper treats technological issues such
ObjectiveThe aim of this study was to evaluate the experiences of patients and physicians in a clinical trial of an online electronic medicalrecord (SPPARO, System Providing Patients Access to Records Online).DesignQuantitative data were obtained from questionnaires. Qualitative data were obtained from individual interviews and focus groups.MeasurementsQuestionnaire items were based on issues identified by patients and physicians in previous studies.
Mark A Earnest; Stephen E Ross; Loretta Wittevrongel; Laurie A Moore; Chen-Tan Lin
Patient electronic personal health record (PHR) use has been associated with improved patient outcomes in diabetes and depression care. Little is known about the effect of PHR use on HIV care processes and outcomes. We evaluated whether there was an association between patient PHR use and antiretroviral adherence. Data came from the Veterans Aging Cohort Study and included cross-sectional survey and medicalrecord data from 1871 HIV+ veterans. Our adherence measure was an antiretroviral medication possession ratio, dichotomized at 0.90, and based on pharmacy refill data. In our sample 44 % did not use the internet, 14 % used internet but not for health, 27 % used internet for health but not the PHR, and 14 % used the PHR. In multivariable analysis PHR use was associated with ?90 % adherence after controlling for socio-demographic variables. Findings provide support for longitudinal studies and studies that identify which PHR functions (e.g. online medication refills, viewing lab results, secure messaging with providers) are most closely associated with medication adherence. PMID:23334359
Keith McInnes, D; Shimada, Stephanie L; Rao, Sowmya R; Quill, Ann; Duggal, Mona; Gifford, Allen L; Brandt, Cynthia A; Houston, Thomas K; Ohl, Michael E; Gordon, Kirsha S; Mattocks, Kristin M; Kazis, Lewis E; Justice, Amy C
Objective: The research evaluated strategies for facilitating physician adoption of an evidence-based medicine literature request feature recently integrated into an existing electronic medicalrecord (EMR) system. Methods: This prospective study explored use of the service by 137 primary care physicians by using service usage statistics and focus group and survey components. The frequency of physicians' requests for literature via the EMR during a 10-month period was examined to explore the impact of several enhanced communication strategies launched mid-way through the observation period. A focus group and a 25-item survey explored physicians' experiences with the service. Results: There was no detectable difference in the proportion of physicians utilizing the service after implementation of the customized communication strategies (11% in each time period, P=1.0, McNemar's test). Forty-eight physicians (35%) responded to the survey. Respondents who had used the service (n=19) indicated that information provided through the service was highly relevant to clinical practice (mean rating 4.6, scale 1 “not relevant”–5 “highly relevant”), and most (n=15) reported sharing the information with colleagues. Conclusion: The enhanced communication strategies, though well received, did not significantly affect use of the service. However, physicians noted the relevance and utility of librarian-summarized evidence from the literature, highlighting the potential benefits of providing expert librarian services in clinical workflow.
Jerome, Rebecca N.; Bettinsoli Giuse, Nunzia; Rosenbloom, S. Trent; Arbogast, Patrick G.
Objectives To examine the current status of hospital information systems (HIS), analyze the effects of Electronic MedicalRecords (EMR) and Clinical Decision Support Systems (CDSS) have upon hospital performance, and examine how management issues change over time according to various growth stages. Methods Data taken from the 2010 survey on the HIS status and management issues for 44 tertiary hospitals and 2009 survey on hospital performance appraisal were used. A chi-square test was used to analyze the association between the EMR and CDSS characteristics. A t-test was used to analyze the effects of EMR and CDSS on hospital performance. Results Hospital size and top management support were significantly associated with the adoption of EMR. Unlike the EMR results, however, only the standardization characteristic was significantly associated with CDSS adoption. Both EMR and CDSS were associated with the improvement of hospital performance. The EMR adoption rates and outsourcing consistently increased as the growth stage increased. The CDSS, Knowledge Management System, standardization, and user training adoption rates for Stage 3 hospitals were higher than those found for Stage 2 hospitals. Conclusions Both EMR and CDSS influenced the improvement of hospital performance. As hospitals advanced to Stage 3, i.e. have more experience with information systems, they adopted EMRs and realized the importance of each management issue.
Purpose: With electronic medicalrecords (eMRs), the option now exists for clinical trial monitors to perform source data verification (SDV) remotely. We report on a feasibility study of remote access to eMRs for SDV and the potential advantages of such a process in terms of resource allocation and cost. Methods: The Clinical Trials Unit at the Peter MacCallum Cancer Centre, in collaboration with Novartis Pharmaceuticals Australia, conducted a 6-month feasibility study of remote SDV. A Novartis monitor was granted dedicated software and restricted remote access to the eMR portal of the cancer center, thereby providing an avenue through which perform SDV. Results: Six monitoring visits were conducted during the study period, four of which were performed remotely. The ability to conduct two thirds of the monitoring visits remotely in this complex phase III study resulted in an overall cost saving to Novartis. Similarly, remote monitoring eased the strain on internal resources, particularly monitoring space and hospital computer terminal access, at the cancer center. Conclusion: Remote access to patient eMRs for SDV is feasible and is potentially an avenue through which resources can be more efficiently used. Although this feasibility study involved limited numbers, there is no limit to scaling these processes to any number of patients enrolled onto large clinical trials.
Uren, Shannon C.; Kirkman, Mitchell B.; Dalton, Brad S.; Zalcberg, John R.
Vesicovaginal fistula was a catastrophic complication of childbirth among 19th century American women. The first consistently successful operation for this condition was developed by Dr J Marion Sims, an Alabama surgeon who carried out a series of experimental operations on black slave women between 1845 and 1849. Numerous modern authors have attacked Sims's medical ethics, arguing that he manipulated the institution of slavery to perform ethically unacceptable human experiments on powerless, unconsenting women. This article reviews these allegations using primary historical source material and concludes that the charges that have been made against Sims are largely without merit. Sims's modern critics have discounted the enormous suffering experienced by fistula victims, have ignored the controversies that surrounded the introduction of anaesthesia into surgical practice in the middle of the 19th century, and have consistently misrepresented the historical record in their attacks on Sims. Although enslaved African American women certainly represented a “vulnerable population” in the 19th century American South, the evidence suggests that Sims's original patients were willing participants in his surgical attempts to cure their affliction—a condition for which no other viable therapy existed at that time.
Objective. Between one-third and half of all radiology examinations worldwide are probably chest studies. The aim of the current study was to retrospectively evaluate the clinical influence of chest radiography. Methods. In a tertiary referral hospital, 939 consecutive daytime chest radiography examinations were evaluated. The outcome was classified as normal, incidental, or pathologic. The referring physician's reaction to radiologic outcome was classified as highly expected, moderately expected, or unexpected. The influence on the patients' treatment was divided into four groups from major to no influence. Results. In all, 71.6% of the studies had a highly expected outcome. Moderately expected or unexpected outcomes were noted in 36.6% of 500 pathologic examinations. Unexpected outcome was noted in 11.6% of all studies. The radiologic outcome influenced treatment in 65.4% of patients where pathology was demonstrated. Patients with normal or incidental findings had treatment influenced in 1/3 of the cases. Unexpected findings influenced treatment more than moderately expected findings. When radiological findings were highly expected, treatment was influenced in less than half of the cases. Surprisingly few chest radiology examinations were commented upon in the medicalrecords.
Healthcare organizations vary in the number of electronic medicalrecord (EMR) systems they use. Some use a single EMR for nearly all care they provide, while others use EMRs from more than one vendor. These strategies create a mixture of advantages, risks and costs. Based on our experience in two organizations over a decade, we analyzed use of more than one EMR within our two health care organizations to identify advantages, risks and costs that use of more than one EMR presents. We identified the data and functionality types that pose the greatest challenge to patient safety and efficiency. We present a model to classify patterns of use of more than one EMR within a single healthcare organization, and identified the most important 28 data types and 4 areas of functionality that in our experience present special challenges and safety risks with use of more than one EMR within a single healthcare organization. The use of more than one EMR in a single organization may be the chosen approach for many reasons, but in our organizations the limitations of this approach have also become clear. Those who use and support EMRs realize that to safely and efficiently use more than one EMR, a considerable amount of IT work is necessary. Thorough understanding of the challenges in using more than one EMR is an important prerequisite to minimizing the risks of using more than one EMR to care for patients in a single healthcare organization. PMID:23646091
Payne, T; Fellner, J; Dugowson, C; Liebovitz, D; Fletcher, G
This study explores whether Internet users have different privacy concerns regarding the information contained in electronic medicalrecords (EMRs) according to gender, age, occupation, education, and EMR awareness. Based on the Concern for Information Privacy (CFIP) scale developed by Smith and colleagues in 1996, we conducted an online survey using 15 items in four dimensions, namely, collection, unauthorized access, secondary use, and errors, to investigate Internet users' concerns regarding the privacy of EMRs under health information exchanges (HIE). We retrieved 213 valid questionnaires. The results indicate that the respondents had substantial privacy concerns regarding EMRs and their educational level and EMR awareness significantly influenced their privacy concerns regarding unauthorized access and secondary use of EMRs. This study recommends that the Taiwanese government organizes a comprehensive EMR awareness campaign, emphasizing unauthorized access and secondary use of EMRs. Additionally, to cultivate the public's understanding of EMRs, the government should employ various media, especially Internet channels, to promote EMR awareness, thereby enabling the public to accept the concept and use of EMRs. People who are highly educated and have superior EMR awareness should be given a comprehensive explanation of how hospitals protect patients' EMRs from unauthorized access and secondary use to address their concerns. Thus, the public can comprehend, trust, and accept the use of EMRs, reducing their privacy concerns, which should facilitate the future implementation of HIE. PMID:22527781
Electronic medicalrecords (EMRs) have become a common source of data for outcomes research. This review discusses trends in EMR data use for outcomes research as well as strengths and limitations, and likely future developments to help optimize value and use of EMR data for outcomes research. EMR-based studies reporting treatment outcomes published between 2007 and 2012 were predominantly from the USA and Europe. There has been a substantial increase in the number of EMR-based outcomes studies published from 2007-2008 (n = 28) to 2010-2011 (n = 55). Many studies evaluated biometric and laboratory test outcomes in common chronic conditions. However, researchers are expanding the scope of evaluated diseases and outcomes using advanced techniques, such as natural language processing and linking EMRs to other patient-level data to overcome issues with missing data or data that cannot be accessed using standard queries. These advances will help to expand the scope and sophistication of outcomes research in the coming years. PMID:23570430
Lin, Junji; Jiao, Tianze; Biskupiak, Joseph E; McAdam-Marx, Carrie
We applied a hybrid Natural Language Processing (NLP) and machine learning (ML) approach (NLP-ML) to assessment of health related quality of life (HRQOL). The approach uses text patterns extracted from HRQOL inventories and electronic medicalrecords (EMR) as predictive features for training ML classifiers. On a cohort of 200 patients, our approach agreed with patient self-report (EQ5D) and manual audit of the EMR 65-74% of the time. In an independent cohort of 285 patients, we found no association of HRQOL (by EQ5D or NLP-ML) with quality measures of metabolic control (HbA1c, Blood Pressure, Lipids). In addition; while there was no association between patient self-report of HRQOL and cost of care, abnormalities in Usual Activities and Anxiety/Depression assessed by NLP-ML were 40-70% more likely to be associated with greater health care costs. Our method represents an efficient and scalable surrogate measure of HRQOL to predict healthcare spending in ambulatory diabetes patients. PMID:22195169
Pakhomov, Serguei V S; Shah, Nilay D; Van Houten, Holly K; Hanson, Penny L; Smith, Steven A
It is commonly believed that the electronic medicalrecord (EMR) will improve patient outcomes. However, there is scant published literature to support this claim and no studies in any surgical population. Our hypothesis was that the EMR would not improve objective outcome measures in patients with traumatic injury. Prospectively collected data from our university-based Level I trauma center was retrospectively reviewed. Demographic, injury severity as well as outcomes and complications data were compared for all patients admitted over a 20-month period before introduction of the EMR and a 20-month period after full, hospital-wide use of the EMR. Implementation of the EMR was associated with a decreased hospital length of stay, P = 0.02; intensive care unit length of stay, P = 0.001; ventilator days, P = 0.002; acute respiratory distress syndrome, P = 0.006, pneumonia, P = 0.008; myocardial infarction, P = 0.001; line infection, P = 0.03; septicemia, P = 0.000; renal failure, P = 0.000; drug complication, P = 0.001; and delay in diagnosis, P = 0.04. There was no difference in mortality, unexpected cardiac arrest, missed injury, pulmonary embolism/deep vein thrombosis, or late urinary tract infection. This is the first study to investigate the impact of the EMR in surgical patients. Although there was an improvement in some complications, the overall impact was inconsistent. PMID:23089444
Schenarts, Paul J; Goettler, Claudia E; White, Michael A; Waibel, Brett H
The curriculum in veterinary medicine in Italy is undergoing important changes, as in the rest of Europe. The 2001 fall semester will mark the beginning of a new format for the degree in veterinary medicine and these changes will obviously affect the teaching of veterinary parasitology. In Italy, veterinary parasitology is usually taught in the third year with a disciplinary
Little is known about longitudinal prescribing practices for psychoactive medications for individuals with intellectual disabilities and developmental disabilities (IDDD) who are living in community settings. Computerized pharmacy records were accessed for 2344 community-based individuals with IDDD for whom a total of 3421 prescriptions were…
Lott, I. T.; McGregor, M.; Engelman, L.; Touchette, P.; Tournay, A.; Sandman, C.; Fernandez, G.; Plon, L.; Walsh, D.
The integration of technology into primary care facilities has the potential to improve patient care, but also may disrupt provider workflows. Technologies that are designed to fit the use patterns and ideal interactions of providers will be better accepted and utilized. Our ethnographic study of Electronic MedicalRecord (EMR) usage by 10 primary care providers identified where providers utilize the
The use of medicalrecords in research can yield information that is difficult to obtain by other means. When such records are released to investigators in identifiable form, however, substantial privacy and confidentiality risks may be created. These risks become more common and more serious as medicalrecords move to an electronic format. In 1996, the state of Minnesota enacted legislation with respect to consent requirements for the use of medicalrecords in research. This legislation has been widely criticized because--it is claimed--it creates an unnecessary impediment to research. In this article, we show that these arguments rest upon misinterpretation and/or misrepresentation of the 1996 legislation. A consent requirement had actually been present in Minnesota since 1976 (though codified in a patient rights statute rather than a privacy statute). The 1996 law does not require specific consent, as often claimed, but rather only a general authorization. The campaign against the Minnesota legislation appears to have been motivated by concern with respect to the then impending federal privacy rule. The HIPAA rule, as enacted, is in fact less stringent with respect to consent than the Minnesota consent law. On the other hand, the Minnesota consent law has not been effectively applied or enforced. As we change the way we manage sensitive medical information, new efforts are needed to provide protection against the confidentiality risks in research. Patient consent is an important tool in this regard. New instrumentalities are needed to solicit and document consent. PMID:14708933
|Little is known about longitudinal prescribing practices for psychoactive medications for individuals with intellectual disabilities and developmental disabilities (IDDD) who are living in community settings. Computerized pharmacy records were accessed for 2344 community-based individuals with IDDD for whom a total of 3421 prescriptions were…
Lott, I. T.; McGregor, M.; Engelman, L.; Touchette, P.; Tournay, A.; Sandman, C.; Fernandez, G.; Plon, L.; Walsh, D.
The objective of this work was to assess the convergent validity of a previously developed rheumatoid arthritis medicalrecords-based index of severity (RARBIS) by comparing it with the 28-joint Disease Activity Score (DAS28). This study was conducted in subjects within the Brigham and Women's Hospital Rheumatoid Arthritis Sequential Study (BRASS). We selected 100 patients with rheumatoid arthritis (RA) from the
Masayo Sato; Sebastian Schneeweiss; Richard Scranton; Jeffrey N Katz; Michael E Weinblatt; Jerry Avorn; Gladys Ting; Nancy A Shadick; Daniel H Solomon
This study applies the Unified Theory of Acceptance and Use of Technology (UTAUT) to the phenomenon of physician adoption of electronic medicalrecords (EMR) technology. UTAUT integrates eight theories of individual acceptance into one comprehensive model designed to assist in understanding what factors either enable or hinder technology adoption and use. As such, it provides a useful lens through which
This report details the results of an experimental study to determine the effect of standard nursing plans on nurses' documentation on individualized care plans and patient medicalrecords on one 60 bed medical ward. Nursing care plans were audited before...
Background Falls are the leading cause of injury-related deaths in the aging population. Electronic medicalrecord (EMR) systems can identify at-risk patients and enable interventions to decrease risk factors for falls. Objective The objectives of this study were to evaluate an EMR-based intervention to reduce overall medication use, psychoactive medication use, and occurrence of falls in an ambulatory elderly population at risk for falls. Design Prospective, randomized by clinic site. Patients/Participants Six-hundred twenty community-dwelling patients over 70 at risk for falls based on age and medication use. Interventions A standardized medication review was conducted and recommendations made to the primary physician via the EMR. Measurements and Main Results Patients were contacted to obtain self reports of falls at 3-month intervals over the 15-month period of study. Fall-related diagnoses and medication data were collected through the EMR. A combination of descriptive analyses and multivariate regression models were used to evaluate differences between the 2 groups, adjusting for baseline medication patterns and comorbidities. Although the intervention did not reduce the total number of medications, there was a significant negative relationship between the intervention and the total number of medications started during the intervention period (p?.01, regression estimate ?0.199) and the total number of psychoactive medications (p?.05, regression estimate ?0.204.) The impact on falls was mixed; with the intervention group 0.38 times as likely to have had 1 or more fall-related diagnosis (p?.01); when data on self-reported falls was included, a nonsignificant reduction in fall risk was seen. Conclusions The current study suggests that using an EMR to assess medication use in the elderly may reduce the use of psychoactive medications and falls in a community-dwelling elderly population.
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 MedicalRecords 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
Deutsch, Madeline B; Green, Jamison; Keatley, JoAnne; Mayer, Gal; Hastings, Jennifer; Hall, Alexandra M
There are constraints embedded in medicalrecord 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 medicalrecord 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.
Introduction: The adoption of electronic medicalrecords (EMRs) in emergency departments (EDs) has changed the way that healthcare information is collected, charted, and stored. A challenge for researchers is to determine how EMRs may be leveraged to facilitate study data collection efforts. Our objective is to describe the use of a unique data collection system leveraging EMR technology and to compare data entry error rates to traditional paper data collection. Methods: This was a retrospective review of data collection methods during a multicenter study of ED, anti-coagulated, head injury patients. On-shift physicians at 4 centers enrolled patients and prospectively completed data forms. These physicians had the option of completing a paper data form or an electronic “dotphrase” (DP) data form. A feature of our Epic®-based EMR is the ability to use DPs to assist in medical information entry. A DP is a preset template that may be inserted into the EMR when the physician types a period followed by a code phrase (in this case “.ichstudy”). Once the study DP was inserted at the bottom of the electronic ED note, it prompted enrolling physicians to answer study questions. Investigators then extracted data directly from the EMR. Results: From July 2009 through December 2010, we enrolled 883 patients. DP data forms were used in 288 (32.6%; 95% confidence interval [CI] 29.5, 35.7%) cases and paper data forms in 595 (67.4%; 95% CI 64.3, 70.5%). Sixty-six (43.7%; 95% CI 35.8, 51.6%) of 151 physicians enrolling patients used DP data entry at least once. Using multivariate analysis, we found no association between physician age, gender, or tenure and DP use. Data entry errors were more likely on paper forms (234/595, 39.3%; 95% CI 35.4, 43.3%) than DP forms (19/288, 6.6%; 95% CI 3.7, 9.5%), difference in error rates 32.7% (95% CI 27.9, 37.6%, P < 0.001). Conclusion: DP data collection is a feasible means of data collection. DP data forms maintain all study data within the secure EMR environment, obviating the need to maintain and collect paper data forms. This innovation was embraced by many of our emergency physicians and resulted in lower data entry error rates.
Offerman, Steven R.; Rauchwerger, Adina S.; Nishijima, Daniel K.; Ballard, Dustin W.; Chettipally, Uli K.; Vinson, David R.; Reed, Mary E.; Holmes, James F.